Simple Casc Tasks and Feedback Forms

2009
SPMM Course
Simple CASC Tasks & Feedback forms
Simple CASC stations and relevant scoring forms are included in this document to
enable group practice ahead of the MRCPsych exams.
SPMM Course
CASC
www.spmmpsychiatrycourse.co.uk
2 SPMM Course
SIMPLE CASC TASKS AD FEEDBACK FORMS PAGE UMBER

1. PTSD- History taking 3
2. Grief reaction- history taking 5
3. Breaking bad news 7
4. Bulimia nervosa- history taking 9
5. Assess cognitive errors 11
6. Panic disorder and hyperventilation syndrome- explanation 13
7. CBT-Counselling 15
8. Psychodynamic psychotherapy- Counselling 17
9. Body dysmorphic disorder- history taking 19
10. Opiod misuse- history taking 21
11. EPSEs- examination 23
12. Somatoform pain disorder-history taking 25
13. Staff Assault-management 27
14. Violence risk assessment 29
15. Sexual offence - Risk assessment 31
16. Fitness to plead- assessment 33
17. Neuroleptic malignant syndrome- discussion 35
18. Frontal lobe function tests- examination 37
19. Lithium augmentation- discussion 39
20. Psychosis- mental state examination 41
21. Autistic spectrum disorder- history taking 43
22. Conduct disorder- history taking 45
23. ADHD- History taking 47
24. Childhood enuresis- history taking 49
25. Childhood sexual abuse- discussion and management 51
26. Post partum psychosis- mental status examination 53
27. Post concussional syndrome- history taking 55
28. Schizophrenia- counselling 57
29. Borderline Personality disorder- Symptom elicitation 59
30. Anti dementia drugs- counselling 61
31. Alzheimer’s dementia- history taking 63
32. Lewy Body dementia- history taking 65
33. Fronto-temporal dementia- history taking 67
34. Vascular dementia- history taking 69
35. Psychotic depression- assessment 71
36. Behavioral and psychological symptoms of dementia 73
37. Learning disability- anxious patient & relative 75
38. Depression in Learning disability- assessment 77
39. Temporal lobe epilepsy- history taking 79
40. Challenging behaviour in learning disabled patient- assessment 81
41. Alcohol withdrawal- physical examination 83
42. Cerebellar signs and symptoms- physical examination 85
43. Sensory and motor examination 87
44. Thyroid examination 89
3 SPMM Course
HISTORY TAKING-NEUROSIS
INSTRUCTION TO THE CANDIDATE:
Mrs. Howard is a 37-year-old schoolteacher referred

by GP who was involved in a serious road accident 6
months ago. The patient initially saw her GP because
of difficulty in coping with her job.
a. Obtain history to arrive at a diagnosis

b. Rule out co-morbidity
c. Explain diagnosis to the patient.
4 SPMM Course
POST TRAUMATIC STRESS DISORDER-HISTORY TAKIG
ame of the candidate:
A- Good pass B-Borderline pass C-Borderline fail D-Fail
Areas of Questioning style- use of appropriate mix of open & A B C D

Concern- closed qns, Listening & responding appropriately to
1 interviewee, communication
Management of interview including empathic responses, A B C D

2 Fluency of interview, Lack of appropriate focus on the
task, Lack of structure
3 Professionalism, establishing rapport, body language A B C D
Details of the traumatic accident- nature and extent of the A B C D

4 problem, severity of symptoms
And impairment in current functioning
Hyper arousal Symptoms A B C D

5 (Anxiety, irritability, Poor concentration, sleep
disturbances etc)
Intrusions (flashbacks, nightmares, A B C D

6 Day dreams)
Avoidance and emotional detachment A B C D

7 (Place, person and activities)
Rule out co-morbidity, coping strategies A B C D

8 (Depression, anxiety, substance misuse etc)
Range and depth of history explored, Significant A B C D

9 omissions, Depth of enquiry into symptoms
A B C D
10 Explanation of diagnosis (Simple terms, avoid jargons)
GLOBAL RATIG A B C D
Additional comments:
5 SPMM Course
HISTORY TAKIG
Instruction to candidate:
The GP has referred Mrs. White, 35-year-old woman

whose husband died seven months ago. She is not
coping well following the death of her husband.
Take an appropriate history to assess whether this is

normal bereavement reaction or determine if she has
features of abnormal grief reaction
6 SPMM Course
GRIEF REACTION-HISTORY TAKING

Areas of Questioning style- use of appropriate mix of open & closed

Concern- qns, Listening & responding appropriately to interviewee A B C D
1
Management of interview including empathic responses,
2 Fluency of interview, Lack of appropriate focus on the task A B C D
Professionalism, Communication, body language, establishing

3 rapport A B C D
Brief assessment of feelings at the time of her husband’s death,
4 onset, Duration and course of symptoms A B C D
Assessment of current mood and Cognitive,
5 Biological sx of depression A B C D
Features of grief reaction

6 a. Pining or searching, A B C D
b. Preoccupation with the deceased
Features of grief reaction

7 c. Feelings of guilt A B C D
d. Pseudohallucinations of widowhood (Normal grief reaction)
Atypical grief reaction-features

8 a. Other hallucinatory experiences A B C D
b. Thoughts of self harm, suicide
Atypical grief reaction-features

9 c. Inability to function A B C D
d. Mummification
Range and depth of history explored, Significant omissions,

10 Analysis of problems, Depth of enquiry into symptoms A B C D
GLOBAL RATING A B C D
7 SPMM Course
BREAKID BAD EWS
ISTRUCTIO TO ACTORS
Mr. Green is a 64-year-old gentleman

admitted to the psychiatric unit 3 days ago
with a working diagnosis of Paranoid
psychosis with sudden change to his
personality and behaviour. He complained of
severe headaches and collapsed once on the
ward with brief loss of consciousness.
His MRI scan showed metastatic brain

tumour (secondaries) involving multiple
regions of the brain including frontal and
parietal lobe.
You want to break this news to his daughter,

discuss the results, further investigations and
treatment.
8 SPMM Course
BREAKIG BAD EWS

Areas of Ice breaking non-medical comments

Concern Begin with introductions and context A B C D
1
Establish what is already known
2 Set the scene; give a warning shot A B C D
Genuine Empathy, allowing time for the news

3 To sink in, allow time for emotional reactions A B C D
Body language, Reassure in verbal and non-verbal ways

4 Establishing rapport A B C D
Communication- Use of simple jargon free language to describe
5 A B C D
Professionalism- Show your own emotions whilst maintaining
6 professionalism A B C D
Discuss about treatment options
7 Surgery, radiotherapy, chemotherapy etc A B C D
Involvement and support from the

8 Medical team, palliative care team and A B C D
Multidisciplinary team, Mac Millan nurse etc
Prognosis, Summarize and clarify Understanding,
9 Encourage Questions A B C D
Advice Counselling for the carer,
10 GP appointment, other sources of information A B C D
11 Listening & responding appropriately to interviewee A B C D
Range and depth of information covered, Significant omissions,

12 Analysis of problems A B C D
Prioritisation and appropriateness of information delivered and
13 or management A B C D
GLOBAL RATIG
A B C D
9 SPMM Course
EATIG DISORDER-HISTORY TAKIG
Instruction to candidate:
You are asked to see Ms. Rose, a 21-year-old medical

secretary who has insulin dependent diabetes
mellitus.
The GP was concerned about her diabetic control and

the patient admitted to omitting insulin in order to
lose weight.
a. Elicit history to arrive at a dignosis.

b. Also obtain personal and family history
10 SPMM Course
BULIMIA ERVOSA-HISTORY TAKIG

Areas of Questioning style- use of appropriate mix of open & closed qns,
Concern fluency of interview and communication A B C D
1
Professionalism, body language, establishing rapport
3 A B C D
Psychological Symptoms
4 (Body image disturbance, Morbid fear of fatness) A B C D
Physical symptoms (Fatigueability, Constipation,
5 Dizziness) Amenorrhoea- to rule out anorexia A B C D
Persistent Preoccupation with eating, irresistible food craving

6 Eating pattern and Bulimic behaviour- Binge eating episodes A B C D
(feelings before During and after binges)
Measures taken to lose weight - Avoidance of foods/fluids

