A 22-year-old man is brought to A&E by his family. Over the past three weeks he has become increasingly withdrawn, is talking to himself, and believes MI5 are monitoring him. This is his first presentation. How would you assess and manage him?

Tips to guide your answer

- First episode psychosis requires comprehensive assessment: history, MSE, risk assessment, collateral history, physical examination

- Exclude organic causes: substance misuse (especially cannabis, stimulants), medical conditions (thyroid, autoimmune, space-occupying lesion)

- Baseline investigations: FBC, U&Es, LFTs, TFTs, fasting glucose/HbA1c, lipids, calcium, CRP, urine drug screen, CT/MRI head if indicated

- NICE CG178 recommends referral to an Early Intervention in Psychosis (EIP) service within 2 weeks

Sign in to unlock speak mode

Create account Sign in

How to approach this Psychiatry interview question

This quality improvement question is common in Psychiatry NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A 22-year-old man is brought to A&E by his family. Over the past three weeks he has..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.

What the panel is testing

A strong quality-improvement answer uses method as well as enthusiasm. Be clear about the problem, baseline measurement, intervention, re-measurement, and how the change was made sustainable. For psychiatry, risk assessment, capacity, legislation, rapport, and multidisciplinary planning are usually central. Keep the answer humane, structured, and legally aware.

Separate audit, QI, research, and clinical governance clearly so the panel can follow your reasoning.
Use a real cycle: baseline, intervention, re-measurement, learning, and sustainability.
Link the project back to patient safety, service reliability, or measurable outcomes.

How to structure your answer

For a quality improvement prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.

Open by naming the main issue in the question.
Give a structured response rather than a memorised script.
End with escalation, documentation, learning, or follow-up.

Common mistakes to avoid

The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.

First episode psychosis requires comprehensive assessment: history, MSE, risk assessment, collateral history, physical examination
Exclude organic causes: substance misuse (especially cannabis, stimulants), medical conditions (thyroid, autoimmune, space-occupying lesion)
Baseline investigations: FBC, U&Es, LFTs, TFTs, fasting glucose/HbA1c, lipids, calcium, CRP, urine drug screen, CT/MRI head if indicated