Psych CASC / OSCE · General adult psychiatry — clinical high risk / attenuated psychosis
Explain clinical high risk to parents — CASC communication station
MRCPsych/FRANZCP-style communication station: explain UHR/CHR without fatalism, outline stepped care (CBT, comorbidity, monitoring), antipsychotics not first-line, omega-3 equipoise, cannabis advice, and escalation if frank psychosis appears.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the youth early-psychosis clinic. [1]
Candidate instructions. Explain the working formulation of clinical high risk / attenuated psychotic symptoms to the parents. Cover what it is and is not, realistic conversion expectations, planned care (psychological therapies, treating anxiety/depression, cannabis, monitoring), when medication might be considered, and what happens if symptoms become frank. Check understanding and safety-net. The examiner plays both parents. [2][3]
Candidate scenario
Your patient, age 17, has attenuated referential ideas and brief name-calling perceptions with residual insight after structured assessment consistent with UHR (attenuated symptoms group). She uses cannabis on weekends. Parents ask: "Is this schizophrenia? Will she definitely get it? Should she take antipsychotic tablets now? We read fish oil cures it. Should she quit school?" [1][2]
Marking domains
- Empathy, structure, agenda-setting
- Accurate plain-language explanation of CHR/UHR as a risk state, not day-one schizophrenia
- Realistic conversion language (minority convert; majority do not in medium-term follow-up)
- Stepped plan: engagement, comorbidity, CBT-informed care, family support, monitoring
- Antipsychotics not routine first-line; specialist shared decision if used
- Honest omega-3 equipoise (not a guaranteed cure)
- Cannabis counselling without blame
- School: adjust support, do not automatically abandon
- Safety-net and escalation if frank psychosis appears [2][3][4][5]
Reveal assessor key
Open. Thank them; name the time; ask main worries first. [1]
Explain CHR. "We use the term clinical high risk or ultra-high risk when a young person has milder, questioned unusual thoughts or perceptions and is struggling, but does not yet have a continuous full psychotic illness such as schizophrenia. Structured interviews such as CAARMS help us be careful with that distinction."[1]
Conversion. "In specialised clinics, some young people do later develop a full psychotic episode, but most do not within a few years of follow-up. We take the risk seriously without treating the future as already decided."[2]
Care package. "We focus on what is hard now — sleep, mood, anxiety, school stress — and offer talking treatments that help re-evaluate unusual experiences, plus family education. Reducing cannabis is one of the highest-yield steps. We review regularly and have a clear plan if symptoms intensify."[3][5]
Medication. "Antipsychotic tablets are not automatic at this stage for everyone. They can help some people but also have side-effects such as weight gain or restlessness. We consider them carefully if symptoms escalate or become frankly psychotic, at low dose with monitoring."[5]
Fish oil. "One early study looked promising; a larger later trial did not confirm prevention. It may be discussed as an option but is not a guaranteed cure."[4]
School. Temporary adjustments and support — not automatic permanent withdrawal from education. [5]
Close. Summarise, invite questions, crisis contacts, written information, review plan, and the red-flag list for earlier contact. [2][5]
References
- [1]Yung AR, Yuen HP, McGorry PD, et al. Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States Aust N Z J Psychiatry, 2005.PMID 16343296
- [2]Salazar de Pablo G, Radua J, Pereira J, et al. Probability of Transition to Psychosis in Individuals at Clinical High Risk: An Updated Meta-analysis JAMA Psychiatry, 2021.PMID 34259821
- [3]van der Gaag M, Smit F, Bechdolf A, et al. Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups Schizophr Res, 2013.PMID 23870806
- [4]McGorry PD, Nelson B, Markulev C, et al. Effect of ω-3 Polyunsaturated Fatty Acids in Young People at Ultrahigh Risk for Psychotic Disorders: The NEURAPRO Randomized Clinical Trial JAMA Psychiatry, 2017.PMID 27893018
- [5]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681