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Antimanic Medication Post-Episode — MRCPsych Paper B MCQ

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ModerateMood DisordersAntimanic Medication Post-EpisodeMRCPsych Paper B

A 22-year-old woman experienced her first manic episode with psychotic symptoms and responded to olanzapine 15 mg daily. Four weeks after full resolution of the episode, she remains euthymic but reports troublesome sedation and has gained 5 kg. According to current NICE guidance, what is the most appropriate approach to her pharmacological treatment?

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Correct answer: B — Review treatment collaboratively now, discussing either a further 3 to 6 months of acute treatment or a transition to long-term relapse-prevention treatment

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

B is correct. NICE recommends a collaborative review within 4 weeks of resolution of mania to discuss whether to continue treatment for the acute episode or begin long-term relapse-prevention treatment. If acute treatment is continued, it should generally be offered for a further 3–6 months and then reviewed. Her rapid weight gain and sedation are important when weighing benefits, risks and alternative long-term options. NICE does not recommend automatic immediate discontinuation after a first episode, so C is incorrect; if an antipsychotic is stopped, it should ordinarily be reduced over at least 4 weeks. Effective olanzapine can prevent recurrence, but indefinite continuation at the same dose without review is inappropriate, excluding A. There is no indication to increase the dose after remission or to use clozapine routinely, excluding D and E.

Reference: NICE. Bipolar disorder: assessment and management (CG185), recommendations 1.5.14, 1.5.15 and 1.10.13. Published 2014; updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/recommendations