Psych CASC / OSCE · General adult psychiatry — anxiety disorders
Explain panic disorder and treatment plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain panic false-alarm model, outline sertraline start with early activation warning, describe CBT with interoceptive exposure in plain language, and correct chronic benzodiazepine expectations.
On this page & tools
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 panic disorder (and mild agoraphobia if raised), the false-alarm model in plain language, the rationale for CBT with exposure, the plan for sertraline including early side-effects and delayed benefit, and why long-term diazepam is not the goal. Check understanding and invite questions. The examiner plays the patient. [3]
Candidate scenario
Your patient has recurrent unexpected panic attacks, inter-attack worry, and has started avoiding crowded staffrooms. Medical work-up in ED was reassuring. You plan CBT referral and sertraline 25 mg orally daily for one week then 50 mg if tolerated, with early review. She fears "personality change," "addiction to antidepressants," and asks for ongoing diazepam "like my aunt."[2][3][4]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language explanation of panic (not "going crazy," not ignored medical risk forever)
- Clear CBT explanation including facing bodily sensations and avoided situations gradually
- Medication plan with dose, early activation warning, delayed benefit
- Benzodiazepine short-term-only framing without shaming
- Safety-netting and follow-up
- Checks understanding [3]
Reveal assessor key
Open and agenda-set. Name time; ask her top fears first (heart disease, madness, addiction, work).[3]
Explain diagnosis. "Panic attacks are sudden false alarms in the body's threat system — real, terrifying sensations that peak within minutes. Panic disorder means these unexpected attacks keep returning and you change your life around the fear of the next one. Avoiding the staffroom is the start of agoraphobic avoidance. It is common and treatable. It is not psychosis."[1][3]
Explain CBT. Therapy teaches that the sensations are uncomfortable but not dangerous, challenges catastrophic thoughts, practices bringing on mild sensations safely (interoceptive exposure), and gradually re-enters avoided situations while dropping safety behaviours.[1]
Explain sertraline. Start 25 mg daily then increase toward 50 mg and higher if needed; benefits build over weeks; early nausea or brief increase in jitteriness can occur — review soon. Antidepressants are not intoxicating addictions like alcohol, but should not be stopped abruptly later. We continue months after recovery to prevent relapse.[2][3]
Diazepam. May help briefly in a severe crisis but is not lifelong treatment; dependence and blunting of therapy learning are risks. We will not make ongoing high-dose diazepam the plan.[3]
Close. Summarise, teach-back, written info, crisis contacts, book early review, encourage reducing excess caffeine if relevant.[3][4]
References
- [1]Clark DM, Salkovskis PM, Hackmann A, et al. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder Br J Psychiatry, 1994.PMID 7952982
- [2]Pollack MH, Otto MW, Worthington JJ, et al. Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial Arch Gen Psychiatry, 1998.PMID 9819070
- [3]Bandelow B, Michaelis S, Wedekind D Treatment of anxiety disorders Dialogues Clin Neurosci, 2017.PMID 28867934
- [4]Roy-Byrne PP, Craske MG, Stein MB, et al. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder Arch Gen Psychiatry, 2005.PMID 15753242