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

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1. 0:03[Music]
2. 0:19hello I'm Jade I'm one of the doctors
3. 0:21from the mental health team today would
4. 0:23I be able to cheack your name and date
5. 0:24of birth
6. 0:26please Sarah Sarah Thomas thir to May 68
7. 0:31okay great so I've just been asked to
8. 0:33come and speak to you because I've been
9. 0:35told that you've been having some
10. 0:36worries about your safety at home is
11. 0:38that
12. 0:40right yes so how have you been feeling
13. 0:45recently just really really stressed
14. 0:50worried okay and what is it that's been
15. 0:53worrying
16. 0:55you I know they want to kill me I know
17. 0:58they want to and I I've I've just I just
18. 1:02can't be in that place I can't be there
19. 1:07because they want to get me okay I don't
20. 1:10know why but they want to kill me okay
21. 1:12they're poisoning my food I know they
22. 1:15are I know they are okay who's
23. 1:19that the imposters that have taken over
24. 1:23the workers that look after me all right
25. 1:27and how do you know that these osters
26. 1:30have taken over the
27. 1:33workers because they're trying to poison
28. 1:36me okay and how did you find that
29. 1:47out sorry sorry oh that's okay um is
30. 1:51there anything else that's been worrying
31. 1:53you from that point of view I'm very
32. 1:55worried because they do want to get me
33. 1:58and I do believe they want to kill me
34. 2:01okay and is there anything in particular
35. 2:04that has made you feel this way because
36. 2:07I know they're putting stuff in my food
37. 2:10okay is there any reason that you think
38. 2:12they might want to hurt
39. 2:16you I don't
40. 2:18know are there any other potential
41. 2:20explanations that you've thought for
42. 2:22what might be going
43. 2:24on that is what's going on okay they're
44. 2:27out to get me I don't know why I've done
45. 2:30nothing but they're definitely out to
46. 2:31get
47. 2:32me that sounds really scary with I'm
48. 2:35very scared yeah with all this going on
49. 2:38have you felt low or depressed at
50. 2:50all I I just want help okay no just
51. 2:54worried worried and with everything
52. 2:57that's been going on have you ever had
53. 2:59any thoughts thoughts of wanting to harm
54. 3:01yourself or not wanting to be
55. 3:04here no no and have you ever had any
56. 3:07thoughts of maybe wanting to harm anyone
57. 3:10else those Impostors need stopping but I
58. 3:12would never never harm them they do need
59. 3:17stopping but I would never harm them I I
60. 3:19would never do that to anyone anyone
61. 3:21anything anyone but they do need
62. 3:23stopping and if I try to try to get them
63. 3:26try to harm them to make them stop I I
64. 3:29think it would make it worse but I
65. 3:31wouldn't do that anyway I would never
66. 3:32harm anyone and do you ever feel like
67. 3:36maybe some of your thoughts aren't your
68. 3:38own so sometimes people might experience
69. 3:42they might feel like somebody's putting
70. 3:44thoughts in their head or taking
71. 3:46thoughts away from
72. 3:49them no nothing like that and sometimes
73. 3:53people might say that they hear their
74. 3:55thoughts being broadcast aloud and it
75. 3:57feels like everyone in the room can hear
76. 4:00their thoughts is that something that
77. 4:02you've
78. 4:06experienced
79. 4:12yes the
80. 4:14imposters were trying to poison me who I
81. 4:17know want to kill me if they can hear my
82. 4:19thoughts that I know that they're trying
83. 4:21to do that then they will definitely
84. 4:23definitely do it quicker they'll know
85. 4:25that I'm on to them they'll do it
86. 4:27quicker therefore I I need
87. 4:31protecting if they hear it they will
88. 4:33they'll put more poison in they'll kill
89. 4:35me quicker they'll I need protection I
90. 4:38need
91. 4:50protection you seem a little bit
92. 4:52distracted is is there anything going on
93. 4:55at the minute that's worrying
94. 4:58you
95. 5:00so I I hear they are the them them
96. 5:06talking okay who is it that you hear
97. 5:08talking I I don't I don't know but they
98. 5:11talk they
99. 5:13talk what do they talk
100. 5:16about
101. 5:19um
102. 5:21Sarah look at Sarah she's sitting on the
103. 5:23chair Sarah's nasty she's evil she's not
104. 5:27a nice person look at her just sitting
105. 5:30there she's really nasty she's horrible
106. 5:33she's not a nice person look at
107. 5:36her sounds awful like they're saying
108. 5:38some really nasty things I can imagine
109. 5:41it must be really hard having to listen
110. 5:42to that all the time do they say it
111. 5:45about you or does it is it like they're
112. 5:47speaking directly to
113. 5:50you the the person the person that
114. 5:53speaks talks talks about
115. 5:56me I hear now
116. 6:02and do you know who it is that no okay
117. 6:06and is it just the one person or is it
118. 6:08different just one person okay so you've
119. 6:11mentioned about these kind of nasty
120. 6:14voices that you've been hearing have you
121. 6:16ever seen anything unusual that others
