MBBS OSCE · General Medicine
OSCE — Psychopharmacology Overview
Eight-minute OSCE station on Psychopharmacology Overview: 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 Psychopharmacology Overview.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Psychopharmacology is the framework every doctor uses when prescribing psychiatric drugs, organised around four pillars — antidepressants, antipsychotics, mood stabilisers, and anxiolytics (plus ADHD stimulants and the antidotes). For each class the exam wants four facts: receptor target, first-line agent, signature side-effect profile, and the named emergency (toxidrome). Antidepressants — SSRIs first-line (sertraline preferred; nausea, sexual dysfunction, hyponatraemia in the elderly, GI bleed, QT with citalopram; serotonin syndrome with serotonergic combinations — hyperreflexia, clonus, autonomic instability — stop, cyproheptadine, benzodiazepine, cooling). Antipsychotics — 2nd-generation
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 | Fever, lead-pipe rigidity, high CK, altered consciousness on antipsychotic - neu |
| Safety | Agitation, hyperreflexia, clonus, hyperthermia, autonomic instability on a serot |
| Safety | Lithium level over 1.5 with coarse tremor, ataxia, dysarthria, confusion, seizur |
| 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.