Showing posts with label CASC. Show all posts
Showing posts with label CASC. Show all posts

Sunday, 29 January 2023

Cardiff CASC Training

Cardiff CASC Training

Royal College CASC exam, since its advent in 2008, has posed a challenge for trainees which is evident in low pass percentages. There had been a need for structured and formal training for the CASC exam in Wales.

Cardiff CASC Training (CCT) has been formed in 2012, to lead the CASC training in Wales. It has got seven members, all in different sub specialties of psychiatry.

Training is organizing CASC examination practice sessions in the form of training days every year. The events are designed to boost the confidence of participants by replicating Royal College examination environment.

Cardiff CASC Training is a non-profit organization ( 08038178). We have links with Wales Deanery in terms of sponsorship and support. We also receive some contribution from pharmaceutical companies.


2 Narcissus Grove
Gwent NP10 9LP


CCT Website

Thursday, 7 January 2021

Sample CASC-Opiate (opioid) Withdrawal Assessment

Opiate Withdrawal History and Physical Examination 

Opiate withdrawal symptoms peak between 36-72 hours. Symptoms run their course in 5-7 days, though craving continues for some time. 

Withdrawal from Heroin

Withdrawal from heroin may begin up to 8 hours after the last use. During the next few hours, the person experiences muscle pain, sneezing, sweating; tearfulness; yawning excessively. At 36 hours after the last use, symptoms are most severe. These symptoms include chills, muscle cramps, flushing, sweating, tachycardia, hypertension, inability to sleep, vomiting & diarrhoea. Symptoms typically continue for about 72 hours & gradually diminish over 5-10 days.


This history part is in Urdu/Hindi. I will add the "Objective Opiate Withdrawal Scale" soon here so anyone can benefit.
For now: COWS 

  1. Aap kia istemal karty
  2. Akhri bar kab lia hai aap ne
  3. Abhi dil chahta ke aap dobara se kar lyn? Kitna had tak? 
  4. Gutno ya baqi jorhon mai dard ho raha hai? Baqi jisam or pat’tho mai takleef? Sar dard? 
  5. Pait ma dard waghera? Ulti ya matli to nai arhaii? Pechas ya ihsal ki shikayat?
  6. Hot and cold flushes? 
  7. Cheenk to naii a rahy baar baar?
  8. Nend kesi hai? Araam se soe rehty han?   
  9. Koi bechainee, pareshani ki keffyat ya ghussa ata ho?  

Physical examination

Start from the hands. 
  1. Inspect the hands and run a hand over the palm. Note any sweating or palmar erythema. 
  2. Note if there is any piloerection if hair visible on the dorsal side of the hands. 
  3. Then check the pulse. 
  4. Inspect the arms for any signs of IV drug abuse. 
  5. Check blood pressure, and then check the temperature. 
  6. Check respiratory rate while checking the above. 
  7. Inspect the face for lacrimation, rhinorrhea and check pupil size for dilation. 
  8. Comment if the patient is shaking or yawning. 
  9. Perform a cardiovascular examination and look for murmurs. 
  10. Examine for the signs of liver failure

Differentiating Factors of Epileptic and Non-epileptic Fits

Differentiating Factors of Epileptic and Non-epileptic Fits

Factors That Favor Epileptic Fits

The following Favor epileptic fits. 
An abrupt onset
A stereotyped course lasting seconds to a few minutes.
Tongue biting, especially on the sides
Urinary incontinence during the fit
Evidence of cyanosis, for example, face turning blue.
Injury during the episode
Prolonged postictal confusion

Favour Non-Epileptic Fits

Treatment resistance to over two antiepileptic drugs.
Antiepileptics do not affect seizures.
Fits occur with specific environmental or emotional triggers.
Presence of witnesses, for example, family members at the time of an event.
History of chronic pain, fibromyalgia, chronic fatigue, syndromes.
History of comorbid psychiatric illness, personality disorder or substance abuse.
History of remote or current abuse or trauma.
Presence of repeatedly normal EEGs in the presence of recurrent seizures.
Drawn from Benbadis and LaFrance (2010).

