Exploring Delusions — Primary vs Secondary, and Risk Assessment: Mrs Margaret Hughes, 60 — CASC Station 3.53 (Mental State Examination)

MRCPsych CASC Mental State Examination station: Exploring Delusions — Primary vs Secondary, and Risk Assessment: Mrs Margaret Hughes, 60. You are a…

Category: Mental State Examination · Chapter 3: Clinical Scenarios & Communication

Candidate brief

You are a psychiatry registrar working in the Section 136 mental health assessment suite. Mrs Margaret Hughes, 60, was brought in an hour ago by police after…

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More Mental State Examination stations

• 3.16 Autism vs Schizophrenia — MSE, Exploration of Behavioural Change, and Differentiating ASD Traits from Psychotic Features
• 3.25 Schizophrenia in a Forensic Unit — Mental State Examination and Risk Assessment of a Patient with Paranoid Delusions and Stated Intent to Harm
• 3.28 Mental State Examination — Acute Psychosis with Persecutory Delusions and Auditory Hallucinations (The Postman)
• 3.29 Mental State Examination — Acute Mania with Grandiose Delusions (Madonna is My Sister)
• 3.31 Mental State Examination — Delusional Disorder (Government Chip Implanted via "The Tube Test"; Significance of 666)
• 3.51 Mental State Examination — Mr Miller, 35, Referred with Possible Psychotic Symptoms

