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Home / Station 19: First-episode psychosis

NAC OSCE preparation

Station 19: First-episode psychosis

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

First-episode psychosis

11 minutes

Discipline: Psychiatry
Station type: Psychiatric history + mental status
Setting: Emergency department

Your task

Interview the patient and perform a verbal mental-status assessment. State differential and disposition.

Information available at entry

HR 104/minBP 132/80 mm HgT 37.2°CSpO₂ 99%

Coach prompt: Assess psychosis, risk, substances and medical causes.

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 19 of 30

Standardized-patient profile

NameMs. Chloe Nguyen

Age22

Pronounsshe/her

RolePatient; roommate available

Demeanour: Suspicious and scanning the room.

Opening statement: “I know my roommates installed cameras because they work for a government agency.”

History and standardized-patient responses

Psychosis

Candidate explores	Standardized-patient response
Delusions	Three weeks of surveillance and reference beliefs.
Hallucinations	Two voices comment on her actions.
Disorganization	Missed classes and stays awake researching surveillance.
Negative symptoms	Social withdrawal and reduced self-care for two months.

Risk/function

Candidate explores	Standardized-patient response
Self-harm	Considered jumping from balcony to escape last night.
Violence/means	Carries kitchen knife for protection.
Intake/sleep	Minimal sleep and reduced food due poisoning fear.
Insight	Wants to leave; denies illness.

Causes

Candidate explores	Standardized-patient response
Substance	Daily high-potency cannabis; methamphetamine once two weeks ago.
Mood	No sustained mania.
Medical	No fever, seizure, head injury or focal symptoms.
Family	Uncle with schizophrenia.

Physical findings

Guarded, mildly disorganized, persecutory/referential delusions, auditory hallucinations and impaired insight/judgment.

Examiner prompts

Differential?

Primary psychotic disorder, cannabis/stimulant-induced psychosis, mood disorder with psychosis and medical/neurologic causes.

Why unsafe discharge?

Escape-related suicidal thought, weapon, poor intake/sleep, impaired judgment and no insight.

Plan?

Safety observation, secure weapon, urgent psychiatric admission, medical first-episode workup, collateral and legal care if needed.

Differential diagnosis

Schizophrenia-spectrum disorder
Cannabis/stimulant-induced psychosis
Mood disorder with psychosis
Delirium
Neurologic/endocrine/autoimmune/infectious cause

Investigations

CBC, electrolytes, renal/liver function, TSH and pregnancy test when relevant
Toxicology by history
Physical/neurologic exam
Additional tests/imaging for atypical features

Management

Immediate safety and admission
Least-restrictive treatment under psychiatric guidance
Address substances
Early-psychosis/family program
Longitudinal diagnostic clarification and metabolic monitoring

Communication behaviours

Validate fear without confirming surveillance
Use calm neutral statements
Offer safe choices

Critical safety actions

Weapon and escape thinking require containment
First episode needs medical/substance assessment
Impaired insight does not equal no risk

Model closing summary

This 22-year-old has first-episode psychosis with persecutory delusions, auditory hallucinations, functional decline, daily high-potency cannabis use and recent stimulant exposure. She is unsafe because she considered jumping to escape and carries a knife. I would secure the weapon, maintain observation, obtain collateral and a medical workup, and arrange urgent psychiatric admission, using involuntary-care provisions if necessary.

Common pitfalls

Aggressively challenging delusion
Assuming all psychosis is schizophrenia
Forgetting substances/medical causes
Discharge because classic suicidal intent denied

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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