Sociological features of Psychogenic Non-Epileptic fits

Gradual onset.
Rapid postictal re-orientation.
Undulating motor activity.
Side-to-side, head shaking.
Closed eyelids during the event.
An event lasting over two minutes.
Resisted eyelid opening.
Lack of cyanosis.
Partial responsiveness during a fit.
Drawn from Benbadis and LaFrance (2010) and Syed et al. (2011).

What are the points you would elicit to differentiate between epileptic and non-epileptic fits?
Does the fit present in diverse ways, or does it always present the same way?
What is the duration of the fits? Does that vary? 
Do you experience any post-ictal headache?
How do you feel after the fit? 
Do you think clearly or do you feel confused?
How soon do you recover after the fit?
Have you noticed any factors that trigger the fits? 
How frequently does the fit occur?
Has it ever occurred while you were sleeping, and someone noticed you having a fit?
Have you injured your tongue ever? Can you show me if the injury is to the side of your tongue?
Sometimes people may void urine because of the fits. Has that ever happened while you had a fit?
Has anyone noticed and told you that your face turned blue? 
Does it occur all sudden or do you feel like it will happen and then the fits happen?
Do you take any treatment for a psychiatric disorder?
Have you ever experienced an injury during the Episode?
Does the fit occur in a specific situation or place?
Is there any pattern to the episodes that you may have noticed?
Okay, this last question is slightly sensitive, but this is relevant so I must ask you: Do you have any childhood history of adverse experiences like punishment, abuse? The information you provide we always treat that confidential. Is there any history of sexual abuse? 

  1. Anwar H, Khan QU, Nadeem N, Pervaiz I, Ali M, Cheema FF. Epileptic seizures. Discoveries (Craiova). 2020;8(2):e110-e110. doi:10.15190/d.2020.7
  2. Benbadis SR, LaFrance Jr. WC. Clinical features and the role of video-EEG monitoring. In: Schachter SC, LaFrance Jr WC, eds. Gates and Rowan’s Nonepileptic Seizures, 3rd ed. New York: Cambridge University Press, 2010.
  3. Syed TU, LaFrance Jr. WC, Kahriman ES, et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol 2011; 69(6): 997-1004.

Assessment of Risk Factors in Post-traumatic Stress Disorder

A 37-year-old woman, who is an intelligent computer programmer, presented with insomnia, restlessness, and anxiety. On detailed assessment, she reveals that the symptoms started after some thieves robbed their house 3 months ago. In the incident, they had killed one of her sons. She also experiences intense imagery related to the event and often wakes up after experiencing a nightmare. The woman feels uncomfortable talking about the event and requests not to talk about it. She had experienced another such incident when she was a child. She also received treatment for depression three years ago. Personality assessment revealed neurotic traits. No one else in the family developed such symptoms, even though all of them experienced the event. 

What are the aims of the Counseling Sessions

What are the aims of the Counseling Sessions?

Counseling Sessions are an important part of psychiatric management. The following list sums up the Aims of Counselling Sessions; 
  1. Establish mutual trust
  2. Clarification and explanation
  3. Freely expresses emotions
  4. Reassurance
  5. Understanding of health
  6. Indent various choices
  7. Making decisions
  8. Seeking support
  9. Learning the necessary skills

What are the Basics of Communication Skills?

The Basics of Communication Skills

Communication skills are central to clinical assessment. The following are the basic techniques that improve communications Skills. 
  1. Attending and listening
  2. Active listening
  3. Verbal techniques
  4. Funneling
  5. Paraphrasing
  6. Selective reflection
  7. Empathy building
  8. Checking for understanding.

CASC on Phobic Disorder

CASC on Phobic Disorder

A dentist refers a young man to you; he cannot get the treatment and needs the dental procedures urgently. What causes phobia and anxiety and how you will treat it? Explain this to the patient.