7 Vomiting, Over exercise, laxatives, stimulants, Diuretics, others A B C D
Co-morbidity
8 (Depression, anxiety, DSH, Substance misuse etc) A B C D
Personal history (Family dynamics, Relationship difficulties)
9 Past history of eating disorder and family history A B C D
Lack of clear structure,

10 Lack of appropriate focus on the task A B C D

GLOBAL RATIG
A B C D
11 SPMM Course
PSYCHOTHERAPY
Instructions to candidate;
Mr. Mark Wallace is a 28-year-old

footballer with performance anxiety. He has
failed to score 8 weeks ago and had been
feeling anxious. He has lost confidence to
perform and is now not willing to play.
His manager referred him for psychology

input and you are seeing him in the
psychotherapy clinic to assess suitability.
Assess him to identify presence of cognitive

distortions.
12 SPMM Course
ADDRESSIG COGITIVE ERRORS AD EGATIVE THOUGHTS

Areas of Communication- simple terms, avoiding jargons, A B C D

Concern Questioning style- use of appropriate mix of open &
1 closed qns
Management of interview including empathic A B C D

2 responses, Listening & responding appropriately to
interviewee,
Professionalism, Establishing rapport, A B C D

3 Body language
History of presenting problems, duration and impact on A B C D

4 normal functioning
Explore and elicit examples of 'maximisation' and A B C D

5 minimisation, selective abstraction
Explore and elicit examples of personalisation and A B C D

6 labelling
Explore and elicit examples of dichotomous thinking A B C D

7 And overgeneralisation
Lack of structure, Fluency and focused history taking A B C D

8 Lack of appropriate focus on the task
Significant omissions, Analysis of problems and A B C D

9 synthesis of opinion
13 SPMM Course
PAIC DISORDER-HYPERVETILATIO
INTSRUCTIONS TO CANDIDATE
Mr. Paul Andrew is a 40 YO gentleman who suffers

from panic disorder. He called the ambulance, as he
was worried that he might be having a heart attack.
He is now medically cleared but he is still feeling
anxious because his father and brother died recently
of heart attack
His wife Mrs. Andrews is extremely concerned about

him and wanted to speak to the psychiatrist.
a. Explain to her the nature of his condition and

address her concerns
b. Also explain what hyperventilation syndrome is
and what happens as a result of it?
14 SPMM Course
PAIC DISORDER-HYPERVETILATIO SYDROME-DISCUSSIO

Areas of Communication- using simple terms, avoiding jargons, A B C D

Concern- Questioning style, fluency of interview, offering clear
1 explanations
2 Listening & responding appropriately to interviewee
Professionalism, Body language, A B C D

3 Establishing rapport
Reassurance- Medically cleared and not having a heart A B C D
4 attack
Explaining diagnosis-panic disorder, nature & frequency A B C D
5 Fight-flight response
Explaining hyperventilation Syndrome, the mechanism A B C D

6 involved, Possible Ways to prevent it.
Offer clear reasons for chest pain, breathlessness, other A B C D

7 symptoms – emphasise Importance of Relaxation
Techniques, Breathing exercises
Concerns- A B C D
8 ? Getting back to work
? Medications
9 Agreeing to talk to patient later and reassure him A B C D
Sources of information
Range and depth of enquiry into symptoms, Significant A B C D

10 omissions, Analysis of problems
Prioritisation and appropriateness of information A B C D
11 delivered and or management
15 SPMM Course
Counselling-CBT
ISTRUCTIOS TO CADIDATE:
You have assessed Mrs. Wood a 35-year-old

lady in the outpatient clinic who has a
diagnosis of recurrent depressive disorder
She has a history of partial response to two
different antidepressant drugs.
You would like her to be referred to the

psychology department for CBT.
The patient wants to know more about CBT.
a. Explain to the patient how CBT works

b. Do not take history.
16 SPMM Course
COGITIVE BEHAVIOURAL THERAPY-DISCUSSIO

Areas of Communication- Avoiding false reassurance A B C D

Concern- Avoid giving false information/ medical jargons, fluency
1 of interview
2 Listening & responding appropriately to interviewee,
Lack of appropriate focus on the task
Professionalism, body language A B C D
3 Establishing rapport
Explain the nature of therapy A B C D

4 (Psychological/talking, ‘here and now’)
(Behaviour-mood-cognition link)
Basic principles of therapy- A B C D

5 (Cognitive/behavioural components, negative automatic
thoughts, thoughts diary, graded task assignments)
Structure of therapy A B C D
6 (Number, duration, therapist-trained in CBT and
supervised etc)
Outcome and offer further information A B C D
7 (Use in depression, prevents relapse)
Addressing patients concerns A B C D

8 (Homework tasks, stopping meds,
Dealing with emergencies)
Significant omissions, Analysis of problems & synthesis A B C D

9 of opinion
Prioritisation and appropriateness of information A B C D

10 delivered and or management
17 SPMM Course
PSYCHODYAMIC PSYCHOTHERAPY
ISTRUCTIOS TO CADIDATE
Mrs. Turner is a 35-year-old lady who suffers from mixed

anxiety and depressive disorder with dependent personality
disorder traits. She also has a history of traumatic
childhood.
Following your review today, you have decided to refer her

to the psychology team for psychodynamic psychotherapy.
a. She would like to know more about it. Explain the

principles and structure of therapy
b. Address her concerns
c. Do not take history.
18 SPMM Course
PSYCHODYAMIC PSYCHOTHERAPY

Areas of Communication, Avoid jargons, Avoiding false A B C D

concern- information, False reassurance
1
2 Listening & responding appropriately to interviewee
Professionalism, body language and establishing rapport A B C D

3
Explain the nature of therapy A B C D
4 (Psychological/talking, Establishing therapeutic
relationship)
Basic principles of therapy A B C D
5 (Emotional Difficulties, Exploration of childhood)
Structure of therapy A B C D
6 (Initial Assessment, Individual/group,
Number, duration, therapist- trained & supervised
Outcome and further discussion- Use in depression, A B C D

7 prevents relapse
Long-term benefits
Address patients concerns A B C D
8 1. Waiting time
2. Emergencies
3. Continue medications
Address patients concerns A B C D
9 4. Unwilling to attend group
5. Confidentiality
Significant omissions, Analysis of problems A B C D
10 Fluency of discussion
Prioritisation and appropriateness of information delivered A B C D
11 and or management
19 SPMM Course
BODY DYSMORPHIC DISORDER
ISNTRUCTIONS TO CANDIDATE
Miss. Sarah White is a 27-year-old lady who

has been referred by her GP. She believes
her eyes are widely set.
Obtain history to explore the nature and

extent of her problems.
20 SPMM Course
BODY DYSMORPHIC DISORDER

Areas of Communication, Questioning style- use of appropriate mix of

Concern open & closed qns and fluency of interview A B C D
1
3 A B C D
Nature and description of presenting problems
4 (Onset, duration, fluctuation, and severity) A B C D
Extent and impact on normal functioning

5 (Personal, social and occupation) A B C D
To assess the strength of Beliefs and degree of conviction
6 (overvalued ideas/ delusional), any other abnormal beliefs A B C D
Avoidance Behaviour-Social situations, social withdrawal, lack

7 of self confidence etc A B C D
Compulsive habits & behaviour- Mirror gazing, Repeated
8 checking and elaborated Grooming rituals A B C D
Risk assessment:
9 1. Suicidal ideation, A B C D
2. Risk of actually performing surgery themselves
3. Risk of unwanted tests and investigations
Past psychiatric history
10 Rule out co-morbidity-Depression, social phobia, schizophrenia A B C D
(psychotic symptoms)
Depth of enquiry into symptoms,
Range and depth of history and risk explored, Significant

12 omissions, Analysis of problems A B C D
GLOBAL RATIG
A B C D
21 SPMM Course
SUBSTACE MISUSE
ISTRUCTIOS TO THE CADIDATE:
Mr. Tony Gordon, a 32-year-old gentleman was

seen in the drug and alcohol outpatient clinic
following referral from his GP, as he has a
history of using recreational drugs
A. Elicit history of opiod misuse and assess

for features of opiod dependence
B. Also assess his level of motivation.
22 SPMM Course
OPIOD MISUSE- HISTORY TAKIG

Concern fluency of interview, communication A B C D
1

3 A B C D
Current usage and Longitudinal history
4 A B C D
Features of dependence
5 (Compulsion, tolerance, withdrawals, re-instatement etc) A B C D
Complications- (Physical, psychological, Social, legal)

