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Psych CASC / OSCEOld age psychiatry — residential care and systems of care

Psych CASC / OSCE · Old age psychiatry — residential care and systems of care

Explain antipsychotic risk and a non-drug plan to a residential care manager — CASC communication station

MRCPsych/FRANZCP-style communication station: explain RAC behavioural assessment, person-centred care evidence, antipsychotic mortality risk, limited indications, chemical restraint concerns, and collaborative plan.

communication2 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Study tools

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
The care manager of a residential aged care facility wants standing antipsychotics for several residents who call out or wander. She is frustrated after a staff injury during personal care of one resident with dementia. She asks why psychiatrists 'always say no to tablets' and wants a clear plan she can take to her team.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the old-age psychiatry registrar on a residential care liaison visit. [1]

Candidate instructions. Acknowledge staff injury and facility pressures; explain multifactorial behaviour (medical causes, pain, unmet needs, care approach); outline non-drug and staff-training plans with plain-language evidence; explain why antipsychotics are not first-line for wandering or calling out and carry death/fall risks; clarify when a short low-dose course might still be used with review; address chemical restraint and documentation; agree a written collaborative plan and follow-up. Examiner plays the care manager. [1][2][3]

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References5ShowHide
  1. [1]Kales HC, Gitlin LN, Lyketsos CG Assessment and management of behavioral and psychological symptoms of dementia BMJ, 2015.PMID 25731881
  2. [2]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
  3. [3]Fossey J, Ballard C, Juszczak E, et al. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial BMJ, 2006.PMID 16543297
  4. [4]Ballard C, Corbett A, Orrell M, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial PLoS Med, 2018.PMID 29408901
  5. [5]Husebo BS, Ballard C, Sandvik R, et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial BMJ, 2011.PMID 21765198
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