Sitting and introduction
Rapport building and inquiries
Explain the fear of pain, injections anesthetic and side effects.
Explain the helplessness, embarrassment and feeling of loss and treatment plan
Close the interview

Using Watch For Physical Examination During CASC


Using Watch For Physical Examination During CASC

Since September 2018, the college expects candidates to provide their own timing device should there be a physical or other examination that requires the use of one. Digital watches/timing devices will not be permitted. Similarly, the Royal College has clarified that they do not permit mobile phones and other such devices these in CASC and will lead to disqualification if used. The candidate brings their device to the exam center. As with other components of the MRCPsych examination, the College does NOT provide spare timing devices and they will accept no liability if a candidate’s device is defective. The Royal College entertains no appeal if you do not bring your own timing device or a defective one and cannot perform a task requiring timing to the satisfaction of the examiner.

CASC means the clinical assessment of skill and applied knowledge 

Wednesday, 6 January 2021

Do you need two years of experience to be eligible for the MRCPsych CASC exam?

Do you need two years of experience to be eligible for the MRCPsych CASC exam? 

No, you do not need enrollment in a fellowship or MD program in psychiatry; you just need to show that you have two years or more of experience in the psychiatry department. This could be an RMO in India or Pakistan, for example. 

Assessment of Fitness to Plead (Capacity to Stand Trial) Pritchard Criteria

Assessment of Fitness to Plead (Capacity to Stand Trial) Pritchard Criteria


To stand trial, the accused should be able to describe his behaviour and whereabouts at the time of the alleged offence, understands what happens in the courtroom and understands the role of the courtroom personnel, instruct his solicitor, distinguish between various pleas and understand the range and nature of verdicts.

Pritchard Criteria

In the law of England and Wales, fitness to plead is the capacity of a defendant in criminal proceedings to comprehend the course of those proceedings. Its equivalent in the United States and Canada is ‘competence to stand trial.’ If the defendant raises fitness to plead, a judge will decide whether an individual fit to plead, usually following a psychiatric evaluation. 

To decide whether a patient is fit to plead, it is important to determine the extent to which the defendant can: 

  1. Understand the nature of the charge
  2. Understand the difference between pleading guilty and not guilty
  3. Follow the course of proceedings on the trial
  4. Challenge any jurors to whom they may object
  5. Understand the evidence presented in the court
  6. Instruct their legal representatives properly
Similarly, in the US, a person is competent to stand trial “if he has a sufficient ability to consult his legal representative with a reasonable understanding and has a rational and factual understanding of the court proceedings.” 

Assessment of Capacity to Stand Trial 

Begin by asking about the offence:
  • Who committed the crime?
  • Is there anyone whom you injured?
  • Were you drinking or under the influence of a substance at the time?
  • Why did the police arrest you?
  • Have you previously been to the court?
  • What do you know about the proceedings of the court?
  • What is your source of information?
  • Do you know the role of the judge in a court of law?
  • Do you have a counsellor? If they do not have one enquire whether they would like to.
  • Do you know if we can appoint one?
  • Do you know what the role of a solicitor?
  • Do you intend to plead guilty or not guilty? follow this question up with the reasons in their mind.
  • Why do you intend to do so?
  • Do you know how your decision will affect you?


  • Understand the nature of the charge.
  • Understands the difference between pleading guilty and not guilty.
  • Instruct counsel.
  • Challenge jurors
  • Follow the evidence presented in court.

>> A person may suffer from a severe mental disorder but still be fit to stand trial.


  1. Harrison P, Cowen P, Burns T, Fazel M. Shorter Oxford Textbook of Psychiatry. 7th ed. Oxford University Press; 2017:896-896.P528
  2. Dusky vs United States(Dusky v. the United States:: 362 U.S. 402 (1960) :: Justia US Supreme Court Center, 1960)

Monday, 4 January 2021

Diagnostic Formulation

Diagnostic formulation

What is the diagnostic formulation??

