Explaining psychotropic choices in CKD and cirrhosis (CASC)

Station instructions (candidate)

You have 7 minutes. Explain in plain language why lithium needs kidney monitoring and why anti-inflammatory painkillers can raise lithium levels; why standard sleeping tablets (benzodiazepines) are risky with her liver disease; and how decisions about antidepressants in kidney disease are individualised — including that a major trial (CAST) found sertraline no better than placebo for depression symptoms in non-dialysis CKD, so expectations and non-drug options matter. Do not terrify her into stopping lithium without a plan. Do not promise cure. Check understanding and safety (suicide risk, who to call if confused or very unsteady).^[1][2][3][5]