Psych CASC / OSCE · General adult psychiatry — secondary / organic psychosis
Explain medical work-up for new psychosis to a worried partner — CASC communication station
MRCPsych/FRANZCP-style communication station: explain secondary vs primary psychosis possibilities, red-flag rationale for investigations, treatment priorities, and hope without false certainty.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading. You are the psychiatry registrar on the assessment unit.[1]
Candidate instructions. Explain why medical tests are needed for a first presentation of psychosis at age 49, what bloods and possible imaging mean, that the diagnosis may be primary or secondary to a medical condition, outline treatment principles (treat medical problems; low-dose medicine for symptoms if needed), and check understanding. Do not give false lifelong fatalism or false total reassurance.[2][3]
Candidate scenario
Your patient is 49, first psychotic episode over 3 weeks, partially insightful, no fever. Partner asks: "Is this schizophrenia? Why more blood tests? Will a brain scan hurt him? Do the antipsychotic tablets mean the brain is permanently broken?" Observations are stable; Tier-1 labs are pending.[1]
Marking domains
- Empathy, structure, agenda-setting
- Accurate plain language: psychosis as a syndrome, not day-one lifelong schizophrenia label
- Clear rationale for physical work-up in new/late-ish psychosis
- Explanation of scan as selective and usually safe; LP only if further concern
- Treatment: medical problems first; cautious short-term antipsychotic possible
- Safety-net for red flags (fever, seizure, confusion)
- Checks understanding; avoids invented legal jargon
Reveal assessor key
Open. Name role/time; ask main worries first.[1]
Explain psychosis. "Psychosis means a break from shared reality — fixed false beliefs or hearing a voice. It is a syndrome, not one disease. Causes include primary mental illness, substances, and sometimes medical conditions that affect the brain."[2]
Why tests at 49. First episode later than typical teens–20s peak raises the chance of a medical driver (thyroid, vitamin deficiency, infection, less often brain inflammation or structural problems). Blood tests and heart tracing are standard before and with antipsychotic medicine. We are not saying "we know it is a tumour"; we are being thorough.[1][3]
Scan. If needed, MRI is preferred when stable; it does not use ionising radiation like CT. We recommend imaging based on age, examination, and red flags — not every young uncomplicated case is the same as this presentation.[3]
Treatment hope. If a medical cause is found, treating it is the main step. Antipsychotic tablets can reduce fear and voices short-term; starting low is common. Diagnosis may evolve over weeks; we avoid saying "schizophrenia forever" on day one while still treating seriously.[2][3]
Red flags to return. Fever, stiff neck, seizure, sudden weakness, severe confusion — emergency care.[4]
Close. Summarise, written info, next review, crisis contacts, invite questions.[1]
References
- [1]Griswold KS, Del Regno PA, Berger RC Recognition and Differential Diagnosis of Psychosis in Primary Care Am Fam Physician, 2015.PMID 26131945
- [2]Keshavan MS, Kaneko Y Secondary psychoses: an update World Psychiatry, 2013.PMID 23471787
- [3]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681
- [4]Pollak TA, Lennox BR, Müller S, et al. Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin Lancet Psychiatry, 2020.PMID 31669058