We use a diagnostic formulation to integrate and better evaluate the information we have obtained from the assessment of the patient. It has these components:

  1. The problem
  2. Differential diagnosis
  3. Etiology
  4. Management
  5. Prognosis

Sunday, 13 December 2020

Factors that Obstruct Effective Communication

Factors that Obstruct Effective Communication

The following factors can interfere with effective communication during clinical assessment. 
  • Lack of exclusivity, for example, assessment on the bedside inside a unit of 20 patients. 
  • Anxiety by a doctor, because of which divides their attention and concentrating, not the assessment is difficult. 
  • Awkward seating that makes it difficult to relax while assessing a patient. 
  • Lack of attention to the nonverbal cues
  • Offensive remarks.
  • Frequent interruptions. 
  • Selective listening.
  • Daydreaming. 

Wednesday, 4 November 2020

Open Ended Questions

An open-ended question is one that puts the least restrictions over the answer to a select option-list. For example, an open-ended question to assess the thoughts would be:

What do you think about most often?

You can already notice, it is impossible to ask an absolute-open ended question. 

For the purpose of the Research Workshop, the College of Physicians and Surgeons states: 

Open-ended questions elicit detailed responses and provide no preselected options. These types of questions are the hallmark of qualitative research.  

Also, learn the advantages of open-ended questions. 

Saturday, 18 January 2020

Advantages of Open-Ended Questions

What are the advantages of open-ended questions?

During the clinical assessment, open-ended questions are always preferred to close-ended questions. there are several advantages to the open-ended questions. 

If you still don't know What are Open-Ended Questions?

  1. Open-ended questions allow patients to start talking about themselves and puts them at ease as they have the floor. 
  2. Allows you time to think and plan areas of questioning as you assess their style and content of the response.
  3. Allows a period of non-verbal response from interviewer; listening and facilitating. 

    >> Just slight info: To Have the floor means to have the right or opportunity to speak in a group, especially at a formal event or gathering. 
Please, Dr. Dunstaple, your colleague has the floor. You'll have the opportunity to reply when he has finished speaking. 

Saturday, 9 August 2014

Post-Traumatic Stress Disorder: Sample CASC

So, I have been asked by your GP to have a chat with you because you are having some difficulties in judging. So, as far as I know, you have, you were in an accident. A few months ago and since then you've been having some difficulties. But if it's okay, I'll let you explain what led you to come in here already.

Yeah, I just had an accident about six months ago. And ever since then, I just can't get out of my head.

was it was a serious accident?

Yeah, it was it could have been, you know, the car was all messed up in a way you

know to sort of concussion

to split a whiplash room in the car was really hard.

I can see where you're getting a bit anxious even talking about it. If you find questions difficult to answer It's okay, we can move on. And you can take your time, too, if you're feeling anxious. So you had this unfortunate accident you said that, although you will not seriously injure the car was quite badly damaged, and you make the most depending on how long you have to be in the hospital.

Just a couple of days.


And you mentioned the competition, did you suffer any kind of memory loss or any confusion? And so this happened, about six months ago. And when did you experience the problems in your programs?

In the beginning, it was normal, you know,

it was really, really horrible.

But it just keeps going on. It just seems to get worse. Get rid of it. It's just taken over my life now.

Difficult. And so, can you describe what has been happening, what sort of experiences have you been to. Have you been experiencing?

And the newest thing is a sort of the last one, really I just sort of. I'll be at work or be out with your friends or anything, I just start hearing. Like screeching tires or metal.

This off. I can hear it and then it's like it's happening all over again. I just feel completely sort of paralyzed. So you've got a couple of minutes. It just seems like a lifetime.

Sounds really scary and some people, when they experience, have this kind of experience they also sometimes have nightmares of these incidents. And is it quite frequent the nightmares?

Yeah, so most nights really seem to get worse. Okay. But now it's sort of every night and it's just sort of stuck in the same thing I'm just reliving it up to where it happens and it's often what we find is a traumatic incident like that, avoid situations that might lead to a similar thing, avoid doing the things that happen on the day of seeing that happen in your case.

