Psych CASC / OSCE · Consultation-liaison psychiatry
Ward explanation of FND and team alignment — CASC / C-L station
MRCPsych/FRANZCP-style C-L communication station: non-pejorative FND explanation after a botched 'all stress' message, MDT plan, and discharge safety-net.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes. You are the C-L psychiatry registrar on the medical ward. Neurology has documented positive Hoover's sign. [1][5]
Candidate instructions. Repair the dismissive “only stress / normal scan” message; explain FND in plain language; affirm that symptoms are real and not feigned; link positive signs; outline specialist physiotherapy and psychological support; safety-net red flags; check understanding and next steps. Avoid jargon dumps and pejorative terms. [1][2]
Candidate scenario
Patient: “They said my scan is fine so it must be stress. Does that mean you think I am faking? Why would I need a physiotherapist if nothing is wrong? I am scared I will never walk properly.” Examination notes: positive Hoover’s, inconsistency, no progressive UMN pattern. [1][4]
Marking domains
- Empathy and repair of prior iatrogenic messaging
- Accurate non-pejorative FND explanation (real, involuntary)
- Rule-in / positive-sign rationale without overwhelming technicality
- Clear physio and psychology MDT plan for the hospital interface
- Safety-net for new red flags and realistic hope
- Check understanding and collaborative next steps [1][2][3][5]
Reveal assessor key
Open. Introduce role, acknowledge hurt from the “only stress” message, agenda-set. “It makes sense that felt dismissive — I want to explain what we think is going on more carefully.” [1]
Name and reframe. “We use the term functional neurological disorder. It means a problem with how the nervous system is functioning rather than a permanent broken structure like a tumour. The weakness is real. You are not faking and you are not crazy.” [1][2][4]
How we know. “When neurology examined you, Hoover’s sign and the pattern of inconsistency showed that the pathways can still work when attention is redirected. The diagnosis is based on those positive findings, not only on a normal scan.” [1][4]
Treatment and ward plan. “Specialist physiotherapy retrains movement and reduces over-focus on the weak leg. Psychological support helps with fear and confidence. We work with medicine and neurology, write a clear plan, and arrange follow-up — we do not leave you with ‘just stress’.” [2][3][5]
Hope and safety-net. “Improvement is possible with the right help; I will not invent a false guarantee. If new red-flag symptoms appear, we reassess.” [2]
Close. Summarise, offer written information, name next appointment, invite questions, document discussion for the ward team. [1][5]
References
- [1]Stone J, Burton C, Carson A Recognising and explaining functional neurological disorder BMJ, 2020.PMID 33087335
- [2]Aybek S, Perez DL Diagnosis and management of functional neurological disorder BMJ, 2022.PMID 35074803
- [3]Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation J Neurol Neurosurg Psychiatry, 2015.PMID 25433033
- [4]Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders JAMA Neurol, 2018.PMID 29868890
- [5]Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder (FND) for the general physician Clin Med (Lond), 2021.PMID 33479065