Family Medicine block

OSCE: depression
Assessment
Done by:
Nawaf Almegbel
Abdulellah Al-adel
Abdallah Tammas
Revised by:
Salwa Alradhid Alhumaid
Abdullah Alhoussien
1- Earn your five points:
- Greet the patient.
- Introduce yourself.
- Ensure privacy.
- Get the patients name and age.
- Explain the reason of the interview and gain consent.

2- Chief complaint: (Start with Open-ended questions)

Ask the patients main complaint. Depression.

3- History of present illness:

- Onset:
When did it start?
Is it the first time?
- Duration:
How long have you had this?
- Severity:
Is it severe enough to interfere with activity of daily living or not? (job absence, Sleeping,
family, friends) IMPORTAN
Variation by day or night, during the week or month. IMPORTANT
- Frequency & previous episodes:
How frequent do you get this?
- Course:
Sudden /Gradual
Continuous /Intermittent
- Aggravating factors:
Is there anything you might think of that might trigger these feelings?
Have you been under pressure at home or work?
- Relieving:
- Associated symptoms:
- Mood:
How has your mood been recently?
Have you been feeling sad, blue, and depressed?

- SIG E CAPS:
- Sleep pattern.
- Have you noticed any changes in your sleep patterns recently?
- Have you had any trouble getting off to sleep in the last few weeks?
- Do you wake up early in the morning?
- Loss of Interest. (anhedonia)
- Have you lost interest in things you usually enjoy?
- Guilt and worthlessness.
- Have you felt recently that you are worthless?
- Fatigue and loss of Energy. (anergia)

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 - How do you find your energy nowadays?
- Diminished ability to Concentrate.
- Appetite. (weight loss/gain) make sure to ask if weight loss/gain is intentional!
- What has your appetite been like recently?
- Has there been a recent change in your weight? Was it intentional?
- Psychomotor abnormality. (inert retard vs. agitate)
- Suicidal ideation. (patients with suicidal ideation need admission)
- What does life mean to you?
- Do you feel life is still worth living?
- Have you thought about ending your life?
- Have made plans to end your life?
- Have you attempted to end your life? What did you use to do that? If yes,
ask about details. IMPORTANT.
- Will you try it again after you go home?
Other questions:
- Homicide/harm to others.
- Are there people you know who dont deserve to live?
- Have you thought about harming somebody else?
- Mania (to rule out Bipolar disorder).
- Have you felt excessively happy recently?
- Do you feel you have been talkative lately?
- Was there a decrease in your need to sleep?
- Psychosis. (hallucinations and delusions)
- Loss of libido.
- Anxiety and worrying.
- Constitutional symptoms: (night sweating, fatigue, fever)
- Headache and back pain.

4- Past medical history:

- Psychiatric diseases. (depression, anxiety, mania, psychosis, etc)
- Chronic diseases. (HTN, DM, Dyslipidemia)
- ANEMIA.
- HYPOTHYROIDISM.
- History of epilepsy.
- Hospitalization.
- Surgery.
- Trauma/fractures.
- Menstrual history.

5- Medications & allergy:

- Medications:
- Name & Side effects.
- Herbal medication, steroids, antihypertensives and antidepressants (know the side
effects).
- Allergy:
- Family Hx of allergy.

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6- Family History:
- Family Hx of SAME PROBLEM.
- Family Hx of psychiatric diseases.

7- Social History:
- Occupation, economic &marital status. (LOSS OF JOB, FRIEND & FAMILY MEMEBERS).
- History of disturbing events or accidents.
- Habits: Smoking, alcohol or drugs.
- Diet & activity.
- Travelling (time, place, foods, bites & vaccinations).
- Sexual Hx.
- Animals and pets.

8- Systematic review:
- Start from head to toes.

9- ICE:
- I Idea about the causes of the symptoms.
- C Concerns about the symptoms & its complication.
- E Expectation from the Dr. (Medications, tests).

10- Summarize to the patient and make sure everything is understood.

11- Thank the Patient and ask if there is any question.

- DDX:
1- Psychiatric Depression & bereavement, bipolar.
2- Medical condition hypothyroidism, anemia, DN, HTN.
3- Substance abuse.
4- Emotional, financial problems.

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