OSCE Mental Health Assessment 3 — Questions and Answers
Question 1: An OSCE station requires you to assess insight in a patient with schizophrenia. Which response best demonstrates poor insight?
- 'I know my beliefs about the CIA are part of my illness.'
- 'I take my medication because it helps me think clearly.'
- 'There is nothing wrong with me; these doctors are the ones who are confused.' (Correct answer)
- 'I sometimes wonder if my fears are exaggerated.'
Correct answer: 'There is nothing wrong with me; these doctors are the ones who are confused.'
Poor insight is demonstrated when a patient denies having any illness, often impairing treatment adherence and prognosis.
Question 2: When performing a standardized mental health OSCE, you must distinguish between compulsions and impulsive acts. Which feature best characterizes a compulsion?
- Performed for immediate pleasure or relief
- Ego-syntonic and voluntary
- Performed to reduce anxiety despite being recognized as irrational (Correct answer)
- Associated with antisocial motivation
Correct answer: Performed to reduce anxiety despite being recognized as irrational
Compulsions are repetitive behaviors performed to neutralize anxiety, recognized as excessive or irrational by the patient.
Question 3: During a structured psychiatric interview in an OSCE, a patient demonstrates 'echolalia.' This is best defined as:
- Repetitive stereotyped movements
- Automatic repetition of the interviewer's words (Correct answer)
- Belief that external events are personally significant
- Difficulty initiating speech despite understanding language
Correct answer: Automatic repetition of the interviewer's words
Echolalia is the pathological repetition of another person's words or phrases, seen in autism spectrum disorder, catatonia, and some psychoses.
Question 4: A patient endorses low mood, anhedonia, hypersomnia, increased appetite, and leaden paralysis that consistently improves when good things happen. The most likely specifier for this depressive presentation is:
- Melancholic features
- Anxious distress
- Atypical features (Correct answer)
- Mixed features
Correct answer: Atypical features
Atypical features of depression include mood reactivity plus at least two of: hypersomnia, increased appetite, leaden paralysis, or rejection sensitivity.
Question 5: In an OSCE mental health station focused on trauma, you must assess for hyperarousal symptoms of PTSD. Which symptom cluster does NOT belong to the hyperarousal criterion?
- Irritability and angry outbursts
- Exaggerated startle response
- Intrusive flashbacks (Correct answer)
- Sleep disturbance
Correct answer: Intrusive flashbacks
Intrusive flashbacks belong to the 'intrusion' symptom cluster of PTSD, not the hyperarousal cluster.
Question 6: A 35-year-old patient describes hearing a running commentary of his actions by two voices that speak to each other. According to Schneider's first-rank symptoms, this is classified as:
- Thought insertion
- Third-person auditory hallucinations (Correct answer)
- Somatic passivity
- Delusional perception
Correct answer: Third-person auditory hallucinations
Voices discussing or commenting on the patient in the third person are Schneiderian first-rank symptoms highly suggestive of schizophrenia.
Question 7: During an OSCE station on capacity assessment, a patient with schizophrenia refuses a recommended antipsychotic. Which criterion is most important to evaluate first?
- Whether the patient agrees with the clinician's recommendation
- Whether the patient can communicate a consistent choice (Correct answer)
- Whether the patient has a legal guardian
- Whether the patient has previously been hospitalized involuntarily
Correct answer: Whether the patient can communicate a consistent choice
The ability to communicate a consistent choice is the foundational criterion; without it, the remaining capacity criteria cannot be meaningfully assessed.
OSCE Mental Health Assessment 3
An OSCE station requires you to assess insight in a patient with schizophrenia.
Which response best demonstrates poor insight?