Appearance: 25-year-old female, appears older than stated age, dark bags underneath her eyes, wearing wrinkled hospital scrubs, holding empty cup of coffee in her hands. No physical scars.
Behavior: No acute distress. When interviewer was searching for their pen, student immediately offered hers and stated that she has at least three more. Extremely cooperative, likely in hopes that she will earn an “honors” grade.
Motor Activity: Notable for slight tremors in both hands. Regular gait. Hunched posturing. No tics or EPS present.
Speech: regular rhythm/volume/tone; extremely reluctant to say the phrases “I think” or “I believe”
Mood: “Fantastic; in fact, I’m ready to go see that new consult right now”
Affect: Agitated, incongruent with mood (“Yeah, I’m fine. I just saw a patient breathe his last in front of me, but I need to catch up to my attending and see the next patient.”)
Thought Process: Linear and goal-directed; feels that she’ll finally be able to breathe after landing a good residency spot and then a good attending position
Thought Content: Denies suicidal/homicidal ideations. Grandiose delusions elicited of feeling “called to serve.” Perseverating on how she must finish her questions and her Anki reviews. Patient also endorses intrusive self-deprecating thoughts (“I just keep thinking I’m not good enough. Not smart enough to answer my attending’s pimp questions. Not organized enough to keep up with my family and friends outside of rotations. Not enough for my patients, for people who are there like a blip in my life. Not enough at all.”)
Perceptions: Endorses auditory hallucinations (“get away from the sterile field or so help me God”). Does not appear to be actively responding to internal stimuli.
Sensorium/orientation: Alert and oriented to person, place, and date
Attention/concentration: Poor. Unable to spell WORLD forward, keeps adding a “U” in front.
Memory: Able to recall 5/9 SIG E CAPS; states that is because she is currently experiencing those symptoms. Recent memory – Can recall this morning when her attending pimped her on adverse medication effects and she didn’t know the answer. Long-term memory – Does not recall life before third year of medical school.