Simple CASC Stations

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You are seeing Mrs. Howard, a 37 year old school teacher in your outpatient
clinic, who was referred by her GP. She was involved in a serious road
accident 6 months ago. The patient initially saw her GP because of difficulty
in coping with her job. Obtain history to arrive at a diagnosis and rule out
co-morbidity.
Name of the candidate:

A- Good pass B-Borderline pass C-Borderline fail D-Fail
Areas of Questioning style- use of appropriate mix

Concern- of open & closed qns, A B C D
1 Communication- Listening & responding
appropriately to interviewee
2 Management of interview including A B C D

empathic responses, Fluency of interview
3 Professionalism, Establishing rapport, body A B C D

language
Obtain details of the traumatic accident-

4 nature and extent of the problem, severity A B C D
of symptoms
And impairment on current functioning
5 Hyper arousal Symptoms (Persistent A B C D

Anxiety, irritability, Poor concentration,
insomnia, enhanced startled response etc)
6 Intrusions (flashbacks, nightmares, A B C D

Recurrent distressing Day dreams)
7 Avoidance of reminders of the events A B C D

(Place, person and activities), emotional
detachment, numbness
8 Rule out co-morbidity, coping strategies A B C D

(Depression, anxiety, substance misuse etc)
9 Range and depth of history explored, A B C D

Significant omissions
10 Depth of enquiry into symptoms A B C D
11 Lack of appropriate focus on the task, Lack A B

of structure C D
A
!"#$%"&'%()*!& B C D
ABNORMAL GRIEF REACTION-HISTORY TAKING
The GP has referred Mrs. White, 35-year-old woman whose husband died
seven months ago. She is not coping well following the death of her
husband. Take an appropriate history to assess whether this is normal
bereavement reaction or determine if she has features of abnormal grief
reaction

Areas of Questioning style- use of appropriate mix of

Concern- open & closed qns, Communication- Listening A B C D
1 & responding appropriately to interviewee
Management of interview including empathic
2 responses, Fluency of interview, Lack of A B C D
appropriate focus on the task
Professionalism, Body language, Establishing

3 rapport A B C D
Assessment of feelings at the time of her
4 husband’s death, onset, duration, course of A B C D
symptoms and impact
Assessment of current mood, biological,

5 emotional and/ or other Sx of depression A B C D
Features of normal grief reaction

6 a. Pining or searching, A B C D
b. Preoccupation with the deceased
Features of normal grief reaction

7 c. Feelings of guilt A B C D
d. Pseudohallucinations of widowhood
Atypical grief reaction-features

8 a. Other hallucinatory experiences A B C D
b. Thoughts of self harm, suicide
Atypical grief reaction-features

9 c. Inability to function A B C D
d. Mummification
Range and depth of history explored,

10 Depth of enquiry into symptoms A B C D
11 Significant Omissions, analysis of problems A B C D
!"#$%"&'%()*!& A B C D
BREAKIND BAD NEWS
Mr. Green is a 78-year-old gentleman admitted to the psychiatric unit 3 days

ago with a history of acute confusional state. He was living independently
until 3 months ago when he began experiencing episodes of confusion and
cognitive problems that were rapidly worsening. CT brain scan was taken
and it showed a large tumour mass with a central necrosis in the left
temporal region and secondaries in the right parietal region. The bloods and
chest X-ray were fine. Discuss CT results with his daughter Mrs. Patricia
Green and address her concerns
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Areas Ice breaking non-medical comments

of Begin with introductions and context A B C D
Conce
rn1
Establish what is already known
2 Set the scene; give a warning shot A B C D

3 responses, allowing time for the news to sink in, A B C D
allow time for emotional reactions
Listening & responding appropriately to

4 interviewee, Reassure in verbal and non-verbal A B C D
ways, body language.
Communication- Use of simple jargon free

5 language to describe A B C D
Avoiding false information and false reassurances
Professionalism- Show your own emotions whilst

6 maintaining professionalism A B C D
Discuss about treatment options (Surgery,

7 radiotherapy, chemotherapy etc) and prognosis A B C D
Involvement and support from the Medical team,
8 palliative care team and Multidisciplinary team, A B C D
Mac Millan nurse etc
Summarize and clarify Understanding,

9 Encourage Questions A B C D
Range and depth of information covered,

10 Significant omissions, Analysis of problems A B C D
Prioritisation and appropriateness of information

11 delivered and or management A B C D
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A B C D
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You are asked to see Ms. Rose, a 24-year-old lady who has insulin
dependent diabetes mellitus.
The GP was concerned about her poor diabetic control and the patient
admits to omitting insulin in order to lose weight. Take a history to assess
for the presence of eating disorder and assess prognostic factors

Areas Questioning style- use of appropriate mix of open

of & closed qns, fluency of interview and A B C D
Conce communication
rn1
2 responses, Listening & responding appropriately A B C D
to interviewee
Professionalism, body language, establishing

3 rapport A B C D
Psychological Symptoms (Body image
4 disturbance, Morbid fear of fatness) A B C D
Physical symptoms (Fatigueability, Constipation,

5 Dizziness) Amenorrhoea- to rule out anorexia A B C D
Persistent Preoccupation with eating, irresistible

6 food craving, Eating pattern and Bulimic A B C D
behaviour- Binge eating episodes (feelings before
During and after binges)
7 Measures taken to lose weight - Avoidance of A B C D

foods/fluids
Vomiting, Over exercise, laxatives, stimulants,
Diuretics, others
8 Prognostic factors: Low self-esteem, personality A B C D

& Relationship difficulties, poor social support etc
9 Fluency of interview, A B C D
Lack of clear structure, Lack of appropriate focus
on the task

!"#$%"&'%()*!& A B C D
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Mrs. Rachel Smith is a 31-year-old lady who delivered a female baby three
months ago. She was referred by her GP and following your assessment in
clinic, you think that she might be suffering from post-natal depression.
a. Discuss the diagnosis and address his concerns.

b. Explain etiology and treatments available for this condition.

Areas Communication- Avoiding Jargons/false

of information A B C D
Conce False reassurances, fluency of interview
rn1
to interviewee,

3 rapport A B C D
Explaining diagnosis, clinical features
4 A B C D
Causal explanation- etiology
5 A B C D
Treatments available (Practical support,
6 counselling, A B C D
Antidepressants, hospital admission-Mother and
baby units)
Preventive methods (GP, antenatal classes, health

7 visitor, A B C D
Educating fathers, family support)
Addressing other concerns

8 (1. ? Breast feeding whilst on antidepressants. A B C D
(2. Hormonal treatments
(3. Recurrence
Prioritisation and appropriateness of information

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PANIC DISORDER-HYPERVENTILATION
Mr. Paul Andrew is a 40 YO gentleman who suffers from panic disorder. He

has called the ambulance, as he was worried that he might be suffering from
a heart attack. He has been investigated with normal results. He is still
feeling anxious because his father died recently of heart attack. His wife
Mrs. Shirley Andrews is extremely concerned about him and wanted to
speak to the psychiatrist.
a. Explain the symptoms to his wife and address her concerns.
b. Also explain what hyperventilation syndrome is and what happens as
a result of it?

Areas of Communication- using simple terms,

Concern- avoiding jargons, Questioning style and A B C D
1 fluency of interview
Management of interview including
2 empathic responses, Listening & A B C D
responding appropriately to interviewee
Professionalism, Body language,

3 Establishing rapport A B C D
Reassurance- Medically cleared and not

4 having a heart attack, investigations done A B C D
so far.
Offer clear explanation for chest pain,
breathlessness and other symptoms
5 Explaining diagnosis-panic disorder, nature A B C D

& frequency
Fight-flight response
Explaining hyperventilation Syndrome, the

6 mechanism involved, Possible Ways to A B C D
prevent it.
Emphasise Importance of Relaxation

7 Techniques and Breathing exercises A B C D
Addressing Concerns-
8 ? Getting back to work A B C D
? Medications
9 Agreeing to talk to patient later and
reassure him A B C D
Sources of information- leaflets etc
Range and depth of enquiry into symptoms,

10 Significant omissions, Analysis of A B C D
problems
Prioritisation and appropriateness of

11 information delivered and or management A B C D
A
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You are seeing Mrs. Pauline Smith in the out-patient clinic. Take history
from her, as she is feeling low in her mood, and assess her suitability for IPT
(Inter Personal Therapy).

