Psych CASC / OSCE · Emergency psychiatry
De-escalation and rapid tranquillisation explanation — CASC communication station
MRCPsych/FRANZCP-style station: de-escalate, offer oral RT with named options, explain IM pathway and combination ban if needed, discuss capacity and least-restrictive care with family, and describe monitoring.
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Target exams
Station brief
Format. Communication and clinical reasoning station, approximately 7–10 minutes after reading time. You are the psychiatry registrar on the acute ward. [1]
Candidate instructions. Engage the patient with de-escalation skills, offer oral medication with clear choices, explain what happens if IM medication is needed (including safety monitoring and that the goal is calm not unconsciousness), and answer the sister's questions about rights, capacity, and least-restrictive care without inventing statute section numbers. The examiner may play patient and/or relative. [2][3]
References3ShowHide
- [1]Patel MX, Sethi FN, Barnes TR, et al. Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation J Psychopharmacol, 2018.PMID 29882463
- [2]Richmond JS, Berlin JS, Fishkind AB, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup West J Emerg Med, 2012.PMID 22461917
- [3]Spencer BWJ, Gergel T, Hotopf M, et al. Unwell in hospital but not incapable: cross-sectional study on the dissociation of decision-making capacity for treatment and research in in-patients with schizophrenia and related psychoses. Br J Psychiatry, 2018.PMID 29909778