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Psych CASC / OSCEConsultation-liaison psychiatry

Psych CASC / OSCE · Consultation-liaison psychiatry

Explaining somatic symptom disorder and a collaborative pain plan — CASC communication station

MRCPsych/FRANZCP-style station: validate symptoms, explain SSD without dualism, outline CBT and cautious meds, and address opioid risk collaboratively.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 41-year-old woman with multi-system pain and fatigue is angry after a ward round comment that her symptoms are 'functional, so nothing to worry about.' She fears cancer, wants more scans, and is taking increasing oxycodone from two GPs. You are the psychiatry registrar asked to explain the formulation and plan.

Station brief

Format. Communication station, approximately 7–10 minutes after reading time. You are the C-L psychiatry registrar. Medical work-up to date is non-diagnostic for a single explanatory disease; red-flag review is negative today. [1][2]

Candidate instructions. Validate experience; apologise for dismissive language if needed; explain SSD/health-anxiety amplification in plain language without saying “imaginary”; outline a collaborative plan (scheduled reviews, CBT, mood treatment, activity, opioid caution); agree when further tests would be reconsidered; check understanding. [2][3][4]

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References5ShowHide
  1. [1]Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM J Psychosom Res, 2013.PMID 23972410
  2. [2]Henningsen P, Zipfel S, Herzog W Management of functional somatic syndromes Lancet, 2007.PMID 17368156
  3. [3]Tyrer P, Cooper S, Salkovskis P, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial Lancet, 2014.PMID 24139977
  4. [4]Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial JAMA, 2018.PMID 29509867
  5. [5]Barsky AJ, Ahern DK Cognitive behavior therapy for hypochondriasis: a randomized controlled trial JAMA, 2004.PMID 15039413
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