Areas of Communication- Appropriate mix of open

Concern- and closed questions. A B C D
1
Professionalism, body language

Assess depressive Symptoms-

4 Core and other Sx-emotional Sx, biological A B C D
etc
5 Rule out psychotic symptoms, risk A B C D

assessment
Selection criteria- outpatient, Establishing

6 mild to moderate depressive illness. Non- A B C D
psychotic depressive illness, non-bipolar
illness
Life events related to illness development

7 (grief, change of roles, interpersonal A B C D
disputes, interpersonal deficits)
Assess motivation and willingness to
8 comply A B C D
Route to recovery- Resolving interpersonal
issues
9 Fluency of interview , Significant omissions A B C D
Analysis of problems & synthesis of

10 opinion A B C D
Lack of appropriate focus on the task
A
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Mrs. Turner is a 35-year-old lady who suffers from mixed anxiety and
depressive disorder with dependent personality disorder traits. She also has a
past history of traumatic childhood.You have seen her in the outpatients’
clinic and have decided to refer her to the psychology department for
psychodynamic psychotherapy. She would like to know more about it.
Explain the principles involved and structure of this therapy and Address her
concerns
Do not take history.

Areas of Communication, Avoid jargons, Avoiding

concern- false information, False reassurance A B C D
1
2 empathic responses, Listening & responding A B C D
appropriately to interviewee
Professionalism, body language and

3 establishing rapport A B C D
Explain the nature of therapy
4 (Psychological/talking, involves listening A B C D
and talking, explores past conflicts and their
impact on current functioning)
Basic principles of therapy (Treat people

5 with serious emotional Difficulties, A B C D
Exploration of childhood, Establishing
therapeutic relationship is important)
Structure of therapy (Initial Assessment,

6 Individual/group, A B C D
Number and duration of sessions, therapist-
trained & supervised)
Outcome and further discussion- Use in

7 depression, prevents relapse, Long-term A B C D
benefits
Address patients concerns

8 1. Waiting time A B C D
2. Emergencies
3. Continue medications
Address patients concerns
9 4. Unwilling to attend group A B C D
5. Confidentiality
Significant omissions, Analysis of problems
10 Fluency of discussion A B C D
A
!"#$%"&'%()*!& B C D
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You are seeing Miss. Sarah White, a 27-year-old lady who has seen her GP
complaining that her eyes are wide apart. Obtain history to explore the
nature and extent of her problems. Assess her to clarify her diagnosis.

Areas Communication, Questioning style- use of

of appropriate mix of open & closed qns and fluency A B C D
Conce of interview
rn1
to interviewee

3 rapport A B C D
Nature and description of presenting problems
4 (Onset, duration, and severity), and impact on A B C D
normal functioning
(Personal, social and occupation)
Assess the strength of Beliefs and degree of

5 conviction (overvalued ideas/ delusional), A B C D
Look for any other abnormal beliefs
Avoidance Behaviour-Social situations, social

6 withdrawal, lack of self confidence etc A B C D
Compulsive habits & behaviour- Mirror gazing,
Repeated checking and elaborated Grooming
rituals
Risk assessment:
7 1. Suicidal ideation A B C D
2. Risk of actually performing surgery themselves
3. Risk of unwanted tests and investigations
Past psychiatric history
8 Rule out co-morbidity-Depression, social phobia, A B C D
schizophrenia
Depth of enquiry into symptoms,

9 Significant omissions A B C D
Range and depth of history and risk explored,

10 Lack of appropriate focus on the task A B C D
Analysis of problems
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Mr. Tony Gordon, a 32-year-old gentleman was seen in the drug and alcohol
outpatient clinic following referral from his GP, as he has a history of
multiple drug use. Take a history of drug misuse and try to establish features
of dependence syndrome.

Areas Questioning style- Use of appropriate mix of open

of & closed qns, Fluency of interview, A B C D
Conce Communication
rn1
to interviewee
3 Professionalism, body language, establishing A B C D

rapport
4 Current usage and Longitudinal history A B C D
5 Elicit Features of dependence A B C D

(Compulsion, tolerance, withdrawals, re-
instatement etc)
6 Assess Complications- (Physical, psychological, A B C D

Social, legal)
7 Range and depth of Risk explored A B C D

(Unsafe sex, sharing needles etc)
8 Insight and motivation A B C D

Rule out mood and psychotic Sx, Alcohol and
other drugs
Lack of clear structure,

9 Lack of appropriate focus on the task, A B C D

!"#$%"&'%()*!& A B C D
PHYSICAL EXAMINATION-EXTRA PYRAMIDAL SIDE EFFECTS
You are a junior doctor in accident and emergency department. The nurses
have asked you to see this young gentleman Mr. Paul Brown who is restless,
angry and agitated. The A&E doctor mentions that he went to his GP three
days ago who gave him some new tablets. He thinks his problems started
after taking those tablets.
1. Explore the reasons why GP prescribed the medication.

2. Assess his symptoms and perform appropriate physical examination

Areas Communication- Dealing with angry patient

of assertively, Establishing rapport and Questioning A B C D
Conce style
rn1
to interviewee
Ensuring privacy, body language,
3 Professionalism, gentle handling, Giving clear A B C D
instructions
Explore the reasons for current symptoms and
4 medication prescribed A B C D
Assess Symptoms of EPSEs- Inner restlessness,
5 stiffness, shakiness, Other abnormal body A B C D
movements
Examination-facial and oral movements
6 Lips, Perioral areas, jaw, Tongue, Dental status A B C D
Examination of upper limbs

7 Tremor-outstretched hands A B C D
Rigidity-Wrist, elbow and shoulder joint
Examination-Leg movements, Resting posture,

8 Seated on chair with Hands on knees (Observe for A B C D
15 secs)
Examination: legs slightly apart, Seated with

9 hands hanging unsupported etc A B C D
Observation on Standing posture, Observation
10 with both arms extended and palms down A B C D
(Observe for 15 sec)
Examination of gait
Explaining the possible diagnosis to the patient
11 (Akathisia, which is medication induced) and A B C D
allay anxiety
Range and depth of Task performed, Significant

12 omissions, Analysis of problems A B C D
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HISTORY TAKING- OCD AND HYPOMANIA
Mr. Brian Goldsmith was referred by Occupational health for a psychiatric

review. He is currently off sick from work and has been feeling stressed
recently. Assess history of current problems and also look for abnormal
psychopathology.

Conce communication
rn1
to interviewee,
3 Professionalism, body language, Establishing A B C D
rapport
4 History- obsessional symptoms (mode of onset, A B C D

duration and progression) and the anxiety Sx
associated, impairment of normal functioning
5 Phenomenology of obsessions-own thought, A B C D

Unpleasurable, repetitive, resistance & response
6 Elicitation of compulsive behaviours and A B C D

associated rituals
Other behaviours-cleaning, checking etc
7 Hypomanic symptoms- mood, biological Sx, poor A B C D

concentration, insight.
8 Risk assessment and rule out psychotic symptoms A B C D
9 Range and depth of history explored A B C D
Range and depth of psychopathogy explored,

Lack of clear structure and fluency

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A B C D
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Mr. John Abraham is a 28-year-old gentleman with a long-standing history
of paranoid schizophrenia. He has been admitted to a low secure forensic
unit and is now been charged with serious assault. You have been asked by
the court to assess him.
a. Assess circumstances leading to index offence.
b. Ask him relevant questions to identify risk of future violent offending.


