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Early Warning Signs Response — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisEarly Warning Signs ResponseMRCPsych Paper B

A 35-year-old woman with schizophrenia is receiving community mental health team follow-up under a community treatment order. Over the past week she has developed increased suspiciousness, reduced sleep and social withdrawal, which are documented as her individual early warning signs of relapse. She is taking her prescribed antipsychotic, agrees to assessment and presents no immediate risk to herself or others. What is the most appropriate next step?

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Correct answer: A — Activate the crisis section of her care plan and arrange prompt review by the identified clinician, increasing support as agreed

The correct answer is A. Increased suspiciousness, reduced sleep and social withdrawal are her documented early warning signs, so the crisis section of her care plan should be activated before the relapse becomes severe. This should include prompt reassessment by the identified clinician or care coordinator, increased contact or support as agreed, and review of risk, adherence, substance use and treatment. Any medication change should follow individual clinical review rather than occur automatically. Waiting for severe symptoms loses the purpose of relapse prevention. A CTO does not make recall automatic; recall depends on responsible-clinician assessment of the need for hospital treatment and associated risk. CTO discharge is unrelated to the immediate relapse response, and emergency-department referral is unnecessary without an acute emergency.

Reference: NICE. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendation 1.5.3.6, 2014; reviewed 2025. https://www.nice.org.uk/guidance/cg178/chapter/recommendations