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Home / Station 18: Depression with suicidal thoughts

NAC OSCE preparation

Station 18: Depression with suicidal thoughts

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Depression with suicidal thoughts

11 minutes

Discipline: Psychiatry
Station type: Suicide-risk assessment
Setting: Emergency mental-health assessment

Your task

Conduct a focused psychiatric interview emphasizing suicide risk. State risk formulation and immediate plan.

Information available at entry

Vital signs stableNo apparent intoxication

Coach prompt: Ask directly about suicide and create a safe disposition.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 18 of 30

Standardized-patient profile

NameMr. David Kim

Age41

Pronounshe/him

RolePatient

Demeanour: Tearful, slowed and initially vague.

Opening statement: “I can't keep doing this. My family would be better without me.”

History and standardized-patient responses

Depression

Candidate explores	Standardized-patient response
Duration	Two months of low mood and anhedonia.
Symptoms	Poor sleep/appetite, weight loss, low energy and concentration.
Function	Stopped work and rarely leaves home.
Cognition	Hopeless and intensely guilty.

Suicide risk

Candidate explores	Standardized-patient response
Thoughts	Daily thoughts of death.
Plan/means	Plans firearm suicide tonight; gun unlocked in bedroom.
Intent/preparation	Goodbye note and financial transfer.
Past	Overdose at 22.
Protective	Loves children but believes they are better without him.

Modifiers

Candidate explores	Standardized-patient response
Substance	Six beers nightly; none today.
Psychosis/mania	None.
Stressor	Lost job.
Support	Spouse waiting and unaware.

Physical findings

Psychomotor slowing, depressed mood, hopeless thought content, active intent, no psychosis and impaired judgment.

Examiner prompts

Acute risk?

Very high because of imminent specific plan, firearm access, intent, preparation, past attempt, alcohol use and hopelessness.

Immediate plan?

Constant observation, safe lethal-means removal, urgent psychiatric admission, medical/withdrawal assessment and mental-health law if required.

Confidentiality?

Explain limited disclosure is necessary for imminent safety.

Differential diagnosis

Major depressive episode
Substance-related depression
Bipolar depression
Psychotic depression
Adjustment disorder

Investigations

Medical assessment and targeted tests
Toxicology/alcohol level when relevant
Collateral and medication review
No test replaces clinical risk assessment

Management

Continuous observation
Emergency psychiatric admission/treatment
Safe lethal-means restriction
Manage alcohol-use/withdrawal risk
Involve spouse with minimum necessary disclosure
Long-term depression/substance treatment

Communication behaviours

Ask direct questions calmly
Thank patient for disclosure
State goal is to keep him alive through crisis

Critical safety actions

Firearm plan requires emergency action
Do not rely on a verbal safety contract
Do not allow patient to leave alone

Model closing summary

This patient has a major depressive episode with very high acute suicide risk: an imminent firearm plan, access, intent, a note, financial preparation, past attempt, alcohol use and profound hopelessness. I would maintain constant observation, explain confidentiality limits, arrange urgent psychiatric admission, coordinate safe lethal-means removal, involve his spouse appropriately and assess alcohol-withdrawal and medical needs.

Common pitfalls

Leading question that invites denial
Overvaluing children as protection
Unsafe spouse-only gun removal
Checklist without formulation

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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