Psych CASC / OSCE · Addiction psychiatry — stimulant and methamphetamine use
Explain methamphetamine care to a partner — CASC communication station
MRCPsych/FRANZCP-style communication station: explain MAP, medical risk, withdrawal crash, contingency management, limited medicines, dual diagnosis, and safety-netting without 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 emergency department. [1]
Candidate instructions. Explain the working diagnosis of methamphetamine-associated psychosis to the partner, outline medical checks (heart, blood pressure), describe what happens when use stops, discuss treatments that work (especially psychosocial), address whether this is "schizophrenia forever," and safety-net for crash suicidality. Check understanding. The examiner plays the partner. [1]
Candidate scenario
Your patient, age 28, has used crystal methamphetamine for several days and presents with persecutory delusions and auditory commentary while oriented. Heart rate and blood pressure are raised; ECG is pending. Partner asks: "Is this schizophrenia forever? Is there a methadone for ice? Will she fit when she stops? What actually works?" [1]
Marking domains
- Empathy, structure and agenda-setting without stigma
- Accurate plain-language MAP explanation and timeline uncertainty
- Medical risk (cardiovascular) clearly stated
- Withdrawal/crash description including mood and suicide vigilance
- Honest statement that no methadone-equivalent exists
- Named psychosocial care (contingency management / structured programmes)
- Dual diagnosis: treat both problems together
- Checks understanding and safety-net [1][2][3][4]
Reveal assessor key
Open. Thank the partner; name the time; ask main worries first. [1]
Explain MAP. "Ice can drive a break from shared reality — fixed false beliefs and hearing a voice — while she is still awake and oriented. This is methamphetamine-associated psychosis. Some people clear as use stops; some need longer mental health care. We avoid saying 'schizophrenia forever' on day one while still treating seriously." [1]
Medical checks. Methamphetamine stresses the heart and blood vessels — we check ECG, blood pressure and other tests because heart attacks and other complications can happen even in young adults.[4]
Stopping. After a binge she may crash — sleep a lot, feel flat or low, and crave. Mood can be very low for several days; we take suicide risk seriously. Fits like alcohol withdrawal are not the usual main danger, but low mood is.[2]
What works. Structured psychosocial treatment is the backbone — especially programmes that reward drug-free progress (contingency management), skills-based talking treatments, and practical support for housing and health. There is no methadone-style replacement tablet that reliably works for everyone. Some medicines are studied in specialist settings but are not a simple cure.[1][3]
Together care. We treat the psychosis and the ice use at the same time — we do not wait for perfect abstinence before helping. [1]
Close. Summarise, invite questions, crisis contacts, written info, review as she comes down from the binge. [1]
References
- [1]ASAM/AAAP Clinical Guideline Committee The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder J Addict Med, 2024.PMID 38669101
- [2]McGregor C, Srisurapanont M, Jittiwutikarn J, et al. The nature, time course and severity of methamphetamine withdrawal Addiction, 2005.PMID 16128721
- [3]Pfund RA, Ginley MK, Boness CL, et al. Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria Clin Psychol (New York), 2024.PMID 38863566
- [4]Kevil CG, Goeders NE, Woolard MD, et al. Methamphetamine Use and Cardiovascular Disease Arterioscler Thromb Vasc Biol, 2019.PMID 31433698