6 A B C D
Risky behaviours (Unsafe sex, sharing needles etc)
7 A B C D
Insight and motivation
8 A B C D
Rule out mood and psychotic Sx
9 Alcohol and other drugs of use A B C D

10 Lack of appropriate focus on the task, A B C D

GLOBAL RATIG
A B C D
23 SPMM Course
PHYSICAL EXAMIATIO
You are a junior doctor in accident and emergency

department. The nurses have asked you to see this young
gentleman Mr. Paul Brown who is restless and very angry.
He went to his GP three days ago who gave him some
tablets for anxiety. He thinks his problems started after
taking those tablets. He has now thrown them away.
1. Explore the reasons why the GP prescribed the

medication and explain your diagnosis.
2. Also perform appropriate physical examination
24 SPMM Course
EXTRAPYRAMIDAL SIDE-EFFECTS-EXAMIATIO

Areas of Communication- Dealing with angry patient assertively,

Concern Establishing rapport, A B C D
1 Giving clear instructions, Questioning style
Ensuring privacy, body language, Professionalism, gentle
3 handling A B C D
Explore the reasons for seeing GP and medication prescribed
4 A B C D
Assess Symptoms of EPSEs- Inner restlessness, stiffness,
5 shakiness, Other abnormal body movements A B C D
Examination-facial and oral movements
6 Lips, Perioral areas, jaw, Tongue, Dental status A B C D
Examination of upper limbs

7 Tremor-outstretched hands A B C D
Rigidity-Wrist, elbow and shoulder joint
Examination-Leg movements, Resting posture,

8 Seated on chair with Hands on knees (Observe for 15 secs) A B C D
Examination: legs slightly apart, Seated with hands hanging

9 unsupported etc A B C D
Observation on Standing posture, Observation with both arms
10 extended and palms down (Observe for 15 sec) A B C D
Examination of gait
Explaining the possible diagnosis to the patient (Akathisia,
11 which is medication induced) and allay anxiety A B C D
Range and depth of Task performed, Significant omissions,

GLOBAL RATIG
A B C D
Additional comments;
25 SPMM Course
HISTORY TAKIG
TASK:
Mr. Brian Gold smith was referred by his GP to your

outpatient clinic for psychiatric assessment.
He is not clearly happy about it as he thinks that there is

nothing with him mentally.
Obtain history to arrive at a diagnosis.
26 SPMM Course
SOMATOFORM PAI DISORDER

1
2 Listening & responding appropriately to interviewee, A B C D
3 Professionalism, body language, Establishing rapport A B C D
Full description of the pain and the circumstance in which it

4 occurs (onset, Duration, frequency, severity, aggravating & A B C D
relieving factors)
Pain behaviour- verbal & non verbal behaviours including the

5 presentation of symptoms, requests for medication, responses to A B C D
pain,
Beliefs about the causes of pain and its implications
Role of psychological factors in maintenance and exacerbation

6 A B C D
Significant distress or impairment of social and family

7 functioning A B C D
Consequences of pain- secondary insomnia, inactivity,
Appropriate examination and thorough investigation of, possible

8 physical causes. A B C D
Rule out co-morbidity- depressive disorder or other psychiatric

9 disorder A B C D


GLOBAL RATIG
A B C D
27 SPMM Course
STAFF ASSAULT
Mr. Steve Wright was detained under the mental health act
and admitted to one of the psychiatric wards.
He assaulted a student nurse who confronted his delusional

beliefs. The student nurse was severely injured and Mr.
Wright is still holding a weapon.
You are the on call doctor

Discuss how you will deal this situation with the consultant
28 SPMM Course
STAFF ASSAULT-MAAGEMET

Areas of Management of the situation, Fluency of discussion, A B C D

Concern- Listening & responding appropriately to qns
1
Prioritisation, recognition of importance and A B C D
2 appropriateness of information delivered.
Communication, body language, Professionalism A B C D

3 including but not limited to harmful interaction
Acknowledge-seriousness of the issue A B C D

4 Concerns and aims; (Ensure safety, disarm & isolate
patient, reassure staff and pts)
Assaulted staff-assess severity, A B C D

5 Transfer to A&E acc by another nurse
Dealing with armed patient, Call police; gather trained A B C D

6 nurse-C&R technique, disarm patient,
Deescalating measures- Seclusion room, time-out A B C D

7 Medication- Oral/IM-Rapid tranquillization
Monitor vitals, discuss seclusion policy
Inform consultant, on call manager, A B C D

8 Clear documentation
Staff debriefing, community meeting, A B C D

9 Staff meeting, incidents form completion
Learning lessons, Press charges
Transfer to PICU/forensic ward
Significant omissions, Analysis of problems and A B C D

10 synthesis of opinion
29 SPMM Course
VIOLECE-RISK ASSESSMET
Mr. John Abraham is a 28-year-old gentleman with has a

long-standing diagnosis of paranoid schizophrenia and is
now been charged with serious assault.
He has now been admitted to a low secure forensic unit.

You have been asked by the court to assess him.
a. Assess circumstances leading to index offence.
b. Ask him relevant questions to assess the risk of future

violent offending.
30 SPMM Course
VIOLECE-RISK ASSESSMET

Areas of Questioning style- use of appropriate mix of open & closed

Concern-1 qns, fluency of interview and communication A B C D
3 Professionalism, establishing rapport, Body language
A B C D
Assess Circumstances leading to Index offence- (location,
4 people, timing, triggers, drug or alcohol involved, A B C D
Severity of violence)
Patients’ view about the offence; Anger, Denial, lack of

5 remorse, lack of guilt A B C D
Ongoing thoughts of violence etc
Personal history (Traumatic childhood, violent father,
6 Victim of domestic violence) A B C D
Psychiatric history- (Low IQ, Conduct disorder, Psychotic

7 illness, non-compliance) A B C D
Previous Forensic history

8 (Past violent offences, arrests, Convictions, sentences etc) A B C D
Social history- (Single, unemployed, homelessness,

9 Drug & alcohol Misuse, lack of stable Relationships) A B C D
Personality traits
10 (Repeated impulsive behaviour, Difficulty in coping with A B C D
stress, Antisocial traits)
11 Range and depth of history explored
Range and depth of Risk explored A B C D
12 Significant omissions, Analysis of problems

Lack of structure and focus on the task A B C D
Additional Comments:
31 SPMM Course
SEXUAL OFFECE
Instructions to actors;
You have been asked by the court to see Mr. Kenneth

Roberts, a 44-year-old man who has been arrested for
child molestation.
Obtain history and ask him relevant

questions to assess the risk of future
offending.
Do not conduct a mental state examination
32 SPMM Course
SEXUAL OFFECE- RISK ASSESSMET


Concern open & closed qns, fluency of interview A B C D
1
3 Professionalism, establishing rapport, Body language

A B C D
Assess Circumstances leading to Index offence- (location,
4 people, timing, triggers, relationship to victim, intoxicated at A B C D
time of offence)
Patients’ view about the offence; Denial, minimisation,

5 justification, lack of remorse, lack of guilt, low victim A B C D
empathy, feelings of ‘entitlement’
Personal history (traumatic childhood, history of childhood

6 abuse), Past psychiatric history, Drug and alcohol history A B C D
Psycho-sexual history (deviant sexual practices, excessive

7 masturbation and urges, sexual fantasies, Paraphilias) A B C D
Previous Forensic history (sexual and non-sexual offences),

8 juvenile sexual offences, history of cautioning, conviction, A B C D
sentencing, previous history of similar offences, poor
engagements with treatments
Current social circumstances- (unemployment, homelessness,

9 lack of stable Relationships, abnormal personality traits- A B C D
impulsivity, inhibition, lack of empathy)
10 Range and depth of history explored

Range and depth of Risk explored A B C D
11 Significant omissions, Analysis of problems

Lack of structure and focus on the task A B C D
33 SPMM Course
FITNESS TO PLEAD
Mr. Peter Curtis is a 35-year-old gentleman, who has

been charged with assault 24 hours ago. The alleged
victim had sustained multiple injuries in his face and
abdomen and required an overnight stay in the
hospital
Mr. Curtis has been remanded in custody and is due

to appear in court tomorrow. The court wishes to
know if he is fit to plead
You have been asked to attend the police cell and

assess him.
a. Determine his fitness to plead.

