Psych CASC / OSCE · Old age psychiatry — mood disorders
Explain late-life depression and SSRI plan to patient and daughter — CASC communication station
MRCPsych/FRANZCP-style communication station: explain late-life depression, differentiate bereavement and cognitive concerns, outline sertraline start with older-adult monitoring, and check understanding.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the old-age outpatient clinic. [4]
Candidate instructions. Explain late-life major depression in plain language; address the daughter's fear that this is "only grief" or "early dementia"; outline starting sertraline with older-adult cautions (including sodium); discuss early worsening of suicidal thoughts and how to seek help; outline approximate duration after recovery; check understanding. Examiner plays the patient; a second examiner or role-player may be the daughter. [1][4]
Candidate scenario
Your patient meets criteria for a first major depressive episode beginning four months after her husband's death, with anhedonia, weight loss, early waking, impaired concentration, and passive death wishes without a plan. MoCA is mildly reduced with effortful performance. You plan sertraline 25 mg orally daily for a few days then 50 mg daily, early review, and psychology referral. She is on a thiazide diuretic. The daughter worries antidepressants will "turn Mum into a zombie" or "mask dementia." [1][4]
Marking domains
- Empathy, structure, and shared agenda with patient and daughter
- Accurate plain-language explanation of late-life depression vs grief vs dementia concern
- Clear medication plan with older-adult start dose and monitoring (sodium, falls, early risk)
- Safety-netting for worsening ideation and crisis contacts
- Maintenance/duration concept without scaring or over-promising
- Checks understanding / teach-back [4][5]
Reveal assessor key
Open and agenda-set. Greet both; ask main worries first (grief vs dementia vs "zombie" medication). Name time available. [4]
Explain diagnosis. "This is major depression — a treatable medical syndrome of persistent low mood and loss of pleasure with sleep, appetite, energy and concentration changes lasting weeks, severe enough to affect daily life. Grief after losing a partner is natural, but the pattern we are seeing has gone beyond expected bereavement into clinical depression. Some concentration problems can come from depression itself and often improve as mood improves; we will reassess memory carefully rather than assuming permanent dementia today."[1][4]
Explain treatment. Psychological therapy and medication can both help; combination is reasonable. Sertraline is an SSRI. In older adults we start lower — 25 mg then 50 mg — and increase only if needed. Benefits often build over several weeks. Early nausea can settle. Because of age and the water tablet, we check blood sodium because low sodium is an uncommon but important side-effect. We also watch for unsteadiness. We review soon after starting because a few people feel more agitated or have more suicidal thoughts early on; if that happens, contact us or emergency services the same day. Antidepressants are not recreational 'zombies' or intoxicating addictions, but should not be stopped abruptly later without a plan.[2][4][5]
Duration. After feeling well, continuing medication for a longer period reduces the chance of coming back — especially important in later life after a serious episode; we individualise duration together.[3]
Close. Summarise, teach-back, written information, crisis contacts, book early review, invite questions. [4]
References
- [1]Taylor WD Clinical practice. Depression in the elderly N Engl J Med, 2014.PMID 25251617
- [2]Fabian TJ, Amico JA, Kroboth PD, et al. Paroxetine-induced hyponatremia in older adults: a 12-week prospective study Arch Intern Med, 2004.PMID 14769630
- [3]Reynolds CF 3rd, Dew MA, Pollock BG, et al. Maintenance treatment of major depression in old age N Engl J Med, 2006.PMID 16540613
- [4]Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders Aust N Z J Psychiatry, 2021.PMID 33353391
- [5]Conwell Y, Van Orden K, Caine ED Suicide in older adults Psychiatr Clin North Am, 2011.PMID 21536168