Concern open & closed qns, fluency of interview and A B C D
-1 communication

to interviewee,
3 Professionalism, Establishing rapport,

Body language A B C D
4 Assess Circumstances leading to Index offence- A B C D

(location, people, timing, triggers, drug or
alcohol involved,
Severity of violence)
Patients’ view about the offence; Anger, Denial,

5 lack of remorse, lack of guilt A B C D
Ongoing thoughts of violence etc
6 Significant Personal history (Traumatic A B C D

childhood, violent father, Victim of domestic
violence)
Psychiatric history- (Low IQ, Conduct disorder,
7 Psychotic illness, non-compliance) A B C D
Previous Forensic history

8 (Past violent offences, arrests, Convictions, A B C D
sentences etc)
Other Risk factors- (Single, unemployed,

9 homelessness, A B C D
Drug & alcohol Misuse, lack of stable
Relationships)
Personality traits- (Repeated impulsive

10 behaviour, Difficulty in coping with stress, A B C D
Antisocial personality traits)
11 Range and depth of history explored

Range and depth of Risk explored A B C D
12 Significant omissions, Analysis of problems

Lack of structure and focus on the task A B C D
!"#$%"&'%()*!& A
B C D
SEXUAL OFFENCE- PAEDOPHILIA
You have been asked by the court to see Mr. Kenneth Roberts, a 44-year-old
man who has been arrested for child molestation. Obtain history and ask him
relevant questions to assess risk of future offending. Do not conduct a
mental state examination

Areas of Communication, Questioning style- use of

Concern appropriate mix of open & closed qns, fluency A B C D
1 of interview

to interviewee
3 Professionalism, establishing rapport, Body

language A B C D
Assess Circumstances leading to Index offence-
4 (location, people, timing, triggers, relationship to A B C D
victim, intoxicated at time of offence)
Patients’ view about the offence; Denial,

5 minimisation, justification, lack of remorse, lack A B C D
of guilt, low victim empathy, feelings of
‘entitlement’
Personal history (traumatic childhood, history of

6 childhood abuse), Past psychiatric history, Drug A B C D
and alcohol history
Psycho-sexual history (deviant sexual practices,

7 excessive masturbation and urges, sexual A B C D
fantasies, Paraphilia etc)
Previous Forensic history (sexual and non-
8 sexual offences), juvenile sexual offences, A B C D
history of cautioning, conviction, sentencing,
previous history of similar offences, poor
engagements with treatments
Current social circumstances- (unemployment,

9 homelessness, lack of stable Relationships, A B C D
abnormal personality traits- impulsivity,
inhibition, lack of empathy)
10 Range and depth of history explored

Range and depth of Risk explored A B C D
11 Significant omissions, Analysis of problems

Lack of structure and focus on the task A B C D
A
!"#$%"&'%()*!& B C D
FITNESS TO PLEAD
Mr. Peter Curtis is a 35-year-old gentleman, who has been charged with
assault 24 hours ago. The alleged victim had sustained multiple injuries in
his face and abdomen and required an overnight stay in the hospital. Mr.
Curtis has been remanded in custody and is due to appear in court tomorrow.
The court wishes to know if he is fit to plead. You have been asked to attend
the police cell and assess him.
a. Determine his fitness to plead.

b. Also ascertain whether he suffers from any form of mental illness


Concern- appropriate mix of open & closed qns, A B C D
1 fluency of interview
Management of interview including A
2 empathic responses, Listening & B C D
3 Professionalism, establishing rapport, A

Body language B C D
Assess Circumstances leading to Alleged A

4 offence B C D
And patient’s view about it
Pritchard Criteria: A
5 Ability to understand charge (What and B C D
why they have been charged
6 Understanding the effect of Plea-guilty/not A

guilty B C D
7 Ability to instruct counsel and Challenge A

juror B C D
Ability to follow evidence and Court A

8 proceedings B C D
Rule out the presence of delusional beliefs A

9 or evidence of mental illness B C D
Range and depth of information explored, A

10 Significant omissions, Analysis of B C D
problems,
A
!"#$%"&'%()*!& B C D
EROTOMANIA- ASSESS DANGEROUSNESS
Mr. John Brown is a 45 year old gentleman who was recently treated as an
inpatient for mental health problems and was discharged. He came back to
the acute psychiatric unit and wanted to speak to a particular nurse as he
believes that she is in love with him. When the receptionist refused to allow
him, he waved a knife at her. The police was called and they want the duty
psychiatrist to speak to him. Assess his beliefs and establish the level of
dangerousness.


Concern open & closed qns, and communication A B C D
-1
2 responses A B C D
Listening and responding appropriately to
interviewee/discussant
Building rapport, Approach patient in a non

3 confrontational and non judgemental manner A B C D
Body language, Taking control of the interview

4 and dealing with angry patient A B C D
Professionalism, including but not limited to

5 harmful interaction, failure to respect individual A B C D
rights; ethical behaviour etc
6 Clarify and Explore erotomania, assess degree of A B C D

conviction and seek explanation
7 Range and depth of Risk explored A B C D

Assessment of static and dynamic risk factors
8 Range and depth of history and psychopathology A B C D
explored
9 Fluency on interview/discussion A B C D
Lack of appropriate focus on the required task
!"#$%"&'%()*!& A B C
D
NEUROLEPTIC MALIGNANT SYNDROME
Mr. Brian White was admitted to the acute Psychiatric ward two days ago
following a first episode of acute psychosis. Brian was very agitated and
required rapid tranquillisation with IM Haloperidol. Unfortunately he
developed Neuroleptic malignant syndrome and was subsequently
transferred to medical unit for treatment. His father who is angry & upset
has come to the ward and demanded to see a doctor to find out what has
happened.
a. Address his concerns and allay his anxiety
b. Explain the nature of his son’s condition and the prognosis.
c. Do not take history

Areas Communication- Verbal & non verbal, avoiding

of false information/ false reassurance, medical A B C D
Conce jargons etc,
rn1
2 responses, fluency of discussion A B C D
Establishing rapport, body language
3 Dealing with angry relative and taking control of A B C D
interview
Explaining rationale for treating with Haloperidol

4 Injection A B C D
Nature, causation and clinical features of NMS
5 A B C D
Investigations & possible treatments
6 Implications for future management and A B C D
antipsychotic rechallenge

7 interviewee A B C D
1. Is he going to die?
2. Prognosis
Helping with Hospital Complaints procedure-

8 Professionalism including but not limited to A B C D
harmful interaction, failure to respect individual’s
rights, ethical behaviour etc
Range and depth of information explored,

Prioritisation, recognition of importance and

10 appropriateness A B C D
Of information delivered and or management
!"#$%"&'%()*!& A B C D
FRONTAL LOBE FUNCTION TESTING
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Perform frontal lobe function tests to complete cognitive assessment and
arrive at a diagnosis.
Areas Communication, Questioning style, Clear

of instructions, simple language and fluency of task A B C D
Conce
rn1
to interviewee,
Professionalism, body language and establishing

3 rapport A B C D
Assessment of verbal fluency (Word-F, word-A,
4 Word-S) A B C D
Category fluency (animals, birds etc)
Assessment of abstraction- Proverb interpretation

5 Similarities test A B C D
Cognitive estimate testing (2 tests)

6 A B C D
Co-ordinated movements- Luria three step task
7 A B C D
Coordinated movements (response inhibition and
8 set shifting) Go-no-go test A B C D
Perseveration (alternate sequences test)
9 A B C D
Examination- Primitive reflexes (Glabellar tap,
10 grasp and pouting reflex) A B C D

Range and depth of examination performed,

!"#$%"&'%()*!& A B C D
COUNSELLING-LITHIUM AUGMENTATION
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Areas Communication- avoid use of jargon, Avoiding

of false information, fluency of interview A B C D
Conce
rn1
2 responses, A B C D
interviewee

rapport
4 Explain the rationale behind Augmentation & A B C D

Nature of the drug
5 Describe the monitoring and duration of treatment A B C D
Describe side effects- Short term & long term

