Continuation ECT — MRCPsych Paper B MCQ
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Correct answer: A — It makes no treatment recommendation for maintenance ECT because evidence is insufficient, and instead identifies its effectiveness and safety as a research question
Explanation lettering: E = shown as B · B = shown as C · C = shown as E
A is correct. NICE NG222 makes no clinical recommendation supporting continuation or maintenance ECT for relapse prevention: the committee found little evidence and instead issued a research recommendation asking whether maintenance ECT is effective and safe for relapse prevention in people whose severe recurring depression has remitted on ECT. After response to acute ECT, NG222 advises starting (or continuing) antidepressant medication or a psychological intervention to prevent relapse, and considering lithium augmentation of antidepressant medication. Option B overstates the guideline: NG222 does not specifically recommend maintenance ECT after failure of pharmacological maintenance (this mirrors older CG90/Maudsley-style practice points, not NG222). Options C and D invent routine or stepped indications that NG222 never provides. Option E is too absolute: NICE highlights cognitive adverse effects and the limited longer-term evidence, but it does not prohibit maintenance ECT or state that repeated treatment inevitably causes cumulative cognitive impairment.
Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222): Recommendations for research (maintenance ECT for relapse prevention), 2022. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations-for-research