Psychosis (Schizophrenia) | Mental State Examination (MSE) | OSCE Guide | SCA Case | UKMLA | CPSA

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0:19hello I'm Jade I'm one of the doctors

0:21from the mental health team today would

0:23I be able to cheack your name and date

0:24of birth

0:26please Sarah Sarah Thomas thir to May 68

0:31okay great so I've just been asked to

0:33come and speak to you because I've been

0:35told that you've been having some

0:36worries about your safety at home is

0:38that

0:40right yes so how have you been feeling

0:45recently just really really stressed

0:50worried okay and what is it that's been

0:53worrying

0:55you I know they want to kill me I know

0:58they want to and I I've I've just I just

1:02can't be in that place I can't be there

1:07because they want to get me okay I don't

1:10know why but they want to kill me okay

1:12they're poisoning my food I know they

1:15are I know they are okay who's

1:19that the imposters that have taken over

1:23the workers that look after me all right

1:27and how do you know that these osters

1:30have taken over the

1:33workers because they're trying to poison

1:36me okay and how did you find that

1:47out sorry sorry oh that's okay um is

1:51there anything else that's been worrying

1:53you from that point of view I'm very

1:55worried because they do want to get me

1:58and I do believe they want to kill me

2:01okay and is there anything in particular

2:04that has made you feel this way because

2:07I know they're putting stuff in my food

2:10okay is there any reason that you think

2:12they might want to hurt

2:16you I don't

2:18know are there any other potential

2:20explanations that you've thought for

2:22what might be going

2:24on that is what's going on okay they're

2:27out to get me I don't know why I've done

2:30nothing but they're definitely out to

2:31get

2:32me that sounds really scary with I'm

2:35very scared yeah with all this going on

2:38have you felt low or depressed at

2:50all I I just want help okay no just

2:54worried worried and with everything

2:57that's been going on have you ever had

2:59any thoughts thoughts of wanting to harm

3:01yourself or not wanting to be

3:04here no no and have you ever had any

3:07thoughts of maybe wanting to harm anyone

3:10else those Impostors need stopping but I

3:12would never never harm them they do need

3:17stopping but I would never harm them I I

3:19would never do that to anyone anyone

3:21anything anyone but they do need

3:23stopping and if I try to try to get them

3:26try to harm them to make them stop I I

3:29think it would make it worse but I

3:31wouldn't do that anyway I would never

3:32harm anyone and do you ever feel like

3:36maybe some of your thoughts aren't your

3:38own so sometimes people might experience

3:42they might feel like somebody's putting

3:44thoughts in their head or taking

3:46thoughts away from

3:49them no nothing like that and sometimes

3:53people might say that they hear their

3:55thoughts being broadcast aloud and it

3:57feels like everyone in the room can hear

4:00their thoughts is that something that

4:02you've

4:06experienced

4:12yes the

4:14imposters were trying to poison me who I

4:17know want to kill me if they can hear my

4:19thoughts that I know that they're trying

4:21to do that then they will definitely

4:23definitely do it quicker they'll know

4:25that I'm on to them they'll do it

4:27quicker therefore I I need

4:31protecting if they hear it they will

4:33they'll put more poison in they'll kill

4:35me quicker they'll I need protection I

4:38need

4:50protection you seem a little bit

4:52distracted is is there anything going on

4:55at the minute that's worrying

4:58you

5:00so I I hear they are the them them

5:06talking okay who is it that you hear

5:08talking I I don't I don't know but they

5:11talk they

5:13talk what do they talk

5:16about

5:19um

5:21Sarah look at Sarah she's sitting on the

5:23chair Sarah's nasty she's evil she's not

5:27a nice person look at her just sitting

5:30there she's really nasty she's horrible

5:33she's not a nice person look at

5:36her sounds awful like they're saying

5:38some really nasty things I can imagine

5:41it must be really hard having to listen

5:42to that all the time do they say it

5:45about you or does it is it like they're

5:47speaking directly to

5:50you the the person the person that

5:53speaks talks talks about

5:56me I hear now

6:02and do you know who it is that no okay

6:06and is it just the one person or is it

6:08different just one person okay so you've

6:11mentioned about these kind of nasty

