Discussing a long-acting injectable with a young adult and parent (CASC)

Station instructions (candidate)

You have 7 minutes. Explain why a long-acting injectable is being offered after early relapses linked to missed tablets. Use plain language. Address needle fear and control concerns. Outline roughly how initiation works (tolerability already known on oral aripiprazole; short oral cover after first monthly injection). Balance benefits (fewer gaps in medicine, lower chance of another admission — early-phase and real-world evidence in simple terms) against side effects similar to the tablet and injection-site discomfort. Do not coerce. Do not promise cure. Do not present LAI as punishment. Check understanding and agree a next step (think time, written info, or start plan).[1][2][3]

Marking domains

Agenda setting with both patient and parent; accurate non-stigmatising explanation of adherence and relapse; shared decision language; practical initiation/overlap explanation; side-effect honesty matched to aripiprazole; needle-fear empathy; evidence-informed hope without hype; safety-net and follow-up; respect for capacity and choice.[1][3][4]

Model communication map

1. Open: thank them; name the shared goal (stay well, stay out of hospital, get back to study/work).[1]
2. Why now: tablets worked when taken; gaps led to relapse; monthly injection keeps the same type of medicine available even on hard weeks — a tool, not a penalty.[2][3]
3. Evidence in plain language: studies in early illness and large real-world data show long-acting options can delay hospital stays for many people when medicine is consistent.[1][2][4]
4. How it works: he already tried oral aripiprazole; first monthly injection usually needs about two weeks of tablets while the depot builds; then often tablets can stop if the plan is stable.[1]
5. Needle fear: acknowledge; describe clinic support, brief injection, site options if available; offer observation of a dummy/teaching conversation if service allows.[3]
6. Control concern: he remains a partner in dose, timing, side-effect review; can discuss switch back if goals change and it is safe.[1]
7. Risks: similar side-effect family to oral aripiprazole; local injection discomfort; still need physical health checks.[3]
8. Close: questions, written leaflet, time to decide if needed, crisis contacts, appointment for first injection if he consents.[1]

Common fails

• Saying "you failed so now you get the needle."[1]
• Ignoring the mother's anxiety or speaking only to one person.[3]
• Omitting oral cover after first aripiprazole monohydrate injection.[1]
• Promising no side effects or guaranteed no re-admission.[2]
• Jumping to clozapine language when TRS criteria are not met — or, conversely, promising endless LAI cycling if true resistance emerges later.[5]