6 Addressing concerns about Renal impairment A B C D
Warning Signs of Lithium toxicity

7 When and how to stop it? A B C D
Risk
8 1.Risk of relapse on stopping medications A B C D
2.Ensure adequate hydration (Salt and water
balance) - Holidays-avoid sunbathing
(dehydration)
Addressing concerns
9 3.? Addictive potential A B C D
4. Drinking alcohol to moderation
5. ? Rash

!"#$%"&'%()*!& A B C D
PSYCHOSIS-EXAMINATION
Mr. Paul Brown is a 45-year-old gentleman brought by the police to the

A&E department. He went to the police station earlier today and said that
‘he is giving up’
a. Assess his thoughts and establish what abnormal belief he holds
b. Establish whether any other psychopathology is present.
.

of & closed qns, fluency of interview, A B C D
Conce communication,
rn1 Picking up clues appropriately

2 responses, Seeking to understand the individual A B C D
patient’s experience, Listening and responding
appropriately

rapport
Delusions of guilt, paranoia, Persecutory

4 delusions- Elicitation, Exploration and A B C D
clarification
Evaluation of falseness of beliefs and degree of

5 conviction, A B C D
Effects and coping
6 Third person auditory hallucinations- content, A B C D

source, timing and reality with which they are
experienced
7 Delusional perception- Elicitation, A B C D
Exploration and clarification
8 Look for other psychotic symptoms A B C D

(Any other abnormal beliefs, other hallucinatory
Experiences, thought alienation etc)
9 Range and depth of history explored A B C D

Range and depth of psychopathology explored
10 Lack of clear structure, Significant omissions A B C D

!"#$%"&'%()*!& A B C D
CHILDHOOD DISORDERS- ADHD
Mrs. Young is a 32-year-old lady attending the CAMHS Clinic with her 6-
year-old son Abraham. The GP referred her son to the clinic for psychiatric
evaluation.
a. Obtain history from his mother looking for features of attention deficit
hyperactivity disorder.
b. Rule out co-morbidity.

Areas Communication- Questioning style, use of

of appropriate mix of open & closed qns, fluency of A B C D
Conce interview
rn1
to interviewee
3 rapport A B C D
Brief history of symptoms: Onset, duration,
4 Nature and severity of presenting problems, A B C D
frequency, provoking and ameliorating factors,
Criteria met both at home and at school
Hyperactivity-extreme and persistent restlessness

5 Sustained and prolonged motor activity (fidgeting, A B C D
moving, getting up and running, continually
interrupting, unable to play quietly)
Impulsiveness and difficulty in withholding

6 responses- talking excessively, blurting out A B C D
answers, jumping the queue etc
Inattention symptoms; difficulty in maintaining

7 attention, A B C D
Lack of persistence with tasks, easily distracted, is
forgetful and loses things for tasks.
Rule out co morbidity (conduct disorder,

8 antisocial behaviour, Tic disorders, Autistic A B C D
spectrum disorders, Learning disability,
depression etc)

9 Lack of appropriate focus on the required task A B C D

!"#$%"&'%()*!& A B C D
CHILD PSYCHIATRY- ADHD COUNSELLING
You have assessed Mr. Abraham, a 6 year old boy attending the CAMHS
Clinic and have been diagnosed with ADHD. Mrs. Young is curious to know
about the diagnosis and drug treatment options available for her son’s
condition. She is worried about other siblings. Address her concerns and
allay her anxiety.

Areas Communication, Avoid false information,

of avoid medical jargons, clear explanation in simple A B C D
Conce terms
rn1
to interviewee

rapport
4 Explain diagnosis, nature of the condition and A B C D

aetiology
Concerns
5 1. ? Blood tests to confirm diagnosis A B C D
2. Growth suppression
3. Stimulant and effect on sleep
4. Need for special diet
6 Methylphenidate- Mode of action and efficacy, A B C D

duration of treatment, Side effects (Short-term and
long-term)
Other Concerns
7 1. Effect on other child A B C D
2. ? affect unborn child
8 Fluency of discussion, Lack of appropriate focus A B C D

on task
9 Significant omissions, A B C D
Analysis of problems & synthesis of opinion

!"#$%"&'%()*!& A B C D
(1"%/'$!2(1")*-20'5.%%2",4'),/'+6&-/+!&'
Miss. Amy Morris is a 14 year old female who was brought into the A&E
Department by her mother after taking an overdose. Assess this young lady
to identify the reasons for taking it and seriousness of the overdose.
,789':;'<=9'>7?@A@7<9B'
Areas Communication- Questioning style- use of

of appropriate mix of open & closed qns, A B C D
Conce
rn1
to interviewee

rapport
4 Obtain more information and explore the reasons A B C D

for overdose
5 Evaluate the degree of suicidal intent and the A B C D

seriousness of the attempt (Planning, performance
in isolation, Precautions to avoid discovery,
Suicidal note etc)
6 Bullying history- physical & Emotional with A B C D

details and examples
7 Risk assessment A B C D
(Clear suicidal plans, fixed or Fleeting suicidal
thoughts, future plans etc)
8 Lack of structure and fluency in the interview A B C D

9 Range and depth of history explored, A B C D

Significant omissions, Analysis of problems
!"#$%"&'%()*!& A B C D
(1"%/1++/'!&C.)%')5.!&'
You are assessing a 14-year-old girl in the A& E department who has taken
an overdose of paracetamol tablets. Whilst assessing her, she showed a paper
on her hand reading ‘RAPE’ and during discussion, she discloses that her
stepfather has been sexually abusing her.
Her stepfather was seated in the waiting room. How would you proceed?
Discuss how you would manage this situation with the consultant.

Areas Communication, fluency of discussion

of Listening & responding appropriately to examiner A B C D
Conce
rn1
Professionalism including but not limited to
2 harmful interaction A B C D
Acknowledge-serious issue, Take as much history

3 as possible, Also not to contaminate evidence A B C D
Inform child-about necessity to break

4 confidentiality A B C D
And share information with colleagues
Short term: Medical Treatment for overdose,

5 Referral to social worker, child protection officer, A B C D
police if needed, To inform-parental responsibility
Child to be accompanied & supported
Assess mental state of the child
6 Risk: Ongoing suicidal thought, plans A B C D
Risk of other siblings at home
Offer admission to hospital- Paediatric ward or

7 child psychiatric unit for further assessment and A B C D
monitoring.
In the intermediate and long term: Social services

8 to conduct a full investigation (SW- Emergency A B C D
protection order, care order if there are imminent
risks involved), Network meetings,
Press charges against the perpetrator if needed
Further mgt for child; Counselling, Psychotherapy

9 and support A B C D
Also seek senior colleague support and discuss
with lead consultant for child abuse issues


!"#$%"&'%()*!&
A B C D
PUERPERAL PSYCHOSIS
Miss. Nicola Palmer is a 21-year-old lady who was admitted to the maternity
ward. She delivered a boy baby five days ago and was discharged three days
after the delivery. She re-admitted herself at the early hours of this morning
in a distressed state complaining of feeling anxious and frightened. There are
no concerns obstetrically. The obstetrician requested for psychiatric
assessment. Assess her mental state and perform risk assessment.


Conce communication
rn1
to interviewee

3 rapport A B C D
Elicit mode of onset, Duration and Reasons for
4 Presentation A B C D
Assess relationship with the baby, partner and

5 previous children, Undue concerns and anxieties A B C D
about the baby
MSE: Features of puerperal psychosis

6 (Paranoia, hallucinations, Delusional ideas about A B C D
the baby, Other psychotic symptoms)
MSE: Guilt feelings, Negative Thoughts-

7 Worthless mother A B C D
Cognitive functions, insight
Risk assessment- Suicidal thoughts and plans

8 Infanticidal thoughts, Risk of absconsion, non- A B C D
compliance
Degree of support network, ? Misfortunes if any

9 (Support from family and partner) A B C D
Past history - (Personal history, family history etc)


11 Range and depth of risk explored, Significant A B C D
omissions
!"#$%"&'%()*!&
A B C D
!+#)*+D+-#'$)",'/"!+-/&-''
Mrs. Lewis was referred by his GP to your outpatient clinic for psychiatric
assessment. He is not happy about it as he thinks that he suffers from severe
chronic pain and there is nothing wrong with him mentally. Obtain history to
arrive at a diagnosis.


