Psych CASC / OSCE · Consultation-liaison — burns and critical illness psychiatry
Post-burn PTSD and body-image avoidance — CASC communication station
MRCPsych/FRANZCP-style CASC: trauma-informed interview for post-burn PTSD and body-image distress, risk assessment, collaborative rehabilitation planning, and family involvement with consent — without inventing legal sections.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar attached to the burns service. [1]
Candidate instructions. Explore trauma symptoms and body-image distress after facial and hand burns. Screen depression and suicide risk. Link avoidance of mirrors and hand therapy to recovery goals without shame or coercion. Collaborate on a graded plan (pain, psychology, peer support, therapy scheduling). Offer family involvement with consent. Avoid inventing legal section numbers. [1][2][3]
Candidate scenario
Your patient is 26, six weeks after 22% TBSA flame burns involving face and dominant hand. They cancel occupational therapy, cover mirrors, wake with nightmares of the fire, and report that 'people will stare forever.' Pain spikes before dressings. A sibling is outside if the patient consents to involve them. No current plan for suicide but intermittent passive death wishes after seeing photos of their scars. [1][2]
Marking domains
- Empathy; non-stigmatising language about appearance
- Screens PTSD clusters, depression, suicide risk
- Validates body-image distress as common and treatable after burns
- Links pain, trauma, and therapy avoidance without threats
- Collaborative graded plan: mirror hierarchy, OT slots, psychology/CBT options, analgesia liaison
- Family involvement with consent
- Summarises and safety-nets [1][3][4][5]
Reveal assessor key
Open. Introduce role; purpose is to support recovery of function and reduce distress, not to force looking at scars today. Check comfort and preference for sibling presence. [1]
Explore. Timeline from injury; nightmares, flashbacks, avoidance of smells/mirrors/therapy, sleep, mood, guilt, passive SI. Normalise that PTSD and body-image problems are well recognised after burn scars. [1][2]
Link. Untreated pain and trauma symptoms worsen disability and block hand therapy — frame as shared problem-solving, not blame. Depression symptoms deserve active treatment pathways. [3][4]
Plan. Optimise pre-dressing analgesia with burn team; graded mirror and social exposure; short frequent OT sessions; psychology for trauma-focused work; mention that structured brief CBT protocols for acute posttrauma distress have been studied in burn populations as an example of early intervention models; sleep hygiene; sibling support if consented; clear crisis contacts for escalating SI. Written summary and follow-up. [3][5]
Close. Check understanding; agree next therapy time; feed plan to burn MDT.[1]
References
- [1]Van Loey NE, Van Son MJ Psychopathology and psychological problems in patients with burn scars: epidemiology and management Am J Clin Dermatol, 2003.PMID 12680803
- [2]McKibben JB, Bresnick MG, Wiechman Askay SA, Fauerbach JA Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries J Burn Care Res, 2008.PMID 18182894
- [3]Corry NH, Klick B, Fauerbach JA Posttraumatic stress disorder and pain impact functioning and disability after major burn injury J Burn Care Res, 2010.PMID 20061832
- [4]Thombs BD, Bresnick MG, Magyar-Russell G Depression in survivors of burn injury: a systematic review Gen Hosp Psychiatry, 2006.PMID 17088165
- [5]Fauerbach JA, Gehrke AK, Mason ST, et al. Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study in Burned Patients Arch Phys Med Rehabil, 2020.PMID 30776324