Anxiety | Mental State Examination (MSE) | OSCE Guide | SCA Case | UKMLA | CPSA | PLAB 2 — Transcript

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1. 0:03[Music]
2. 0:19hello my name is Jade I'm one of the
3. 0:21doctors can I just check your name and
4. 0:23date of birth please yeah and it's it's
5. 0:25Jan Jan Wilkinson and um
6. 0:28it's the 3rd of May 85. lovely thank you
7. 0:32and what brings you in today oh I've
8. 0:34just been really struggling with anxiety
9. 0:37okay what do you mean by that what do
10. 0:40you feel
11. 0:41[Music]
12. 0:42um
13. 0:43well it makes my heart race
14. 0:46um
15. 0:47and I can um
16. 0:49I can also feel quite sweaty okay and
17. 0:52it's just I feel like that when just
18. 0:56when I think really bad things that can
19. 0:58happen and get anxious yeah okay and how
20. 1:01long has this been going on for
21. 1:03a few months now
22. 1:06and is there anything in particular you
23. 1:08think might have triggered it
24. 1:10yeah
25. 1:11I know exactly what it was um
26. 1:14so uh
27. 1:16a few months ago um
28. 1:18Layla my partner she was um
29. 1:22so she was in a car accident gosh I know
30. 1:25I know
31. 1:27um I mean I I know at the time she you
32. 1:29know she wasn't badly hurt but
33. 1:32I just kept thinking about what could
34. 1:34happen and um
35. 1:36and just ever since then I I just
36. 1:39think everything bad it's going to
37. 1:42happen all the time yeah that sounds
38. 1:45really stressful is there anything in
39. 1:48particular that you worry about
40. 1:51yeah I am I I just really worry about my
41. 1:56family and and their safety
42. 1:59and are there any kind of situations
43. 2:01that cause you to be more worried
44. 2:04yeah I am
45. 2:07so whenever
46. 2:08um you know Layla goes out to drive I I
47. 2:12am convinced she's gonna have an
48. 2:13accident
49. 2:14you know I've um I just worry about my
50. 2:18children you know when they go to school
51. 2:20I just thinking things are going to
52. 2:22happen to them and yeah
53. 2:26and when you get these worries is there
54. 2:28anything that you can do to help
55. 2:30yourself calm down or get relief for
56. 2:33them
57. 2:34um
58. 2:35yeah I mean it if if I maybe
59. 2:38you know if I'm watching something on
60. 2:40the television and I don't like one of
61. 2:43the soaps or something
62. 2:45um
63. 2:46anything that can distract me
64. 2:49that that can sometimes help yeah a
65. 2:52little bit and have you ever had a panic
66. 2:55attack at all yeah I am I I did have
67. 3:00some panic attacks as a teenager
68. 3:03um
69. 3:04but I am I mean I I hadn't had any you
70. 3:08know for years
71. 3:10I I did have one however about a week
72. 3:13ago
73. 3:14um
74. 3:15oh I just got the school have been in
75. 3:18touch because I've been texting the kids
76. 3:20and then I just got into this state
77. 3:21about I don't know they were going to
78. 3:24get Social Services and take the kids
79. 3:26away and I no I just
80. 3:29I just couldn't catch my breath um
81. 3:37she was great she um
82. 3:40she managed to
83. 3:42okay you know calm me down but um sorry
84. 3:45I'm done I think I'm just going to be
85. 3:46crazy no no not at all it sounds like
86. 3:49you've had a lot on your plate recently
87. 3:50so I can understand why you know you're
88. 3:52feeling really stressed about these
89. 3:54things
90. 3:56what would you say how has it been
91. 3:58impacting your life full of these
92. 4:00anxieties
93. 4:02Majestic
94. 4:04I think it's really affecting my
95. 4:06relationships with my children okay
96. 4:09yeah how's it been doing that God is all
97. 4:13this constant checking how they are
98. 4:15where they are they
99. 4:18I think they just find it embarrassing
100. 4:20and okay
101. 4:21I I mean Layla's lovely but I I think
102. 4:25even she now is just thinking it's just
103. 4:27all getting a bit out of hand okay
104. 4:30and with everything that's been going on
105. 4:32have you still been able to look after
106. 4:34yourself
107. 4:36oh yeah you know I I I'm eating drinking
108. 4:40um
109. 4:42yeah but
110. 4:44it's just all consuming it's time yes
111. 4:46have you been sleeping oh crikey no
112. 4:51I just can't sleep you know just
113. 4:54worrying about worse things that can
114. 4:56happen those are pretty exhausting
115. 5:02with all of this going on recently how's
116. 5:04your mood been
117. 5:06um
118. 5:08yeah I I have felt a little bit low
119. 5:12but that's just because I'm just getting
120. 5:13fed up of okay just constantly worrying
121. 5:18yeah
122. 5:19and do you still able to enjoy the
123. 5:22things that you normally would
124. 5:24[Music]
125. 5:29probably because
126. 5:30I just find these worries are all
127. 5:33consuming so no
128. 5:38things ever felt so bad that you've
129. 5:40thought of harming yourself
