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Psych CASC / OSCEOld age psychiatry — psychopharmacology

Psych CASC / OSCE · Old age psychiatry — psychopharmacology

Explain safer prescribing and antipsychotic risks to family — CASC communication station

MRCPsych/FRANZCP-style communication station: explain geriatric psychotropic safety, Beers-type caution, antipsychotic mortality/stroke risk, deprescribing, and when medicines may still be used.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Study tools

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
The daughter of an 84-year-old residential care resident with Alzheimer disease and recurrent falls wants to know why you are reducing risperidone and temazepam, why staff should not 'just give more tablets' for calling out, and what you will do if severe aggression returns. She has read about black-box warnings online.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar reviewing residential care medications with the resident's daughter. [1]

Candidate instructions. Explain in plain language why long-term risperidone and night temazepam are being reviewed; summarise mortality/stroke concerns with antipsychotics in dementia without causing panic; outline non-drug approaches for calling out; describe a supervised taper and what happens if severe aggression returns; check understanding. Examiner plays the daughter. [1][2][3]

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References5ShowHide
  1. [1]Schneider LS, Dagerman KS, Insel P Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials JAMA, 2005.PMID 16234500
  2. [2]Ballard C, Lana MM, Theodoulou M, et al. A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial) PLoS Med, 2008.PMID 18384230
  3. [3]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults J Am Geriatr Soc, 2023.PMID 37139824
  4. [4]Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
  5. [5]Devanand DP, Mintzer J, Schultz SK, et al. Relapse risk after discontinuation of risperidone in Alzheimer's disease N Engl J Med, 2012.PMID 23075176
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