MBBS OSCE · Psychiatry
OSCE — Adjustment Disorders & Grief
Eight-minute OSCE station on Adjustment Disorders & Grief: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Adjustment Disorders & Grief.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Adjustment disorders are emotional or behavioural symptoms arising within 3 months of an identifiable stressor, disproportionate to the stressor and causing impairment, that do not meet criteria for another mental disorder and resolve within 6 months of the stressor (or its consequences) ending. Normal grief (bereavement) is the universal human response to loss: sadness that comes in waves, longing for the deceased, preserved self-esteem and capacity for positive memories, with gradual re-engagement in life over weeks to months. Prolonged grief disorder (PGD) — added to the DSM-5-TR in 2022 and to the ICD-11 (6B42) — is intense yearning/longing for, or preoccupation with, the deceased, plus
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Symptoms disproportionate to stressor with impairment within 3 months of identif |
| Safety | Intense yearning/preoccupation with the deceased with identity disruption, meani |
| Safety | Bereaved person with pervasive anhedonia, worthlessness, hopelessness, psychomot |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.