Psychosis OSCE scenario
candidate brief
A 28 year old female, Sarah, believes that she is having the devil's baby. She has some superficial self-inflicted lacerations to her abdomen that have already been treated. Assess her mental state.
actor brief
Sarah Willows 08/08/1998
You are a 28yo who has some to ED because you want help getting the devil's baby out of you.
You are a bit euphoric - you are quite delighted to talk to the doctor.
This is the first time this has ever happened.
Bizarre, fast paced speech
You don't drink any alcohol, but you have taken some pills lately to exorcise the evil spirits and they have made you feel
pregnancy test negative - previously consented to urine pregnancy test
consents to history taking
previously started on some medication from GP with previous bipolar disorder but you stopped
examiner brief
- Washes hands, Introduces self
- Checks patient identity
- Obtains verbal consent for interview
- Comments on appearance
- Comments on speech pattern
- Asks about mood
- Comments on affect
- Asks about thought disorders - "are you thinking clearly?"
- Asks about delusions - "do you believe things that other people find impossible to believe?"
- Asks about hallucinations - "do you see or hear things that other people don't seem to see or hear?"
- Asks about insight
- Attempts to check cognition
- Asks about insight - psychiatric history, follow-up
- Asks about medical history
- Asks about medications and compliance
- Asks about alcohol + illicit drugs
- Family history
- social history + ?safeguarding
- performs risk assessment - harm to self or others
- Appropriate management plan
- Invites questions
- Address patient's concerns
- global score from patient
- Global score from examiner
Adapted from https://accssurvivor.net/ed/osce-practice - Anna Bayston