Conce communication
rn1
to interviewee,

rapport
Full description of the pain and the circumstance

4 in which it occurs (onset, Duration, frequency, A B C D
severity, aggravating & relieving factors)
Pain behaviour- verbal & non verbal behaviours

5 including the presentation of symptoms, requests A B C D
for medication, responses to pain,
Beliefs about the causes of pain and its
implications
6 Role of psychological factors in maintenance and A B C D

exacerbation
Significant distress or impairment of social,

7 occupational and family functioning A B C D
Consequences of pain- secondary insomnia,
inactivity etc
Appropriate examination and thorough

8 investigation of, possible physical causes. A B C D
Rule out co-morbidity- depressive disorder or

9 other psychiatric disorder A B C D


!"#$%"&'%()*!&
A B C D
PSYCHOSIS- EXPLANATION
Mr. Peter Hill is a 19-year-old university student, who is currently an in-
patient on your ward and was admitted few days ago with bizarre behaviour,
persecutory delusions and auditory hallucinations. He is recovering from his
first episode of psychosis and is being treated with Olanzapine. His mother
is angry to know from the nurses that he has been diagnosed with
schizophrenia. Ms. Linda Hill wants to discuss with you about Peter’s illness
and Prognosis of his condition
Areas Communication- fluency of interview,

of Avoid Jargons/false information, False A B C D
Conce reassurance
rn1
to interviewee
Professionalism, Body language and establish

3 rapport A B C D
Calming down angry relative without getting
aggressive
Explain diagnosis and nature of the illness

4 A B C D
Causal explanation and alleviate guilt
5 (Multifactorial-family history, Chemical A B C D
imbalance,
Stress,? Sparked off by illicit drugs etc)
Address concerns-
6 1. Violent behaviour A B C D
2. Other children to be affected.
3. Worries about son getting back to normal
life
7 Medication-Olanzapine- Discuss Efficacy and A B C D

side effects
Duration of treatment
8 Explain prognosis A B C D
Support –MDT, CMHT, CPN etc
Sources of information-Information leaflets and
website

10 appropriateness of information delivered and or A B C D
management
EFG%HF$IHJKLE$ A
B C D
%++,++)*!&-%.%-)(/&
Miss. Franklin was admitted to the medical ward following acute GI

bleeding and your medical colleagues wanted to investigate it and treat him
further. The medics called you because he is refusing IV fluids, medications,
sedatives and upper GI endoscopy. He is known to have past psychiatric
history and is on depot injection. The medics wanted him to be assessed by
the psychiatrist to determine whether the patient has the mental capacity to
refuse treatment.


Conce interview
rn1
to interviewee,
Body language
Professionalism including but not limited to

3 harmful interaction; failure to respect individual’s A B C D
Mental state examination: Look for delusional

4 ideas, paranoid beliefs, other Psychotic/Mood A B C D
symptoms/any evidence of Impairment of
disability of mind or brain
Ability to Understand information relevant to the

5 decision-nature and Purpose of treatment A B C D
Ability to retain information for a sufficient length

6 of time to make decisions A B C D
Use or weigh the information as part of the

7 decision making process (Benefits and risks of A B C D
the various treatment options, alternatives and
identify the choices available to the patient)
Consequences of accepting or refusing proposed

8 treatments, A B C D
Communicate the decision and maintain choices
Inform patient that the best Possible decision not

9 made A B C D
Range and depth of Psychopathology explored,

Prioritisation appropriateness of information

EFG%HF$IHJKLE$
A B C D
ANTIDEMENTIA DRUGS
!"#$%&'($A+*68$7&,$3*&452,13$7*68$B(C81*+1"D,$3*,1&,1$&53$&(($31+156*&$
,:"115*54$*5<1,6*4&6*25,$8&<1$527$>115$:2+;(1613#$=*,$!!AE$,:2"1$7&,$
FGHI.#$?2'$&"1$,11*54$8*+$*5$681$+1+2"0$:(*5*:$&53$02'$8&<1$31:*313$62$
,6&"6$8*+$25$J*<&,6*4+*51$KEL1(25M#$=*,$>"2681"$!"#$N250$A+*68O$782$*,$&$
PI$01&"$2(3$,:822($61&:81"O$7&56,$62$3*,:',,$+2"1$&>2'6$681$3"'4#$$$
Talk to him about effects and side- effects of this drug. Address his concerns

Areas Fluency and style of interview, Body language,

of Establishing rapport, Professionalism A B C D
Conce
rn1
to interviewee,
Communication- (Simple terms, avoiding medical

3 jargons, A B C D
Not providing false information, Avoid false
reassurance)
Explain the rationale for starting this drug

4 Mechanisms of action A B C D
Duration and efficacy of treatment (40- 50%)

5 A B C D
Describe side effects (GI upsets, nausea, vomiting,
6 headache, dizziness etc) A B C D
Monitoring and follow-up (memory clinic,

7 MMSE, CPN support) A B C D
Concerns- ? Hepatic impairment- no evidence,

8 titrate slowly A B C D
? Expensive
? Addictive potential
Sources of information-
9 Leaflets, web sites A B C D
Appropriateness of information provided,

!"#$%"&'%()*!&
A B C D
)%E1&"#&-F!'/&#&,*")0'(+.,!&%%",4'
Mr. Williams is a 73-year-old gentleman who was assessed in the memory

clinic and has been diagnosed with Alzheimer’s dementia following
dementia screening blood tests and CT scan. Explain the diagnosis to his
partner and address his concerns. He would like to know more about the
condition.


Conce communication, Avoiding Jargons.
rn1
to interviewee

3 rapport A B C D
Breaking the diagnosis and the rationale behind it
4 (diagnosis of exclusion- mainly clinical, A B C D
confirmation- post mortem)
5 Etiology and course of the condition A B C D
Addressing concerns:
6 a. Future A B C D
b. Care home
Driving- advise to stop, mild stages- can still drive

7 inform DVLA, Insurance company A B C D
specialist assessment
Range and depth of Information offered

8 Analysis of problems A B C D
Significant omissions,
9 Lack of clear structure, A B C D

10 appropriateness of information delivered and or A B C D
management
!"#$%"&'%()*!& A B C D
ALZHEIMER’S DEMENTIA COLLATERAL HISTORY
Obtain Collateral history from Mr. White whose 81-year-old wife was
referred to you by her GP as she has problems with her memory for the last
2 years.
• Obtain history to identify her cognitive difficulties
• Also look for evidence of functional impairment.