122. 6:18might not have seen no no or maybe felt
123. 6:23any strange Sensations on your skin that
124. 6:25you couldn't explain no no and then
125. 6:30sometimes people might feel as if the
126. 6:32world around them isn't real is that
127. 6:35something you've ever
128. 6:36felt
129. 6:38no or sometimes people might also say
130. 6:41they feel as though the world around
131. 6:43them is real but they themselves aren't
132. 6:45real is that something you've ever
133. 6:49experienced no no okay and I just need
134. 6:53to check a few things so would you be
135. 6:55able to tell me where we are right now
136. 7:01so right now hospital hospital yeah
137. 7:05that's right and do you know what day of
138. 7:08the week it is and what roughly what
139. 7:10time is yeah so it's it's about 8:00 um
140. 7:15Monday Monday yeah great and then can
141. 7:18you remember who I
142. 7:20am you
143. 7:23um I do are you you you the you're from
144. 7:27the mental health team do doctor doctor
145. 7:31yeah yes I I do I do and what do you
146. 7:34think is the cause of the problems that
147. 7:36you've been experiencing
148. 7:39recently I don't know why they want to
149. 7:41kill me I don't know why but they do
150. 7:44I've I've done nothing I I I don't
151. 7:48know okay and sometimes when people um
152. 7:52come into hospital with problems like
153. 7:54this it can be related to deterioration
154. 7:57of their Mental Health is that something
155. 8:00you've considered at all it isn't no
156. 8:04okay
157. 8:07and and what do you think we could do to
158. 8:10help
159. 8:11you I need the imposters taken
160. 8:15away the police need to come around they
161. 8:18need to take you need to give me a safe
162. 8:20space I I I cannot go back there and I I
163. 8:24need a safe space and they need to be
164. 8:26caught and put in prison I need
165. 8:28protection
166. 8:30okay so would you be willing to come
167. 8:32into hospital for us to try and help you
168. 8:35if I I don't want to stay at home if
169. 8:38that's a safe place I will do okay and I
170. 8:43just wanted to check so if you were to
171. 8:46go home how would you manage to eat and
172. 8:49drink if you're worried about them
173. 8:51poisoning you I have all prepacked food
174. 8:54and drinks packet drinks in in you know
175. 8:59all prepacked so I do eat I will not eat
176. 9:03their
177. 9:04food okay and what if there was no other
178. 9:06food around well I know I know that they
179. 9:10are putting poison in the food and the
180. 9:14drink I know they are but I think I've
181. 9:19got that covered but they have ways
182. 9:22they'll probably get into my prepacked
183. 9:24food they will have ways they will have
184. 9:27ways so they need to be taken and I need
185. 9:30protection they need locking up okay
186. 9:33well thank you very much for telling me
187. 9:35all that I know it must have been really
188. 9:36hard to speak about what's been going on
189. 9:39um I'd like to go and have a chat with
190. 9:41the rest of my team if that's okay just
191. 9:43to see what else we can do to help you
192. 9:46and try and find a safe space for you to
193. 9:49stay in hospital would that be okay with
194. 9:51you please yeah you got any other
195. 9:54questions at all just thank you okay
196. 9:57thank you thanks very much for speaking
197. 9:59speaking to me
198. 10:00today today I assess Sarah a 54y old
199. 10:04lady with a background of schizophrenia
200. 10:06she presented to the emergency
201. 10:08department with concerns of being
202. 10:09poisoned by her support workers on
203. 10:12examination she appeared distracted but
204. 10:15was able to engage well in the
205. 10:17assessment she was disheveled and
206. 10:19visibly anxious Her speech was
207. 10:21monotonous at times but there were n
208. 10:23other the abnormalities of note in terms
209. 10:26of her mood Sarah said she was stressed
210. 10:28and worried
211. 10:29objectively she appeared anxious she
212. 10:32denied any thoughts of self harm or
213. 10:34wanting to harm others Sarah described
214. 10:37paranoid persecutory delusional beliefs
215. 10:40that staff had been replaced with
216. 10:41imposters and were attempting to poison
217. 10:43her she had concerns about thought
218. 10:46broadcasting but there were no other
219. 10:47symptoms of thought
220. 10:49interference Sarah reported auditory
221. 10:52hallucinations and appeared to be
222. 10:54responding to voices at various points
223. 10:56throughout the interview she described a
224. 10:58voice providing running commentary on
225. 11:00her behavior and making derogatory
226. 11:03comments about her she did not describe
227. 11:05any of the abnormal perceptions Sarah
228. 11:07was orientated to time place and person
229. 11:10she appeared to lack insight into her
230. 11:12symptoms being related to a
231. 11:14deterioration in her mental health her
232. 11:17limited oral intake due to her
233. 11:19delusional beliefs may be impacting her
234. 11:21nutritional status if you enjoyed this
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244. 11:43[Music]