MBBS OSCE · Psychiatry
OSCE — Specific Phobias & Agoraphobia
Eight-minute OSCE station on Specific Phobias & Agoraphobia: 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 Specific Phobias & Agoraphobia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Specific phobias are marked, persistent, excessive fear of a circumscribed object or situation, provoking immediate anxiety, recognised as out of proportion, leading to avoidance, lasting 6 months or more, with impairment. DSM-5 subtypes: animal, natural environment, blood-injection-injury (BII — UNIQUE: vasovagal bradycardia/syncope, not tachycardia), situational, other. Agoraphobia is marked fear of 2 or more of 5 situations where escape might be difficult or help unavailable. Treatment of choice and often curative: CBT with exposure therapy (graded / systematic desensitisation); applied tension for BII phobia; SSRIs reserved for severe/agoraphobic or comorbid cases.
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 | Marked persistent fear of a specific object/situation causing avoidance and impa |
| Safety | Fear of being in situations where escape is difficult or help unavailable (2 or |
| Safety | Blood-injection-injury phobia with vasovagal syncope - applied tension technique |
| 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.