Conce communication
rn1
to interviewee

3 rapport A B C D
Cognitive Sx: Memory & confusion- Short term
4 and long term memory impairment with examples A B C D
Presenting problems: Onset, duration, severity and
progression
5 Cognitive Sx- Orientation to time, place, person, A B C D
attention & concentration, Visuospatial
dysfunction
6 Cognitive Sx; Language/communication A B C D

difficulties, Recognition, naming difficulties,
Reading, writing etc
Functional abilities- Personal ADLs

7 Domestic ADLs & Community ADLs A B C D
Range and depth of history explored

Depth of enquiry into symptoms

9 Analysis of problems, A B C D

!"#$%"&'%()*!& A B C D
COGNITIVE EXAMINATION
Perform cognitive examination on Mr. Smith a confused elderly gentleman,

who was found wandering in the streets and brought to the A&E department
by the police.
Areas Communication, Questioning style,

of Clear instructions, simple language and fluency of A B C D
Conce task
rn1
to interviewee

3 rapport A B C D
Orientation to time (Year, season, month, date

4 &day), Orientation to place (Country, county, A B C D
town, building, floor), Orientation to person
(name, age etc)
Registration (three-item test)
5 Retention and recall A B C D
Attention and calculation ( 93,86, 79, 72, 65)

6 Or WORLD backwards(D-L-R-O-W), A B C D
Months of the year backwards
Language & Comprehension:

7 Naming, repeating and 3 Stage command A B C D
Reading, writing
8 Visuo-spatial: copying / draw a clock face A B C D

9 Working memory- Digit span A B C D
Semantic memory

Range and depth of examination,

!"#$%"&'%()*!&
A B C D
Additional comments;
%&)-,",4'/"!)5"%"*20'(1)%%&,4",4'5&1)6"+.-0'1"!*+-2'
*)3",4'
You are in the learning disability outpatient clinic. Mr. Daniel Benjamin,
who is the manager of the Seven seas care home, attends your clinic with
Ms. Pauline Baker who suffers from severe Learning disability and has poor
communication skills.Mr. Benjamin mentioned that the care staffs at home
are finding it increasing difficult to cope with his challenging behaviour.
Elicit more history, to identify possible cause of challenging behaviour and
explain it to him briefly


Conce interview
rn1
to interviewee,
3 rapport A B C D
Brief history of symptoms & exploration of

4 presenting complaints-Mode of onset, duration, A B C D
frequency, severity, possible triggers.
Exclusion of psychiatric disorder

5 (Sx of Depression, psychosis) A B C D
Exclusion of physical disorder and drug-induced

6 (Infection, pain, constipation, medication induced A B C D
etc)
Assmt of physical Impairment (vision, hearing,

7 mobility) A B C D
Communication difficulties/Cognitive impairment
Identification of environmental and social factors

8 (Changes in carers/homes, history of major loss A B C D
etc)
Explain reasons to carer (Multifactorial-change in

9 carers, A B C D
Chest infection, Medication-induced,
Communication Difficulties etc)
Lack of clear structure, Appropriateness of

10 information delivered, Lack of appropriate focus A B C D
on the task
!"#$%"&'%()*!& A B C D
*&#$+-)%'%+5&'&$"%&$!20'1"!*+-2'*)3",4'
Mr. Martin Brown is a 30-year-old gentleman with borderline IQ and has

reasonably good communication skills. You have been asked to assess him
at A&E department because he has been ‘behaving strangely whilst out
drinking with his girl friend. His girl friend Rosy has mentioned to him that
he has had a few ‘weird turns’ in the last couple of months.
He also takes Dothiepin 150 mg. Take appropriate history to arrive at a
diagnosis


Conce interview
rn1
to interviewee
Professionalism, body language, Establishing

3 rapport A B C D
Description of episodes (Nature, type, frequency,
4 duration) A B C D
h/o absence seizures
Pre-epileptic phase- History of Aura,

5 Absences (stare blankly and become unresponsive A B C D
to commands)
Automatisms (lip smacking, chewing, swallowing
6 movements, facial grimacing, hand gestures etc) A B C D
Abnormal experiences (Illusions, hallucinations,
De’javu experiences, depersonalisation, Others)
Ictal phase: Secondary generalization and loss of

7 consciousness, A B C D
Generalised tonic-clonic activity
Post ictal phase (confused, sleepy, headache,
8 amnesia, incontinence etc) A B C D
Past history (incl febrile seizures), head injury etc

9 Medical conditions, Medications, recreational A B C D
drugs, alcohol etc
Family history of seizures
Risk assessment- Driving, operating dangerous
10 machinery A B C D
Lack of clear structure, Lack of appropriate focus

11 on the task A B C D
Depth of Enquiry into symptoms
!"#$%"&'%()*!&
A B C D
/&$-&!!"+,'",'%&)-,",4'/"!)5%&/0)!!&!!#&,*'
Mr. Alan Smith is a 25-year-old gentleman with mild degree of mental
retardation, who was referred to your clinic by his CPN as he was concerned
about his deteriorating mood.
Elicit features of depression and perform risk assessment for Suicidality.

Areas Communication, use of simple language,

of Questioning style- use of appropriate mix of open A B C D
Conce & closed qns, fluency of interview
rn1
to interviewee,

rapport
Brief history & Exploration of Presenting

4 Problems- A B C D
mode of onset, duration and severity
Core features of depression

5 (Low mood, anhedonia, Low energy levels) A B C D
Biological features of depression

6 (Sleep, appetite, weight) A B C D
Emotional and behavioural features of depression

7 (Social withdrawal, irritability, lack of motivation, A B C D
low self confidence and self-esteem,
Worthlessness, helplessness and guilt feelings)
Risk: Suicidal thoughts and plans, self-neglect,

8 Agitation/aggression A B C D


!"#$%"&'%()*!&
A B C D
LEARNING DISABILITY- ANXIOUS RELATIVES
You are seeing Mr. Robert Lawrence, a 26-year-old gentleman with mild
learning disability in your clinic. He lives with his girl friend in a residential
home who also has mild learning disability. She is now 6 months pregnant.
They expect the baby will be taken away after birth by social services. Elicit
his concerns. His mother Mrs. Dorothy Lawrence has accompanied him to
the clinic today. Elicit her fears and allay her anxiety

Areas Listening and responding appropriately to

of interviewee/ discussant, Establishing Rapport and A B C D
Conce body language
rn1
Management of interview/ examination including
2 empathic responses A B C D
Lack of appropriate focus on the required task

3 A B C D
4 Fluency of interview/examination/discussion A B C D
5 Professionalism including but not limited to A B C D

harmful interaction; failure to respect individual’s
6 Address concerns by the son A B C D
7 Elicit mother’s fears and allay her concerns A B C D
8 Analysis of problems and synthesis of opinions A B C D
9 Range and depth of enquiry into concerns A B C D

10 Prioritisation, recognition of importance and A B C D

appropriateness
!"#$%"&'%()*!&
A B C D
*12-+"/'&C)#",)*"+,0$12!"()%'&C)#",)*"+,'
Mr. Ronald suffers from bipolar affective disorder and is currently on
lithium carbonate 1000 mg. Over the last six months he has been feeling
increasingly tired and lethargic. His blood tests reveal low T3, T4 and raised
TSH Levels. Elicit possible symptoms and signs of thyroid dysfunction.
Perform appropriate clinical examination. Do not take history of bipolar
disorder

Areas Communication, giving clear instructions,

of Questioning style- use of appropriate mix of open A B C D
Conce & closed qns,
rn1
to interviewee,
Professionalism, establishing rapport
3 Ensuring privacy, body language A B C D
To check for symptoms of hypothyroidism

4 (At least 3 of them) A B C D
General Examination
5 Hands, Nails, Pulse rate and tremors A B C D
Examination of Eyes (Lid Lag. Lid Retraction,
Exophthalmos)
Inspection- Swelling on swallowing

6 Scars, sinuses, engorged veins, pulsations A B C D
Palpation (Confirm inspection findings)

7 Feel for trachea, cervical lymph nodes A B C D
Carotid pulsations, Lahey’s method of
examination
Percussion and auscultation

8 Thyroid bruit and carotid bruit A B C D
Reflexes for ankle jerk and

9 Pretibial myxoedema A B C D

10 Range and depth of tasks performed, A B C D
!"#$%"&'%()*!&
A B C D
$12!"()%'&C)#",)*"+,0'(&-&5&%%)-'!"4,!'G''D)(")%',&-6&'
&C)#",)*"+,'
Mr. John Murphy is a 43-year-old divorced gentleman with a history of

severe alcohol dependence. He has not been drinking for 2 months but feels
a little unsteady in walking and clumsy when using his hands. He also has
history of facial nerve palsy in the past. A recently performed CT brain scan
showed evidence of cerebellar atrophy.
a. Perform physical examination looking for features of cerebellar

dysfunction.
b. Also examine him for features of facial nerve palsy (7th cranial nerve)


of Questioning style, establishing rapport A B C D
Conce
rn1
to interviewee,
Obtaining informed consent
Professionalism and gentle handling

3 Ensuring privacy, body language A B C D
Facial nerve Examination

4 (Sensory and motor components) A B C D
Cerebellar signs
5 Eye signs (nystagmus) and Hands (intention A B C D
tremors)
Cerebellar signs
6 (Alternating movements-Dysdiadochokinesia A B C D
And dysarthria-staccato speech)
Co-ordination: Finger-Nose test,
7 Heel-shin test A B C D
Gait-examination (Ataxic gait-with eyes open and

8 closed) A B C D
Motor examination (Tone, Power and reflexes)
9 A B C D
Range and depth of tasks performed,

!"#$%"&'%()*!&
A B C D
PHYSICAL EXAMINATION- CARDIOVASCULAR EXAMINATION
Mr. Brown is a 57-year old gentleman admitted to the psychiatric ward with
history of cognitive difficulties. He is a known type 2 diabetic for five years
and has had a number of falls recently. Perform cardio vascular examination
looking in particular for signs of vascular dementia Explain to the examiners
what you are looking for?


of Questioning style, establishing rapport A B C D
Conce
rn1
to interviewee, obtaining informed consent
3 Professionalism and gentle handling A B C D
General examination (Eyes, Xanthelesmas,

4 tongue, nails, A B C D
carotids, Raised JVP)
Cardiovascular examination- Pulse (Rate,

5 regularity, volume and character), Look for A B C D
features of atrial fibrillation
Blood pressure-to be mentioned,

6 Peripheral oedema, peripheral pulses
Inspection (Precordial examination, Apex beat,

7 Deformity, redness, scars and engorged veins) A B C D
Palpation- locate apex beat & mention its

8 character, A B C D
Feel for any thrills, Parasternal heave
Auscultation (mitral, tricuspid, aortic, pulmonary

9 areas) A B C D
Basal crepitations

Range and depth of tasks performed,

!"#$%"&'%()*!&
A B C D
NEUROLOGICAL EXAMINATION
Mr. Lawrence was admitted informally to the ward this morning with a
diagnosis of depression and somatisation disorder.He complains of
numbness and tingling sensations in his right upper limb for the last 4
weeks. Perform both sensory and motor examination in his upper limb and
rule out any neurological deficits. Do not take history.
$12!"()%'&C)#",)*"+,0!&,!+-2'),/'#+*+-'&C)#",)*"+,'


of Questioning style, Establishing rapport A B C D
Conce
rn1
to interviewee,

3 Professionalism, A B C D
General Examination
4 (Nails, hair, joint pathology, pulse) A B C D
Inspection and palpation

5 (Posture, deformity, wasting, scars, swelling A B C D
Temperature, Limb girth measurement)
Sensory examination
6 (Lateral column-Pain, Temperature) A B C D
Sensory examination
7 (Dorsal Column-Touch, Vibration, positional A B C D
sense)
Motor examination
8 (Tone and Power-flexors at elbow, wrist Flexors, A B C D
deltoid, biceps, triceps, Thumb extensors and
opposition)
Motor examination
9 (Reflexes-Biceps, Triceps and supinator) A B C D
Motor examination- (Tremors, Co-ordination

10 Finger-nose test) A B C D
Range and depth of tasks performed,, Significant

11 omissions A B C D
!"#$%"&'%()*!&
A B C D
C&/'./D+(.,!./"&()D+-#,'+"&/'./,
Miss. Sarah Cohen is a 23-year-old woman who presented to the A&E with
multiple lacerations in both her legs. The nurses think that she has a
personality disorder. Elicit history to arrive at a diagnosis and perform risk
assessment

A- Good pass B-Borderline pass C-Borderline fail D-
Fail

Concern- appropriate mix of open & closed qns, A B C D
1 Listening & responding appropriately
2 responses, Fluency of interview, A B C D

3 rapport A B C D
Affective instability & Chronic feelings of
5 emptiness A B C D
A pattern of unstable and intense Interpersonal
relationships
Impulsivity & recurrent suicidal Behaviour,

6 gestures or threats, (History of DSH), A B C D
Inappropriate intense anger
Frantic efforts to avoid Real or imagined
abandonment,
Identity disturbance; unstable Self-image or

7 sense of self, Lack of achievable goals, H/O A B C D
abuse
Transient stress related paranoid Ideation or
quasi-psychotic experiences
Risk assessment
8 (Suicidal thoughts, plans etc) A B C D
Depth of enquiry into symptoms,

9 Lack of structure, A B C D
!"#$%"&'%()*!&
A B C D
(+4,"*"6&'5&1)6"+.-)%'*1&-)$20/"!(.!!"+,''
You have assessed Mrs. Wood a 35-year-old lady in the outpatient clinic
who has a diagnosis of recurrent depressive disorder. She has a history of
partial response to two different antidepressant drugs. You would like her to
be referred to the psychology department for CBT and the patient wants to
know more about it. Explain to the patient how CBT works and address her
concerns

Areas of Communication- Avoiding false

Concern- reassurance A B C D
1 Avoid giving false information/ medical
jargons,

responding appropriately to interviewee,
Professionalism, body language
Explain the nature of therapy

4 (Psychological/talking, ‘here and now’ A B C D
principles)
(Behaviour-mood-cognition link)
Basic principles of therapy

5 (Cognitive/behavioural components, A B C D
negative automatic thoughts, thoughts diary,
graded task assignments)
Structure of therapy
6 (Number, duration, therapist-trained in CBT A B C D
and supervised etc)
Outcome and offer further information
7 (Use in depression, prevents relapse) A B C D
Addressing patients concerns

8 (Homework tasks, stopping meds, A B C D
Dealing with emergencies)
Fluency of interview , Significant

9 omissions, A B C D
Analysis of problems & synthesis of
opinion

A
!"#$%"&'%()*!& B C D
PSYCHOTIC DEPRESSION- ELICIT PSYCHOPATHOLOGY
Miss. Rosie Green is a 33-year-old lady who was detained under the mental
health act and admitted last night, as she thinks she is dead and tried to burn
her body on a fire. Examine the patient to establish what abnormal belief she
holds.

A-PASS B-BORDERLINE PASS C-BORDERLINE FAIL
D-FAIL
Areas of Communication,
Concern- Questioning style- use of appropriate mix of A B C D
1 open & closed qns
2 interviewee, A B C D
Picking up clues

3 responses, Fluency of interview A B C D
Professionalism, body language,

5 Range and depth of psychopathology explored A B C D
6 Eliciting Nihilistic delusions- exploration and A B C D

clarification, assess degree of conviction
7 Eliciting Delusions of guilt- explore, clarify A B C D

delusions, assess degree of conviction
8 Risk assessment A B C D
(Self-harm, self neglect, non compliance etc)
9 Depth of enquiry into symptoms, A B C D

significant omissions
!"#$%"&'%()*!&
A B C D
OUT-PATIENT REVIEW- MSE
You are seeing Miss. Lisa Stewart who has a long standing history of
paranoid schizophrenia in your out-patient clinic. Perform a Mental State
Examination and look for features of any residual psychotic symptoms.
A-PASS B-BORDERLINE PASS C-BORDERLINE FAIL

D-FAIL

Concern- open & closed qns, Listening & responding A B C D
1 appropriately to interviewee
2 Management of interview including empathic A B C D

responses

rapport
4 Range and depth of psychopathology explored A B C D
5 Eliciting delusions and hallucinations- explore A B C D

and clarify
6 Assess mood and thoughts A B C D
7 Risk assessment (Self-harm, self neglect, non A B C D

compliance, violence etc)
8 Lack of fluency in interview A B C D
9 Depth of enquiry into symptoms, significant A B C D

omissions
!"#$%"&'%()*!&
A B C D
(1"%/'$!2(1")*-20'(+,/.(*'/"!+-/&-01"!*+-2'*)3",4'
You have been asked to assess John, 12-year-old boy in the CAMHS clinic.
He was referred for outpatient evaluation by his GP, after being picked up
by police for running away from home.
Obtain history from his mother Ms. Kate to arrive at a diagnosis. Also obtain
relevant background information.


