Psychiatry Station 1

Setting:

You are a junior doctor working for liaison psychiatry. You have been asked to see a patient on the general medical ward who presented after a paracetamol overdose. They are stable and are being medically treated by the ward team. You have been asked for a psych review.

Name: Charlie Simpson

Tasks:

1. Take a history of the overdose from the patient.

2. Risk assess the patient.

3. Explain the patients risk to the examiner.

4. Explain your management plan to the examiner.

You are not required to examine the patient.

Briefing

Diagnosis / Risk Level: High Risk
In this scenario we are asking you to role play a patient attending the emergency department following a medication overdose on a background of depression. The candidate will carry out a risk assessment, feedback their diagnosis to the examiner and then explain their management plan to the examiner.

For this scenario, your details are;
Patient Name: Charlie Simpson (age: 23)

Appearance and Behaviour

Avoid eye contact and talk quietly. Use closed off body language.

Opening statement

“I just took some pills. I just want to go home now, the other doctor said I was medically fit.”

Information to Give Freely

You’ve had a lot of time to think about it in lockdown and don’t see the point in going on any more.

Presenting Complaint - Overdose

How many did you take? - 30
What strength? - 500 mg
All at once or staggered? - All at once
When did you take it/when was the last? - about an hour ago
Did you take anything else with the medications - No

Risk Assessment - Risk to Self

Is there anything that triggered it? - You lost your job about 6 months ago and you’ve been feeling down since then.
Was there anything stopping you up until now - No
Planning

Was this planned in advance - Yes, you started planning it a week ago

How did you plan it - went to different shops to get the pills, made sure your housemate wouldn’t be home

Did you make any preparations for your death - Yes, wrote a note

Location and Lethality

Where did you take the pills? - Home

Is there anybody else at home - Housemate, but he’s away for the month

Why did you choose paracetamol? - Because it’s easy to get and you’ve read it’s deadly

Did you take them with the intention of ending your life - Yes

Afterwards

How do you feel about it now/Do you regret it? - You don’t regret it

If I were to let you go today would you try it again? - Yes

How would you try it? - There’s a tall building with roof access I’ve thought of jumping from

Do you have means to get there? - Yes, I can walk there

Narcotics/intoxication

Were you intoxicated when you planned any of this - No

Were you intoxicated when you took the medications - No

Risk Assessment - Risk to Others

Are you a carer? - No
Any pet at home? - You have some fish
Do you ever hear voices that others can’t hear? - No
Have you ever been involved with the police? - No

Risk Assessment - Risk to Property

Have you ever damaged any property? - No
No other positive symptoms in history.

Past Medical History

Previous attempts - None
History of self harm - No, but you thought about it
Other medical conditions - None
Previous involvement with mental health services - No

Drug History

Medications - None
Allergies - None

Family History

Nil significant

Social History

Smoking - No (and hasn’t previously)
Alcohol - Drinks a couple of pints of lager on weekends
Job - Unemployed
Housing - Lives in flat-share with a friend
Childhood - Nil significant, good relationships with family.

Ideas / Concerns / Expectation

Ideas - You don’t think this is a big issue
Concerns - You’ll get put into hospital with all the ‘crazy’ people
Expectations - They’ll let you go

Discussion

The candidate will then discuss their findings and management plan with the examiner. If they attempt to discuss this with you or inform you of their plans, you should be receptive to the suggestions made.