b. Also ascertain whether he suffers from any
form of mental illness
34 SPMM Course
FITESS TO PLEAD-ASSESSMET

Areas of Communication, Questioning style- use of appropriate A B C D

Concern-1 mix of open & closed qns, fluency of interview
Management of interview including empathic A B C D
2 responses, Listening & responding appropriately to
interviewee
3 Professionalism, establishing rapport, Body language A B C D
Assess Circumstances leading to Alleged offence A B C D

4 And patient’s view about it
Pritchard Criteria: A B C D
5 Ability to understand charge (What and why they have
been charged
6 Understanding the effect of Plea-guilty/not guilty A B C D
7 Ability to instruct counsel and Challenge juror A B C D
Ability to follow evidence and Court proceedings A B C D

8
Rule out the presence of delusional beliefs or evidence A B C D

9 of mental illness
Range and depth of information explored, Significant A B C D

10 omissions, Analysis of problems,
Lack of clear structure
35 SPMM Course
EUROLEPTIC MALIGAT SYDROME
ISTRUCTIOS TO CADIDATE;
Mr. Brian White was admitted to the acute Psychiatric ward

two days ago following a first episode of acute psychosis.
Brian was very agitated and required rapid tranquillisation
with IM Haloperidol.
Unfortunately he developed Neuroleptic malignant
syndrome and was subsequently transferred to medical unit
for treatment. His father who is angry & upset has come to
the ward and demanded to see a doctor to find out what has
happened.
a. Address his concerns and allay his anxiety

b. Explain the nature of his son’s condition and the
prognosis.
c. Do not take history
36 SPMM Course
EUROLEPTIC MALIGAT SYDROME-DICUSSIO

Areas of Communication- Verbal & non verbal, avoiding false

Concern information/ false reassurance, medical jargons etc, fluency of A B C D
1 discussion
Establishing rapport, body language and dealing with angry

3 relative assertively A B C D
Explaining rationale for treating

4 With Haloperidol Injection A B C D
Nature and causation of NMS
5 A B C D
Investigations & possible treatments
6 Implications for future management and antipsychotic A B C D
rechallenge
Listening & responding appropriately to interviewee

7 1. Is he going to die? A B C D
2. Prognosis
Helping with Complaints procedure- Professionalism

8 including but not limited to harmful interaction, failure to A B C D
respect individual’s rights, ethical behaviour etc
Range and depth of information explored, Significant

Prioritisation, recognition of importance and appropriateness

10 Of information delivered and or management A B C D
GLOBAL RATIG
A B C D
37 SPMM Course
FROTAL LOBE FUCTIO TESTIG
ISTRUCTIO TO THE CADIDATE
Mr. Brown is a 52-year-old gentleman who was

picked up by the police as he was found
wandering in the streets and exposed himself to
a female in the public. His MMSE was 22/30
Perform frontal lobe function tests to complete

cognitive assessment and arrive at a diagnosis.
Do not take history.
38 SPMM Course
FROTAL LOBE FUCTIO TESTS

Areas of Communication, Questioning style, Clear instructions, simple

Concern language and fluency of task A B C D
1
Professionalism, body language and establishing rapport

3 A B C D
Assessment of verbal fluency (Word-F, word-A, Word-S)
4 Category fluency (animals, birds etc) A B C D
Assessment of abstraction- Proverb interpretation

5 Similarities test A B C D
Cognitive estimate testing (2 tests)

6 A B C D
Co-ordinated movements- Luria three step task
7 A B C D
Coordinated movements (response inhibition and set shifting)
8 Go-no-go test A B C D
Perseveration (alternate sequences test)

9 A B C D
Examination- Primitive reflexes (Glabellar tap, grasp and
10 pouting reflex) A B C D

Range and depth of examination performed, Significant

GLOBAL RATIG
A B C D
39 SPMM Course
COUSELLIG-LITHIUM AUGMETATIO
Mr. Paul Williams is a 40-year-old

gentleman who suffers from recurrent
depressive disorder. He has been tried on
antidepressants with minimal success. Your
team has decided to start him on Lithium for
augmentation.
He would like to discuss with you to know

more about this medication. Address his
concerns.
40 SPMM Course
LITHIUM AUGMETATIO-COUSELLIG

Areas of Communication- avoid use of jargon, Avoiding false

Concern information, fluency of interview A B C D
1
3 Professionalism, body language, Establishing rapport A B C D
4 Explain the rationale behind Augmentation & Nature of the A B C D

drug
5 Describe the monitoring and Duration of treatment A B C D
Describe side effects- Short term & long term

6 A B C D
Warning Signs of Lithium toxicity
7 When and how to stop it? A B C D
Risk
8 1.Risk of relapse on stopping medications A B C D
2.Ensure adequate hydration (Salt and water balance)
Addressing concerns
9 3.? Addictive potential A B C D
4. Holidays-avoid sunbathing (dehydration)

GLOBAL RATIG
A B C D
41 SPMM Course
PSYCHOSIS-EXAMIATIO
INSTRUCTIONS TO CANDIDATES
Mr. Paul Brown is a 45-year-old gentleman brought

by the police to the A&E department. He went to the
police station earlier today and said that he is giving
up.
a. Examine this patient to establish what

abnormal belief he holds
b. Establish whether any other
psychopathology is present.
.
42 SPMM Course
PSYCHOSIS-EXAMIATIO

Concern fluency of interview, communication, Picking up clues A B C D
1 appropriately
2 Seeking to understand the individual patient’s experience, A B C D
Listening and responding appropriately
3 Professionalism, body language, establishing rapport A B C D
Persecutory delusions- Exploration and clarification

4 A B C D
Evaluation of falseness of beliefs and degree of conviction
5 Effects and coping A B C D
Third person auditory hallucinations- content, source, timing

6 and reality with which they are experienced A B C D
Delusional perception- Exploration and clarification

7 A B C D
Risk assessment
8 A B C D
Look for other psychotic symptoms
9 (Any other abnormal beliefs, other hallucinatory A B C D
Experiences)
Range and depth of history explored

10 Range and depth of psychopathology explored A B C D
Lack of clear structure, Significant omissions

GLOBAL RATIG
A B C D
43 SPMM Course
CHILDHOOD DISORDERS
TASK:
Mrs. Young is a 32-year-old lady attending the CAMHS

Clinic with his 6-year-old son Paul who was referred by the
community paediatrician.
Obtain developmental history from his mother looking for

features of autistic spectrum disorder and discuss your
working diagnosis briefly.
44 SPMM Course
AUTISTIC SPECTRUM DISORDER- HISTORY AD DISCUSSIO

1

3 A B C D
Developmental History
4 (Motor, language, cognitive and social skills) A B C D
Gross impairment in reciprocal social interaction (Poor Eye

5 contact, failure to develop peer relationships, Reduced interest A B C D
in shared Enjoyment, lack of social reciprocity & empathy etc)
Qualitative impairments in communication or play

6 (Delay or lack of spoken language, difficulty A B C D
In initiating or sustaining conversation, lack of developmentally
appropriate symbolic or social play)
Restricted, repetitive and stereotyped interests or activities

7 (Resistance to change, obsessive preoccupations with routine, A B C D
timetable, objects; stereotyped body movements like hand
flapping, Body rocking)
Rule out co morbidity

8 (Learning disability, seizures, ADHD etc) A B C D
Explaining the diagnosis & Need for Involvement of

9 multidisciplinary approach to complete assessment A B C D

Range and depth of history explored, Depth of enquiry into

11 symptoms, Significant omissions A B C D
GLOBAL RATIG
A B C D
45 SPMM Course
CHILD PSYCHIATRY
You have been asked to assess John, 12-year-old boy

in the CAMHS clinic. He was referred for outpatient
evaluation by his GP, after being picked up by police
for running away from home. You would like to see
his mother first before assessing him.
a. Obtain history from his mother Ms. Kate Fitch

with a view of identifying features of conduct
disorder.
b. Also look for possible risk factors for conduct
disorder
46 SPMM Course
CODUCT DISORDER-HISTORY TAKIG

1

3 A B C D
History of presenting symptoms, duration and reasons for
4 presentation A B C D
Physical aggression or threats of harm to people, cruelty to

5 people and animals, bullying and intimidation of others, starting A B C D
physical fights, using weapons in fights.
Destruction of their own property or that of others, vandalism

