Clozapine Not for Mania — MRCPsych Paper B MCQ

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ModerateMood DisordersClozapine Not for ManiaMRCPsych Paper B

A 34-year-old adult develops an acute manic episode and is not currently taking an antipsychotic or mood stabiliser. According to NICE CG185, which ONE of the following antipsychotics is NOT among those recommended to be offered initially?

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Correct answer: B — Clozapine

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

E. Clozapine is not among the antipsychotics that NICE CG185 recommends offering initially when an adult develops mania or hypomania while not taking an antipsychotic or mood stabiliser. Recommendation 1.5.3 lists haloperidol, olanzapine, quetiapine and risperidone, with selection guided by preference, previous response, comorbidity and adverse-effect profiles. Therefore, options A–D are all specifically listed and are incorrect. Clozapine is not licensed in the UK for mania and is principally indicated for treatment-resistant schizophrenia or schizophrenia with otherwise untreatable neurological adverse effects; it is also indicated for refractory psychosis associated with Parkinson's disease. The original explanation was therefore too absolute in stating that clozapine is used only for treatment-resistant schizophrenia.

Reference: National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185), section 1.5, recommendation 1.5.3. Published 2014; last updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations