Lithium toxicity counselling — CASC communication station

Station brief

Format. Communication and psychoeducation station, approximately 7–10 minutes after reading time. You are the psychiatry registrar on the medical ward. [1]

Candidate instructions. Explain what lithium toxicity is in plain language, why ibuprofen and dehydration mattered, what warning symptoms to report, how blood tests are timed, and how the team will decide about restarting lithium. Involve the partner’s concerns about safety without inventing legal statutes. Avoid false reassurance and avoid permanent nihilism. [2][4]

Candidate scenario

Patient: “They said my lithium nearly poisoned me because of Nurofen. Does that mean lithium is too dangerous forever? My partner is terrified.” Partner: “Should we throw all the lithium away tonight?” Observations stable; last level falling toward therapeutic range off drug. [1]

Marking domains

• Clear explanation of toxicity as clinical illness from high lithium effect, not moral failure
• Accurate precipitants: NSAID + illness/dehydration (and mention ACEI/thiazides as related future risks)
• Warning symptoms: coarse tremor, unsteadiness, slurred speech, vomiting, confusion — seek urgent care
• Monitoring: timed blood tests (12-hour trough concept for maintenance), sick-day rules
• Balanced restart discussion: lithium can still be the best long-term option for many people, including mood stability and reduced suicide risk, only after kidneys recover and with a safety plan
• Collaborative plan; check understanding; no invented EXTRIP jargon unless asked and then simplified