Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining post-stroke depression and the care plan to a family — CASC communication station
MRCPsych/FRANZCP-style station: explain post-stroke depression without location dogma, the treatment plan, the fluoxetine motor-recovery trials, and an honest outlook.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
A 70-year-old man is 4 weeks after ischaemic stroke with mild aphasia. He has been tearful, withdrawn from physiotherapy, and started on sertraline 50 mg daily. His daughter is distressed: 'The left side of his brain is dead so of course he is depressed. Give him fluoxetine so his arm comes back. Will he ever get better?'
Candidate brief
Format. Communication station. You are the psychiatry registrar on the stroke rehabilitation unit. The patient is not in the room for this conversation.
Candidate instructions. Explain post-stroke depression in plain language, respond gently to the left-brain belief, explain why an antidepressant and rehabilitation are being used, address the fluoxetine-for-the-arm request, and give an honest outlook.
References8ShowHide
- [1]Towfighi A, Ovbiagele B, El Husseini N, Hackett ML, et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke, 2017.PMID 27932603
- [2]Carson AJ, MacHale S, Allen K, Lawrie SM, et al. Depression after stroke and lesion location: a systematic review Lancet, 2000.PMID 10963248
- [3]FOCUS Trial Collaboration Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial Lancet, 2019.PMID 30528472
- [4]Hackett ML, Pickles K Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies Int J Stroke, 2014.PMID 25117911
- [5]Robinson RG, Jorge RE Post-Stroke Depression: A Review Am J Psychiatry, 2016.PMID 26684921
- [6]Paolucci S Epidemiology and treatment of post-stroke depression. Neuropsychiatric disease and treatment, 2008.PMID 18728805
- [7]Ayerbe L, Ayis S, Wolfe CD, et al. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. The British journal of psychiatry : the journal of mental science, 2013.PMID 23284148
- [8]AFFINITY Trial Collaboration Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 2020.PMID 32702334