Quadrants for the Psychiatry Clerkship OSCE
Possible Dxs
Record for write-up
Psychosis Depression Mania (BPAD)
1. AVH - Has your mind been playing any tricks on you? Are you seeing S - How has your sleep been? D - Have you felt easily
I - What do you like to do for fun? distractible?
or hearing anything that other people can’t see or hear? Have you been able to do X lately? I - Have you done anything that
2. Delusions G - Do you ever feel like things are seemed risky to you or anyone?
your fault? G - Do you ever feel like you’re
3. Disorganized speech - Has anyone in your life noticed you talking E - How has your energy been particularly good at something that
any differently than normal? lately? others aren’t good at?
C - How has your concentration F - What kind of thoughts have
4. Disorganized behavior - Has anyone in your life noticed you talking been at work/school? you been having?
any differently than normal? A - How has your appetite been? A - Do you feel like you’ve been
Any change in weight recently? more irritable than usual?
5. Negative symptoms - (Flat affect, avolition, anhedonia, asocial, P - Has anyone noticed you S - How is your sleep?
alogia) moving or talking any differently T - (Talkative)
lately?
S - Have you had any thoughts
about dying? (SI-intent)
Have you ever made any plans for
ending your life? (SI-plan)
If you had a plan, would you have
How long has this been going on for you?
the means to complete
this plan? (SI-means) How long have you
Brief Psychotic (<1mo) vs Schizophreniform (1-6mo) vs Schizophrenia
Have you had any thoughts of been feeling this way?
(>6mo)
wanting anyone else dead? (HI)
Have you had any thoughts of
hurting yourself or others?
(SH/violence)
A B
How would you describe
your relationships with MDD (≥4 Sx) vs BPAD I (mania) vs BPAD II
others? (hypomania)
Anti-social couldn’t care less
Narcissistic what others?
Histrionic they love me!
Borderline … I’m not sure…
Substance Abuse (>12mo) – Could ask after medication review C Anxiety
➤ See DSM criteria
1. EtOH 1. How much do you use?
2. BNZ 2. How often do you use?
3. Coc/amph 3. When was the last time you 1. Social phobia, specific phobia
➤ Fear of judgment or embarrassment
4. OPD used?
2. PTSD
5. Other – MJ, Ketm, PCP, 4. How do you feel when you
D - Has this trauma caused you to quit your hobbies?
LSD, etc. use? (Decreased interest)
R - Do you still think of your trauma? (Reliving)
5. How have you ever had
E - (Emotional detachment)
withdrawal? A - Do you Avoid things related to the trauma?
M - How long have you felt this way? (>1mo)
Have you ever received treatment for your use? S - Do you ever feel on edge? How is this affecting your Sleep?
Have you ever had to detox from one of these? 3. GAD (3 of 6)
Worry – Do you feel Wound up?
How long have you been sober? W - Do you feel Worn out?
A - Do you notice yourself ever being Absentminded (Difficulty
concentrating)
R - Is it hard for you to relax? (Restless)
T - Do you feel any muscle Tension?
S - Have you had any trouble Sleeping?
4. Panic disorder
Miscellaneous ➤ Acute, unexpected anxiety attack
➤ Persistent worry of additional attacks
AN (BMI <18) 5. OCD
➤ Obsessions – recurrent, intrusive
BN (BMI >18)
➤ Compulsions – time-consuming, impairing
Somatic Symptom D/O ➤ Ego-dystonic
Conversion D/O