6:14voices that you've been hearing have you

6:16ever seen anything unusual that others

6:18might not have seen no no or maybe felt

6:23any strange Sensations on your skin that

6:25you couldn't explain no no and then

6:30sometimes people might feel as if the

6:32world around them isn't real is that

6:35something you've ever

6:36felt

6:38no or sometimes people might also say

6:41they feel as though the world around

6:43them is real but they themselves aren't

6:45real is that something you've ever

6:49experienced no no okay and I just need

6:53to check a few things so would you be

6:55able to tell me where we are right now

7:01so right now hospital hospital yeah

7:05that's right and do you know what day of

7:08the week it is and what roughly what

7:10time is yeah so it's it's about 8:00 um

7:15Monday Monday yeah great and then can

7:18you remember who I

7:20am you

7:23um I do are you you you the you're from

7:27the mental health team do doctor doctor

7:31yeah yes I I do I do and what do you

7:34think is the cause of the problems that

7:36you've been experiencing

7:39recently I don't know why they want to

7:41kill me I don't know why but they do

7:44I've I've done nothing I I I don't

7:48know okay and sometimes when people um

7:52come into hospital with problems like

7:54this it can be related to deterioration

7:57of their Mental Health is that something

8:00you've considered at all it isn't no

8:04okay

8:07and and what do you think we could do to

8:10help

8:11you I need the imposters taken

8:15away the police need to come around they

8:18need to take you need to give me a safe

8:20space I I I cannot go back there and I I

8:24need a safe space and they need to be

8:26caught and put in prison I need

8:28protection

8:30okay so would you be willing to come

8:32into hospital for us to try and help you

8:35if I I don't want to stay at home if

8:38that's a safe place I will do okay and I

8:43just wanted to check so if you were to

8:46go home how would you manage to eat and

8:49drink if you're worried about them

8:51poisoning you I have all prepacked food

8:54and drinks packet drinks in in you know

8:59all prepacked so I do eat I will not eat

9:03their

9:04food okay and what if there was no other

9:06food around well I know I know that they

9:10are putting poison in the food and the

9:14drink I know they are but I think I've

9:19got that covered but they have ways

9:22they'll probably get into my prepacked

9:24food they will have ways they will have

9:27ways so they need to be taken and I need

9:30protection they need locking up okay

9:33well thank you very much for telling me

9:35all that I know it must have been really

9:36hard to speak about what's been going on

9:39um I'd like to go and have a chat with

9:41the rest of my team if that's okay just

9:43to see what else we can do to help you

9:46and try and find a safe space for you to

9:49stay in hospital would that be okay with

9:51you please yeah you got any other

9:54questions at all just thank you okay

9:57thank you thanks very much for speaking

9:59speaking to me

10:00today today I assess Sarah a 54y old

10:04lady with a background of schizophrenia

10:06she presented to the emergency

10:08department with concerns of being

10:09poisoned by her support workers on

10:12examination she appeared distracted but

10:15was able to engage well in the

10:17assessment she was disheveled and

10:19visibly anxious Her speech was

10:21monotonous at times but there were n

10:23other the abnormalities of note in terms

10:26of her mood Sarah said she was stressed

10:28and worried

10:29objectively she appeared anxious she

10:32denied any thoughts of self harm or

10:34wanting to harm others Sarah described

10:37paranoid persecutory delusional beliefs

10:40that staff had been replaced with

10:41imposters and were attempting to poison

10:43her she had concerns about thought

10:46broadcasting but there were no other

10:47symptoms of thought

10:49interference Sarah reported auditory

10:52hallucinations and appeared to be

10:54responding to voices at various points

10:56throughout the interview she described a

10:58voice providing running commentary on

11:00her behavior and making derogatory

11:03comments about her she did not describe

11:05any of the abnormal perceptions Sarah

11:07was orientated to time place and person

11:10she appeared to lack insight into her

11:12symptoms being related to a

11:14deterioration in her mental health her

11:17limited oral intake due to her

11:19delusional beliefs may be impacting her

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