Psychiatric OSCE Station

Question 1

To begin…

Answer 1

To begin - Introduce yourself, consent, explore open questions

Question 2

After open questions, SOCRATES (psych focus) then carry out a …

Answer 2

Risk assessment

Question 3

.. before asking sensitive questions!

Answer 3

Signpost

Question 4

Risk assessment (psych)

Answer 4

Self harm - ideation, behaviour
Suicide - ideation, behaviour
Harm to others - ideation, behaviour

Question 5

How to ask about recreational drugs

Answer 5

Sometimes we find some people find certain things make it worse, eg smoking cannabis

Question 6

Mania - how to ask

Answer 6

Sometimes we see people who feel/have felt unusually energetic, and can do lots of activities with little sleep - has this ever happened with you?

Question 7

Elicit any organic pathology in psych such as…

Answer 7

Weight loss/physical symptoms

Infective symptoms

Question 8

Past psychiatric history - what should you cover in psych?

Answer 8

Have you seen a psychiatrist before?
Have you been diagnosed with any mental health conditions in the past?
Any hospital admissions? Any sectioning?

Question 9

Past medical history - what should you cover in psych?

Answer 9

Do you see the doctor for anything regularly?
Do you have any diagnosed medical/physical health conditions?
Have you had to stay in hospital for anything in the past?

Question 10

Past drug history - what should you cover in psych?

Answer 10

Are you on any regular medications?
Allergies?
OTC meds?
Recreational drug use? - quantify it like smoking and alcohol

Question 11

Personal history for psych?

Answer 11

Childhood
Education
Life story up to now

Question 12

Family history in psych?

Answer 12

Any history of mental health conditions?

Any family history of medical/physical health conditions e.g. hypothyroidism

Question 13

Forensic history for psych?

Answer 13

Any police involvement?

Question 14

Social history in psych?

Answer 14

Smoking
Alcohol
Occupation
Functionality
Live at home with

Question 15

ICEE - psych

Answer 15

Ideas
Concerns
Expectations
Effects on life

Question 16

Do and don’t in psych

Answer 16

Do - signpost, empathise/acknowledgement, probe for details

Don’t - summarise back, lie, forget about physical symptoms

Question 17

Mental state exam - appearance

Answer 17

Appearance - general appearance, weight/body habitus/features of disease/stigmata of physical disease

Question 18

Mental state exam - behaviour

Answer 18

Rapport
Body language and eye contact
Psychiatric signs (abnormal movement, psychomotor)

Question 19

Mental state exam - cognition

Answer 19

Memory, orientation, concentration

Question 20

Mental state exam - speech

Answer 20

Speed
Amount
Tone
Volume
Rhythm

Question 21

Mental state exam - mood and affect

Answer 21

Affect = weather (objective observed)
Mood = climate

Question 22

Mental state exam - insight

Answer 22

Understand condition, abnormal?

Question 23

Mental state exam - judgement

Answer 23

What would they do in a fire ?

Question 24

Mental state exam - thoughts

Answer 24

Form (flow, coherence, speed)
Content (delusions, harm)
Possession (broadcasting, withdrawal, insertion)

Question 25

Mental state exam - perception

Answer 25

``` Hallucination Illusion Depersonalisation Derealisation Pseudo-hallucination ```

Question 26

Psychosis pathophysiology

Answer 26

Schizophrenia, Bipolar | Organic - drug induced, electrolyte abnormality (hyponatraemia, hypomagnesaemia, hypo or hypercalcaemia) delirium

Question 27

Clinical features of psychosis

Answer 27

``` Delusions Formal thought disorder Thought possession disorder Perception disorder Lack of insight ```

Question 28

Psychosis treatment

Answer 28

Bio-psych-social Antipsychotic - acute and long term (Clozapine only after 2 previous ones) CBT, family therapy, psychoeducation Risk assessment + social support groups

Question 29

Mania - pathophysiology

Answer 29

BPAD | Organic - drug induced, electrolytes, delirium

Question 30

Mania - clinical features

Answer 30

``` Hypomania, mania - functionality Increased energy + activities Less sleep Pressured speech Delusions ```

Question 31

BPAD - type 1 = mania + depression | BPAD - type 2 = hypomania, less commonly diagnosed

Answer 31

BPAD - type 1 = mania + depression | BPAD - type 2 = …, less commonly diagnosed

Question 32

Mania - treatment

Answer 32

Antipsychotic - acute Mood stabilising - lithium, sodium valproate CBT, IPT, family therapy, psychoeducation Risk assessment, social support groups

Question 33

Anxiety - pathophysiology

Answer 33

GAD, panic disorder, PTSD | Organic causes - drug induced, anything that can cause hyperventilation (e.g. asthma, PE, AF)

Question 34

Anxiety - clinical features

Answer 34

Cardiac, palpitations and chest pain Resp - hyperventilation GI - nausea and vomiting Derealisation and depersonalisation

Question 35

Diagnosis of anxiety

Answer 35

ICD 10/11 criteria for GAD, panic disorder, OCD, PTSD, organic cause

Question 36

Treatment of anxiety …

Answer 36

Antidepressants (e.g. SSRIs) Benzodiazepines (with caution) CBT, psychodynamic therapy, EMDR Risk assessment, social support groups

Question 37

BBOXE - bedside, bloods, orifice, x ray and ECG (psych)

Answer 37

Full history, NEWS, relevant exam Bloods - FBC, U+E, CRP, LFTS, bone profile, prolactin, TFTs Relevant drug serum, potential lithium level Orifice - urine dip, sputum X-ray and ECG - CXR, AXR, specific x-ray, ECG

Question 38

ECT can be used in

Answer 38

Catatonic schizophrenia or severe depression | Senior led