Integrated Dual Diagnosis — MRCPsych Paper B MCQ
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Correct answer: C — Provide coordinated treatment for both conditions within secondary care mental health services
Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E
The correct answer is B. NICE recommends that, for most adults with psychosis and coexisting substance misuse, secondary care mental health professionals provide treatment for both conditions. Care should therefore be coordinated rather than restricted to one disorder or divided into disconnected treatment pathways. Specialist substance misuse advice or joint working may be required for severe dependence, difficult-to-control use or substantial associated impairment, but mental health services should continue psychosis treatment and care coordination. Options A and D incorrectly use sequential treatment, which risks leaving one clinically important condition untreated. Option C is inappropriate because substance misuse services should not ordinarily assume sole responsibility for the psychosis. Option E fragments care and conflicts with the requirement for coordinated treatment and an individualised care plan.
Reference: National Institute for Health and Care Excellence. CG120: Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings, recommendations 1.4.5–1.4.7 and 1.4.18–1.4.21. Published 2011; updated May 2024. https://www.nice.org.uk/guidance/cg120/chapter/Recommendations