Psych CASC / OSCE · General adult psychiatry — anxiety disorders
Explain social anxiety disorder and start sertraline with CBT — CASC communication station
MRCPsych/FRANZCP-style communication station: explain SAD in plain language, outline sertraline start with monitoring, sell CBT that drops safety behaviours, address alcohol and benzo expectations, and check understanding.
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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 social anxiety disorder, the rationale for CBT and starting sertraline, common side-effects, what to do if anxiety or mood worsens after starting treatment, why relying on alcohol or daily long-term diazepam is not recommended as the main plan, expected timeline of benefit, and rough duration after improvement. Check understanding and invite questions. The examiner plays the patient. [2][3]
Candidate scenario
Your patient meets criteria for social anxiety disorder of moderate-severe severity (high SPIN; avoids meetings and parties; drinks before social events). You plan sertraline 25–50 mg orally daily with early review, and high-intensity CBT referral targeting safety behaviours and exposure. She fears "personality change" and "addiction" to antidepressants, and asks why you will not simply increase diazepam she was given before a wedding. She believes she is "just shy" and that therapy will force her to be "fake and confident". [1][2][3]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language explanation of SAD (fear of negative evaluation under scrutiny, not "just shyness")
- Clear medication plan with dose, early side-effects, delayed benefit
- Safety-netting for activation/worsening ideation
- CBT rationale without jargon dump (exposure, drop safety behaviours)
- Alcohol and benzodiazepine stewardship without shaming
- Checks understanding [3][4]
Reveal assessor key
Open and agenda-set. Name time available; ask her main worries first (addiction, personality, diazepam, being forced into socialising). [3]
Explain diagnosis. "Social anxiety disorder is a medical condition where fear of being judged or humiliated in social or performance situations is strong, keeps coming, and leads to avoidance or white-knuckle endurance that interferes with study, work or relationships. It is common and treatable. It is more than ordinary shyness." [2]
Explain CBT. Psychological therapy teaches skills: noticing the fear cycle, shifting attention outward, testing what actually happens when you drop habits that feel protective (like over-rehearsing or drinking to cope), and graded practice in real situations — with homework between sessions. Evidence supports these approaches for social anxiety.[4]
Explain sertraline. An SSRI starting at 25–50 mg daily. Benefits often build over several weeks; early nausea or headache may settle. Some people feel more jittery early on — that is why we review soon and start low. Sexual side-effects can occur — raise them early. Antidepressants are not intoxicating "addictions" like alcohol or diazepam, but should not be stopped abruptly later without a plan.[1][3]
Alcohol and diazepam discussion. Pre-drinks can become a trap that keeps fear going and risks dependence. Short-term diazepam can calm severe spikes, but daily long-term use risks dependence and does not teach long-term skills — so it is not our main plan. [2][3]
Duration. After feeling better, continuing medication for many months reduces relapse risk; we individualise together. [1][3]
Close. Summarise, teach-back, written information, crisis contacts, book early review, confirm CBT referral pathway. [3]
References
- [1]Van Ameringen MA, Lane RM, Walker JR, et al. Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study Am J Psychiatry, 2001.PMID 11156811
- [2]Stein MB, Stein DJ Social anxiety disorder Lancet, 2008.PMID 18374843
- [3]Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders BMC Psychiatry, 2014.PMID 25081580
- [4]Mayo-Wilson E, Dias S, Mavranezouli I, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis Lancet Psychiatry, 2014.PMID 26361000