Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining PD psychosis, agonist ICD risk, and treatment choices to a spouse — CASC communication station
MRCPsych/FRANZCP-style station: explain PD psychosis and ICD, why high-potency antipsychotics are dangerous, rationale for DRT review and low-dose clozapine or pimavanserin, and safe shared plan.
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Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar. Neurology remains involved. You meet the spouse alone first.[1]
Candidate instructions. Explain PD psychosis in plain language (not primary schizophrenia). Explain that some Parkinson medicines — especially dopamine agonists — can drive impulse control problems such as gambling. Explain why drugs like haloperidol are dangerous in PD, and why low-dose clozapine (with blood tests) or pimavanserin (if available) differ. Agree a plan that does not stop all Parkinson medicines abruptly. Address safety and follow-up. Avoid inventing legal section numbers.[2][3][5]
References5ShowHide
- [1]Ravina B, Marder K, Fernandez HH, et al. Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group Mov Disord, 2007.PMID 17266092
- [2]Weintraub D, Koester J, Potenza MN, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients Arch Neurol, 2010.PMID 20457959
- [3]Parkinson Study Group Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease N Engl J Med, 1999.PMID 10072410
- [4]Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial Lancet, 2014.PMID 24183563
- [5]Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review Mov Disord, 2019.PMID 30653247