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Suicidality in Dementia — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatrySuicidality in DementiaMRCPsych Paper B

A 72-year-old man with mild Alzheimer's dementia retains good awareness of his diagnosis. He has developed a major depressive episode and reports that he intends to take an overdose today. He has accumulated medication for this purpose. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Arrange urgent specialist assessment, immediate safety measures and adapted depression treatment

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

B is correct. His stated intent, current plan and access to the intended means indicate considerable immediate suicide risk, requiring urgent specialist mental health assessment and immediate safety management. Depression treatment must not be withheld because he has dementia or is suicidal, although communication and treatment delivery should be adapted to his cognitive needs. Means restriction and carer involvement are important but are insufficient without urgent assessment, making D incorrect. Routine psychological treatment (A) is inappropriate as the sole immediate response. Option C provides an unsafe quantity of medication and delays review; overdose toxicity and restricted supply must be considered. Dementia does not invalidate suicidal statements, but neither does it by itself justify compulsory admission without an individual capacity, risk and Mental Health Act assessment, so E is incorrect.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.2.8–1.2.12, 1.2.15 and 1.4.22–1.4.23. 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/recommendations