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Psych CASC / OSCESpecialty psychiatry — sleep medicine interface

Psych CASC / OSCE · Specialty psychiatry — sleep medicine interface

Explain delayed sleep-wake phase disorder and timed melatonin/light plan — CASC communication station

MRCPsych/FRANZCP-style communication station: reframe DSWPD as timing disorder, explain light/melatonin timing, negotiate school/uni plan, avoid colluding with open-ended hypnotics.

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Target exams

FRANZCPMRCPsychABPNMD-DNB
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Study tools

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 19-year-old university student and their parent attend clinic. The parent is angry about 'laziness' and wants a strong sleeping tablet. The student sleeps from 03:30–12:00 when free, cannot attend 09:00 lectures, and is open to help but ashamed.

Station brief

Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar in outpatient clinic. [2]

Candidate instructions. Explain delayed sleep-wake phase disorder in plain language, validate both parent concern and student experience without colluding with “laziness” stigma or indefinite strong hypnotics, outline morning light and carefully timed low-dose melatonin plus schedule change, negotiate a collaborative university return plan, and check understanding. The examiner may play parent, student, or both. [1][4][5]

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References5ShowHide
  1. [1]Sletten TL, Magee M, Murray JM, et al. Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial PLoS Med, 2018.PMID 29912983
  2. [2]Auger RR, Burgess HJ, Emens JS, et al. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline J Clin Sleep Med, 2015.PMID 26414986
  3. [3]van Geijlswijk IM, Korzilius HP, Smits MG The use of exogenous melatonin in delayed sleep phase disorder: a meta-analysis Sleep, 2010.PMID 21120122
  4. [4]Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update J Psychopharmacol, 2019.PMID 31271339
  5. [5]Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review Sleep, 2007.PMID 18041481
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