MBBS OSCE · Psychiatry

First-episode psychosis — collateral history and management OSCE

OSCE on first-episode schizophrenia assessment, risk, antipsychotic counselling and Mental Health Act awareness.

10 min stationVerification in progress
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Exam tags

NEET-PGINICET

Candidate instructions

Interview the parents (and patient if cooperative). Clarify psychotic and negative symptoms, risk, and explain next steps including medication and follow-up.

Candidate tasks

  1. Obtain timeline of prodrome, positive symptoms, negative symptoms, and function.
  2. Assess risk (suicide, violence, self-neglect, exploitation) and insight.
  3. Exclude red-flag organic features (fever, seizures, focal neurology, substance).
  4. Explain likely first-episode psychosis/schizophrenia spectrum working diagnosis carefully.
  5. Outline investigations, antipsychotic start, monitoring, and psychosocial supports.

Examiner checklist

  • Elicits hallucinations, delusions, thought phenomena, negative symptoms
  • Duration and functional decline documented
  • Suicide and violence risk asked
  • Substance and organic screen
  • Names a first-line antipsychotic with starting dose and metabolic monitoring
  • Mentions legal framework if insight/risk require detention
  • Involves family; early-intervention ethos; relapse prevention
  • Avoids premature diagnostic over-certainty while still acting

Model standard

Working diagnosis first-episode schizophrenia-spectrum psychosis after organic/substance exclusion. Admit if risk/insight demand. Start one SGA at low dose (e.g. risperidone 2 mg nocte) with baseline ECG/metabolic panel; trial 4–6 weeks; psychoeducation and family intervention; clozapine only after two failed adequate trials.

Common errors

  • Jumping to high-dose polypharmacy
  • No metabolic baseline
  • Ignoring suicide risk
  • Failing to arrange urgent follow-up if discharged
First-episode psychosis — collateral history and management OSCE · MBBS OSCE · NeetVellum