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Psych CASC / OSCEConsultation-liaison psychiatry

Psych CASC / OSCE · Consultation-liaison psychiatry

Explaining demoralisation, adjustment, and mood treatment in medical illness — CASC communication station

MRCPsych/FRANZCP-style station: explain demoralisation and adjustment, DHD without stigma, named therapies, and careful antidepressant decisions in medical illness.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 59-year-old man with newly progressed metastatic lung cancer is on the ward. His partner is distressed that 'psychiatry wants to put him on antidepressants just for being sick' and that he keeps saying there is no point living. The patient, when calmer, says he is not mad but feels trapped and useless. You must explain demoralisation vs depression, why desire for death needs careful assessment, what therapies help, and when medicines are and are not indicated.

Station brief

Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar on the medical ward. Partner attends; patient may join.[1][2]

Candidate instructions. Explain that feeling trapped and pointless after progressive cancer news can be demoralisation or an adjustment response — real suffering, not weakness or lifelong madness. Explain that major depression is different and still treatable if present. Address wish for death compassionately as a signal to treat depression, hopelessness, symptoms, and meaning collapse. Outline talking therapies (dignity-oriented, meaning-centred, CALM-style) and clarify antidepressants are not automatic for all distress but can help if depression criteria are met.[1][2][3][4][5][6]

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References6ShowHide
  1. [1]Clarke DM, Kissane DW Demoralization: its phenomenology and importance Aust N Z J Psychiatry, 2002.PMID 12406115
  2. [2]Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer JAMA, 2000.PMID 11147988
  3. [3]Chochinov HM, Kristjanson LJ, Breitbart W, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial Lancet Oncol, 2011.PMID 21741309
  4. [4]Rodin G, Lo C, Rydall A, et al. Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer J Clin Oncol, 2018.PMID 29958037
  5. [5]Rayner L, Price A, Evans A, et al. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis Palliat Med, 2011.PMID 20935027
  6. [6]Bachem R, Casey P Adjustment disorder: A diagnosis whose time has come J Affect Disord, 2018.PMID 29107817
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