Psych CASC / OSCE · Consultation-liaison psychiatry
Explaining TBI personality change and the care plan to a partner — CASC communication station
MRCPsych/FRANZCP-style station: explain post-TBI personality change and depression, aggression ladder without oversedation, realistic recovery, and capacity for major financial decisions.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar on the brain-injury rehab unit. The patient is not in the room for this conversation. [1]
Candidate instructions. Explain personality change and depression after TBI in plain language, outline behavioural and medication plans without promising "knock-out" sedation, address dementia fears honestly, and carefully manage the house-sale capacity question. [1][2][4]
Candidate scenario
Partner: “He is not the man I married. He swears, laughs at the wrong times, and sometimes scares the kids. Knock him out at night. Is his brain gone for good? We need him to sign the house papers this week.” Notes confirm frontal contusions, sertraline recently started, intermittent aggression without psychosis. [1][3]
Marking domains
- Empathy for grief of personality change without colluding with hopelessness
- Clear explanation: injury to frontal control systems, not "chosen bad behaviour"
- Depression treatable (sertraline + rehab psychology); aggression: environment and possibly beta-blockers, not chronic knockout sedation
- Honest prognosis: improvement can continue months; some lasting change possible
- Capacity: major financial decisions may be invalid if weighing impaired; involve proper legal pathways
- Safety for children/family; offer supports and follow-up contact [1][2][4]
Reveal assessor key
Open. Acknowledge loss and fear: “You are describing a real change that many partners notice after frontal brain injury — it is medical, not that he stopped loving the family overnight.” [1]
Explain. “The parts of the brain that put a brake on impulses and smooth mood were bruised. That can look like a personality change. He also has depression, which is common after TBI and can make irritability worse. Sertraline is an antidepressant studied after brain injury — it is not a sedative knockout drug.” [1][3]
Plan. “We work on structure, sleep, therapy adapted to his thinking, and family strategies. If aggression continues after those steps, we often consider medicines such as beta-blockers carefully, rather than strong sedatives that can slow recovery. Antipsychotics are reserved for danger or true psychosis, not as a default personality fix.” [2][4]
Prognosis. “Recovery can continue for months. Some people have lasting changes; we will not pretend otherwise, and we will not write him off either. Rehab and treating mood improve function.” [1]
House sale. “Signing a major property deal needs understanding and weighing risks. If his judgement is impaired from the injury and depression, this week may not be safe for that signature. We should involve the treating team, social work, and the correct legal substitute decision process rather than rush a sale.” [4]
Close. Summarise, check understanding, safety-net for crises, named contact, document. [1]
References
- [1]Howlett JR, Nelson LD, Stein MB Mental Health Consequences of Traumatic Brain Injury Biol Psychiatry, 2022.PMID 34893317
- [2]Plantier D, Luauté J, SOFMER group Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice Ann Phys Rehabil Med, 2016.PMID 26797170
- [3]Fann JR, Bombardier CH, Temkin N, et al. Sertraline for Major Depression During the Year Following Traumatic Brain Injury: A Randomized Controlled Trial J Head Trauma Rehabil, 2017.PMID 28520672
- [4]Rao V, Koliatsos V, Ahmed F, et al. Neuropsychiatric disturbances associated with traumatic brain injury: a practical approach to evaluation and management Semin Neurol, 2015.PMID 25714869