Other stations in Chapter 3

• 3.1 Assessing Suitability for IPT (Interpersonal Psychotherapy)
• 3.2 Antenatal Mental Health Review — Quetiapine and Gestational Diabetes
• 3.3 Clozapine Discussion in Treatment-Resistant Schizophrenia
• 3.4 Informing and Reassuring an Angry Relative About a Schizophrenia Diagnosis
• 3.5 Exploring Therapy Termination — Patient Wanting to Leave Psychotherapy Following Therapist's Leave of Absence
• 3.6 Perinatal Risk Assessment — Domestic Abuse and Disrupted Family Relationships
• 3.7 Collateral History from Spouse — Vascular Dementia
• 3.8 Reassuring an Anxious Patient with Normal Cognitive Testing — Memory Concerns Without Dementia
• 3.9 Acute Psychosis and DVLA — Addressing Driving Concerns After a Psychotic Episode
• 3.10 Hyperprolactinaemia on Olanzapine — Focused History, Explaining Results, and Holistic Management
• 3.11 Postpartum Psychosis — Assessing Nature and Severity of Symptoms and Risk in a Mother Who Believes Her Baby Is Possessed
• 3.12 Lewy Body Dementia — Devising a Management Plan with the Grandson Following New Behavioural Changes
• 3.13 Dementia and Depression in Down Syndrome — Collateral History from Mother and Arriving at an Explanation
• 3.14 Self-Harm History and Risk Assessment — First-Time Wrist Cutting in a University Student Under Academic and Financial Stress
• 3.15 Conversion Disorder (Functional Neurological Symptom Disorder) — History of Presenting Complaint and Social History
• 3.17 Schizophrenia and Employment Loss — Explore Changes After Employer Conflict, Risk Assessment, and Management Plan
• 3.18 Alzheimer's Disease — Genetic Risk Counselling for the Adult Child of a Newly Diagnosed Patient
• 3.19 Adult ADHD — Explaining Diagnosis and Discussing a Comprehensive Management Plan
• 3.20 Mental Capacity Assessment — Starting Sertraline in a Depressed Man with Learning Disability
• 3.21 SSRI Sexual Dysfunction — Explore the Patient's Reasons for Stopping Medication and Assess Aetiological Factors
• 3.22 Anorexia Nervosa — Discussing Prognosis with a Relative: Favourable and Unfavourable Prognostic Factors Including Personality Traits
• 3.23 Schizophrenia — Discharge Planning Discussion with the Mother of a Patient Who Assaulted Her: Psychoeducation, Expectations, and Safety Plan
• 3.24 Elderly Depressed Patient with Alcohol Use — History-Taking to Explore Reasons for Weight Loss
• 3.26 Lewy Body Dementia — Neurological Examination Focused on Parkinsonism
• 3.27 Family Dynamics and Highly Expressed Emotion — History-Taking with a Carer and Introduction to Family Intervention
• 3.30 Somatic Symptom Disorder with Predominant Pain — History-Taking (Do Not Discuss Diagnosis)
• 3.32 Lewy Body Dementia with Learning Disability — Explaining the DATscan Result and Biopsychosocial Management to the Patient's Sister
• 3.33 First Episode Psychosis — Biopsychosocial Management Discussion with the Patient's Mother (Olanzapine Side Effects, High Expressed Emotion, and Social Losses)
• 3.34 Forensic Risk Assessment — Indecent Exposure (Exhibitionistic Disorder)
• 3.35 Delirium Superimposed on Lewy Body Dementia — Informant History from Nursing Staff, Coming to the Diagnosis (UTI, Bereavement, Fall, Aggression)
• 3.36 Opioid Use — Comprehensive Drug History and Associated Risk Assessment
• 3.37 Alcohol History — Social Impact Assessment and Insight/Motivation (Marital Crisis, Wife's Ultimatum)
• 3.38 PTSD History-Taking — Ex-Combat Veteran, Afghanistan (IED Incident, Survivor Guilt, Moral Injury)
• 3.39 Panic Attacks and Social Avoidance — History-Taking and Diagnosis Delivery (Best Man Speech, Wedding in Six Weeks)
• 3.40 Paedophilic Disorder — Risk Assessment (Voluntary Disclosure to Police; Babysitting Incident; Pre-Contact Presentation)
• 3.41 Heroin Dependence — History-Taking and Risk Assessment (IV Use, Three Overdoses, HCV, Pregnant Partner, Harm Reduction)
• 3.42 Displacement Reaction — Occupational Agitation Secondary to Suspected Marital Infidelity
• 3.43 Neuroleptic Malignant Syndrome — Explaining the Diagnosis and Management Plan to a Patient's Father
• 3.44 Hypochondriasis — Explaining the Diagnosis and Treatment to a Patient's Girlfriend
• 3.45 Post-MI Depression and Cardiac Rehabilitation — Teaching a Medical Student
• 3.46 Alcohol Withdrawal Delirium — Liaison Discussion with an Orthopaedic Nurse
• 3.47 Anorexia Nervosa — Explaining the Diagnosis and Treatment to a Patient's Mother
• 3.48 Puerperal Psychosis Prophylaxis — Pre-Birth Counselling at 36 Weeks
• 3.49 Medically Unexplained Cardiac Symptoms — History, Vulnerability, and Allaying Anxiety
• 3.50 CAMHS Developmental History — Thomas, Age 8, with Aggressive Behaviour
• 3.52 Dissociative Stupor — Brief History from Mother and Explanation of Diagnosis
• 3.54 Clozapine, Discharge Concerns, and Safeguarding — Talking to Daniel Carter's Angry Mother
• 3.55 Delusions of Guilt in Late Life — History from Mrs Dorothy Hawkins, 73
• 3.56 Suicide Risk Assessment After Overdose — Ms Sophie Ahmed, 22, Third ED Presentation in 10 Days
• 3.57 Psychosocial Treatments for Negative Symptoms and Depression — Miss Brown, 31
• 3.58 Post-Bereavement History and Formulation — Mrs. Margaret Brown, 53
• 3.59 Weight Gain — Psychosocial History and Motivation to Change
• 3.60 Lithium Augmentation — Explanation and Discussion
• 3.61 Electroconvulsive Therapy — Explanation and Discussion
• 3.62 Bipolar Affective Disorder — Diagnosis and Management Plan
• 3.63 Mental Capacity Assessment and Best Interests — Collateral: Support Worker
• 3.64 Morbid Jealousy — Diagnosis, Risk, and Management — Collateral: Partner
• 3.65 Paracetamol Overdose — History, Risk Assessment, and Discharge Decision — Aisha Khan, 16
• 3.66 Clozapine-Induced Metabolic Syndrome — Explaining Results and Management Plan
• 3.67 Erotomania — History Taking and Dangerousness Assessment
• 3.68 Refeeding Syndrome in Anorexia Nervosa — Collateral: CAMHS CPN
• 3.69 Acute Mania on PICU — Discussing Treatment Options with Nurse in Charge
• 3.70 Seclusion Review of a Dehydrated Patient — Handover from Nurse O'Brien
• 3.71 Olanzapine-Induced Weight Gain — Discussing Weight Management with a Patient

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