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Psych CASC / OSCEConsultation-liaison psychiatry

Psych CASC / OSCE · Consultation-liaison psychiatry

Explaining possible normal pressure hydrocephalus and realistic hope — CASC communication station

MRCPsych/FRANZCP-style station: explain possible iNPH in plain language, set realistic expectations about reversibility (Clarfield), outline organised work-up and shunt risks/benefits, address driving without alarmism, and avoid false certainty.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 75-year-old man and his son attend after CT report of 'large ventricles'. For 2 years the patient has had a shuffling magnetic gait, urinary urgency, and slowing of thought. His GP said 'Alzheimer's' and started donepezil 5 mg daily with no clear benefit. The son read online that NPH is a 'reversible dementia' and wants a shunt 'this week so Dad is normal for Christmas'. The patient is frightened he will be 'a vegetable' if he refuses surgery and asks whether his licence is already invalid.

Station brief

Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar in a memory/CL clinic. [2][8]

Candidate instructions. Explain possible normal pressure hydrocephalus in accessible language using the gait–thinking–bladder triad; distinguish it from a default Alzheimer label without denigrating prior care; explain that “reversible dementia” means sometimes improvable after careful selection, not guaranteed cure; outline next steps (bloods already done or pending, specialist imaging review, walking assessment before/after CSF removal); discuss shunt benefits (especially walking) and risks; address driving as case-by-case and jurisdiction-guided; check understanding and respond to emotion. [1][2][3][4]

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References8ShowHide
  1. [1]Relkin N, Marmarou A, Klinge P, et al. Diagnosing idiopathic normal-pressure hydrocephalus Neurosurgery, 2005.PMID 16160425
  2. [2]Williams MA, Malm J Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus Continuum (Minneap Minn), 2016.PMID 27042909
  3. [3]Clarfield AM The decreasing prevalence of reversible dementias: an updated meta-analysis Arch Intern Med, 2003.PMID 14557220
  4. [4]Toma AK, Papadopoulos MC, Stapleton S, et al. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus Acta Neurochir (Wien), 2013.PMID 23975646
  5. [5]Kazui H, Miyajima M, Mori E, et al. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial Lancet Neurol, 2015.PMID 25934242
  6. [6]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
  7. [7]Kito Y, Kazui H, Kubo Y, et al. Neuropsychiatric symptoms in patients with idiopathic normal pressure hydrocephalus Behav Neurol, 2009.PMID 19996513
  8. [8]Carswell C Idiopathic normal pressure hydrocephalus: historical context and a contemporary guide Pract Neurol, 2023.PMID 36162853
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