Early-onset psychosis and mania — branching viva

Opening

Examiner: A 15-year-old boy is brought in believing classmates implanted a chip in his head, has not slept for four nights, and smokes high-potency cannabis daily. Walk me through your approach from the moment you meet him. ^[2]

Candidate: He is a medical patient first and a psychiatric patient second. I run the gate in order: assess, distinguish, exclude danger, refer early and treat. I greet him first, set a joint agenda, and secure time alone with conditional confidentiality stated aloud. Because a psychotic young person is an unreliable sole historian, I gather collateral from family and school on onset, course, function, family psychiatric history, substance use and trauma. I perform a mental-state examination, run HEEADSSS with focused probes, and screen suicide risk with plan, intent and means — then exclude organic disease before any label. ^[2]