Psych CASC / OSCE · General adult psychiatry — mood disorders
Explain depression diagnosis and antidepressant plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain MDD in plain language, outline sertraline start with monitoring, discuss early activation and help-seeking, address alcohol, and check understanding.
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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 the diagnosis of major depressive disorder, the rationale for starting sertraline, common side-effects, what to do if mood or suicidal thoughts worsen after starting treatment, expected timeline of benefit, and rough duration after recovery. Check understanding and invite questions. The examiner plays the patient. [3]
Candidate scenario
Your patient meets criteria for a first major depressive episode of moderate severity. You plan sertraline 50 mg orally daily with early review, and you will also offer CBT referral. She fears "personality change" and "addiction" to antidepressants. She drinks most evenings. [1][3]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language explanation of MDD (not "just sadness")
- Clear medication plan with dose, early side-effects, delayed benefit
- Safety-netting for worsening ideation/activation
- Alcohol advice without blame
- Duration/maintenance concept
- Checks understanding [3]
Reveal assessor key
Open and agenda-set. Name time available; ask her main worries first (addiction, personality, work). [3]
Explain diagnosis. "Major depression is a medical syndrome — persistent low mood and loss of pleasure plus changes in sleep, energy, appetite, concentration and self-view lasting weeks, severe enough to affect work and life. It is common and treatable. It is not weakness." [3]
Explain treatment. Psychological therapy (CBT) and medication can both help; combination is reasonable. Sertraline is an SSRI starting at 50 mg daily. Benefits often build over 2–6 weeks; early nausea or headache may settle. Sexual side-effects can occur — raise them early. We review soon after starting because a few people feel more agitated or have more suicidal thoughts early on; if that happens she must contact us or emergency services the same day. Antidepressants are not intoxicating "addictions" like alcohol, but should not be stopped abruptly later without a plan.[1][3]
Alcohol. Regular heavy drinking worsens depression and sleep; cutting down supports recovery. Offer practical steps and support services. [3]
Duration. After feeling well, continuing medication for many months reduces the chance of relapse; we individualise duration together rather than stopping the week she feels better.[2]
Close. Summarise, check teach-back, provide written information and crisis contacts, book early review. [3]
References
- [1]Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice Am J Psychiatry, 2006.PMID 16390886
- [2]Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review Lancet, 2003.PMID 12606176
- [3]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