Psych CASC / OSCE · General adult psychiatry — perinatal
Explain postnatal depression treatment and infant-safety thoughts — CASC communication station
MRCPsych/FRANZCP-style communication station: explain postnatal depression and perinatal OCD-spectrum intrusions, distinguish from psychosis, discuss sertraline and breastfeeding principles, safety-netting and when services escalate — without false reassurance or stigma.
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 perinatal clinic. [3]
Candidate instructions. Build rapport, explore her fears, explain the likely formulation (postnatal depression with ego-dystonic intrusive thoughts), contrast with psychosis in plain language, discuss sertraline 50 mg daily and breastfeeding monitoring principles, outline psychological treatment and safety-netting, and address child-protection fears honestly without promising absolute secrecy if acute risk emerges. Check understanding. The examiner plays the patient. [1][4]
Candidate scenario
She meets criteria for postnatal major depression. She describes vivid unwanted images of dropping the baby on the stairs that make her cry and check repeatedly; she says "I would never do it — that is what scares me." No manic symptoms, no delusions, no command hallucinations. She wants to keep breastfeeding. Partner is supportive. [1][3]
Marking domains
- Empathy and non-stigmatising stance
- Accurate explanation of depression plus OCD-spectrum intrusions
- Clear distinction from psychosis without dismissing risk assessment
- Medication plan with dose and lactation monitoring principles
- Safety-netting and crisis contacts
- Honest discussion of confidentiality limits if acute risk
- Checks understanding [4]
Reveal assessor key
Open. Agenda-set; thank her for disclosing thoughts many mothers fear naming. [3]
Explain. Postnatal depression is a medical illness, not weakness. Unwanted infant-harm images that feel alien and horrifying are often part of anxiety/OCD spectrum in new parents and differ from psychosis, where people believe harmful ideas are true or feel commanded. We still assess safety carefully because that is good care, not punishment.[1]
Treatment. Psychological therapy (CBT/ERP-informed work and depression therapies) plus practical supports. Sertraline often starts at 50 mg orally daily; benefits build over weeks; we review early. Many antidepressants enter milk at low levels; sertraline is commonly chosen when breastfeeding; we watch baby for unusual sleepiness, poor feeding or irritability.[2][4]
Safeguarding. Services aim to support families. If risk became acute (intent, inability to keep baby safe, psychosis), we would need to act protectively and involve others — we would try to work with her openly. Today her presentation is disclosure of ego-dystonic thoughts with care-seeking, which is a protective sign. [3]
Close. Summarise plan, crisis numbers, early review, partner involvement with consent, teach-back. [4]
References
- [1]Speisman BB, Storch EA, Abramowitz JS Postpartum obsessive-compulsive disorder J Obstet Gynecol Neonatal Nurs, 2011.PMID 22092284
- [2]Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants Am J Psychiatry, 2004.PMID 15169695
- [3]Howard LM, Molyneaux E, Dennis CL, et al. Non-psychotic mental disorders in the perinatal period Lancet, 2014.PMID 25455248
- [4]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