Psych CASC / OSCE · General adult psychiatry — OCRD
Explain OCD and ERP to a patient — CASC communication station
MRCPsych/FRANZCP-style communication station: explain OCD, ERP hierarchy, SSRI timeline, family accommodation, and safety-netting for mood/suicidality.
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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 OCD in plain language, outline ERP (exposure and response prevention), discuss a possible SSRI with delayed benefit and common side-effects, address partner reassurance/cleaning, and check understanding. The examiner plays the patient. [3][4]
Candidate scenario
Your patient meets criteria for contamination OCD with good insight. You plan referral for ERP and discussion of sertraline starting at 50 mg orally daily with planned titration and early review. She fears ERP will “make anxiety unbearable forever” and thinks medication will change her personality. Her partner currently re-cleans the kitchen each night at her request. [1][2][3]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language model of OCD (obsession → anxiety → compulsion → short relief)
- Clear ERP explanation (hierarchy, response prevention, homework)
- Medication discussion: start dose concept, delayed benefit, side-effects, not addictive like alcohol
- Family accommodation advice without blame
- Safety-net for worsening mood/suicidality
- Checks understanding / teach-back [3][4]
Reveal assessor key
Open and agenda-set. Name time; ask main fears (ERP unbearable; personality change; partner role). [3]
Explain OCD. “OCD involves unwanted intrusive thoughts or images that spike anxiety, and rituals that briefly reduce anxiety but keep the cycle going. It is a recognised medical condition, not a character flaw.” [4]
Explain ERP. Therapy helps you gradually face contamination triggers while not doing the wash or getting reassurance, so the brain learns the anxiety falls without the ritual. We build a step-by-step ladder; you are not thrown into the hardest item first. Evidence supports this approach strongly.[1][3]
Medication. An SSRI such as sertraline can reduce OCD intensity; start low and build; benefits often take weeks; early nausea or sexual side-effects should be reported. Not an intoxicating “personality eraser.” Combine with ERP when possible.[2][3]
Partner. Kind help that includes endless cleaning/reassurance can accidentally maintain OCD; we will coach planned support that backs response prevention. [3]
Close. Summarise, teach-back, written information, crisis contacts if mood worsens, book review. [3]
References
- [1]Foa EB, Liebowitz MR, Kozak MJ, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder Am J Psychiatry, 2005.PMID 15625214
- [2]Soomro GM, Altman D, Rajagopal S, et al. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) Cochrane Database Syst Rev, 2008.PMID 18253995
- [3]Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder Am J Psychiatry, 2007.PMID 17849776
- [4]Hirschtritt ME, Bloch MH, Mathews CA Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment JAMA, 2017.PMID 28384832