Depression — outpatient assessment and safety-planning OSCE

Candidate instructions

You are the doctor in the medicine/psychiatry clinic. Take a focused history, assess risk, and explain first-line management. You have 8 minutes with the patient and 2 minutes for examiner questions.

Candidate tasks

1. Elicit core depressive symptoms using a structured approach (SIGECAPS).
2. Perform a suicide risk assessment (ideation, plan, intent, means, protective factors).
3. Screen for prior mania/hypomania, psychosis, substance use, and medical mimics.
4. Explain diagnosis in plain language and propose SSRI + CBT with review timing.
5. Agree a safety plan and follow-up.

Examiner checklist

• Confirms ≥2-week duration and functional impairment
• Covers sleep, interest, guilt, energy, concentration, appetite, psychomotor change, suicide
• Explicitly asks plan/intent/means and protective factors
• Screens DIGFAST / prior elevated mood before antidepressant
• Proposes sertraline (or other SSRI) with dose and 1–2 week review
• Mentions delayed onset 4–6 weeks and early side effects
• Offers psychological therapy (CBT/IPT)
• Safety-nets red flags for emergency return / admission criteria
• Empathic communication and shared decision-making

Model standard

Major depressive episode meeting diagnostic threshold without bipolar features; passive SI without plan may be managed outpatient with tight review if supports exist. First-line: SSRI (e.g. sertraline 50 mg OD) plus CBT; review within 1–2 weeks for suicidality; full effect 4–6 weeks; continue 6–9 months after remission. Escalate if risk rises, psychosis, catatonia, or severe self-neglect.

Common errors

• Prescribing without suicide assessment or bipolar screen
• No early review plan
• Starting a TCA in a patient with suicidal ideation
• Minimising passive SI as "not serious"