Psych CASC / OSCE · Addiction psychiatry
Benzodiazepine dependence counselling — CASC communication station
MRCPsych/FRANZCP-style communication station: explain dependence vs moral failure, seizure risk of abrupt stop, gradual taper plan, alcohol interaction, sleep/anxiety alternatives, and shared decision-making.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 58-year-old man has taken diazepam 5 mg three times daily for 8 years since a workplace accident for 'nerves and sleep'. He also drinks 4–6 standard drinks most nights. After reading online about dependence he wants to stop this weekend before a family wedding. His partner fears seizures because an uncle had fits stopping 'sleeping tablets'.
Station brief
Format. Communication and shared decision-making station, approximately 7–10 minutes after reading time. You are the psychiatry registrar in outpatient clinic. [1]
Candidate instructions. Explain physiological dependence without stigma, why stopping this weekend is unsafe, outline a gradual taper in plain language, address alcohol, offer alternatives for sleep and anxiety, involve the partner’s seizure fears accurately, and agree follow-up. Do not invent statute numbers. [2][3]
References5ShowHide
- [1]Brett J, Murnion B. Management of benzodiazepine misuse and dependence Aust Prescr, 2015.PMID 26648651
- [2]Soyka M. Treatment of Benzodiazepine Dependence N Engl J Med, 2017.PMID 28614686
- [3]Ashton H. The diagnosis and management of benzodiazepine dependence Curr Opin Psychiatry, 2005.PMID 16639148
- [4]Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med, 2014.PMID 24733354
- [5]Brunner E, Chen CA, Klein T, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits J Gen Intern Med, 2025.PMID 40526204