Assessment First ID — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateIntellectual DisabilityAssessment First IDMRCPsych Paper B

A 32-year-old man with moderate learning disability has developed increasing shouting and aggression towards carers over the past 2 weeks. He was previously settled, no clear psychiatric syndrome has been established, and there is no immediate risk requiring emergency containment. What is the most appropriate first step in his management?

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

Reveal the answer and explanation

Correct answer: A — Undertake a comprehensive biopsychosocial and functional assessment

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

B is correct. New or worsening behaviour that challenges in a person with learning disability should prompt a comprehensive biopsychosocial and functional assessment rather than diagnostic overshadowing. This should characterise the behaviour and assess communication needs, physical illness and pain, mental state, medication effects, recent life or routine changes, sensory factors, the care environment, triggers and maintaining consequences. Antipsychotics are not routine first-line treatment: NICE reserves them for severe risk or when treatment of coexisting problems and psychological or environmental interventions have been insufficient. CBT may subsequently be appropriate for a formulated problem and must be adapted to the person’s abilities. Restrictive measures should be used only when necessary and proportionate to immediate risk. DoLS authorisation is a legal safeguard for a deprivation of liberty, not a treatment for behavioural deterioration.

Reference: National Institute for Health and Care Excellence. NG11, Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges, sections 1.5 and 1.8. 2015, minor update 2020. https://www.nice.org.uk/guidance/ng11/chapter/recommendations