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Summary of Psychiatry OSCE guides
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the summary of common Psychiatry OSCE questions
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Psychiatric OSCE guide1. Mental state examination
Mnemonic: All Sane Men Think That Pizza Is Italian
Appearance
-age sex
-distinctive appearance
-clothing
-hygiene status
-evidence of self-harm
Behaviour
-level of arousal-calm/agitated/aggression
-psychomotor activity: agitated, retardation
-eye contact
-body language (disinhibited, overfamiliar)
-good rapport /engagement
Speech
-rate-slowed/pressured
-rhythm-fluent articulate / clear / slurred
-volume-normal, loud, soft
-quantity-minimal (response only to questions)
-tone-monotonous/tremulous
Mood
-objectively, the patient looks depressed, sluggish and tired, elated, euphoric, euthymic
-affect blunted, expansive, incongruent/congruent
-subjectively, the patient says she feels fed up and miserable and tearful
Thought form
-speed
-flow- linear, incoherent, tangential, circumstantial, perseveration, flight of ideas
Thought content
Summarize what did the patient said
Rumination about previous act, delusion of guilt, delusion of grandeur, paranoid delusions
Delusions, overvalued ideas, rumination/ obsessions, suicidal thoughts, homicidal thoughts
-thought insertion, broadcasting, withdrawal
Perception
-hallucination, pseudo-hallucinations, illusions
-command hallucination
-2nd person or 3rd person auditory hallucination
-auditory, vision, olfactory, tactile, somatic
Cognitive (IQ)
,Grossly cognitive is intact, but not formally assessed
If assessed, mnemonic (OALMC)
Orientation (Time, place, person)
Attention (count calendar months backward)
Language (ask patient to name objects)
Memory (give them an address and ask them at the end of the consultation)
Construction (draw a clock face with pointers of a specific time)
Insight
Ask question to assess whether or not the patient is able to recognise their problems and do
they need help with that.
Risk assessment
2. Alcohol dependence
Introduction
Ask screening questions
C: have you thought of cutting down? What makes u want to cut down?
A: do u feel annoyed when ppl criticize u?
G-guilty about your drinking?
E- do u think drink alcohol as the 1st thing u do in the morning to calm ur nerves?
HOPI:
how long? How many in a week? Getting more?
Did u remember the 1st drink? experience?
When?
Where?
Who?
How much did u spend on alcohol?
If u stop drinking, do u get shakes? To assess withdrawal symptoms
Do u have to drink more to achieve the same effect? To assess tolerance
Do u have a strong urge to drink?
Do u feel angry or sad when u stop drinking?
Social:
Home? Job? Family? Friends? Financial? Any alcohol related crime?
Medical? Past medical? Any problem now?
Family?
Assess for mood
Assess for psychotic symptoms as well
, Risk assessment
Treatment for withdrawal
Diazepam/chordiazepoxide
Treatment:
Refer to specialist, CBT/self-help group therapy
Disulfiram-makes u feel sick
Naltrexone-opioid receptors antagonist, reduce the pleasure effect from it
Acamprosate – reduce withdrawal symptoms
3. Alzheimer explanation to patients
Disease explanation mnemonic: We Can Probably Manage
What-a type of dementia which affects the brain to process and retain information
Causes-genetic and environmental factors
Problem- if left untreated, the progression of the disease will be faster, it can affect patient
life greatly as they could not carry put their daily life activities by themselves, however, if we
detected it early, like what we did today, with some medication, we will be able to delay the
progression of the disease, so that patient can carry out their daily activities for as long as
possible
Investigation: AMTS, ACE iii, mental state examination, urine drug, TFT, FBC, rule out any
organic cause
Management: refer to specialist memory service
Medical: donepezil, rivastigmine and galantamine (can cause heart block and peptic ulcer)
ask about symptoms and ECG 1st
Memantine side effects-hallucination, confusion and hypersexuality
If patient display aggressive features which can bring harm to himself and people around
him, antipsychotic medication might be needed, however we think this is very unlikely, as
this is more prevalent in late stage of the disease
4. Atypical antipsychotic explanation -olanzapine
Drug explanation mnemonic: ATHLETIC
Action- it works by blocking the receptors which dopamine binds to, a neurotransmitter in
our brain which is responsible for thought process, to prevent over activity of the dopamine
in the brain
Time- depending on what type u are using, there are two types, tablets and depot
injections, for tablets u have to take it every day, injection is longer lasting, u have to receive
another injection in 2 to 4 weeks depending on the dosage u r using
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