And now I'm going to drive with anybody else in the car.

Right. My friend.

I just keep thinking that I could have killed her.

Are you able to drive with no kind of emotional

Avoid at all costs, but I need to keep working. If I can avoid doing anything more than I have to do. I'm late every morning because it's just such a workout to get myself in the car to go.

And are you doing anything to deal with all these problems? And when you say drinking is more than community drink after the incident. Did you use to drink before?

I sort of had a glass of wine after work, but now it's just so I just have another one and then another one. I'm just so worried about going to sleep. So I just, I just have a couple more drinks and it just helps me. It helps me get to sleep.

How much do you drink?

Probably. Probably, um, maybe a bottle of wine.

So asking this, but you won't be using any other substances, middle class, here. So, your drinking has gone up You said that you were feeling quite anxious and agitated. Do you also find that you have become a bit more snappy, irritable, with people?

He says I'm a different person now. He thinks I'm just angry all the time. I get mortgage irritated, the normal, a film just got shorter views than I did before.

And you also are quite easy to be always vigilant about what's going on around you.

You know, if I have to sit in the car with my boyfriend's driving to somewhere. I'm constantly on edge I'm looking around for other cars and any sort of hazards, constantly jumping or saying oh slow down or things like that. Yes.

I think all of this must be quite draining on you, how do you say your mood has been in the last few weeks.

I just feel so tearful all the time. On the verge of crying because I just seem so frustrated, but it's still, still going on.

Do you have any happy times in between the lives of many you're doing anything specific?

that already enjoy much,

Because you feel constantly alone and not enjoying things as well. What would you say your energy levels are like

guess just because on the edge all the time we're just taking a lot out from this what

Do you find the most interesting things that you used to enjoy? And you mentioned trying to sleep. Because you are afraid of sleeping, you have been drinking the evening. But when you go to sleep. Go to sleep.

Wake up a lot. Having these dreams gets to a point. So it's all happening again with the car, and then it gets to a point and then a shock. Wake up and then go back to sleep and it just happens.

So good focus on being able to look after yourself. Eat. Look after food and diet.

And since you've been feeling stressed, I mean, do you find that you've had any specific negative thoughts towards where you're not wanting to live anymore or felt like harming yourself or something.

Oh yeah, I don't, I don't want to live like this anymore. I don't kill myself, that's

Been asking lots of questions and you've been very patient with me Thank you very much. I need to speak to my team, and especially the psychologists in my team, because from what you're paying, what you're doing. Today, it seems like you are experiencing symptoms of post-traumatic stress disorder, commonly known as PTSD, and your concern appears below. So, I would speak to the Secretary of State and see if what the missed approach would be because we need to have. We go for psychological therapy first or try combination therapy and medication. But we have a discussion with the team and arrange another appointment for you so I can discuss more what the plan will be.

Wednesday, 10 October 2012

Courses and Mock Exams for MRCPsych CASC

Courses and Mock Exams for MRCPsych CASC

Different courses offer unique features. The primary focus of CASC courses is the practice of different stations.  How the authors have organized them can differ; for example, whether candidates take turns completing stations or do complete circuits.  Psychiatrists from higher trainees to consultants staff these exams. Sometimes these might include college examiners themselves.  The role-players include those who have taken the exam themselves.



You can best cover communication and clinical skills within local deanery-run MRCPsych courses. This includes CASC scenarios and can be helpful in the run-up to exams. This may help if communication skills at your medical institute, you did not learn communication skills or if English is not your first language.  

Private Courses

There are also several private providers that vary in terms of content, cost, and quality.  Some focus on communication skills (e.g. Oxford course), some courses contain actual CASC scenarios but with limited feedback (e.g., SPMM), and others offer individual practice stations via Skype with consultants, higher trainees, and CASC actors (e.g., Cognitions for CASC).

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