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Psychological Adjuncts Bipolar — MRCPsych Paper B MCQ

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ModerateMood DisordersPsychological Adjuncts BipolarMRCPsych Paper B

A 35-year-old with bipolar I disorder has recovered from a manic episode and is taking lithium as long-term treatment. They have mild persisting symptoms between episodes and would like a psychological intervention to reduce their risk of relapse. According to NICE CG185, which is the most appropriate psychological adjunct?

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Correct answer: BA structured, manualised individual, group or family intervention designed for bipolar disorder

The correct answer is B. NICE recommends offering a structured psychological intervention—delivered individually, in a group or with the family—that was designed specifically for bipolar disorder and has a published evidence-based manual. This applies to relapse prevention and to persisting symptoms between manic or depressive episodes. Such interventions include psychoeducation, mood and behaviour monitoring, identification of relapse risks and early warning signs, and development of a staying-well plan. Supportive counselling without structured relapse work is insufficient. Unadapted CBT for unipolar depression does not address bipolar-specific relapse risks. Family intervention is not restricted to episodes caused by family conflict, and psychoanalytic psychotherapy is not NICE's preferred relapse-prevention intervention.

Reference: National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185), recommendations 1.7.2–1.7.4. Published 2014; last updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations