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.
Task: – 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.
Acting – 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
PMH – You do not have any ongoing medical problems that you are aware of
DH – You cannot remember the medications you were discharged on – You do not have any drug allergies
SH – 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
FH – No conditions run in the family that you know of
ICE – 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