Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining somatic symptom disorder and a collaborative pain plan — CASC communication station
MRCPsych/FRANZCP-style station: validate symptoms, explain SSD without dualism, outline CBT and cautious meds, and address opioid risk collaboratively.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the C-L psychiatry registrar. Medical work-up to date is non-diagnostic for a single explanatory disease; red-flag review is negative today. [1][2]
Candidate instructions. Validate experience; apologise for dismissive language if needed; explain SSD/health-anxiety amplification in plain language without saying “imaginary”; outline a collaborative plan (scheduled reviews, CBT, mood treatment, activity, opioid caution); agree when further tests would be reconsidered; check understanding. [2][3][4]
Candidate scenario
Patient: “They think I am faking. I still have pain. I need a full-body scan and more painkillers or I will go to A&E.” She is tearful, not suicidal on screen, high health anxiety, multiple prior normal investigations. [1]
Marking domains
- Empathy and repair of alliance after invalidation
- Accurate plain-language explanation: symptoms real; brain–body processing can amplify suffering; SSD is not malingering
- Clear plan: GP continuity, CBT/health-anxiety therapy, depression care, functional goals
- Opioid caution explained without abandonment (SPACE-informed non-superiority of opioids for function in studied chronic pain)
- Safety net for red flags and re-investigation thresholds
- Avoid colluding with endless unfocused scanning
- Check understanding and offer written plan/contact [2][3][4][5]
Reveal assessor key
Open. Introduce role; acknowledge anger and fear. “I am sorry you were made to feel dismissed. Your pain and fatigue are real and they are affecting your life.” [2]
Explain. “We use a both–and model. The sensations are genuine. When the brain’s threat and attention systems stay on high alert — especially with fear of cancer — symptoms and disability can intensify. That pattern can meet criteria for somatic symptom disorder or illness anxiety features. It does not mean you are faking.” [1]
Plan. “We will keep watching for any new warning signs that would justify targeted tests. Between times, regular GP reviews work better than emergency-only care. Psychological therapy (CBT for health anxiety and coping with pain) has good evidence. We will also treat depression/anxiety if present. For medicines, we prefer options like certain antidepressants that can help pain and mood rather than steadily increasing opioids, which often do not improve long-term function and can add risk.” [3][4][5]
Opioids. “I want you comfortable and safe. Relying on more oxycodone from multiple doctors is risky. We will coordinate one prescriber, set function goals, and discuss safer multimodal care. If dependence is developing, that is a medical problem we treat — not a moral failure.” [4]
Close. Summarise three actions, invite questions, safety-net red flags (new neurology, weight loss, night fevers), provide contact. [2]
References
- [1]Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM J Psychosom Res, 2013.PMID 23972410
- [2]Henningsen P, Zipfel S, Herzog W Management of functional somatic syndromes Lancet, 2007.PMID 17368156
- [3]Tyrer P, Cooper S, Salkovskis P, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial Lancet, 2014.PMID 24139977
- [4]Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial JAMA, 2018.PMID 29509867
- [5]Barsky AJ, Ahern DK Cognitive behavior therapy for hypochondriasis: a randomized controlled trial JAMA, 2004.PMID 15039413