Psych CASC / OSCE · General adult psychiatry — trauma and stressor-related
Explain prolonged grief and grief-focused therapy — CASC communication station
MRCPsych/FRANZCP-style communication station: explain PGD vs normal grief vs MDD, CGT rationale, limited medication role, cultural respect, and safety-netting after COVID bereavement.
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Target exams
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 that intense grief can remain impairing after many months and may meet criteria for prolonged grief disorder; distinguish this from ordinary mourning and from major depression; explain why grief-focused talking therapy is recommended; discuss limited role of tablets; respect cultural mourning; safety-net for suicidal thoughts. Check understanding. The examiner plays the patient. [1][3]
Candidate scenario
Your patient lost her partner to COVID-related illness 15 months ago. Funerals were restricted. She has daily yearning, avoids hospital reminders, feels identity-shattered, and has withdrawn socially. Risk is currently low (no plan) but she sometimes wishes she could "go to him". You plan referral for Complicated Grief Treatment / grief-focused CBT, GP review, alcohol advice if relevant, and no long-term sleeping tablets. She fears being judged as weak or "over it too slowly". [2][3]
Marking domains
- Empathy, structure, agenda-setting
- Clear explanation of PGD without pathologising love
- Accurate distinction from normal grief and from major depression
- Rationale for grief-focused psychotherapy (CGT/CBT ingredients in plain language)
- When medication might be considered
- Cultural respect and COVID-context validation
- Safety-netting for reunion/suicidal thoughts
- Teach-back / shared decision-making [1][3][4]
Reveal assessor key
Open. Name time; ask her main worries (going mad, depression label, tablets, family pressure to move on, unfinished goodbye after COVID restrictions). [2][3]
Explain adaptive grief vs PGD. "Grief is a normal response to losing someone you love. For some people, after many months, the yearning and stuck avoidance stay so intense that life cannot restart — that pattern can be called prolonged grief disorder. It does not mean your love was wrong or that you should forget him." Anchor adult DSM timing language carefully if asked (about a year or more) and note systems differ. [3]
Differentiate depression. "Major depression is diagnosed when a broader set of symptoms is present most of the day nearly every day for at least two weeks, with more pervasive loss of pleasure. We will keep checking for that because treatment can include antidepressants if depression is present. Your main picture today is stuck grief with yearning and avoidance." [3]
Explain therapy. Complicated Grief Treatment / grief-focused CBT helps people process the story of the death, reduce avoidance of reminders, rebuild meaningful activities, and keep a healthy continuing bond without being frozen. Trials show this approach helps complicated or prolonged grief more than some other talking therapies. [1][5]
Medication discussion. Long-term sleeping tablets risk dependence and do not treat the core of prolonged grief. If major depression develops or sleep is severely broken short-term, we can discuss options carefully. Therapy remains central. [5]
Culture and COVID. Validate disrupted farewell and family expectations; invite her cultural or spiritual practices as part of healing rather than obstacles. Diagnosis requires reactions that go beyond what is expected in her culture — we will explore that with her, not impose a single timeline. [2][4]
Safety-net. If thoughts of joining him become plans, or she cannot stay safe, use crisis lines/ED; provide written contacts; book early review. [3]
Close. Summarise, teach-back, written information, confirm therapy pathway and GP follow-up. [3]
References
- [1]Shear K, Frank E, Houck PR, Reynolds CF 3rd Treatment of complicated grief: a randomized controlled trial JAMA, 2005.PMID 15928281
- [2]Simon NM, Saxe GN, Marmar CR Mental Health Disorders Related to COVID-19-Related Deaths JAMA, 2020.PMID 33044510
- [3]Simon NM, Shear MK, Reynolds CF, Cozza SJ, et al. Commentary on evidence in support of a grief-related condition as a DSM diagnosis Depress Anxiety, 2020.PMID 31916663
- [4]Moore BS, da Silva JP, Farias M Diagnosing Prolonged Grief Disorder: Cultural Challenges to the DSM-5-TR Criteria Cult Med Psychiatry, 2025.PMID 40830691
- [5]Shear MK, Reynolds CF 3rd, Simon NM, Zisook S, et al. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial JAMA Psychiatry, 2016.PMID 27276373