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Valproate PPP Capacity Considerations — MRCPsych Paper B MCQ

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HardIntellectual DisabilityValproate PPP Capacity ConsiderationsMRCPsych Paper B

A 29-year-old woman in England has moderate intellectual disability and bipolar I disorder. She remains well on valproate after other appropriate treatments were ineffective or not tolerated. She menstruates and there is no permanent reason why pregnancy is impossible. Information has been adapted to her communication needs, but she lacks capacity to decide about continuing valproate and the associated reproductive-risk measures. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Assess capacity for the relevant decisions and, if it is lacking, make and document a best-interests decision while involving her and a responsible person and applying Pregnancy Prevention Programme measures

Explanation lettering: B = shown as A · A = shown as B

B is correct. Intellectual disability is neither evidence that a person lacks capacity for every decision nor a reason to presume that pregnancy cannot occur. Capacity should be assessed for the particular decision after practicable support to understand and communicate. If capacity is lacking, continuation of valproate is not automatically prohibited: the clinician must make and document a Mental Capacity Act best-interests decision, involve the woman as far as possible, and consult relevant supporters or a legally authorised decision-maker where applicable. The current Annual Risk Acknowledgement Form specifically allows a responsible person to be involved for patients lacking capacity. As she may become pregnant, Pregnancy Prevention Programme requirements still apply. A and E wrongly equate disability or supported living with no pregnancy risk. C is too absolute. D is incorrect because a relative has no automatic authority to consent for an adult.

Reference: Medicines.org.uk, Annual Risk Acknowledgement Form for Female Patients, May 2025, pages 1–2. https://www.medicines.org.uk/emc/rmm/2522/Document