Psych CASC / OSCE · General adult psychiatry — trauma and stressor-related disorders
Explain PTSD diagnosis and trauma-focused treatment plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain PTSD in plain language, outline PE/CPT/TF-CBT/EMDR options, sertraline start with monitoring, alcohol advice, and safety-netting.
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 PTSD in accessible language, why trauma-focused psychological therapy is first-line, what sessions involve at a high level without forcing detail of the assault, optional medication (sertraline) with early side-effects and delayed benefit, alcohol reduction, and when to seek urgent help. Check understanding. The examiner plays the patient. [3]
Candidate scenario
Your patient meets criteria for PTSD after assault (intrusions, avoidance, hyperarousal, negative cognitions) for 3 months. You recommend referral for prolonged exposure or another trauma-focused therapy and discuss sertraline 50 mg daily as an option. He fears "reliving it will break me" and worries antidepressants are addictive. He drinks heavily some nights. [1][2]
Marking domains
- Empathy, structure, agenda-setting
- Accurate plain-language explanation of PTSD (not "just stress")
- Clear first-line role of trauma-focused therapy with collaborative control
- Medication explanation with dose, early monitoring, non-addiction clarification
- Alcohol and safety-netting for worsening ideation
- Checks understanding [3]
Reveal assessor key
Open. Name time; ask main fears first (reliving, addiction, work). [3]
Explain diagnosis. PTSD is a treatable condition after a terrifying event: unwanted memories/nightmares, avoidance, feeling on edge, and harsh negative thoughts lasting more than a month and affecting life. It is not weakness. [3]
Explain therapy. Trauma-focused therapies (e.g. prolonged exposure) help the brain learn that trauma memories and safe reminders can be faced gradually so fear reduces — sessions are paced with the therapist; he stays in control. Evidence shows these approaches help many people. [1][3]
Explain medication option. Sertraline is an SSRI starting at 50 mg daily; benefits build over weeks; early nausea or sleep change can occur; we review early because mood or suicidal thoughts can worsen in a minority after starting — contact us/emergency same day if that happens. Not an intoxicating addiction like alcohol, but do not stop abruptly later without a plan.[2]
Alcohol. Heavy drinking worsens sleep, nightmares and risk; cutting down supports recovery. [3]
Close. Summarise, teach-back, crisis contacts, book review and therapy referral. [3]
References
- [1]Foa EB, Hembree EA, Cahill SP, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring J Consult Clin Psychol, 2005.PMID 16287395
- [2]Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial JAMA, 2000.PMID 10770145
- [3]Bisson JI, Roberts NP, Andrew M, et al. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults Cochrane Database Syst Rev, 2013.PMID 24338345