Structured Patient Management Problems for the MRCPsych Part II
Sample from the pilot examination

Vignette Number GAP 034

Speciality:

General Psychiatry

Date:

10 October 2001

Vignette:

You are asked to do a domiciliary visit by a GP - the wife of a 45 year old man had attended the surgery earlier that day - she was concerned about her own safety. The previous evening her husband was angry and challenging - he accused her of sleeping with a neighbour.

How would you assess and manage this situation?

Suggested Probes:

1. Where would you get important additional information?
2. What factors might be relevant in a risk assessment in this case?
3. What management options might be necessary?

1. Necessary to obtain comprehensive background from wife - and additional information from GP regarding particularly past history.
2. The patient may refuse to be interviewed.
3. Demonstrate awareness of risk/dangerousness to wife and perhaps others - psychodynamics within relationship.
4. Must discuss and elaborate on factors such as drug and alcohol misuse, formal mental illnesses/delusional processes/pathological jealousy, cognitive impairment-allegations may be truthful.
5. Raise the possible need for involuntary admission and pre discharge case conference if necessary.