• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an F1 attached to the psychiatry firm

Patient: 22 year old patient Alex was found acting oddly in the street and has been brought into A&E by the police.

– Take a focused history from the patient based on the presenting complaint
– After 6 minutes you will be asked a series of questions by the examiner.
– Answer any questions that the patient may have

Note to actor: Try to restrain yourself from volunteering to much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

– You are a vulnerable person, who has no idea where they are. You are confused most of the time
– Randomly in the consultation you will look around quickly as if someone has said your name behind you
– You look visibly distressed, you are muttering under your breath to people who aren’t there. You will say randomly “shhhh” “stop” “okay”

Presenting complaint
– People have been watching you, you believe they are high up in the government
– They have invented a device that can read what you are thinking.
– Before the police got you, you were out in the high street trying to tell the public all about the device that the government has made the read all your thoughts. You were screaming in the street but no one was listening to you. You refuse to tell the doctor how the device works because you are worried you will be killed if you tell anyone.

Auditory hallucinations
– You can hear two voices which are talking about you, saying you are worthless and you should kill yourself
– You have no thoughts of harming anyone
– They are male, soft in tone, whispering in nature

Past psychiatric history
– You deny that you have a mental health problem
– You have been admitted to a psychiatric hospital previously and were discharged about a month ago. On this occasion you have decided to stop taking your medications as you feel better now so you no longer need the medications and you are worried about taking these long term

Forensic history
– You have never been arrested
– The police took you to the hospital last time you were admitted

– You do not have any ongoing medical problems that you are aware of

– You cannot remember the medications you were discharged on
– You do not have any drug allergies

– You live alone
– You do not drink
– You have started smoking cannabis since the age of 14 and thinks this has been helping things recently, so you’ve been smoking more of it

– No conditions run in the family that you know of

– You do not understand why you are here again
– You do not believe you have a mental health problem
– You violently deny that you have previously been diagnosed with anything

Category Question
Introduction Candidate appropriately introduced themselves with:
Full name
Clarifies who they are talking to
Asks patient for preferred name

Establishes general context of persecutory delusion
Tries to challenge belief
Screens for thought interference = thought insertion, broadcast, withdrawal and echo

Establishes auditory hallucinations present
Talking to patient instructing to cause harm

Psychiatric history review
Low mood

Establishes if patient is risk of self harm to self
Establishes if risk of self harm to others

Engagement in treatment
Willingness to accept treatment
Asks about illicit substance use

PMH Past Medical History
Asks about mental health diagnosis
Previously been admitted into mental health hospital
Physical health problems

DH Drug History
Not currently taking medications prescribed from hospital

Social and family history appropriately asked about

Actor overall mark
Candidate actively listens to you
Established rapport and empathy
Consultation is non-judgemental
Actor would wish to see patient again over same issue

Question What is your differential diagnosis?
Mania with psychosis
Drug induced psychosis
Other appropriate option