MRCPsych Patient Communication Skills 2 — Questions and Answers
Question 1: A patient with schizophrenia becomes agitated during an interview and starts pacing. Which de-escalation technique is most appropriate?
- Maintain close physical proximity to show support
- Lower your voice, slow your speech, and offer the patient space (Correct answer)
- Immediately call for security assistance
- Challenge the patient's perception to redirect their focus
Correct answer: Lower your voice, slow your speech, and offer the patient space
Lowering voice tone, slowing speech, and providing physical space are evidence-based de-escalation techniques for agitated patients.
Question 2: When breaking bad news using the SPIKES protocol, what does the 'K' step refer to?
- Kindness — showing empathy throughout
- Knowledge — assessing what the patient already knows
- Knowledge — delivering the bad news itself (Correct answer)
- Keeping the family informed
Correct answer: Knowledge — delivering the bad news itself
In SPIKES, 'K' stands for Knowledge — giving the patient medical facts and delivering the bad news in clear, plain language.
Question 3: A patient refuses to answer questions and sits silently. The most therapeutic initial response is to:
- End the interview and reschedule
- Ask a direct closed question to prompt engagement
- Sit quietly with the patient and tolerate the silence (Correct answer)
- Explain that you cannot help unless they cooperate
Correct answer: Sit quietly with the patient and tolerate the silence
Tolerating silence communicates acceptance and gives the patient space to engage at their own pace.
Question 4: Which approach best demonstrates the use of 'normalizing' as a communication technique?
- Telling a patient their symptoms are not serious
- Informing a patient that many people experience similar feelings (Correct answer)
- Suggesting the patient compare themselves to others
- Minimizing the impact of the patient's distress
Correct answer: Informing a patient that many people experience similar feelings
Normalizing reduces shame and stigma by conveying that the patient's experience is shared by others, without minimizing it.
Question 5: During a mental state examination, a patient uses many words but conveys little meaning. This is best described as:
- Tangentiality
- Circumstantiality (Correct answer)
- Poverty of speech
- Loosening of associations
Correct answer: Circumstantiality
Circumstantiality is characterized by overinclusiveness and excessive detail that eventually reaches the point, unlike tangentiality which never does.
Question 6: A carer asks you to withhold a diagnosis from their relative. The most appropriate response is to:
- Agree, to maintain the carer's trust
- Explore the carer's concerns while maintaining commitment to patient-centred honesty (Correct answer)
- Immediately inform the patient regardless of context
- Refer the decision to a senior colleague
Correct answer: Explore the carer's concerns while maintaining commitment to patient-centred honesty
Exploring the carer's motivations is important, but patient autonomy and the right to information must guide the ultimate approach.
Question 7: Which interview technique is most effective for eliciting a patient's health beliefs about their psychiatric diagnosis?
- Use of the mental state examination questions
- Direct confrontation of irrational beliefs
- Asking 'What do you think is causing your difficulties?' (Correct answer)
- Referring to established diagnostic criteria
Correct answer: Asking 'What do you think is causing your difficulties?'
Open-ended questions about causation directly elicit the patient's own explanatory model, informing shared treatment planning.
MRCPsych Patient Communication Skills 2
A patient with schizophrenia becomes agitated during an interview and starts pacing.
Which de-escalation technique is most appropriate?