The NICE guidance as referenced the clinical recommendation statement states that patients who are severely distressed are candidates for antipsychotics. But there is no exclusion allowed for this indication.

Even if present in an individual patient, practically it would be hard to find "severe distress" in discrete documentation, it would be written into a note. And if a clinician can't adequately document this reasonable exclusion in a way that counts for the measure, the overall validity of the measure should be questioned.