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Psych CASC / OSCEGeneral adult psychiatry — bipolar and related disorders

Psych CASC / OSCE · General adult psychiatry — bipolar and related disorders

Explain mixed features, suicide risk, and stopping the antidepressant — CASC communication station

MRCPsych/FRANZCP-style communication station: explain mixed features and high suicide risk in plain language, justify stopping antidepressant monotherapy with STEP-BD framing, outline lithium/SGA benefits and monitoring, and check understanding.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Study tools

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
Partner of a 34-year-old woman admitted with mixed-features mania wants an explanation of why sertraline was stopped, what mixed features and rapid cycling mean, and what lithium plus olanzapine will involve.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar on the inpatient unit. [3]

Candidate instructions. Explain mixed features and why this presentation is high risk for suicide. Explain why sertraline monotherapy was stopped. Outline the plan for lithium and olanzapine including common side-effects and blood tests. Briefly define rapid cycling if the partner asks about a year of many ups and downs. Check understanding and invite questions. The examiner plays the partner. [1][3]

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References4ShowHide
  1. [1]Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression N Engl J Med, 2007.PMID 17392295
  2. [2]Cipriani A, Hawton K, Stockton S, et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis BMJ, 2013.PMID 23814104
  3. [3]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391
  4. [4]Tohen M, McIntyre RS, Kanba S, et al. Efficacy of olanzapine in the treatment of bipolar mania with mixed features defined by DSM-5 J Affect Disord, 2014.PMID 25046739
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