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

Vignette Number PSYCH03

Speciality:

Psychotherapy

Date:

10 October 2001

Vignette:

You are asked to see a 51 year old widow on a domiciliary visit whose husband died 3 months ago from cancer.

On 2 occasions in the past week she has "come to" some distance from her home and she does not remember what has happened. She had similar lapses in memory 10 years ago after her mother's death.

How would you go about an assessment and management of this patient?

Suggested Probes:

1. Would you consider further neurological investigations?
2. What might be some predisposing factors?
3. How would you assess and manage her bereavement responses?

1. The differential diagnosis including dissociative versus organic states.
2. The candidate should discuss further neurological investigations.
3. The candidate should be aware of predisposing factors, e.g., childhood, histrionic personality.
4. The candidate should understand the stages of normal bereavement and what constitutes an abnormal grief reaction.
5. The candidate should understand how to manage an abnormal grief reaction, reflect upon the use of antidepressants or not, benzodiazepines or not.