Table Of ContentFast Revision for the
MRCPsych CASC Exam
Fast Revision for the
MRCPsych CASC Exam
Don’t Panic!
GIDEON FELTON
Specialty Registrar, General Adult Psychiatry
St Mary’s Rotational Training Scheme
Radcliffe Publishing
London • New York
Radcliffe Publishing Ltd
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London
EC1V 0BB
United Kingdom
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Electronic catalogue and worldwide online ordering facility.
© 2011 Gideon Felton
Gideon Felton has asserted his right under the Copyright, Designs and Patents Act
1998 to be identified as the author of this work.
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior permission of
the copyright owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN- 13: 978 184619 528 0
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Contents
Preface ix
About the author xi
List of contributors xii
Acknowledgements xiii
1 Substance misuse 1
Two linked scenarios
1a Eliciting signs and symptoms of alcohol dependence 1
1b Management of alcohol addiction with detoxification
and aftercare planning 5
2a Management of opiate addiction with substitute
prescribing 9
2b Management of a relapse into opiate addiction with
discussion of management 13
2 Schizophrenia 17
Three stand-a lone scenarios, one linked scenario
3 Eliciting signs and symptoms of schizophrenia and
assessing risk in an acutely distressed patient 17
4a Discussion of the acute management of an inpatient
who is having his first psychotic episode 21
4b Discharge planning and discussion of the long-t erm
management and aftercare for the same patient
when the acute psychotic episode has resolved 25
5 Management of a patient who gets better quickly
while in hospital but relapses easily in the community,
i.e. a ‘revolving door’ patient 29
6 Management of a patient who is treatment resistant 33
3 Mood disorders 37
Two linked scenarios
7a Discussion of side effects of antidepressant medication 37
7b Discussion of psychotherapies 41
8a Management of bipolar affective disorder in a
pregnant patient 45
8b Eliciting signs and symptoms of a mood disorder
post- partum 49
4 Neurotic disorders 53
Two stand- alone scenarios
9 Assessment of a patient with ‘slowness’ 53
10 Assessment of a patient with sudden onset
agoraphobia 57
5 Liaison psychiatry 61
One stand- alone scenario, one linked scenario
11 Assessment of a patient with chronic physical pain 61
12a Discussion of the management of a patient who
is refusing life-s aving treatment in A&E 65
12b Carrying out a risk assessment of this patient who
has taken a life- threatening overdose 69
6 Forensic psychiatry 73
One linked scenario, two stand- alone scenarios
13a Assessing a patient who has committed a serious
offence in order to establish whether mental illness
had any direct role in the offence 73
13b Discussion of the management plan of this patient 77
14 Assessing a patient to establish whether he is fit to
stand trial 81
15 Eliciting signs and symptoms of a dissocial personality
disorder 85
7 Psychiatry of older people 89
Two stand- alone scenarios, two linked scenarios
16 Assessing an older patient with paranoid symptoms 89
17a Examination of neurological system 93
17b Examination of cardiovascular system 97
18 Management of treatment resistant depression of
an older inpatient 101
19a Assessment of declining cognitive function 105
19b Management of declining cognitive function 109
8 Child and adolescent psychiatry 113
Two linked scenarios, two stand- alone scenarios
20a Assessment of a young child with behavioural
difficulties 113
20b Management of a child with behavioural difficulties 117
21 Management of an older child with a psychotic illness 121
22a Assessment of a child’s non-a ttendance at school 125
22b Management of this child’s non-a ttendance at school 129
23 Assessment of a child with unusual behaviour 133
9 Risk management scenarios 137
One linked scenario, one stand- alone scenario
24a Assessment of morbid jealousy 137
24b Risk management of morbid jealousy 141
25 Management of psychosis during pregnancy 145
Index 149
Preface
One of the best ways to prepare for any practical examination is to anti-
cipate the range of likely scenarios that you will encounter. There is a
limited range of scenarios within each subspecialty of psychiatry that can
be examined. For example, within the field of substance misuse, you can
anticipate the following scenarios:
1 eliciting signs and symptoms of alcohol/opiate addiction
2 short- and long- term management of opiate/alcohol/
benzodiazepine addiction
3 management of relapse into addiction.
When you have developed model answers for each scenario, you are
then more likely to enter the examination arena confidently. You will feel
clinically ‘armed and ready’, which will allow you to focus more on your
communication skills.
The purpose of this book is to anticipate a set of likely scenarios
within each subspecialty. There will be both single-i tem scenarios and
linked ones. Linked scenarios, denoted by a and b prefixes involve testing
two different aspects within the same scenario. For example, part a may
ask you to interview the patient with the purpose of eliciting signs of a
psychiatric disorder, and part b may be a discussion of the management
of the psychiatric disorder elicited in part a. You should treat the linked
scenarios as two separate stand- alone scenarios because different aspects
are being tested.
As there is sufficient time, actual CASC questions will try to exam-
ine several scenarios simultaneously. When faced with this, you need to
unravel how many scenarios are being examined in a particular question
