Explain GAD and start sertraline with CBT — CASC communication station · Psych CASC / OSCE

Prompt

A 33-year-old teacher newly diagnosed with generalised anxiety disorder wants an explanation of the diagnosis, why CBT and an SSRI are suggested, side-effects including early activation, why long-term diazepam is not the plan, and how long treatment lasts.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [3]

Candidate instructions. Explain the diagnosis of generalised anxiety disorder, the rationale for CBT and starting sertraline, common side-effects, what to do if anxiety or mood worsens after starting treatment, why daily long-term diazepam is not recommended as the main plan, expected timeline of benefit, and rough duration after improvement. Check understanding and invite questions. The examiner plays the patient. [3]

Candidate scenario

Your patient meets criteria for GAD of moderate-severe severity (GAD-7 is 14). You plan sertraline 25–50 mg orally daily with early review, and high-intensity CBT referral for worry. She fears "personality change" and "addiction" to antidepressants, and asks why you will not simply increase diazepam she was given after a flight. She drinks coffee heavily and wine most nights. [1][2][3]

Marking domains

Empathy, structure and agenda-setting
Accurate plain-language explanation of GAD (free-floating multi-domain worry, not "just stress")
Clear medication plan with dose, early side-effects, delayed benefit
Safety-netting for activation/worsening ideation
CBT rationale without jargon dump
Benzodiazepine stewardship without shaming
Caffeine/alcohol advice
Checks understanding [3][4]

Reveal assessor key

Open and agenda-set. Name time available; ask her main worries first (addiction, personality, diazepam expectation, work). [3]

Explain diagnosis. "Generalised anxiety disorder is a medical condition where worry is excessive, hard to switch off, covers many areas of life for months, and comes with tension, poor sleep and concentration that interfere with work and life. It is common and treatable. It is not weakness." [3]

Explain CBT. Psychological therapy teaches skills: spotting worry cycles, testing fears, handling uncertainty, reducing reassurance habits, and relaxation for muscle tension — with practice between sessions. Evidence supports these approaches for GAD.[4]

Explain sertraline. An SSRI starting at 25–50 mg daily. Benefits often build over several weeks; early nausea or headache may settle. Some people feel more jittery early on — that is why we review soon and start low. Sexual side-effects can occur — raise them early. Antidepressants are not intoxicating "addictions" like alcohol or diazepam, but should not be stopped abruptly later without a plan.[1][3]

Diazepam discussion. Short-term use can calm severe spikes, but daily long-term use risks dependence, fogginess and rebound anxiety and does not teach long-term skills — so it is not our main plan. [3]

Lifestyle. Cutting caffeine and reducing evening alcohol often improves sleep and jitteriness. [3]

Duration. After feeling better, continuing medication for many months reduces relapse risk; we individualise together. [3]

Close. Summarise, teach-back, written information, crisis contacts, book early review, confirm CBT referral pathway. [2][3]

References

[1]Allgulander C, Dahl AA, Austin C, et al. Efficacy of sertraline in a 12-week trial for generalized anxiety disorder Am J Psychiatry, 2004.PMID 15337655
[2]Spitzer RL, Kroenke K, Williams JB, Löwe B A brief measure for assessing generalized anxiety disorder: the GAD-7 Arch Intern Med, 2006.PMID 16717171
[3]Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders BMC Psychiatry, 2014.PMID 25081580
[4]Hunot V, Churchill R, Silva de Lima M, Teixeira V Psychological therapies for generalised anxiety disorder Cochrane Database Syst Rev, 2007.PMID 17253466

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [3]

Candidate scenario

Marking domains

Empathy, structure and agenda-setting

Accurate plain-language explanation of GAD (free-floating multi-domain worry, not "just stress")

Clear medication plan with dose, early side-effects, delayed benefit

Safety-netting for activation/worsening ideation

CBT rationale without jargon dump

Benzodiazepine stewardship without shaming

Caffeine/alcohol advice

Checks understanding [3][4]

Reveal assessor key

Open and agenda-set. Name time available; ask her main worries first (addiction, personality, diazepam expectation, work). [3]

Lifestyle. Cutting caffeine and reducing evening alcohol often improves sleep and jitteriness. [3]

Duration. After feeling better, continuing medication for many months reduces relapse risk; we individualise together. [3]

Close. Summarise, teach-back, written information, crisis contacts, book early review, confirm CBT referral pathway. [2][3]

References

[1]Allgulander C, Dahl AA, Austin C, et al. Efficacy of sertraline in a 12-week trial for generalized anxiety disorder Am J Psychiatry, 2004.PMID 15337655
[2]Spitzer RL, Kroenke K, Williams JB, Löwe B A brief measure for assessing generalized anxiety disorder: the GAD-7 Arch Intern Med, 2006.PMID 16717171
[3]Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders BMC Psychiatry, 2014.PMID 25081580
[4]Hunot V, Churchill R, Silva de Lima M, Teixeira V Psychological therapies for generalised anxiety disorder Cochrane Database Syst Rev, 2007.PMID 17253466