Low mood and poor sleep
PLAB 2 practice station

The task

You are a doctor in a GP surgery. Ms Aoife Brennan, aged 35, has booked an appointment because she has been feeling low and cannot sleep. She is alone. Take a focused history. Then explain to her what you think is going on and what the options are, answering her questions, and tell her what to do if things change. There is no need to examine her. The examiner will not take part in the conversation.

What this station tests

• Ask directly about suicidal thoughts; it does not increase risk and is essential in any depression assessment.
• Always ask about plans, intent, protective factors and access to means.
• Early waking and weight loss are common features of depression; screen for bipolar disorder and thyroid problems.
• Offer a safety plan and early follow-up rather than leaving the patient alone with the risk.
• Avoid hypnotics as first-line for insomnia linked to depression.
• Do not label suicide risk as low, medium or high; focus on her needs, her safety and the plan.

Sources for the clinical content

• NICE NG222: Depression in adults: treatment and management
• NICE NG225: Self-harm: assessment, management and preventing recurrence

An original practice scenario with invented patients. Not an exam question.

Practise next

• Severe headache since yesterday
• Chest tightness that comes and goes
• Breathlessness and cough in a long-term smoker
• Lower abdominal pain in a young woman
• Weight loss and a change in bowel habit