6 Theft or acts of deceit, shoplifting, setting fires to cause damage A B C D
Frequent and serious violation of Age-appropriate rules

7 (Like truanting or running away, lying, cheating etc) A B C D
Risk factors; (Family history of antisocial behaviour,

8 Parental criminality, domestic violence A B C D
Poor School achievement etc)
Rule out co-morbidity

9 (Depression, ADHD, substance misuse etc) A B C D

Range and depth of history explored,

11 Depth of enquiry into symptoms, Significant omissions A B C D
GLOBAL RATIG
A B C D
47 SPMM Course
CHILD PSYCHIATRY
TASK:
Mrs. Young is a 32-year-old lady attending the

CAMHS Clinic with her 6-year-old son
Abraham. The GP referred her son to the clinic
for psychiatric evaluation.
a. Obtain history from his mother looking for

features of attention deficit hyperactivity
disorder.
b. Rule out co-morbidity
c. Also obtain developmental history
48 SPMM Course
ADHD- HISTORY TAKIG

Areas of Communication- Questioning style, use of appropriate mix of

1

3 A B C D
Brief history of symptoms: Age of onset, duration,
4 Nature and severity of presenting problems, frequency, A B C D
provoking and ameliorating factors, Criteria met both at home
and at school
Hyperactivity-extreme and persistent restlessness

5 Sustained and prolonged motor activity (fidgeting, moving, A B C D
getting up and running, continually interrupting, unable to play
quietly)
Impulsiveness and difficulty in withholding responses- talking
6 excessively, blurting out answers, jumping the queue etc A B C D
Inattention symptoms; difficulty in maintaining attention,

7 Lack of persistence with tasks, easily distracted, is forgetful and A B C D
loses things for tasks.
Developmental history (prenatal, antenatal history, early

8 milestones, early temperamental characteristics, past illness, A B C D
separations, hospitalisations, schooling history-ease of
attendance and educational progress)
Rule out co morbidity (conduct disorder, antisocial behaviour,
9 Tic disorders, Autistic spectrum disorders, Learning disability, A B C D
depression etc)


GLOBAL RATIG
A B C D
49 SPMM Course
CHILD PSYCHIATRY
Laura is an eight-year-old girl referred to the

outpatient clinic, by her GP with worsening
school performance. Her mother is extremely
concerned about her.
Speak to her mother Ms. Sarah Cohen with a

view of identifying her presenting problems and
explore possible reasons behind it.
50 SPMM Course
EXPLORATIO OF PROBLEM BEHAVIOUR- EURECTIC

CHILD
1
Professionalism, body language, Establishing rapport

3 A B C D
History of presenting complaints, Mode of onset,
4 Duration etc A B C D
Change in Behaviour at School

5 (Socially anxious, worsening school performance) A B C D
Change in Behaviour at home

6 (Not her usual self, Moodiness, social withdrawal etc) A B C D
Enuresis-nature and frequency

7 Duration (diurnal & nocturnal) A B C D
Exploration of Possible causes

8 (Sibling rivalry-Birth of her sister, Father spending more time A B C D
with elder brother etc)
Rule out physical causes for presentation

9 A B C D
Range and depth of history explored, Range and depth of

11 enquiry into symptoms, Significant omissions. A B C D
GLOBAL RATIG
A B C D
51 SPMM Course
CHILDHOOD SEXUAL ABUSE
You are assessing a 14-year-old girl in the A& E

department who has taken an overdose of
paracetamol tablets. Whilst assessing her, she
showed a paper in her hand saying ‘RAPE’ and
discloses that her stepfather has been sexually
abusing her. Her stepfather was seated in the
waiting room. How would you proceed?
Discuss how you would manage this situation

with the consultant.
52 SPMM Course
CHILDHOOD SEXUAL ABUSE- MAAGEMET

Areas of Communication, fluency of interview and body language

Concern Listening & responding appropriately to interviewee A B C D
1
Professionalism including but not limited to harmful interaction
2 A B C D
Acknowledge-serious issue, Take as much history as possible,
3 Also not to contaminate evidence A B C D
Inform child-about necessity to break confidentiality
4 And share information with colleagues A B C D
Short term: Medical Treatment for overdose,
5 Referral to social worker, child protection officer, police if A B C D
needed, To inform-parental responsibility
Child to be accompanied & supported
Assess mental state of the child

6 Risk: Ongoing suicidal thought, plans A B C D
Risk of other siblings at home
Offer admission to hospital- Paediatric ward or child psychiatric

7 unit for further assessment and monitoring. A B C D
In the intermediate and long term: Social services to conduct a
8 full investigation (SW- Emergency protection order, care order A B C D
if there are imminent risks involved), Network meetings,
Press charges against the perpetrator if needed
Further mgt for child; Counselling, Psychotherapy and support

9 Also seek senior colleague support and discuss with lead A B C D
consultant for child abuse issues

GLOBAL RATIG
A B C D
53 SPMM Course
PUERPERAL DISORDER
TASK
Miss. Nicola Palmer is a 21-year-old lady who was

admitted to the maternity ward. She delivered a boy baby
five days ago and was discharged three days after the
delivery.
She re-admitted herself at the early hours of this morning in

a distressed state complaining of feeling anxious and
frightened that something terrible is going to happen to her
baby.
There are no concerns obstetrically. The obstetrician

requested for psychiatric assessment.
Assess her mental state and perform risk assessment.
54 SPMM Course
POST PARTUM PSYCHOSIS

1

3 A B C D
Elicit mode of onset, Duration and Reasons for
4 Presentation A B C D
Assess relationship with the baby, partner and previous

5 children, Undue concerns and anxieties about the baby A B C D
MSE: Features of puerperal psychosis

6 (Paranoia, hallucinations, Delusional ideas about the baby, A B C D
Other psychotic symptoms)
MSE: Guilt feelings, Negative Thoughts-Worthless mother

7 Cognitive functions, insight A B C D
Risk assessment- Suicidal thoughts and plans

8 Infanticidal thoughts, Risk of absconsion, non-compliance A B C D
Degree of support network, ? Misfortunes if any

9 (Support from family and partner) A B C D
Past history - (Personal history, family history etc)
Range and depth of history explored, Range and depth or risk

11 explored, Significant omissions A B C D
GLOBAL RATIG
A B C D
55 SPMM Course
EUROSIS- HISTORY TAKIG
Mrs. Sandra Luckett is a 42-year-old lady

who is extremely concerned about her
brother’s mental state and requested for an
outpatient appointment to review him. She
has requested you to see her first before you
see Mr. Luckett.
Obtain collateral history from her to arrive

at a diagnosis.
56 SPMM Course
POST COCUSSIOAL SYDROME- HISTORY TAKIG


Concern open & closed qns and fluency of interview A B C D
1
Professionalism, body language and establishing rapport

3 A B C D
Establish history of head injury and details of the incident-
4 nature and extent of injury (closed or open injury), severity A B C D
(mild or severe),
? Impairment of consciousness
Psychological symptoms- Sx of anxiety, fear of permanent brain

5 damage, sleep disturbance, depression, irritability, reduced A B C D
tolerance to stress, loss of self-esteem, Hypochondriacal
symptoms etc
Physical symptoms- Headache, dizziness, fatigue, poor

6 concentration, impairment of memory and insomnia (duration A B C D
and severity of symptoms)
Impact on current functioning (social, occupational & family)

7 Vulnerability factors- past psychiatric history and family A B C D
history, Personality
? Compensation motives
8 Embark on a search for diagnosis and cure & adoption of a A B C D
permanent sick role
Lack of clear structure, Depth of enquiry into symptoms,

GLOBAL RATIG
A B C D
57 SPMM Course
PSYCHOSIS- Explanation
Mr. Peter Hill is a 19-year-old university student, who is

currently an in-patient on your ward and was admitted few
days ago with bizarre behaviour, persecutory delusions and
auditory hallucinations.
He is recovering from his first episode of schizophrenia and

is being treated with Olanzapine. His mother is angry to
know from the nurses that he has schizophrenia.
Ms. Linda Hill wants to discuss with you to find out more
information about Peter’s illness and outcomes of his
condition
58 SPMM Course
SCHIZOPHREIA-EXPLAATIO

Areas of Communication- Avoid Jargons/false information, False

Concern reassurance, fluency of interview, A B C D
1
Professionalism, Body language and establish rapport

