Explain safer prescribing and antipsychotic risks to family — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar reviewing residential care medications with the resident's daughter. [1]

Candidate instructions. Explain in plain language why long-term risperidone and night temazepam are being reviewed; summarise mortality/stroke concerns with antipsychotics in dementia without causing panic; outline non-drug approaches for calling out; describe a supervised taper and what happens if severe aggression returns; check understanding. Examiner plays the daughter. [1][2][3]

Candidate scenario

Mrs L, 84, has moderate Alzheimer disease, two falls in three months, and calls out mainly at personal care times. She has been on risperidone 0.5 mg twice daily for 7 months without a documented review, and temazepam 10 mg most nights. Pain has not been systematically assessed. You plan gradual reduction of both agents, a pain and constipation review, staff ABC strategies, and a written plan to restart a low-dose antipsychotic only if severe aggression with risk of harm returns. The daughter fears both "taking away the only thing that helps" and "poisoning Mum with black-box drugs." [1][2][5]

Marking domains

• Empathy, structure, and agenda-setting with the daughter's dual fears
• Accurate plain-language explanation of antipsychotic risks in dementia and sedative fall risk
• Clear deprescribing plan with monitoring and restart threshold (not abandonment)
• Non-drug care and pain assessment as first-line for calling out
• Safety-netting and shared decision-making / teach-back [1][3][4]