Transplant and ICU psychiatry — structured clinical viva

Station A — Transplant. Open with role clarity: psychiatry contributes structured risk and optimisation to an MDT, not unilateral veto theatre. Use ISHLT-style domains and SIPAT constructs: psychopathology stability (bipolar treatment adherence, mood episode control, lithium/other level monitoring plans), substance use, social support, and adherence behaviour (DNA pattern, barriers, willingness to engage).^[1][2] Frame intermittent DNAs as a modifiable adherence signal — problem-solve transport, depression/hypomania contribution, health beliefs — then state residual risk honestly. Capacity for transplant consent is decision-specific after material disclosure of lifelong immunosuppression and risks.^[7]

Station B — ICU. Sequence: safety and medical ownership of causes; RASS for arousal; CAM-ICU when arousable; motor subtype (do not miss hypoactive).^[3] Management aligns with PADIS-informed bundles: non-pharmacological first; short-term antipsychotics only for severe distress/danger with review.^[4] Capacity fluctuates with delirium — assess per decision; emergency necessity when incapacity and serious harm; reassess when lucid; family are informants and may be distressed (PICS-F), not automatic legal proxies unless appointed under local law.^[7] For "brain damage/PTSD": cite that long-term cognitive impairment after critical illness is common in major cohort data and associated with delirium exposure, and that PTSD symptoms are well documented in ICU survivors — offer follow-up and name interventions such as diaries where used.^[5][6]

Communication. Avoid pejorative "psych clear." Prefer: domains assessed, optimisations completed, residual risks, monitoring plan, and explicit capacity statement with timestamp.^[1][7]