Conce communication
rn1
to interviewee

3 rapport A B C D
History of presenting problems, duration and
4 reasons for presentation- Explore mum’s concerns A B C D
in detail.
Physical aggression or threats of harm to people,

5 cruelty to people and animals, bullying and A B C D
intimidation of others, starting physical fights,
using weapons in fights.
Destruction of their own property or that of others,

6 vandalism A B C D
Theft or acts of deceit, shoplifting, setting fires to
cause damage
Frequent and serious violation of Age-appropriate

7 rules A B C D
(Like truanting or running away, lying, cheating
etc)
Risk factors; (Family history of antisocial

8 behaviour, A B C D
Parental criminality, domestic violence
Poor School achievement etc)
Rule out co-morbidity

9 (Depression, ADHD, substance misuse etc) A B C D


11 Depth of enquiry into symptoms, Significant A B C D
omissions
!"#$%"&'%()*!& A B C D
CHILDHOOD DISORDERS- AUTISTIC SPECTRUM DISORDER
Mrs. Young is a 32-year-old lady attending the CAMHS Clinic with her 6-
year-old son Paul. He was referred by the community paediatrician, because
he wanted a psychiatric opinion as his speech is delayed and he is reported
to be‘not normal’. Obtain developmental history from his mother looking for
features of autistic spectrum disorder and discuss your working diagnosis
briefly.


Conce communication
rn1
to interviewee

3 rapport A B C D
Developmental History
4 (Motor, language, cognitive and social skills) A B C D
Gross impairment in reciprocal social interaction
5 (Poor Eye contact, failure to develop peer A B C D
relationships, Reduced interest in shared
Enjoyment, lack of social reciprocity & empathy
etc)
Qualitative impairments in communication or play
6 (Delay or lack of spoken language, difficulty A B C D
In initiating or sustaining conversation, lack of
developmentally appropriate symbolic or social
play)
Restricted, repetitive and stereotyped interests or
7 activities A B C D
(Resistance to change, obsessive preoccupations
with routine, timetable, objects; stereotyped body
movements like hand flapping, Body rocking)
Rule out co morbidity
8 (Learning disability, seizures, ADHD etc) A B C D
Explaining the diagnosis & Need for Involvement

9 of multidisciplinary approach to complete A B C D
assessment
Lack of clear structure

Range and depth of history explored, Depth of

11 enquiry into symptoms, Significant omissions A B C D
!"#$%"&'%()*!&
A B C D
&C$%+-)*"+,'+D'$-+5%&#'5&1)6"+.-0'&,.-&(*"('(1"%/'
Laura is an eight-year-old girl referred to the outpatient clinic, by her GP

with worsening school performance and her mother is extremely concerned
about her. Speak to her mother Ms. Sarah Cohen to identify her presenting
problems and explore possible reasons behind it.


Conce communication
rn1
to interviewee
Professionalism, body language, Establishing

3 rapport A B C D
History of presenting complaints, Mode of onset,
4 Duration etc A B C D
Change in Behaviour at School

5 (Socially anxious, worsening school performance) A B C D
Change in Behaviour at home

6 (Not her usual self, Moodiness, social withdrawal A B C D
etc)
Enuresis-nature and frequency

7 Duration (diurnal, nocturnal or both) A B C D
Exploration of Possible causes

8 (Birth of a sibling, Sibling rivalry- Father A B C D
spending more time with elder brother etc)
Rule out physical/organic causes for presentation

9 A B C D
Range and depth of history explored, Range and

11 depth of enquiry into symptoms, Significant A B C D
omissions.
!"#$%"&'%()*!& A B C D
POST-CONCUSSION SYNDROME- HISTORY TAKING
Mrs. Sandra Luckett is a 42-year-old lady who is extremely concerned about

her brother’s mental state and requested for an outpatient appointment to
review him. She has requested you to see her first before you see Mr.
Luckett. Obtain collateral history from her to arrive at a diagnosis.


of appropriate mix of open & closed qns and fluency A B C D
Conce of interview
rn1
to interviewee

3 rapport A B C D
Establish history of head injury and details of the

4 incident- nature and extent of injury (closed or A B C D
open injury), severity (mild or severe),
? Impairment of consciousness
Psychological symptoms- Sx of anxiety, fear of

5 permanent brain damage, sleep disturbance, A B C D
depression, irritability, reduced tolerance to stress,
loss of self-esteem, Hypochondriacal symptoms
etc
Physical symptoms- Headache, dizziness, fatigue,

6 poor concentration, impairment of memory and A B C D
insomnia (duration and severity of symptoms)
Impact on current functioning (social,
7 occupational & family) A B C D
Vulnerability factors- past psychiatric history and
family history, Personality
? Compensation motives
8 Embark on a search for diagnosis and cure & A B C D
adoption of a permanent sick role
Lack of clear structure, Depth of enquiry into
9 symptoms, A B C D
Range and depth of history explored, Significant
10 omissions, Analysis of problems A B C D
!"#$%"&'%()*!& A B C D

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!"#$%&'()!

Name of the candidate:

Areas of Questioning style- use of appropriate mix

2 Management of interview including A B C D

3 Professionalism, Establishing rapport, body A B C D

Obtain details of the traumatic accident-

5 Hyper arousal Symptoms (Persistent A B C D

6 Intrusions (flashbacks, nightmares, A B C D

7 Avoidance of reminders of the events A B C D

8 Rule out co-morbidity, coping strategies A B C D

9 Range and depth of history explored, A B C D

10 Depth of enquiry into symptoms A B C D

11 Lack of appropriate focus on the task, Lack A B

ABNORMAL GRIEF REACTION-HISTORY TAKING

Name of the candidate:

Areas of Questioning style- use of appropriate mix of

Professionalism, Body language, Establishing

Assessment of current mood, biological,

Features of normal grief reaction

Features of normal grief reaction

Atypical grief reaction-features

Atypical grief reaction-features

Range and depth of history explored,

11 Significant Omissions, analysis of problems A B C D

Mr. Green is a 78-year-old gentleman admitted to the psychiatric unit 3 days

Areas Ice breaking non-medical comments

Management of interview including empathic

Listening & responding appropriately to

Communication- Use of simple jargon free

Professionalism- Show your own emotions whilst

Discuss about treatment options (Surgery,

Summarize and clarify Understanding,

Range and depth of information covered,

Prioritisation and appropriateness of information

Name of the candidate:

Areas Questioning style- use of appropriate mix of open

Professionalism, body language, establishing

Physical symptoms (Fatigueability, Constipation,

Persistent Preoccupation with eating, irresistible

7 Measures taken to lose weight - Avoidance of A B C D

8 Prognostic factors: Low self-esteem, personality A B C D

Range and depth of history explored,

a. Discuss the diagnosis and address his concerns.

Name of the candidate:

Areas Communication- Avoiding Jargons/false

Professionalism, body language, establishing

Preventive methods (GP, antenatal classes, health

Addressing other concerns

Prioritisation and appropriateness of information

Mr. Paul Andrew is a 40 YO gentleman who suffers from panic disorder. He

Name of the candidate:

Areas of Communication- using simple terms,

Professionalism, Body language,

Reassurance- Medically cleared and not

5 Explaining diagnosis-panic disorder, nature A B C D

Explaining hyperventilation Syndrome, the

Emphasise Importance of Relaxation

Range and depth of enquiry into symptoms,

Prioritisation and appropriateness of

Name of the candidate:

Areas of Communication- Appropriate mix of open

Professionalism, body language

Assess depressive Symptoms-