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

[Music] hello I'm Jade I'm one of the doctors from the mental health team today would I be able to check your name and date of birth please Sarah Sarah Thomas third of May 68. great worries about your yesterday at home is that right yes so how have you been feeling recently it's really really stressed worried okay and what is it that's been worrying you I know they want to kill me I know they want to and I I've just I just can't be in that place I can't be there because they want to get me

I don't know why but they want to kill me okay they're poisoning my food I know they are I know they are okay who's that the imposters that have taken over the workers that look after me right and how do you know that these imposters have taken over the workers because they're trying to poison me and how did you find that out sorry sorry oh that's okay um is there anything else that's been worrying you from that point of view I'm very worried because they do want to get me and I do believe they want

to kill me and is there anything in particular that's made you feel this way because I know they're putting stuff in my food okay is there any reason that you think they might want to hurt you I don't know are there any other potential explanations that you've thought for what might be going on that is what's going on okay they're out to get me I don't know why I've done nothing but they definitely have to get me that sounds really scary very scary yeah with all this going on have you felt low or depressed at

all I I just want help okay no it's just worried worried and with everything that's been going on have you ever had any thoughts of wanting to harm yourself or not wanting to be here no no and have you ever had any thoughts of maybe wanting to harm anyone else those imposters need stopping but I would never never harm them they do need stopping but I would never harm them I would never do that to anyone anyone anything anyone but they do need stopping and if I tried to try to get them try to harm

them to make them stop I think it would make it worse but I wouldn't do that anyway I would never harm anyone and do you ever feel like maybe some of your thoughts aren't your own so sometimes people might experience who might feel like somebody's putting thoughts in their head or taking thoughts away from them no nothing like that and sometimes people might say that they hear their thoughts being broadcast aloud and it feels like everyone in the room can hear their thought is that something that you've experienced yes the imposters were trying to poison

me who I no want to kill me if they can hear my thoughts that I know that they're trying to do that then they will definitely definitely do it quicker they'll know that I'm on to them they'll do it quicker therefore I need protecting if they hear it they will they'll put more poison in they'll kill me quicker they'll I need protection I need protection you seem a little bit distracted is is there anything going on at the minute that's worrying you so I I hear that they are the them then talking who is it

that you hear talking I I don't I don't know what they talk they talk what do they talk about um Sarah look at Sarah she's sitting on the chair Sarah's nasty she's evil she's not a nice person look at her just sitting there she's really nasty she horrible she's not a nice person look at her sounds awful like they're saying some really nasty things I can imagine it must be really hard on to listen to that all the time do they say about you or does it is it like they're speaking directly to you the

the person the person that speaks talks talks about me I hear now and do you know who is that okay and is it just the one person or is it different just one person okay so you've mentioned about these kind of nasty voices that you've been hearing have you ever seen anything unusual that others might not have seen no no or maybe felt any strange Sensations on your skin that you couldn't explain no no and then sometimes people might feel as if the world around them isn't real is that something you've ever felt no well

sometimes people might also say they feel as though the world around them is real but they themselves aren't real is that something you've ever experienced no no okay and I just need to check a few things so would you be able to tell me where we are right now yeah so right now hospital hospital yeah that's right and do you know what day of the week it is and what roughly what time is yeah so it's it's about eight o'clock on my Monday Monday yeah great and then can you remember who I am you um

I do are you you you you're from the mental health Team doctor your doctor doctor yeah yes I do I do and what do you think is the cause of the problems that you've been experiencing recently I don't know why they want to kill me I don't know why but they do I've done nothing I I don't know okay and sometimes when people um come into hospital with problems like this it can be related to deterioration of their mental health is that something you've considered at all it isn't no okay and and what do you

think we could do to help you I need the imposters taken away the police need to come round they need to take you need to give me a safe space I I cannot go back there and I I need a safe space and they need to be caught and put in prison I need protection okay okay so would you be willing to come into Hospital tool for us to try and help you if I don't want to stay at home if that's a safe place I will do okay and I just wanted to check so

if you were to go home how would you manage to eat and drink if you're worried about imposing you I have all pre-packed food okay and drinks packet drinks in in you know all pre-packed so I do eat I will not eat their food and what if there was no other food around well I know I know that they are putting poison in the food and the drink I know they are but I think I've got that covered but they have ways they'll probably get into my pre-packed food they will have ways they will have

ways so they need to be taken and I need protection they need locking up thank you very much for telling me all that and it was almost the rest of my team if that's okay just to see what else we can do to help you and try and find a safe space for you to stay in hospital would that be okay with you please yeah if you've got any other questions at all just thank you okay thank you thanks very much for speaking to me today I assess Sarah a 54 year old lady with a

background of schizophrenia she presented to the emergency department with concerns of being poisoned by her support workers on examination she appeared distracted but was able to engage well in the assessment she was disheveled and visibly anxious Her speech was monotonous at times but there were no other abnormalities of note in terms of her mood Sarah said she was stressed and worried objectively she appeared anxious she denied any thoughts of self-harm or wanting to harm others Sarah described paranoid persecutory delusional beliefs that staff had been replaced with imposters and were attempting to poison her share concerns

about thought broadcasting but there were no other symptoms of thought interference Sarah reported auditory hallucinations and appeared to be responding to voices at various points throughout the interview she described a voice providing running commentary on her behavior and making derogatory comments about her she did not describe any of the abnormal perceptions Sarah was orientated to time place and person she appeared to lack insight into her symptoms being related to a deterioration in her mental health her limited oral intake due to her delusional beliefs may be impacting her nutritional status if you enjoyed this video check

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