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Psych CASC / OSCEFoundations — EEG and clinical neurophysiology

Psych CASC / OSCE · Foundations — EEG and clinical neurophysiology

Explain EEG and clozapine seizure risk to a patient and partner — CASC communication station

MRCPsych/FRANZCP-style CASC: neurophysiology communication, clozapine counselling, and safety netting without overclaim.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 34-year-old with treatment-resistant schizophrenia had a first seizure on clozapine titration. Partner asks whether EEG will prove the diagnosis, whether clozapine has 'fried the brain,' whether all medicines must stop forever, and whether staring spells mean the person is 'just zoning out.' You must explain EEG purpose and limits, clozapine seizure risk, NCSE concern in plain language, and shared next steps with neurology.

Station brief

Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar on the inpatient unit. [1]

Candidate instructions. Build rapport with patient and partner. Explain what EEG is (safe recording of brain electrical activity) and what it cannot do (prove schizophrenia; a normal result does not exclude all seizure risk). Discuss clozapine and seizures in plain language: recognised dose-related risk, monitoring and review plan, not automatic permanent abandonment if still needed. Address staring spells as possible seizures needing proper assessment (including EEG when indicated). Outline joint care with neurology, safety advice after a first seizure (driving local rules as appropriate, bathing/heights), and invite questions. Avoid jargon dumps and false certainty. [1][2][3][4]

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References5ShowHide
  1. [1]O'Sullivan SS, Mullins GM, Cassidy EM, et al. The role of the standard EEG in clinical psychiatry Hum Psychopharmacol, 2006.PMID 16783810
  2. [2]Centorrino F, Price BH, Tuttle M, et al. EEG abnormalities during treatment with typical and atypical antipsychotics Am J Psychiatry, 2002.PMID 11772698
  3. [3]Pacia SV, Devinsky O Clozapine-related seizures: experience with 5,629 patients Neurology, 1994.PMID 7991106
  4. [4]Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus Epilepsia, 2013.PMID 24001066
  5. [5]Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications J Clin Neurophysiol, 2015.PMID 25626778
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