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Psych Treatment Without Meds — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisPsych Treatment Without MedsMRCPsych Paper B

A 22-year-old man with a first episode of psychosis has capacity to make treatment decisions. After discussion of the benefits and adverse effects, he declines antipsychotic medication but would accept psychological treatment. He lives with his parents, consents to their involvement and presents no immediate risk to himself or others. According to NICE guidance, what is the most appropriate management?

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

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Correct answer: E — Explain that combined treatment is more effective, then offer CBT for psychosis and family intervention, with review within 1 month and regular monitoring

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

The correct answer is B. NICE recommends antipsychotic medication together with CBT and family intervention for first-episode psychosis. If a person with capacity declines medication, they should be advised that psychological interventions are more effective when combined with an antipsychotic. If they still prefer psychological treatment alone, CBT and family intervention should nevertheless be offered. Treatment options should be reviewed within 1 month, with regular monitoring of symptoms, distress, impairment and functioning. CBT should therefore not be withheld until medication is accepted (A), nor should active treatment simply be omitted or delayed (C and E). Counselling is not the preferred substitute: NICE advises against routinely offering counselling or supportive psychotherapy as specific interventions when more effective treatments such as CBT are available (D).

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.3.4.1–1.3.4.2 and 1.4.4.6, 2014. https://www.nice.org.uk/Guidance/CG178/chapter/recommendations