Psychiatrists must be prepared to manage patients exhibiting challenging psychological states, including suicidal ideation, hallucinations, and other high-risk behaviors. However, opportunities to safely practice such interactions are limited. While recent conversational agents can simulate patients, existing approaches largely rely on large language models (LLMs) to determine patient responses, making it difficult to consistently maintain psychological state, adapt to the clinician's responses, and generate clinically plausible challenges that meaningfully test the clinician. We present a state-aware virtual patient simulation pipeline for training psychiatrists in challenging clinical scenarios. The proposed system maintains an evolving patient state throughout the interaction and orchestrates patient behavior rather than leaving response generation entirely to an LLM. At each interaction, a learning-based behavioral strategy selector determines the type and level of challenge appropriate to the current patient and clinician context. The selected strategy, patient state, clinician response, interaction history, and relevant clinical knowledge are then provided as grounded context to an LLM to generate a semantically relevant and psychologically consistent patient response. Following each session, the system analyzes the interaction and provides feedback to the clinician on their communication and management of the virtual patient.

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