Elicit descriptive psychopathology safely — CASC communication station · Psych CASC / OSCE

Prompt

A 29-year-old is referred after family noticed withdrawal and fear of cameras. You must elicit perceptual experiences, thought content, passivity phenomena, mood and affect, and risk without leading or colluding, then summarise findings in plain language.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in outpatient or ED assessment.[1]

Candidate instructions. Build rapport. Explore current experiences using open then focused questions. Capture form of speech/thought, content (including cameras/chip themes if offered), perceptual phenomena, possible passivity (thought insertion/broadcast), mood (quote) and observed affect, and risk (self-harm, acting on voices). Avoid leading, collusion, and humiliation. Summarise in plain language and outline next steps without dumping a diagnostic monologue. Do not invent legal section numbers.[1][2]

Candidate scenario

Your patient is 29, English-speaking, tense, soft-spoken with long latency. If asked open questions they may allude to 'people talking about me,' 'comments when I walk past the TV,' and 'thoughts put into my head.' They deny 'being mad.' No current agitation. Explore suicide gently if indicated. If spiritual explanations appear, explore respectfully.[3][4]

Marking domains

Empathy, pacing, non-stigmatising language
Open-then-focused structure covering speech/thought form, content, perception, passivity, mood/affect, cognition sample, insight, judgement
Safe elicitation without heavy leading
Risk exploration with appropriate depth
Multidimensional insight language if relevant [3]
Cultural humility if explanatory models arise [4]
Clear summary and collaborative next steps

Reveal assessor key

Open. Introduce role; explain you want to understand how things have been and how they feel today; check comfort and privacy.[1]

Observe. Grooming, eye contact, psychomotor state, speech latency/volume — feed appearance/behaviour/speech without announcing checklist domains.[1]

Thought form and content. Listen for goal-directedness vs tangentiality/derailment. Explore fears about cameras/TV; clarify conviction, distress, and cultural context before calling content delusional.[1][4]

Perception and passivity. Normalise unusual experiences; ask about hearing/seeing things others do not; for voices — content, person, commands, resistance, acting. For thought insertion — alien ownership language, not merely worry. Do not debate reality or collude.[2]

Mood and affect. Quote subjective mood; observe affect range/reactivity/congruence.[1]

Insight. What do they make of these experiences; do they need help; map awareness, relabelling, treatment attitude.[3]

Close. Summarise key findings in plain language; propose assessment next steps; safety-net; thank them.[1]

Teaching note for examiner. If candidate claims first-rank phenomena 'prove schizophrenia,' mark down — FRS are not pathognomonic.[2]

References

[1]Andreasen NC Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability Arch Gen Psychiatry, 1979.PMID 496551
[2]Nordgaard J, Arnfred SM, Handest P, et al. The diagnostic status of first-rank symptoms Schizophr Bull, 2008.PMID 17562695
[3]David AS Insight and psychosis Br J Psychiatry, 1990.PMID 2207510
[4]Lam PC, Lewis-Fernández R, Aggarwal NK The Cultural Formulation Interview: Building the Case for Cultural Competence in Clinical Care Psychiatr Serv, 2023.PMID 36722093

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in outpatient or ED assessment.[1]

Candidate scenario

Marking domains

Empathy, pacing, non-stigmatising language

Open-then-focused structure covering speech/thought form, content, perception, passivity, mood/affect, cognition sample, insight, judgement

Safe elicitation without heavy leading

Risk exploration with appropriate depth

Multidimensional insight language if relevant [3]

Cultural humility if explanatory models arise [4]

Clear summary and collaborative next steps

Reveal assessor key

Open. Introduce role; explain you want to understand how things have been and how they feel today; check comfort and privacy.[1]

Observe. Grooming, eye contact, psychomotor state, speech latency/volume — feed appearance/behaviour/speech without announcing checklist domains.[1]

Mood and affect. Quote subjective mood; observe affect range/reactivity/congruence.[1]

Insight. What do they make of these experiences; do they need help; map awareness, relabelling, treatment attitude.[3]

Close. Summarise key findings in plain language; propose assessment next steps; safety-net; thank them.[1]

Teaching note for examiner. If candidate claims first-rank phenomena 'prove schizophrenia,' mark down — FRS are not pathognomonic.[2]

References

[1]Andreasen NC Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability Arch Gen Psychiatry, 1979.PMID 496551
[2]Nordgaard J, Arnfred SM, Handest P, et al. The diagnostic status of first-rank symptoms Schizophr Bull, 2008.PMID 17562695
[3]David AS Insight and psychosis Br J Psychiatry, 1990.PMID 2207510
[4]Lam PC, Lewis-Fernández R, Aggarwal NK The Cultural Formulation Interview: Building the Case for Cultural Competence in Clinical Care Psychiatr Serv, 2023.PMID 36722093