Psych CASC / OSCE · General adult psychiatry — early psychosis pathway
Explain first-episode psychosis care to parents — CASC communication station
MRCPsych/FRANZCP-style communication station: explain FEP pathway, EIS multi-element care, low-dose antipsychotic plan, DUP, maintenance after remission, cannabis advice, and vocational hope.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the early intervention clinic. [1]
Candidate instructions. Explain the working diagnosis of first-episode psychosis to the parents, outline medical checks and treatment (medication and psychosocial), discuss cannabis, address medication duration after improvement, and discuss study/work goals. Check understanding. The examiner plays both parents. [1]
Candidate scenario
Your patient, age 19, has a working diagnosis of first-episode psychosis after medical exclusion is underway. He has started aripiprazole 10 mg daily.[1] He uses cannabis most nights. Parents ask: "Is this schizophrenia forever? Will the drugs change his personality? How long is medication for? Should he quit university?" [1]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language explanation of FEP as a pathway (not day-one lifelong fatalism)
- Clear description of multi-element care and why early treatment matters (DUP)
- Medication purpose, common side-effects (e.g. akathisia), and monitoring
- Maintenance duration framed with relapse risk if stopped early
- Cannabis counselling without blame
- Vocational/education hope (adjust, do not automatically abandon)
- Checks understanding and safety-net [1][2][3]
Reveal assessor key
Open. Thank them; name the time; ask main worries first. [1]
Explain FEP. "First-episode psychosis means a break from shared reality — for example fixed false beliefs and hearing a voice commenting — severe enough to affect study and relationships. We use careful language: some people recover fully, others need longer care. We avoid saying 'this is schizophrenia forever' on day one while still treating seriously." [2]
Explain care package. Medication reduces intensity of positive symptoms for many people; aripiprazole is a common first choice with relatively favourable metabolic profile; early restlessness (akathisia) can occur. We also offer family education, talking treatments, sleep and routine support, and help to stay in education or work — coordinated specialty care improves outcomes versus fragmented care.[1]
DUP. Longer time untreated links to poorer outcomes — seeking help now matters.[2]
How long on medication. If he remits, stopping early has a high chance of symptoms returning. We usually plan continued medication for a substantial period (often discussed as at least 1–2 years), then review together. Any later reduction is slow and supervised with a written early-warning plan.[3]
Cannabis. Frequent high-THC use can trigger and worsen psychosis; stopping is one of the highest-yield steps he can take. [1]
University. May need temporary adjustment, not automatic abandonment; recovery includes roles and goals. [1]
Close. Summarise, invite questions, crisis contacts, written info, review plan. [1]
References
- [1]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [2]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review Arch Gen Psychiatry, 2005.PMID 16143729
- [3]Zipursky RB, Menezes NM, Streiner DL Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review Schizophr Res, 2014.PMID 23972821