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

Vignette Number GAP 014

Speciality:

General Psychiatry

Date:

10 October 2001

Vignette:

A 32 year old man who got married six months ago has developed constant preoccupations about an incident which occurred when he was 16 babysitting a girl of 6. He thinks that he might have interfered with her sexually and caused her permanent psychological damage.

The actual incident consisted of him patting the girl on her bottom. He is now buying magazines, books and newspapers that relate to accounts of child molestation and is so distressed that he has contemplated suicide.

How would you assess and manage this man.

Suggested Probes:

1. What psychological interventions might you recommend?
2. How would you assess the risk of suicide?
3. Is the timing of this presentation of any significance?

1. The candidate will be expected to pay particular attention to the temporal sequence of events. These thoughts have started preoccupying the patient six months after marriage. Is there any trigger to their appearance, for example, marital problems, sexual problems, etc.?
2. The candidate should pay particular attention to eliciting the nature of the sexual interference. Was it real, imagined, exaggerated?
3. The differential diagnosis should cover the possibility of depression, obsessive compulsive order, psychosis.
4. The management should address the issue of the underlying disorder and should look at both chemotherapy and psychological interventions.
5. The candidate needs to assess the suicidality of the patient and also possible risk to others and organise the management in accordance with the findings.