130. 5:42oh absolutely no I would never do that I
131. 5:45mean goodness no you know I would never
132. 5:48put Layla through that or my children no
133. 5:52no I no I wouldn't no definitely not no
134. 5:54and have you ever had any thoughts of
135. 5:57wanting to harm others oh absolutely not
136. 6:00no no not at all no no no no
137. 6:04okay okay sometimes when people are
138. 6:07dealing with things like this they might
139. 6:09turn to drugs or alcohol to help them
140. 6:11cope is that something no no no I don't
141. 6:14know I don't really like drink or
142. 6:16anything like that no no okay so just a
143. 6:18couple more questions about some things
144. 6:20that you may or may not have experienced
145. 6:23and do you ever get intrusive thoughts
146. 6:26of like unpleasant things that you're
147. 6:29not able to get out of your head
148. 6:33um
149. 6:34not really but but I have to say you
150. 6:38know
151. 6:39um
152. 6:40if I see a car on the street on the
153. 6:44television I can't stop thinking
154. 6:49kids are going to get knocked over we're
155. 6:51going to be in an accident Layla's going
156. 6:53to be in another accident I find it
157. 6:55Sparks off me thinking that okay so it
158. 6:58triggers some of your anxieties and yeah
159. 7:01that it wouldn't necessarily just kind
160. 7:03of pop into your mind out of no no no no
161. 7:06no no
162. 7:07and are there ever any kind of routines
163. 7:10or rituals that you feel you need to do
164. 7:13to help you manage these worries
165. 7:17um no no no no no no
166. 7:20to prevent kind of bad things from
167. 7:22happening
168. 7:24no no I I do worry about bad things
169. 7:27happening there
170. 7:29and do you ever have any worries that
171. 7:32someone's um trying to hurt you or out
172. 7:35to get you no no no no no not at all no
173. 7:39okay and do you ever feel like someone
174. 7:43can or something might be able to hear
175. 7:47your thoughts or interfere with them at
176. 7:49all no no okay and have you ever been
177. 7:53worried that someone might be able to
178. 7:54control your thoughts or your actions no
179. 7:58no okay do you ever see or hear things
180. 8:02that other people can't
181. 8:04no oh
182. 8:07what do your family and friends think
183. 8:09about everything that's been going on
184. 8:10God yeah I mean
185. 8:13my children they're just embarrassed you
186. 8:16know I have this constant texting of
187. 8:18mine checking they're all right and
188. 8:21I mean you know Layla's she's lovely and
189. 8:24supportive but
190. 8:26I just think it is beginning to weigh
191. 8:29her down you know I'm constantly
192. 8:31asking her for reassurance that
193. 8:34everything's gonna be all right yeah
194. 8:37do you think these worries that you've
195. 8:39been having are reasonable
196. 8:43no I am
197. 8:46I I do know that
198. 8:48they are getting out of hand yeah
199. 8:51okay
200. 8:51and is there anything in particular you
201. 8:54were hoping would be able to do to help
202. 8:57you
203. 8:58um
204. 8:59I was hoping
205. 9:00um just hoping I don't know maybe maybe
206. 9:03some counseling or someone I can just
207. 9:06talk to just to
208. 9:09to make me feel normal again really
209. 9:13well thank you so much for telling me
210. 9:15all of that I think it'd be best if I
211. 9:18speak to my team about what we can do to
212. 9:20help you and I can give you a call a bit
213. 9:22later on if that would be okay yeah
214. 9:25thank you have you got any other
215. 9:27questions for now no thanks for your
216. 9:31help though okay thank you very much
217. 9:34today I assessed Jan a 38 year old lady
218. 9:37presenting with generalized anxiety
219. 9:39which is affecting her relationships she
220. 9:42has a history of panic attacks and
221. 9:45describes multiple social stresses on
222. 9:47examination Jan appeared anxious and
223. 9:50Restless she demonstrated good eye
224. 9:52contact and it was easy to build a
225. 9:54report there were no abnormalities of
226. 9:56speech she reported feeling generally on
227. 9:59edge with difficulty relaxing at times
228. 10:01her mood has been a little low Jan
229. 10:04reports ruminating anxious Thoughts with
230. 10:07evidence of catastrophizing
231. 10:09there was no formal thought disorder
232. 10:11thought interference or perceptual
233. 10:13abnormalities Jan demonstrated good
234. 10:16insight and judgment into her Mental
235. 10:18Health
236. 10:19in terms of risk Jen strongly denied any
237. 10:22thoughts or plans to harm herself or
238. 10:24others citing her family is a strong
239. 10:26protective Factor
240. 10:28she was future orientated and was
241. 10:30motivated to engage with professionals
242. 10:32to improve her Mental Health
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253. 11:04thank you
254. 11:07[Music]