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

Summary

In this mental health assessment, Dr. Jade meets Sarah, a 54-year-old woman with a history of schizophrenia. Sarah presents with extreme paranoia, believing her support workers are imposters trying to poison her. She reports hearing derogatory voices commenting on her behavior, adding to her distress. Despite her fear, Sarah denies self-harm or harm towards others. Throughout the interview, Sarah shows signs of anxiety and a lack of insight into the deterioration of her mental health. The assessment highlights her ongoing struggle with delusions and the impact on her ability to eat or trust others.

Takeaways

• 😀 Sarah, a 54-year-old woman with schizophrenia, is concerned that her support workers are imposters trying to poison her.
• 😀 Sarah presents with paranoid and persecutory delusions, believing that people want to harm her without understanding why.
• 😀 She reports auditory hallucinations, specifically hearing derogatory voices commenting on her behavior.
• 😀 Sarah denies any thoughts of self-harm or harming others, but she does express fear of the imposters and feels they need to be stopped.
• 😀 She exhibits limited insight into her condition and does not recognize that her experiences may be related to a deterioration in her mental health.
• 😀 Sarah is oriented to time, place, and person, but her delusions and hallucinations significantly impact her daily functioning.
• 😀 Her delusional beliefs about being poisoned have led her to avoid eating food provided by others, relying on pre-packed meals.
• 😀 Despite her concerns, Sarah believes the pre-packed food may also be tampered with, which reflects the depth of her paranoia.
• 😀 The psychiatric assessment highlights a need for a secure and supportive environment to address her mental health needs and ensure her safety.
• 😀 The multidisciplinary team should consider pharmacological management and continuous monitoring of Sarah's nutritional status, given her limited intake due to delusional beliefs.

Q & A

What is the main reason Sarah sought help from the mental health team?

Sarah sought help due to concerns about her safety at home. She believes that her support workers have been replaced by imposters who are attempting to poison her.

How did Sarah describe her emotional state during the assessment?

Sarah described feeling very stressed and worried. She appeared visibly anxious and disheveled, with a monotonous speech pattern during the assessment.

What delusions did Sarah express during the conversation?

Sarah expressed paranoid, persecutory delusions, believing that staff members had been replaced by imposters and were trying to poison her. She also had concerns about thought broadcasting.

Did Sarah mention any suicidal or violent thoughts?

No, Sarah denied having any thoughts of self-harm or harming others. She stated that although the imposters needed to be stopped, she would never harm anyone.

What auditory hallucinations did Sarah report experiencing?

Sarah reported hearing voices that provided a running commentary on her behavior, making derogatory comments about her. She was responding to these voices during the assessment.

Was Sarah aware of her surroundings during the assessment?

Yes, Sarah was oriented to time, place, and person. She accurately identified that she was in the hospital and correctly named the day of the week and the approximate time.

How did Sarah react when asked about the cause of her mental health issues?

Sarah expressed that she did not understand why the imposters wanted to kill her, but she firmly believed that they were out to get her. She did not consider that her symptoms might be related to a deterioration in her mental health.

What impact might Sarah's delusional beliefs have on her health?

Sarah's delusional beliefs may be affecting her nutritional status, as her limited oral intake is due to her belief that her food and drink are poisoned. This could potentially lead to malnutrition.

What steps did Sarah suggest to ensure her safety?

Sarah requested that the imposters be taken away and imprisoned, and she asked for a safe space in the hospital, as she believed she could not return home due to the risk of being poisoned.

How did Sarah manage her food and drink due to her fears?

Sarah reported that she consumes pre-packed food and drinks to avoid being poisoned. However, she remains fearful that the imposters might find a way to tamper with these items.