[Ciaran88]

Alright peeps, final 2 stations of my OSCE tomorrow and rumour has it one of them is taking an MH history from someone who has taken an overdose.

Does anybody in the know when it comes to psychiatry, know what kind of important questions/red flags I need to cover in the Hx of a patient who has taken an OD?

[Madprof]

Don't rely too much on rumours - it's likely stations change frequently.

The way I think about it:

1) About the attempt (precipitant? How long had they been thinking about it? Affairs in order? Left a note? Precautions against discovery? Violent method? Method the patient believed would work? Sought help afterwards?)

2) Background (SMI? Previous DSH or suicide attempts?)

3) Socioeconomic and demographic risk factors (male, divorced, socially isolated, older, financial stress)

4) Why did they do it? (To die? To send a message/control a situation? To get help?)

5) Now - "If you were to leave hospital today, how would you cope?" Current plans and details. Preparations? "What would stop you?"

I imagine that's plenty for a history-taking station but in real life you'd continue onto a full history, including development and past psych history. You'd then do a MSE, with permission talk to any family or friends involved, and negotiate a plan of action with the patient. They'd also need to know what to do/who to contact if they wanted to harm themselves again.

Good luck!

[Ciaran88]

Not here, the rumours have been 100% true so far 8)

Thanks, those are good questions, we have to do the full history afterwards and then present the MSE, but it was those focused questions I was unsure about. Cheers!

[Helenia]

Look up the SAD PERSONS risk-assessment mnemonic.

[ThisLittlePiggy]

(Original post by Helenia)
Look up the SAD PERSONS risk-assessment mnemonic.

Definitely do this.

You need to see why they did what they did, evaluate the seriousness of the attempt and whether or not they are a further risk to themselves and therefore need to be detained.


What was the precipitant?
What was the specific trigger?
Did they plan it? How long had they planned it for?
Did they make a note? Who was it for? What did it say?
Where they alone? Did they take steps against being found?
Where they intoxicated?
What was the method?
Did they expect it to be lethal?
How did help arrive? - Did they phone it? What changed their mind?
How did they feel when help arrived?
Would they try again? What would stop them if not?
Will they be going back to the same situation?
Do they have children? - who would look after them? - are they involved in the plan?

Previous history of severe depression?
Previous attempts?
Other DSH?
Other mental illness, chronic / severe physical illness?
Alcohol abuse?
Domestic abuse?

If pose further risk to themselves or others - phone senior for detention, phone psych liaison / crisis team for specialist assessment.

[idiopathic]

(Original post by Madprof)
Don't rely too much on rumours - it's likely stations change frequently.

The way I think about it:

1) About the attempt (precipitant? How long had they been thinking about it? Affairs in order? Left a note? Precautions against discovery? Violent method? Method the patient believed would work? Sought help afterwards?)

2) Background (SMI? Previous DSH or suicide attempts?)

3) Socioeconomic and demographic risk factors (male, divorced, socially isolated, older, financial stress)

4) Why did they do it? (To die? To send a message/control a situation? To get help?)

5) Now - "If you were to leave hospital today, how would you cope?" Current plans and details. Preparations? "What would stop you?"

I imagine that's plenty for a history-taking station but in real life you'd continue onto a full history, including development and past psych history. You'd then do a MSE, with permission talk to any family or friends involved, and negotiate a plan of action with the patient. They'd also need to know what to do/who to contact if they wanted to harm themselves again.

Good luck!

Pretty good summary, as is above this post.
Depending on whether you need to do a bit of medicine with it you should aksk what they took, how much, was it with alcohol. Although this is relevant to psych itself as if a person has gone to 5 different shops to stock up on paracetamol it shows a bit more determination than just taking 10 tablets. Also an alcohol history increases the risk of going through with it too.
Ask about psychosis/hallucinations and history of mania (may be part of bipolar).

[Ciaran88]

Done and done. Did a standard psych history with the specific OD questions tagged into the HPC and presented the Hx, MSE and a SADPERSONS score at the end.

They had severe depression with psychotic features and had taken a paracetamol and citalopram overdose. The hardest bit was knowing how to pitch the history, it was in the acute setting but it was supposed to be a full psychiatric history.

I think I did enough to pass. Cheers for the help guys!