Post-ICU PTSD and transplant clinic avoidance — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar embedded in the transplant clinic. [1]

Candidate instructions. Explore why the patient has avoided clinic after ICU. Screen sensitively for PTSD symptoms (intrusions, nightmares, avoidance, hyperarousal) and depressive symptoms. Link avoidance to graft risk without coercion or shame. Collaborate on a graded return plan, psychological therapy options, medication review if appropriate, and family support. Check safety (suicide). Avoid inventing legal section numbers. [1][2][3]

Candidate scenario

Your patient is 42, six months after deceased-donor kidney transplant. Two months ago they spent 18 days in ICU with septic shock and delirium. Since discharge they report nightmares of "staff trying to kill me," panic when smelling alcohol swabs, and cancelled clinic because "hospitals are dangerous." Immunosuppressant levels were therapeutic last month; one dose may have been missed last week. A partner is outside if the patient consents to involve them. [1][3]

Marking domains

• Empathy; trauma-informed, non-stigmatising language
• Explores ICU memories as real-to-patient even if factually distorted
• Screens PTSD and depression clusters; suicide risk
• Explains adherence/graft risk clearly without threats
• Collaborative plan: flexible appointment, graded exposure ideas, psychology referral, diary/education if available
• Considers PICS cognitive fog and family (PICS-F) with consent
• Summarises and safety-nets [1][2][5]