Psych CASC / OSCE · Old age psychiatry — psychosis
Explain late-onset psychosis and treatment plan to patient and niece — CASC communication station
MRCPsych/FRANZCP-style communication station: explain late-onset psychosis construct, organic work-up, sensory factors, low-dose antipsychotic, monitoring, and safety without jargon overload.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 74-year-old woman with new VLOSLP-type persecutory and partition delusions and her niece want a clear explanation of what is happening, why medical tests and a brain scan are needed, why a low-dose antipsychotic is suggested, what side-effects and dementia-related risks mean if cognition declines, and what supports will help at home.
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the old-age outpatient clinic. The patient may have partial insight; the niece is worried about dementia and medication harm.[2]
Tasks.
- Explain that new psychosis in later life is a syndrome with several possible causes, including a primary late-onset schizophrenia-like illness (VLOSLP construct after age 60) after medical causes are checked.[1]
- Explain why blood tests, heart tracing, hearing check, and brain imaging are recommended.
- Discuss non-drug steps (hearing support, safety, social contact).[5]
- Propose a low-dose antipsychotic example, side-effects, monitoring, and review; mention special caution if dementia is later confirmed (including increased mortality risk with antipsychotics in dementia studies).[3][4][6]
- Check understanding; agree a safety and follow-up plan.
References6ShowHide
- [1]Howard R, Rabins PV, Seeman MV, Jeste DV Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus Am J Psychiatry, 2000.PMID 10671383
- [2]Devanand DP, Jeste DV, Stroup TS, Goldberg TE Overview of late-onset psychoses Int Psychogeriatr, 2024.PMID 36866576
- [3]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia JAMA, 2005.PMID 16234500
- [4]Scott J, Greenwald BS, Kramer E, Shuwall M Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis Int Psychogeriatr, 2011.PMID 21118614
- [5]Prager S, Jeste DV Sensory impairment in late-life schizophrenia Schizophr Bull, 1993.PMID 8303225
- [6]Castle DJ, Galletly CA, Dark F, et al. The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders Med J Aust, 2017.PMID 28918734