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Clinical Atlas Prestige · Evidence-first

Psych CASC / OSCEChild and adolescent psychiatry — OCRD

Psych CASC / OSCE · Child and adolescent psychiatry — OCRD

Explain childhood OCD and treatment options to parents — CASC communication station

MRCPsych/FRANZCP-style communication station: explain paediatric OCD without psychosis myths, outline ERP and family roles, address SSRI black-box concerns, and place PANDAS in context.

communication
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
Parents of a 10-year-old attend after teachers report endless rewriting and handwashing. History supports contamination and symmetry OCD for 18 months with high family accommodation. Parents fear the child is 'going psychotic', ask if antibiotics will cure it because of an internet article on PANDAS, and worry that 'antidepressants will make him suicidal'.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the child mental health clinic. [2]

Candidate instructions. Explain the working diagnosis of OCD in plain language, correct psychosis and PANDAS myths as appropriate to a gradual developmental presentation, outline ERP and the family’s role in reducing accommodation, discuss when SSRIs are considered including monitoring for activation/suicidality, and agree a collaborative plan with school liaison. The examiner plays a parent. [2][3]

Candidate scenario

Assessment supports childhood-onset OCD with contamination and symmetry symptoms, high family accommodation, and school impairment. No primary psychotic features. Course is gradual over 18 months. You plan psychoeducation, family-inclusive ERP, CY-BOCS tracking, school liaison, and a measured discussion of SSRI if severity or ERP access warrants — not immediate antipsychotic and not automatic antibiotics. Parents are anxious and information-seeking. [1][2][6]

Marking domains

  • Empathy and agenda-setting (psychosis fear, internet PANDAS, antidepressant fear, school)
  • Accurate plain-language OCD explanation (intrusions + rituals + impairment)
  • Corrects psychosis mislabelling without dismissing poor-insight continuum
  • Clear ERP plan and family accommodation coaching
  • Balanced SSRI discussion with black-box monitoring language
  • Places PANDAS as uncommon acute concept, not default for gradual OCD
  • Checks understanding; shared decision; follow-up and school letter [1][2][3][4][5]
Reveal assessor key

Open and agenda-set. Name time; invite priorities (is it psychosis, school, medicine fears, internet PANDAS). Validate worry without catastrophising. [2]

Explain OCD. Unwanted intrusive thoughts and rituals that temporarily reduce anxiety but take over life. Not naughtiness. We measure severity (e.g. CY-BOCS language as “a checklist clinicians use”). [6]

Psychosis fear. OCD can include frightening thoughts and sometimes reduced insight, but this presentation fits OCD, not schizophrenia. We treat OCD with ERP ± SSRI, not automatic strong antipsychotics. [2]

ERP and family. Skills-based therapy helps the child face triggers without rituals. Parents’ natural reassurance can accidentally keep OCD strong — we coach gradual reduction of accommodation with support.[3][2]

Medicines. If needed (severity or limited response/access), SSRIs such as sertraline have paediatric trial evidence. We start carefully, review early, and watch for activation or mood/self-harm thoughts — honest black-box discussion, not scare tactics or false absolute safety claims.[1][5][2]

PANDAS. Some rare children have sudden OCD/tics after infections; classic descriptions exist. Gradual 18-month OCD is usually managed as standard OCD; we do not automatically start antibiotics from an internet article, but we take red-flag histories seriously.[4][2]

Close. Summarise plan, school liaison, written info, follow-up, invite questions. [2]

References

  1. [1]Pediatric OCD Treatment Study (POTS) Team Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial JAMA, 2004.PMID 15507582
  2. [2]American Academy of Child and Adolescent Psychiatry Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder J Am Acad Child Adolesc Psychiatry, 2012.PMID 22176943
  3. [3]Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder Am J Psychiatry, 1995.PMID 7864273
  4. [4]Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases Am J Psychiatry, 1998.PMID 9464208
  5. [5]March JS, Biederman J, Wolkow R, et al. Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial JAMA, 1998.PMID 9842950
  6. [6]Scahill L, Riddle MA, McSwiggin-Hardin M, et al. Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity J Am Acad Child Adolesc Psychiatry, 1997.PMID 9183141