Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining steroid psychosis and thyroid screening in medical illness — CASC communication station
MRCPsych/FRANZCP-style station: explain steroid-induced neuropsychiatric effects, avoid premature bipolar labelling, outline safety and steroid liaison, and link thyroid disease to anxiety-like presentations.
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Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar on the medical/oncology ward. The partner is present and distressed.[1][4]
Candidate instructions. Explain that high-dose steroids can cause insomnia, mood change, and psychosis without meaning the patient has lifelong bipolar disorder. Outline a plan: medical liaison about steroid dose, safety, short-term medicine only if needed, daily review. Address past “anxiety attacks” as possibly thyroid-related and the value of thyroid testing in such presentations. Avoid defensive jargon; check understanding; agree shared next steps with the medical team.[1][2][3]
References5ShowHide
- [1]Warrington TP, Bostwick JM Psychiatric adverse effects of corticosteroids Mayo Clin Proc, 2006.PMID 17036562
- [2]Dubovsky AN, Arvikar S, Stern TA, et al. The neuropsychiatric complications of glucocorticoid use: steroid psychosis revisited Psychosomatics, 2012.PMID 22424158
- [3]Feldman AZ, Shrestha RT, Hennessey JV Neuropsychiatric manifestations of thyroid disease Endocrinol Metab Clin North Am, 2013.PMID 24011880
- [4]Ismail MF, Lavelle C, Cassidy EM Steroid-induced mental disorders in cancer patients: a systematic review Future Oncol, 2017.PMID 29186986
- [5]Thomsen AF, Kvist TK, Andersen PK, et al. Increased risk of affective disorder following hospitalisation with hyperthyroidism - a register-based study Eur J Endocrinol, 2005.PMID 15817908