Person-Centred Care BPSD — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryPerson-Centred Care BPSDMRCPsych Paper B

An 80-year-old woman with severe dementia is admitted to an acute medical ward. She becomes agitated and repeatedly calls out. She is physiologically stable, is not attempting to harm herself or others, and can be assessed safely. The medical team asks for a sedative. According to NICE NG97, what is the most appropriate initial management?

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Correct answer: D — Assess causes of distress and use personalised psychosocial and environmental measures

The correct answer is D. NICE recommends first conducting a structured assessment to identify and address causes of distress, including pain, delirium, infection, discomfort, inappropriate care and environmental factors. Initial and ongoing management should use personalised psychosocial and environmental interventions, such as reassurance, appropriate communication, familiar routines or objects, environmental adjustment and meaningful activities. Haloperidol and chlorpromazine are antipsychotics and are not first-line responses to uncomplicated calling out or agitation; antipsychotics are reserved for risk of harm or agitation, hallucinations or delusions causing severe distress. Lorazepam does not replace assessment and person-centred management and may worsen sedation, confusion and falls. Physical restraint is not routine treatment and should not be used when the person can be assessed safely.

Reference: National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers (NG97), recommendations 1.7.1–1.7.3 and 1.7.9. 2018. https://www.nice.org.uk/guidance/ng97/chapter/Recommendations