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

Summary

Dr. Jade, a mental health professional, assesses Sarah, a 54-year-old woman with schizophrenia, who presents with delusions of being poisoned by her support workers. Sarah describes hearing derogatory voices and believes her thoughts are being broadcasted to others. Despite her extreme paranoia, she denies self-harm or harming others. Sarah’s lack of insight into her mental health deterioration and her refusal to eat food provided by others due to fears of poisoning suggest potential risks to her health. The assessment highlights the need for a safe hospital environment and further psychiatric intervention.

Takeaways

• 😀 Sarah, a 54-year-old woman with schizophrenia, presents to the emergency department with concerns of being poisoned by her support workers.
• 😀 She is anxious, disheveled, and reports feeling stressed and worried, showing signs of paranoid delusions.
• 😀 Sarah believes that the workers caring for her have been replaced by imposters who are trying to poison her.
• 😀 She is convinced that the imposters' goal is to kill her, but she doesn't know why they want to harm her.
• 😀 Sarah reports auditory hallucinations where a voice makes derogatory comments about her, such as calling her nasty and evil.
• 😀 Despite the distressing delusions and hallucinations, Sarah denies any thoughts of self-harm or harming others.
• 😀 She appears to lack insight into the fact that her symptoms are likely a result of mental health deterioration.
• 😀 Sarah denies experiencing any abnormal perceptions of the world around her or feeling as though she is not real.
• 😀 She is able to engage in the assessment and orient herself to time, place, and person, despite her delusions.
• 😀 Sarah expresses a need for protection and insists on a safe space away from the alleged imposters, suggesting she needs to be taken to a hospital or secure environment.
• 😀 The mental health assessment highlights the need for close monitoring, possible medication, and intervention to address her delusional beliefs and auditory hallucinations.

Q & A

What is Sarah's primary concern during the interview?

Sarah's primary concern is that she believes her support workers have been replaced by imposters who are trying to poison her.

How does Sarah describe the voices she is hearing?

Sarah describes hearing a single voice providing running commentary on her behavior, making derogatory comments about her, calling her 'nasty' and 'evil.'

What type of delusions is Sarah experiencing?

Sarah is experiencing persecutory delusions, believing that people, specifically her support workers, are out to harm her, and that they are trying to poison her.

Does Sarah show any signs of insight into her condition?

No, Sarah lacks insight into her condition and does not believe that her symptoms are related to a deterioration in her mental health.

How does Sarah manage her food intake despite her delusions?

Sarah avoids food provided by others, believing it to be poisoned, and relies on prepackaged food and drinks to ensure her safety.

Has Sarah ever had thoughts of harming herself or others?

Sarah denies any thoughts of harming herself or others, although she expresses a desire to stop the imposters but insists she would never harm anyone.

How does Sarah react when asked if she ever experiences abnormal perceptions like hearing or seeing things?

Sarah acknowledges hearing voices but denies experiencing any visual hallucinations or unusual sensations on her skin.

What was Sarah’s orientation during the interview?

Sarah was oriented to time, place, and person, demonstrating awareness of where she was and the time of day.

What does Sarah believe is the cause of her distress?

Sarah believes her distress is caused by the imposters trying to harm her, and she is unsure why they want to kill her.

What are the immediate concerns regarding Sarah's physical health?

The primary concern is Sarah’s limited food intake due to her belief that her food is poisoned, which could affect her nutritional status.