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Functional Analysis — MRCPsych Paper B MCQ

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EasyIntellectual DisabilityFunctional AnalysisMRCPsych Paper B

An adult with an intellectual disability has developed recurrent episodes of shouting and hitting carers. Assessment has considered pain, physical illness, medication effects, mental illness and relevant environmental factors. There is no immediate risk requiring emergency containment. According to NICE NG11, which approach should form the basis of the planned intervention?

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Correct answer: E — Use functional assessment to develop a person-centred behaviour support plan

The correct answer is E. NICE recommends gaining a functional understanding of behaviour that challenges by identifying antecedents, environmental and personal factors, consequences and reinforcers. This formulation should inform a written, person-centred behaviour support plan containing proactive, preventive and proportionate reactive strategies. Antipsychotics are not routine first-line treatment: they are considered only when other interventions have failed, treatment of a contributing disorder has not reduced the behaviour, or risk is very severe, and they must be combined with psychological or other interventions. Regular benzodiazepines are not a recommended primary strategy. Restraint and seclusion are restrictive reactive measures reserved for situations involving significant risk, not the basis of planned treatment.

Reference: National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges. NICE guideline NG11, recommendations 1.5.1–1.5.11, 1.6.1, 1.7.5 and 1.8.2. 2015. https://www.nice.org.uk/guidance/ng11/chapter/recommendations