Location: You are a psychiatry F1 doctor in A&E
Patient: Matthew is a 25 year old man, who has taken an overdose of paracetamol and was brought to A&E
The A&E consultant has declared the patient medically fit for discharge
Task: – Take a focused history from the patient around the suicide attempt in order to determine risk of self harm if discharged – Consider the need for hospital admission – 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 Matthew a 25 year old man.
Overall: you are low in mood, you struggle to make eye contact, you look at the floor a lot. You do not lead the conversation but if asked a specific question will answer appropriately.
Everything has been really crap recently, you do not see the point in living anymore. You have nothing to live for and you want it all to end. The only solution is to kill yourself.
Event: yesterday you wanted to kill yourself, you left your flat where your housemate gives and bought as much paracetamol as you could (if asked 45 x 500mg tablets taken all in one go). You went to a local river to avoid being found, you had all the tablets and you drank a liter of vodka and then passed out. After this point everything was a bit of a blur, you remember a dog walker calling an ambulance, next thing you remember is waking up in A&E. You are annoyed that you weren’t able to kill yourself and you still believe there is no point in living.
Leading up to the event:
Past psychiatric history