MRCPsych Clinical Practice & Ethical Standards 2 — Questions and Answers
Question 1: A psychiatrist is treating a patient with schizophrenia who refuses depot antipsychotic medication. The patient has capacity. What is the most appropriate action?
- Administer the depot under the Mental Health Act without further assessment
- Respect the refusal and explore reasons, offering alternative formulations (Correct answer)
- Discharge the patient immediately for non-compliance
- Contact the patient's family to override the refusal
Correct answer: Respect the refusal and explore reasons, offering alternative formulations
A capacitous patient has the right to refuse treatment; the clinician should explore barriers and offer alternatives rather than overriding consent.
Question 2: During a ward round, a trainee psychiatrist notices their consultant is consistently documenting assessments without examining patients. What should the trainee do first?
- Report directly to the GMC without further steps
- Raise concerns with the consultant directly or through local clinical governance channels (Correct answer)
- Ignore the issue as it is the consultant's responsibility
- Document the observations in the patient notes
Correct answer: Raise concerns with the consultant directly or through local clinical governance channels
The GMC's Good Medical Practice requires raising concerns through local processes first before escalating to regulatory bodies.
Question 3: A patient on a Section 3 of the Mental Health Act 1983 requests access to their medical records. What applies?
- They have no right to records while detained under the MHA
- They retain rights under the Data Protection Act 2018 subject to limited exemptions (Correct answer)
- Access can be denied solely because of the Section 3 detention
- Only the nearest relative can request records on their behalf
Correct answer: They retain rights under the Data Protection Act 2018 subject to limited exemptions
Detention under the MHA does not remove a patient's data rights; records can be withheld only where disclosure would cause serious harm.
Question 4: A forensic psychiatrist is asked by a solicitor for a report on a defendant's fitness to plead. Which legal test applies in England and Wales?
- The MacNaughten Rules
- The Pritchard criteria (Correct answer)
- The Bolam test
- The Capgras criteria
Correct answer: The Pritchard criteria
The Pritchard criteria (1836) assess whether a defendant can understand the charge, distinguish a plea, follow court proceedings, instruct counsel, and challenge jurors.
Question 5: A 16-year-old presents requesting contraception and discloses she is in a relationship with a 25-year-old. She has capacity and asks for confidentiality. What must the clinician prioritise?
- Maintain full confidentiality as she has Gillick competence
- Assess safeguarding risk given the significant age gap and potential grooming (Correct answer)
- Refuse to treat without parental consent as she is under 18
- Immediately notify police without any further assessment
Correct answer: Assess safeguarding risk given the significant age gap and potential grooming
A significant age gap raises safeguarding concerns that override standard confidentiality; a structured risk assessment and referral to safeguarding should occur.
Question 6: Which of the following best describes the 'dual role' conflict in forensic psychiatry?
- Treating the same patient in both inpatient and outpatient settings
- Tension between therapeutic duty to the patient and providing objective evidence to the court (Correct answer)
- Conducting both diagnosis and pharmacological management simultaneously
- Working across two NHS trusts at the same time
Correct answer: Tension between therapeutic duty to the patient and providing objective evidence to the court
The dual role dilemma arises when a clinician's therapeutic obligations conflict with their duty to provide impartial expert evidence.
Question 7: Under the Mental Capacity Act 2005, what is the standard of proof required to demonstrate that a person lacks capacity?
- Beyond reasonable doubt
- Balance of probabilities (Correct answer)
- Clear and convincing evidence
- Reasonable suspicion
Correct answer: Balance of probabilities
Capacity assessments under the MCA 2005 use the civil standard of the balance of probabilities, not the criminal standard.
MRCPsych Clinical Practice & Ethical Standards 2
A psychiatrist is treating a patient with schizophrenia who refuses depot antipsychotic medication.
The patient has capacity.
What is the most appropriate action?