OET Rx - Lesson 26: Initial Mental Health Consultations
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OET Rx

Lesson 26: Initial Mental Health Consultations

Course Progress: Lesson 26 of 100

In this lesson, you will be able to:

  • Create a safe, confidential, and non-judgmental environment for a patient to discuss their mental health.
  • Ask open-ended questions to explore a patient's mood, feelings, and the impact on their life.
  • Conduct a basic but essential risk assessment in an empathetic and professional manner.
  • Introduce mental health concepts and treatment options (e.g., talking therapy) clearly.

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Watermark: Persia Global

Part 1: Lesson Objectives

By the end of this lesson, you will be able to:

  • Create a safe, confidential, and non-judgmental environment for a patient to discuss their mental health.
  • Ask open-ended questions to explore a patient's mood, feelings, and the impact on their life.
  • Conduct a basic but essential risk assessment in an empathetic and professional manner.
  • Introduce mental health concepts and treatment options (e.g., talking therapy) clearly.

Part 2: Vocabulary & Examples

General Vocabulary

message /ˈmesɪdʒ/:

پیام

The key message I want you to take home is that you are not alone in this, and effective help is available.

method /ˈmeθəd/:

روش، متد

The most effective method for an initial mental health consultation is to start with broad, open-ended questions.

might /maɪt/:

ممکن است

I understand you might find it difficult to talk about these feelings, but I am here to listen without judgment.

mild /maɪld/:

خفیف

Even mild symptoms of depression can have a significant impact on a person's quality of life if they persist.

mind /maɪnd/:

ذهن، فکر

Can you tell me what has been on your mind lately?

minor /ˈmaɪnər/:

جزئی، کم‌اهمیت

Sometimes, what seems like a minor issue can be the final straw that affects a person's mental well-being.

miss /mɪs/:

از دست دادن

Have you had to miss any work or social events because of how you've been feeling?

missing /ˈmɪsɪŋ/:

مفقود، گمشده

The patient reported feeling that a sense of joy was missing from his life.

mistake /mɪˈsteɪk/:

اشتباه

It is not a mistake to ask for help; in fact, it is a sign of great strength.

mix /mɪks/:

ترکیب

It's very common to feel a mix of emotions, such as sadness and anger, at the same time.

mixed /mɪkst/:

مختلط

The patient gave a mixed account, stating that he has good days and very bad days.

model /ˈmɒdl/:

مدل، الگو

We use a collaborative care model, which means we will work together with therapists and you to form a plan.

modern /ˈmɒdən/:

نوین، مدرن

Modern approaches to mental health emphasize a combination of therapy, lifestyle changes, and medication if needed.

moment /ˈmoʊmənt/:

لحظه

Let's take a moment to just sit with that feeling. There is no need to rush.

monitor (v.) /ˈmɒnɪtər/:

تحت نظر گرفتن

We will monitor your mood closely over the next few weeks to see how you respond to the treatment.

month /mʌnθ/:

ماه

You mentioned that you have been feeling this way for over a month; was there any particular trigger around that time?

mood /muːd/:

خُلق، حالت روحی

Can you describe your general mood over the past few weeks?

moral /ˈmɒrəl/:

اخلاقی

As a doctor, I have a moral and professional duty to ask about your safety if you are feeling very low.

mostly /ˈmoʊstli/:

اغلب، بیشتر

Do you feel this way all the time, or is it mostly in the evenings?

move /muːv/:

حرکت کردن، پیش رفتن

The first step is to acknowledge how you feel; then we can move towards a plan to help you feel better.

movement /ˈmuːvmənt/:

جنبش، حرکت

A key sign of severe depression can be psychomotor slowing, which is a slowing down of thought and physical movement.

Medical Vocabulary

Affect /ˈæfekt/:

عاطفه، حالت چهره

Although the patient reported a low mood, her affect was bright and reactive, which was an interesting finding.

Anhedonia /ˌænhɪˈdoʊniə/:

آنهدونیا، بی‌لذتی

A key symptom of depression is anhedonia, so I need to ask: are you still enjoying the hobbies you used to love?

Insight /ˈɪnsaɪt/:

بینش

The patient has good insight into his condition and is highly motivated to engage with therapy.

Mental State Examination (MSE) /ˈmentl steɪt ɪɡˌzæmɪˈneɪʃn/:

معاینه وضعیت روانی

A formal Mental State Examination includes assessing a patient's appearance, mood, affect, and thought content.

