Psych CASC / OSCE · General adult psychiatry — trauma and stressor-related
Explain adjustment disorder and brief therapy plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain AD vs depression, watchful waiting and brief psychological care, selective medication, alcohol/sleep advice, and safety-netting.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [3]
Candidate instructions. Explain the likely diagnosis of adjustment disorder, how it differs from major depression, why brief psychological treatment and active monitoring are recommended first, when medication might be considered later, sleep and alcohol advice, and clear safety-netting for suicidal thoughts. Check understanding. The examiner plays the patient. [1][3]
Candidate scenario
Your patient has stressor-linked mixed anxiety and low mood for 7 weeks after redundancy without full major depressive episode criteria. Risk is currently low (no plan or intent) but she feels hopeless some evenings. You plan problem-solving therapy referral, GP review in 2 weeks, and no antidepressant today. She fears being "fobbed off" without tablets. [1][2][3]
Marking domains
- Empathy, structure, agenda-setting
- Clear explanation of adjustment disorder (stressor link, timing, impairment) without minimising
- Accurate distinction from major depression
- Rationale for brief psychological care / problem-solving
- When antidepressants would be reconsidered
- Sleep and alcohol advice; avoid chronic sedatives
- Safety-netting and crisis contacts
- Teach-back / shared decision-making [2][3][4]
Reveal assessor key
Open. Name time; ask her main worries (depression label, wanting tablets, job fear, sleep). [3]
Explain AD. "Adjustment disorder means a strong, understandable but clinically significant reaction to a major life stress — here, losing your job — that starts within a few months and causes distress or problems functioning. It is a real diagnosis, not 'all in the mind', and it often improves with support and skills while the situation is worked through." [1][3]
Differentiate depression. "Major depression is diagnosed when a fuller set of symptoms is present most of the day nearly every day for at least 2 weeks, with more pervasive loss of pleasure and other features. Today your picture fits adjustment disorder more closely; we will re-check that carefully because the plan would change if major depression develops." [1]
Explain brief therapy. Problem-solving therapy breaks problems into parts, generates options (finances, job search, routine), chooses steps, and reviews — with brief CBT strategies for unhelpful predictions and rebuilding routine. Evidence supports psychological approaches as first-line active care for many with AD.[2][4]
Medication discussion. Antidepressants are not automatic for uncomplicated adjustment disorder. If symptoms worsen, last, or become a full depressive illness, or if therapy is not enough, we can discuss an SSRI such as sertraline starting low with close review. Long-term sleeping tablets risk dependence and are not the main plan. [3][4]
Safety-net. If suicidal thoughts become active plans, or she cannot stay safe, use crisis lines/ED; provide written contacts; book early review; reduce evening alcohol which worsens mood and sleep. [3]
Close. Summarise, teach-back, written information, confirm psychology pathway and GP follow-up. [3]
References
- [1]Bachem R, Casey P Adjustment disorder: A diagnosis whose time has come J Affect Disord, 2018.PMID 29107817
- [2]Domhardt M, Baumeister H Psychotherapy of adjustment disorders World J Biol Psychiatry, 2018.PMID 30204563
- [3]Geer K Adjustment Disorder: Diagnosis and Treatment in Primary Care Prim Care, 2023.PMID 36822730
- [4]Casey P Adjustment disorder: epidemiology, diagnosis and treatment CNS Drugs, 2009.PMID 19845414