3 Calming down angry relative assertively A B C D
Explain nature of the illness and clinical presentation

4 A B C D
Causal explanation and alleviate guilt
5 (Multifactorial-family history, Chemical imbalance, A B C D
Stress,? Sparked off by illicit drugs etc)
Address concerns-
6 1. Caused by parents A B C D
2. Violent behaviour
3. ? Split mind
Medication-Olanzapine- Discuss Efficacy and side effects
7 Duration of treatment A B C D
Explain prognosis,
8 Worries about son getting back to normal life A B C D
Support –MDT, CMHT, CPN etc

9 Sources of information-Information leaflets and website A B C D

Prioritisation, recognition of importance and appropriateness of

11 information delivered and or management A B C D
GLOBAL RATING A B C D
59 SPMM Course
BORDERLIE PERSOALITY DISORDER
ISTRUCTIOS TO CADIDATE:
Miss. Sarah Cohen is a 23-year-old woman who

was admitted to the ward with a history of low
mood.
She has history of recurrent episodes of

deliberate self-harm and is considered to have a
‘difficult personality’ by the nurses. She has not
yet had a formal diagnosis.
Your consultant would like you to obtain more

history from her to arrive at a diagnosis.
60 SPMM Course
BORDERLIE PERSOALITY DISORDER-HISTORY TAKIG


Concern- open & closed qns, Listening & responding appropriately A B C D
1
2 Fluency of interview, A B C D

3 A B C D
Analysis of problems A B C D
4
Affective instability & Chronic feelings of emptiness

5 A pattern of unstable and intense Interpersonal relationships A B C D
Impulsivity & recurrent suicidal Behaviour, gestures or

6 threats, (History of DSH), Inappropriate intense anger A B C D
Frantic efforts to avoid Real or imagined abandonment,
Identity disturbance; unstable Self-image or sense of self,

7 Lack of achievable goals, H/O abuse A B C D
Transient stress related paranoid Ideation or quasi-psychotic
experiences
Risk assessment
8 (Self-harm, violence etc) A B C D
Past psychiatric history and personal history

9 Rule out Co-morbidity (Depression, substance misuse etc) A B C D
Depth of enquiry into symptoms, Lack of structure,

GLOBAL RATIG
A B C D
61 SPMM Course
ATIDEMETIA DRUGS
Mr.Smith was diagnosed with Alzheimer’s

disease and all necessary investigations are now
completed. His MMSE score was 19/30.
You are seeing him in the memory clinic and

decided to start him on Rivastigmine (Exelon).
His brother wants to discuss more about the
drug. Address his concerns
62 SPMM Course
ATIDEMETIA DRUGS- DISCUSSIO

Areas of Fluency and style of interview, Body language,

Concern Establishing rapport, Professionalism A B C D
1
Communication- (Simple terms, avoiding medical jargons,

3 Not providing false information, Avoid false reassurance) A B C D
Explain the rationale for starting this drug

4 Mechanisms of action A B C D
Duration and efficacy of treatment (50%)

5 A B C D
Describe side effects (GI side-effects)
6 A B C D
Monitoring and follow-up (memory clinic, MMSE, CPN
7 support) A B C D
Concerns- Cardiac condition- ECG, Seek advice from

8 specialists A B C D
Other concerns-? Expensive

9 ? Addictive potential A B C D
Sources of information-
10 Leaflets, web sites A B C D
Appropriateness of information provided, Significant omissions,

GLOBAL RATIG
A B C D
63 SPMM Course
DEMETIA COLLATERAL HISTORY AD COUSELLIG
FIRST STATIO:
Obtain Collateral history from Mr. White whose 81-year-

old wife was referred to you by her GP as she has problems
with her memory for the last one year.
• Assess her for cognitive difficulties in detail

• Assess her functional abilities
• Perform Risk assessment.
64 SPMM Course
ALZHEIMER’S DEMETIA- ASSESSMET

1
3 A B C D
Presenting problems: Onset, duration, severity and progression
4 A B C D
Cognitive symptoms: Short term; long term memory, Attention,
5 concentration, orientation, Intermittent confusion etc A B C D
Cognitive symptoms; Language/communication difficulties,

6 Visuospatial difficulties, Recognition, naming, Reading, writing A B C D
etc
Functional abilities- Personal ADLs,
7 Domestic ADLs & Community ADLs A B C D
Risk assessment: Self neglect, self harm, aggression, wandering,

8 Carer’s strain A B C D
Risk assessment:
9 Accidental self harm, Fire risk, falls, driving, exploitation, non A B C D
compliance with medications
Range and depth of risk explored,


11 Significant omissions, A B C D

GLOBAL RATIG
A B C D
65 SPMM Course
DEMETIA- HISTORY TAKIG

Obtain Collateral history from Mr. Steve White

whose 81-year-old elder brother Mr. Alfred White
was referred to you by his GP for Psychiatric
assessment. He has history of memory loss and he
appears to have visual hallucinations.
Obtain history to arrive at a diagnosis.
66 SPMM Course
LEWY BODY DEMETIA- HISTORY TAKIG

1
3 A B C D
History of presenting problems
4 Onset, duration, severity and progression A B C D
Features of LBD-Cognitive impairment, fluctuating levels of

5 consciousness A B C D
Parkinson’s disease- History, physical signs, medication history,

6 functional disabilities caused, recurrent falls, Neuroleptic A B C D
sensitivity
Explore visual hallucinations (nature, content, source, timing,

7 reality with which they are experienced) , rule out other A B C D
perceptual abnormalities
Explore paranoia and rule out other Psychotic Sx

8 A B C D
Risk assessment: Self-neglect, falls, Care giver’s strain
9 A B C D
Lack of clear structure, Lack of appropriate focus on the task
10 Range and depth of psychopathology explored A B C D

GLOBAL RATIG
A B C D
67 SPMM Course
DEMETIA
Mr. Williams is a 66-year-old gentleman

referred to you by his GP as he is behaving out
of character and has shown significant
deterioration in his behaviour and mental state.
a. Obtain collateral history from Mr. Brown,

who is his live in carer to identify the
features of Fronto-temporal dementia.
b. Perform appropriate risk assessment
68 SPMM Course
DEMETIA - HISTORY
Obtain Collateral history from Mr. Brown whose

70-year-old wife was referred to you by her GP
as she has problems with her memory for the last
two years.
Obtain detailed history to arrive at a diagnosis
69 SPMM Course
VASCULAR DEMETIA- HISTORY TAKIG


1

3 A B C D
Mode of onset, duration and progression of symptoms
4 Further exploration of presenting symptoms A B C D
Cognitive symptoms (Short term; long term memory

5 Orientation, Intermittent confusion) A B C D
Other cognitive difficulties-Language difficulties

6 Visuospatial difficulties, recognition, reading, writing etc A B C D
Functional abilities- ADL skills

7 Psychological, behavioural symptoms (Depression, anxiety, A B C D
irritability, aggression)
Physical Symptoms- (Incontinence, gait disturbance, sensory &

8 Motor deficits, aphasia, parkinsonian movements) A B C D
Medical Hx (DM, HT, Heart disease, high cholesterol etc)

9 & Medications (Aspirin, statins, warfarin etc) A B C D
Personal and family history
Risk assessment (Falls, aggression, wandering, Non-

10 compliance) A B C D

11 Analysis of problems, Lack of clear structure A B C D
GLOBAL RATIG
A B C D
70 SPMM Course
OLD AGE PSYCHIATRY
INSTRUCTIONS TO CANDIDATES:
Mr. Paul Green is a 70-year-old gentleman

with a history of low mood and poor sleep. He
was detained under the mental health act and
admitted last night.
He has been depressed for the last six months

since he witnessed a fire accident in his
neighbour hood and can’t take it any more.
a. Take an appropriate history aiming to

identify features of psychotic depression.
b. Examine the patient to establish what
abnormal belief he holds.
71 SPMM Course
PSYCHOTIC DEPRESSIO-MSE

1

3 A B C D
Eliciting Symptoms of depression- Core Sx, Emotional,
4 Cognitive and biological Sx A B C D
Delusions of guilt and nihilistic delusions-Elicitation,

