MENTAL STATE EXAMINATION: FIRST-RANK SYMPTOMS
Instructions for Candidates
Scenario
Mandy Smith, a 23-year-old woman, has been admitted to the ward with psychotic
symptoms. She has no previous psychiatric history. It is suspected that she is
developing schizophrenia.
Instructions
Elicit the presence of ‘first-rank’ symptoms of schizophrenia.
PLEASE REMEMBER TO HAND YOUR IDENTITY LABEL TO THE
EXAMINER
Station Number AFFIX CANDIDATE
LABEL HERE
Mental State Examination: First-rank symptoms
CANDIDATE No:
Instructions for Patients
Answer questions based on the following scenario.
Do not volunteer information unless asked.
This station tests the candidate’s ability to take a history from a patient, and examine specific
aspects of the mental state. In this OSCE, the candidate is expected to elicit specific symptoms
of a psychotic illness.
You are Mandy Smith, a 23-year-old woman.
Key Attributes
You have been admitted as a result of increasing symptoms of psychosis, affecting your
emotions, perception, and ability to think. Consequently, you are quite guarded. You are
distracted by hearing voices, and you find it difficult to concentrate on the candidate’s questions.
Key Dialogue
In the last few weeks you have been becoming increasingly suspicious at home and at work.
Last year you had an appendicectomy, and you have gradually been more convinced that
someone put a device in your abdomen during the operation.
You know this because you can feel it as a kind of tingling when it is transmitting.
You also think that it is affecting your internal organs, possibly causing cancer. You don’t know
exactly who is involved, but you suspect your previous employer who sacked you.
You are paranoid among other people, because you feel that their reactions indicate they know
what you are thinking. You think that the device has something to do with it.
You don’t think that anyone is putting thoughts into your head, but when asked you wonder if
sometimes your thoughts are suddenly stopped by something – your head just goes empty. You
are not sure by what.
You don’t think that anyone is controlling your actions, but do have some thoughts that your
irritability recently is directly attributable to the device and is caused by others listening in to
your thoughts.
You also think that you can hear these unseen people listening in to your thoughts, as in the
last few weeks you have been hearing two or three people talking about you. You experience
this as clear voices which appear to be coming from outside your head, but sometimes in
your head. You don’t recognise the voices. Once or twice the voices have said what you are
thinking – you find this particularly scary.
Much of this has been clearer since last week when you saw two red cars go past, the first with
the registration HAT 12E and the second one with HER 36S. You think this spelt out ‘[We]
hate her’.
Station Number AFFIX CANDIDATE
LABEL HERE
Mental State Examination: First-rank symptoms
CANDIDATE No:
Instructions for Examiners
REMEMBER TO ASK THE STUDENT FOR THEIR IDENTITY LABEL AND
AFFIX IT TO THE TOP OF THE MARK SHEET.
This is a clinical case where the candidate must:
a) Demonstrate knowledge and familiarity of Schneiderian first-rank symptoms
b) Proceed to ask appropriate questions to elicit the presence of such symptoms
c) Be able to differentiate clearly between the different symptoms, and stay
focussed on the required task
Station Number
Examiner’s Name:
AFFIX CANDIDATE
……………………… LABEL HERE
Mental State Examination: First-rank symptoms
CANDIDATE No:
Marking Sheet
Please circle the appropriate mark for each criterion. The standard expected is that
of a psychiatric Senior House Officer.
Criterion Performed Performed, Not
Clear Pass Borderline
competently but not fully Clear Fail
performed
competent
Approach to the patient – Rapport, empathy, 2 1 0
and style
Auditory hallucinations (each of the following
scores 2 points, up to a maximum of 6):
Hearing thoughts spoken aloud 2 1 0
3rd person hallucinations 2 1 0
commentary hallucinations 2 1 0
Delusions of passivity (each of the following
scores 2 points, up to a maximum of 4):
thought withdrawal, insertion, thought
broadcasting 2 1 0
feelings or actions experienced as made
or influenced by external agents 2 1 0
Somatic passivity 2 1 0
Delusional perception 2 1 0
Overall Approach to Task 4 3 2 1 0
Score (Max 20)
Overall Grading of station
