Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining MS depression, PBA, and treatment choices to a partner — CASC communication station
MRCPsych/FRANZCP-style station: explain MS depression and suicide risk, distinguish PBA from bipolar disorder, outline CBT/antidepressant and DM/Q options, and refuse unsafe unilateral DMT cessation.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar. Neurology remains involved. You meet the partner first (with patient consent as per local practice).[1]
Candidate instructions. Explain that depression in MS is common, treatable, and linked to suicide risk — not something to ignore as "understandable." Distinguish pseudobulbar affect (brief involuntary crying) from bipolar disorder. Outline talking therapies (including telephone CBT) and antidepressants. Explain that stopping interferon today without neurology is unsafe. Agree a collaborative plan. Avoid inventing legal section numbers.[2][4][5]
Candidate scenario
Partner: "She cries for no reason — she is bipolar and putting it on. Anyone with MS would want to die. Stop the psychiatric tablets and the interferon today. Therapy is a waste of time." Notes confirm MDD features, passive SI, PBA-type crying, no current steroid mania.[1][5]
Marking domains
Empathy without collusion with minimisation; accurate plain-language model of MS depression and suicide risk; clear PBA explanation; balanced treatment offer (CBT ± antidepressant; DM/Q if available); refuse unsafe same-day DMT cessation; shared neurology–psychiatry plan; understanding check.[1][2][3]
Reveal assessor key
Open. Acknowledge fear and frustration: "Living with MS is hard for both of you. Wanting clear answers about the crying and the low mood makes sense." [1]
Explain depression. "Depression is common in MS and often under-treated. It is a real medical condition — not a weakness. It can include hopelessness and thoughts of death, which we take seriously because suicide risk is higher than in people without MS." [1][5]
Explain PBA. "The short bursts of crying when she does not feel sad can be pseudobulbar affect — a neurological problem with emotional expression. That is different from bipolar mood swings. Treatments can include specific medicines such as dextromethorphan with low-dose quinidine where available, or sometimes antidepressants." [3]
About stopping everything. "We will review all medicines with neurology. Stopping interferon suddenly today because of mood is not safe decision-making — disease control and mental health both matter. Changes need a joint plan." [2]
About therapy and tablets. "Talking treatments such as CBT — including by telephone if travel is hard — help. Antidepressants can also help when depression is moderate to severe. We monitor side effects carefully." [4]
Close. Summarise, invite questions, offer written information, introduce MS clinic and mental health contacts, document. [2]
References
- [1]Goldman Consensus Group The Goldman Consensus statement on depression in multiple sclerosis Mult Scler, 2005.PMID 15957516
- [2]Minden SL, Feinstein A, Kalb RC, et al. Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS Neurology, 2014.PMID 24376275
- [3]Pioro EP, Brooks BR, Cummings J, et al. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect Ann Neurol, 2010.PMID 20839238
- [4]Mohr DC, Hart SL, Julian L, et al. Telephone-administered psychotherapy for depression Arch Gen Psychiatry, 2005.PMID 16143732
- [5]Feinstein A, Pavisian B Multiple sclerosis and suicide Mult Scler, 2017.PMID 28327056