5 Exploration and clarification A B C D
Paranoid ideation and Persecutory delusions-exploration

6 Rule out other psychotic symptoms
Evaluation of falseness of beliefs and degree of conviction

7 Effects and coping A B C D
Risk assessment (Self-harm, self-neglect, Non-compliance)-

8 range and depth of risk explored A B C D

9 and appropriateness of information gathered A B C D
Range and depth of psychopathology explored, significant

10 omissions and analysis of problems A B C D
GLOBAL RATIG
A B C D
72 SPMM Course
DEMETIA
Mr. Williams is a 66-year-old gentleman with a

diagnosis of dementia and was referred by his
GP as he is behaving out of character and has
shown significant deterioration in his mental
state.
Obtain collateral history from Mr. Brown, who

is his live in carer to look for behavioural and
mood symptoms of dementia.
Also perform appropriate risk assessment
73 SPMM Course
BEHAVIOURAL AD PSYCHOLOGICAL SYMPTOMS OF DEMETIA


1
Onset, duration and progression

4 Exploration of presenting problems A B C D
Behavioural symptoms
5 (Personality changes, irritability, Agitation, Aggression, A B C D
disinhibition, withdrawn behaviour etc)
Psychological symptoms (Anxiety, depression, apathy

6 Emotional flattening, Paranoia, hallucinations etc) A B C D
Risk assessment - Self-neglect, aggression, wandering

7 A B C D
Risk assessment- Exploitation, falls, caregiver’s strain
8 A B C D
9 Range and depth of risk explored A B C D
Significant omissions, Analysis of problems
Prioritisation, Lack of structure and

GLOBAL RATIG
A B C D
74 SPMM Course
LEARIG DISABILITY- AXIOUS FAMILY
You are seeing Mr. Robert Lawrence, a 26-year-old

gentleman with mild learning disability in your
clinic. He has a history of indecent exposure. He lives
with his girl friend in a residential home who also has
mild learning disability. She is now 6 months
pregnant. Address his concerns
His father has accompanied him to the clinic today.

Explore his concerns and address his questions.
75 SPMM Course
LEARIG DISABILITY- AXIOUS PATIET AD RELATIVE

Areas of Listening and responding appropriately to interviewee/

Concern discussant A B C D
1
Management of interview/ examination including empathic
2 responses A B C D
Lack of appropriate focus on the required task

3 A B C D
Fluency of interview/examination/discussion
4 A B C D
Professionalism including but not limited to harmful interaction;
5 failure to respect individual’s rights; ethical behaviour etc A B C D
Appropriate choice of avenues of enquiry, tests or examination

6 including significant omissions A B C D
Analysis of problems and synthesis of opinions

7 A B C D


Establishing Rapport and body language

11 A B C D
GLOBAL RATIG
A B C D
76 SPMM Course
DEPRESSIO I LEARIG DISABLED PATIET
Mr. Alan Smith is a 25-year-old gentleman

with moderate degree of mental retardation,
was referred to your clinic by his CPN as he
complains of feeling low in his mood. He
has reasonably good communication skills.
Elicit features of depression and perform

risk assessment for Suicidality.
77 SPMM Course
DEPRESSIO I LEARIG DISABLED-ASSESSMET

Areas of Communication, use of simple language, Questioning style- use

Concern of appropriate mix of open & closed qns, fluency of interview A B C D
1
Brief history & Exploration of Presenting Problems-mode of

4 onset, duration and severity A B C D
Core features of depression

5 (Low mood, anhedonia, Low energy levels) A B C D
Biological features of depression

6 (Sleep, appetite, weight) A B C D
Emotional and behavioural features

7 (Social withdrawal, irritability, lack of motivation, low self A B C D
confidence and self-esteem, Worthlessness, helplessness and
guilt feelings)
Risk: Suicidal thoughts and plans, self-neglect, non compliance,

8 Agitation/aggression A B C D


GLOBAL RATIG
A B C D
78 SPMM Course
HISTORY TAKIG-EPILEPSY I LD
Mr. Martin Brown is a 30-year-old gentleman

with borderline IQ with reading and writing
difficulties. You have been asked to see him in
A&E department because he has been behaving
strangely whilst out drinking with his girl friend.
His girl friend has mentioned to him that he has

had a few ‘weird turns’ in the last couple of
months.
He also takes Dothiepin 150 mg
Take appropriate history to arrive at a diagnosis
79 SPMM Course
TEMPORAL LOBE EPILEPSY


1
Professionalism, body language, Establishing rapport

3 A B C D
Detail Description of episode (Nature, type, frequency,
4 duration) A B C D
Pre-epileptic phase- History of Aura,
5 Absences (stare blankly and become unresponsive to A B C D
commands)
Automatisms (lip smacking, chewing, swallowing movements,
6 facial grimacing, hand gestures etc) A B C D
Abnormal experiences (Illusions, hallucinations, De’javu
experiences, depersonalisation, Others)
Ictal phase: Secondary generalization and loss of consciousness,

7 Generalised tonic-clonic activity A B C D
Post ictal phase (confused, sleepy, headache, amnesia,

8 incontinence etc) A B C D
Past history (incl febrile seizures), head injury etc

9 Medical conditions, Medications, recreational drugs, alcohol etc A B C D
Family history of seizures
Risk assessment- Driving, operating dangerous machinery
10 A B C D
11 Depth of Enquiry into symptoms A B C D

GLOBAL RATIG
A B C D
80 SPMM Course
LEARIG DISABILITY
TASK
You are in the learning disability outpatient clinic.

Mr. Daniel Benjamin, who is also the manager of the
Seven seas care home, attends your clinic with Ms.
Pauline Baker who suffers from severe Learning
disability with poor communication skills.
Mr. Benjamin mentioned that the care staffs at home

are finding it increasing difficult to cope with his
challenging behaviour at the care home.
Elicit more history, to identify possible cause of

challenging behaviour and explain it to him briefly
81 SPMM Course
CHALLEGIG BEHAVIOUR- HISTORY TAKIG


1

3 A B C D
Brief history of symptoms & exploration of presenting
4 complaints-Mode of onset, duration, frequency, severity, A B C D
possible triggers.
Exclusion of psychiatric disorder

5 (Sx of Depression, psychosis) A B C D
Exclusion of physical disorder and medication-induced

6 (Infection, pain, constipation etc) A B C D
Assmt of physical Impairment (vision, hearing, mobility)

7 Communication difficulties/Cognitive impairment A B C D
Identification of environmental And social factors

8 (Changes in carers, homes etc) A B C D
Explain reasons to carer (Multifactorial-change in carers,

9 Chest infection, Medication-induced, Communication A B C D
Difficulties etc)


GLOBAL RATIG
A B C D
Additional comments
82 SPMM Course
PHYSICAL EXAMIATIO
Mr. Brown is a 30-year old gentleman who is a

known alcoholic for several years and was admitted
to the ward this morning for alcohol detoxification.
He has not yet had a physical examination. The blood
tests done by GP prior to his admission show raised
MCV and deranged LFTs
1. Given his history, enquire about features of

alcohol withdrawal symptoms.
2. Look for features of classical Liver
stigmata.
3. Also perform other appropriate examination
that might be relevant
Explain to the examiners what you are looking for?
83 SPMM Course
PHYSICAL EXAMIATIO- ALCOHOL WITHDRAWAL

Areas of Communication, giving clear instructions,

Concern Questioning style, establishing rapport A B C D
1
2 Listening & responding appropriately to interviewee, obtaining A B C D
informed consent
Ensuring privacy, body language, Professionalism and gentle

3 handling, A B C D
Alcohol withdrawal symptoms-elicit 2 or 3

4 (Anxiety, tremors, palpitations, hangover Effects etc) A B C D
Look for features of classical Liver stigmata

5 (Jaundice, Spidernaevi, Gynaecomastia, Abdominal distension, A B C D
caput medusae etc
General examination- Examination of hands, eyes, skin
6 (Leuconychia, clubbing, palmar erythema, Asterixis, A B C D
Dupuytren’s contracture, Icterus, pallor, nystagmus)
Cardiovascular examination- (Pulse, Blood pressure-to be

7 mentioned, Peripheral oedema and precordial examination) A B C D
Abdominal examination
8 (Ascites, hepatomegaly, asymmetry) A B C D
Neurological examination (Check Tone, power, reflexes,

9 Tremors, co-ordination and gait) A B C D
Worth mentioning higher cortical
Functions-orientation & memory
Range and depth of tasks performed,