Mood /muːd/:

خُلق

The central question in this consultation is to assess the patient's mood, which he describes as "persistently low".

Psychotherapy / Talking Therapy /ˌsaɪkoʊˈθerəpi/:

روان‌درمانی / گفتاردرمانی

I believe you would benefit greatly from psychotherapy, as it can provide you with coping mechanisms for these feelings.

Referral to Psychiatry /rɪˈfɜːrəl tuː saɪˈkaɪətri/:

ارجاع به روانپزشکی

Due to the complexity of the symptoms, a referral to psychiatry is the most appropriate next step.

Risk Assessment /rɪsk əˈsesmənt/:

ارزیابی خطر

A crucial part of any mental health consultation is a risk assessment, which includes asking directly about suicidal ideation.

Stigma /ˈstɪɡmə/:

انگ، ننگ اجتماعی

The stigma surrounding mental health can make it very difficult for people to ask for help, so your coming here today is a brave step.

Suicidal Ideation /ˌsuːɪˈsaɪdl ˌaɪdiˈeɪʃn/:

افکار خودکشی

I need to ask a direct and important question: have you had any suicidal ideation or thoughts of harming yourself?

Part 3: Pre-Class Practice Tests

Reading Task (Longer & More Professional):

Excerpt from "A Guide to the Mental State Examination (MSE) for Non-Psychiatrists"

The Mental State Examination (MSE) is a foundational skill in medicine, analogous to a physical examination for the mind. It is a systematic method of observing and assessing a patient's psychological functioning at a specific point in time. Its utility extends far beyond psychiatry; every clinician should be proficient in its basic components. The MSE is structured around several key domains: appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, and insight.

Two of the most crucial, and often confused, domains are mood and affect. Mood refers to the patient's pervasive, subjective emotional state, which is what the patient tells you they feel (e.g., "I feel depressed," "I'm anxious"). Affect, conversely, is the objective expression of that mood that the clinician observes. It is described in terms of its quality (e.g., sad, euphoric), range (e.g., restricted, expansive), and congruence (i.e., whether it matches the stated mood). A patient might state their mood is "fine" while exhibiting a flat affect with tearful eyes; this incongruence is a significant clinical finding.

Another key domain is the assessment of thought content, which includes looking for evidence of delusions, obsessions, or suicidal ideation. This often requires gentle but direct probing questions. The final component, insight, evaluates the patient's awareness of their own condition. A patient who does not believe they are ill is said to have poor insight, which has significant implications for treatment adherence. A well-conducted MSE provides a detailed snapshot that is invaluable for diagnosis, risk assessment, and treatment planning.

Question: According to the text, what is the primary difference between "mood" and "affect"?

Listening Task (Part A Simulation):

Scenario: You will hear a GP taking an initial history from a young university student.

0:00

Task: Complete the notes below. Write one or two words for each gap.

GP Consultation Notes

Patient: 21-year-old male university student.

Presenting Complaint: Reports feeling (1)

Duration: For the past (2)

Key Symptoms:

  • Loss of interest, specifically (3) .
  • Sleep: (4) .
  • Appetite: Decreased.

Risk Assessment: Denies any thoughts of (5)

Part 4: Answer Key for Pre-Class Work

Reading Answer: b) Mood is the patient's subjective report of their feelings, while affect is the doctor's objective observation of their emotional expression.

Listening Answers: (1) overwhelmed/stressed, (2) few months, (3) anhedonia / not enjoying football, (4) difficulty sleeping / poor, (5) self-harm / harming himself

Part 5: In-Class Preparation

This section is designed specifically for doctors. Be prepared to discuss the vocabulary and practice the following tasks in class.

Speaking Task: OET Role-Play Card (Medicine)

Setting: Your GP office.

Patient: A 30-year-old patient who has come for a follow-up about their asthma. After discussing this, they become tearful and admit they "can't cope with things anymore" and are feeling very low.

Task:

  1. Acknowledge the patient's distress and create a safe space to talk.
  2. Gently transition the focus of the consultation from the physical issue to their mental health.
  3. Ask open-ended questions to explore their mood, feelings, and any recent stressors.
  4. Conduct a basic risk assessment by asking about thoughts of self-harm.
  5. Introduce the idea that help is available and suggest a follow-up appointment dedicated to discussing this further.

Writing Task:

You are the doctor from the speaking scenario. Write the "S" (Subjective) and "A" (Assessment) sections of your SOAP notes for this consultation. Ensure you document the patient's emotional state, their key reported symptoms, and your initial assessment, including a note on the risk evaluation.