Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining post-ACS depression and the care plan to a family — CASC communication station
MRCPsych/FRANZCP-style station: explain post-ACS depression, SADHART/ENRICHD literacy in plain language, beta-blocker myth, safety of sertraline, capacity caution, and rehab plan.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar on the cardiology step-down unit. The patient is not in the room for this conversation.[1]
Candidate instructions. Explain post-ACS depression in plain language, outline why sertraline and rehab psychology are used, address reinfarction-prevention expectations honestly, correct the beta-blocker myth gently, manage house-transfer capacity timing, and address heart-failure concerns without false hopelessness.[1][3][4]
Candidate scenario
Partner: “Just sedate him. The tablet will stop the next heart attack. Stop the beta-blocker — it always causes depression. Sign the house to me tomorrow. If he has a weak heart the antidepressant is useless.” Notes confirm depressive features, sertraline recently started, dual antiplatelets, beta-blocker continued, no psychosis, rehab non-attendance.[1][2][3]
Marking domains
- Empathy without colluding with hopelessness or knockout sedation
- Clear explanation: depression after heart attack is common and treatable
- Honest trial message: treating mood helps the person; large trials did not prove antidepressants prevent reinfarction
- Plan: sertraline + support + cardiac rehab, not heavy sedation
- Protect beta-blocker unless specialist reason to change
- Capacity: major property decisions may need to wait
- Safety-netting and follow-up contact [1][3][4][6]
Reveal assessor key
Open. Acknowledge strain: “Seeing him withdrawn after the heart attack is frightening — depression after a coronary event is common and we take it seriously, not as something to ignore as only ‘understandable.’”[1][2]
Explain. “Depression after a heart attack is linked with harder recovery and poorer outlook if ignored, but it is treatable. It involves brain and body stress systems and the shock of the illness — not a moral failure.”[2][6]
Plan. “Sertraline is an antidepressant studied after heart attacks and found relatively safe and helpful for depression. We watch for side effects including sodium changes and bleeding risk with blood thinners. We also use talking support and cardiac rehab. Strong sedatives that knock him out would slow recovery, so that is not our aim.”[1][3]
Reinfarction myth. “A large trial of counselling and support after heart attack improved mood and support measures but did not clearly stop death or another heart attack. We still treat depression because it matters for quality of life, participation, and taking medicines — not as a guaranteed stent-saver.”[4]
Beta-blocker. “Beta-blockers protect the heart after a heart attack. They are not automatically the cause of depression. We treat the mood while usually keeping heart-protecting medicines unless the cardiology team has a specific reason to change them.”[1]
House transfer / capacity. “Signing over a house is a major decision. He needs to understand and weigh options. Depression can colour hopeless decisions. Rushing papers tomorrow may not be safe; we should assess properly and may need the correct legal process if he cannot decide.”[1]
Heart failure concern. “In people with weaker heart pumping, sertraline has been studied and looked relatively safe, though mood improvement is not always dramatic compared with placebo — we still use careful combined care, not hopelessness.”[5]
Close. Summarise, check understanding, crisis plan, named contact, document.[1]
References
- [1]Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment Circulation, 2008.PMID 18824640
- [2]Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome Circulation, 2014.PMID 24566200
- [3]Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina (SADHART) JAMA, 2002.PMID 12169073
- [4]Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction (ENRICHD) JAMA, 2003.PMID 12813116
- [5]O'Connor CM, Jiang W, Kuchibhatla M, et al. Safety and efficacy of sertraline for depression in patients with heart failure (SADHART-CHF) J Am Coll Cardiol, 2010.PMID 20723799
- [6]Frasure-Smith N, Lespérance F, Talajic M Depression following myocardial infarction. Impact on 6-month survival JAMA, 1993.PMID 8411525