11 Significant omissions A B C D
GLOBAL RATIG
A B C D
84 SPMM Course
INSTRUCTIONS TO CANDIDATE:
Mr. John Murphy is a 43-year-old divorced

gentleman with a history of severe alcohol
dependence. He has not been drinking for 2
months but feels a little unsteady in walking and
clumsy when using his hands. He also has
history of facial nerve palsy in the past.
A recently performed CT brain scan showed

evidence of cerebellar atrophy.
a. Perform physical examination looking for

features of cerebellar dysfunction.
b. Also examine him for features of facial

nerve palsy (7th cranial nerve)
85 SPMM Course
PHYSICAL EXAMINATION- CEREBELLAR SIGNS AND FACIAL NERVE

EXAMINATION


Concern Questioning style, establishing rapport A B C D
1
2 Listening & responding appropriately to interviewee, Obtaining A B C D
informed consent
Ensuring privacy, body language, Professionalism and gentle

3 handling, A B C D
Facial nerve Examination

4 (Sensory and motor components) A B C D
Cerebellar signs
5 Eye signs (nystagmus) and Hands (intention tremors) A B C D
Cerebellar signs
6 (Alternating movements-Dysdiadochokinesia A B C D
And dysarthria-staccato speech)
Co-ordination: Finger-Nose test,

7 Heel-shin test A B C D
Gait-examination (Ataxic gait-with eyes open and closed)

8 A B C D
Motor examination (Tone, Power and reflexes)
9 A B C D
Range and depth of tasks performed,

11 Significant omissions A B C D
GLOBAL RATIG
A B C D
86 SPMM Course
NEUROLOGICAL EXAMINATION
Instructions to the candidate:
Mr. Lawrence was admitted informally to the

ward this morning with a diagnosis of
depression and somatisation disorder.
He complains of numbness and tingling
sensations in his right upper limb for the last
4 weeks.
Perform both sensory and motor

examination in his upper limb and rule out
any neurological deficits.
87 SPMM Course
PHYSICAL EXAMIATIO-SESORY AD MOTOR EXAMIATIO


Concern Questioning style, Establishing rapport A B C D
1
Ensuring privacy, body language, Professionalism,

3 A B C D
General Examination
4 (Nails, hair, joint pathology, pulse) A B C D
Inspection and palpation

5 (Posture, deformity, wasting, scars, swelling A B C D
Temperature, Limb girth measurement)
Sensory examination
6 (Lateral column-Pain, Temperature) A B C D
Sensory examination
7 (Dorsal Column-Touch, Vibration, positional sense) A B C D
Motor examination
8 (Tone and Power-flexors at elbow, wrist Flexors, deltoid, A B C D
biceps, triceps, Thumb extensors and opposition)
Motor examination
9 (Reflexes-Biceps, Triceps and supinator) A B C D
Motor examination- (Tremors, Co-ordination

10 Finger-nose test) A B C D
Range and depth of tasks performed,, Significant omissions

GLOBAL RATIG
A B C D
88 SPMM Course
PHYSICAL EXAMIATIO
ISTRUCTIOS TO THE CADIDATE
Mr. Ronald suffers from bipolar affective disorder

and is currently on lithium carbonate 1000 mg. Over
the last six months he has been feeling increasingly
tired and lethargic. His blood tests reveal Low T3, T4
and raised TSH Levels.
Elicit possible symptoms and signs of thyroid

dysfunction. Perform appropriate clinical
examination.
Do not take history of bipolar disorder
89 SPMM Course
THYROID EXAMIATIO-PHYSICAL EXAMIATIO


Concern Questioning style- use of appropriate mix of open & closed qns, A B C D
1
Ensuring privacy, body language, Professionalism, establishing

3 rapport A B C D
To check for symptoms of hypothyroidism

4 (At least 3 of them) A B C D
General Examination
5 Hands, Nails, Pulse rate and tremors A B C D
Examination of Eyes (Lid Lag. Lid Retraction, Exophthalmos)
Inspection- Swelling on swallowing

6 Scars, sinuses, engorged veins, pulsations A B C D
Palpation (Confirm inspection findings)

7 Feel for trachea, cervical lymph nodes A B C D
Carotid pulsations, Lahey’s method of examination
Percussion and auscultation

8 Thyroid bruit and carotid bruit A B C D
Reflexes for ankle jerk and

9 Pretibial myxoedema A B C D

10 Range and depth of tasks performed,, Significant omissions A B C D
GLOBAL RATIG
A B C D
90 SPMM Course

Simple Casc Tasks and Feedback Forms

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2009

SIMPLE CASC TASKS A D FEEDBACK FORMS PAGE UMBER

INSTRUCTION TO THE CANDIDATE:

Mrs. Howard is a 37-year-old schoolteacher referred

a. Obtain history to arrive at a diagnosis

POST TRAUMATIC STRESS DISORDER-HISTORY TAKI G

ame of the candidate:

A- Good pass B-Borderline pass C-Borderline fail D-Fail

Areas of Questioning style- use of appropriate mix of open & A B C D

Management of interview including empathic responses, A B C D

3 Professionalism, establishing rapport, body language A B C D

Details of the traumatic accident- nature and extent of the A B C D

Hyper arousal Symptoms A B C D

Intrusions (flashbacks, nightmares, A B C D

Avoidance and emotional detachment A B C D

Rule out co-morbidity, coping strategies A B C D

Range and depth of history explored, Significant A B C D

The GP has referred Mrs. White, 35-year-old woman

Take an appropriate history to assess whether this is

GRIEF REACTION-HISTORY TAKING

ame of the candidate:

Areas of Questioning style- use of appropriate mix of open & closed

Professionalism, Communication, body language, establishing

Features of grief reaction

Features of grief reaction

Atypical grief reaction-features

Atypical grief reaction-features

Range and depth of history explored, Significant omissions,

BREAKI D BAD EWS

Mr. Green is a 64-year-old gentleman

His MRI scan showed metastatic brain

You want to break this news to his daughter,

BREAKI G BAD EWS

ame of the candidate:

Areas of Ice breaking non-medical comments

Genuine Empathy, allowing time for the news

Body language, Reassure in verbal and non-verbal ways

Involvement and support from the

Range and depth of information covered, Significant omissions,

EATI G DISORDER-HISTORY TAKI G

You are asked to see Ms. Rose, a 21-year-old medical

The GP was concerned about her diabetic control and

a. Elicit history to arrive at a dignosis.

BULIMIA ERVOSA-HISTORY TAKI G

ame of the candidate:

Persistent Preoccupation with eating, irresistible food craving

Measures taken to lose weight - Avoidance of foods/fluids

Lack of clear structure,

Range and depth of history explored, Significant omissions,

Mr. Mark Wallace is a 28-year-old

His manager referred him for psychology

Assess him to identify presence of cognitive

ADDRESSI G COG ITIVE ERRORS A D EGATIVE THOUGHTS

ame of the candidate:

Areas of Communication- simple terms, avoiding jargons, A B C D

Management of interview including empathic A B C D

Professionalism, Establishing rapport, A B C D

History of presenting problems, duration and impact on A B C D

Explore and elicit examples of 'maximisation' and A B C D

Explore and elicit examples of personalisation and A B C D

Explore and elicit examples of dichotomous thinking A B C D

Lack of structure, Fluency and focused history taking A B C D

Significant omissions, Analysis of problems and A B C D

Mr. Paul Andrew is a 40 YO gentleman who suffers

SIMPLE CASC TASKS AD FEEDBACK FORMS PAGE UMBER

POST TRAUMATIC STRESS DISORDER-HISTORY TAKIG

BREAKID BAD EWS

BREAKIG BAD EWS

EATIG DISORDER-HISTORY TAKIG

BULIMIA ERVOSA-HISTORY TAKIG

ADDRESSIG COGITIVE ERRORS AD EGATIVE THOUGHTS

PAIC DISORDER-HYPERVETILATIO SYDROME-DISCUSSIO

COGITIVE BEHAVIOURAL THERAPY-DISCUSSIO

PSYCHODYAMIC PSYCHOTHERAPY

PSYCHODYAMIC PSYCHOTHERAPY

OPIOD MISUSE- HISTORY TAKIG

PHYSICAL EXAMIATIO

EXTRAPYRAMIDAL SIDE-EFFECTS-EXAMIATIO