Antimanic APs — MRCPsych Paper B MCQ

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EasyMood DisordersAntimanic APsMRCPsych Paper B

An adult presents to secondary care with an acute manic episode. They are not currently taking an antipsychotic or mood stabiliser. According to NICE CG185, which group contains the antipsychotics that should be offered as initial pharmacological treatment?

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Correct answer: A — Haloperidol, olanzapine, quetiapine or risperidone

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

B is correct. NICE recommends offering haloperidol, olanzapine, quetiapine or risperidone when an adult develops mania or hypomania and is not already taking an antipsychotic or mood stabiliser. The particular drug is selected according to the person's preferences and clinical context, including physical comorbidity, previous response and adverse effects. Lithium is considered as an addition if two sequential antipsychotics are insufficiently effective, rather than being the specified initial treatment in this scenario. Valproate is also a later option and is subject to major reproductive-safety restrictions. Lamotrigine should not be offered for mania. Other antipsychotics in A, D and E may have psychiatric indications, but they are not the four agents listed by NICE for this initial adult acute-mania recommendation.

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