Psych CASC / OSCE · Psychopharmacology
Explaining tardive dyskinesia and treatment options — CASC communication station
MRCPsych/FRANZCP-style station: explain TD in plain language, balance relapse risk vs movement harm, outline monitoring (AIMS), switch options, and evidence-based VMAT2 therapy without jargon dumps.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar meeting the patient and partner in clinic after an AIMS assessment showed moderate orofacial TD.[1]
Candidate instructions. Explain tardive dyskinesia in plain language, acknowledge the link to dopamine-blocking medicines without abandoning hope, outline options (dose review, switch including possible clozapine pathway if psychosis requires ongoing treatment, VMAT2 inhibitors with trial-level evidence), and check understanding. Do not invent legal section numbers or claim SGAs never cause TD.[2][4][5]
Candidate scenario
Partner: “Look at her face — she can’t eat without chewing air. You caused this. Should she stop every tablet today? Is that new movement medicine just experimental?” Patient is stable in mental state but distressed by stigma of facial movements. [1]
Marking domains
- Empathy, non-defensive acknowledgement of drug association
- Clear plain-language explanation of TD as late movement effect of dopamine-blocking medicines
- Honest epidemiology: still occurs with modern antipsychotics
- Balanced plan: measure severity, review dose/need, consider switch, consider VMAT2 (valbenazine/deutetrabenazine) supported by phase 3 trials
- Relapse risk if abrupt stop without plan
- Shared decision, follow-up with AIMS, local access for specialist medicines [1][2][3][5]
Reveal assessor key
Open. Introduce role, acknowledge anger and fear. “You are right to notice these movements and to ask direct questions about the medicine.” [1]
Explain TD. “We think this is tardive dyskinesia — involuntary movements, often of the mouth and tongue, that can appear after months or years of medicines that block dopamine. It is a recognised side-effect, not her ‘fault,’ and not a new primary brain disease we ignore.” Mention that modern antipsychotics lower but do not remove the risk. [4][1]
What we will do. “We will document severity with a structured exam (AIMS), review whether the dose can be lowered safely, and discuss whether a different medicine with lower movement risk is better — sometimes that includes specialist options such as clozapine if psychosis still needs treatment. There are also medicines called VMAT2 inhibitors — for example valbenazine and deutetrabenazine — studied in large randomised trials that reduce the movements for many people. They are not experimental first-in-human drugs; access depends on local availability and specialist prescribing.” [2][3][5]
Relapse balance. “Stopping antipsychotic suddenly can bring psychosis back. We make changes carefully together, not overnight abandonment, unless there is a separate emergency.” [1]
Close. Summarise plan, written information, named follow-up, invite questions, document discussion. [1]
References
- [1]Correll CU, Citrome L Diagnostic and Treatment Fundamentals for Tardive Dyskinesia J Clin Psychiatry, 2021.PMID 34644461
- [2]Hauser RA, Factor SA, Marder SR, et al. KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia Am J Psychiatry, 2017.PMID 28320223
- [3]Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD) Lancet Psychiatry, 2017.PMID 28668671
- [4]Carbon M, Hsieh CH, Kane JM, Correll CU Tardive Dyskinesia Prevalence in the Period of Second-Generation Antipsychotic Use: A Meta-Analysis J Clin Psychiatry, 2017.PMID 28146614
- [5]Ricciardi L, Pringsheim T, Barnes TRE, et al. Treatment Recommendations for Tardive Dyskinesia Can J Psychiatry, 2019.PMID 30791698