CASC: Family psychoeducation after first-episode psychosis

Candidate instructions

You are the psychiatry registrar in early-psychosis follow-up. Sam, 21, had a first episode of schizophrenia, now improving on risperidone 3 mg orally at night. You will meet Jordan, Sam's parent. Sam has consented to a family meeting about illness education and support, and is waiting outside for the second half if invited. Your tasks in 10 minutes:[17]

1. Engage Jordan with a non-blaming, partnership stance.
2. Give plain-language psychoeducation: stress-vulnerability model, role of medication, early warning signs.
3. Normalise carer stress; avoid implying Jordan caused the illness.
4. Outline multi-session family psychoeducation (what it involves and why).
5. Address confidentiality limits and Sam's privacy.
6. Agree one concrete next step (e.g. first FPE session date; early warning signs card together).

Actor brief (Jordan)

• Exhausted, frightened, slightly angry: "If we'd been stricter this wouldn't have happened."
• Opens if clinician validates stress and rejects parent-blame.
• Worried about cannabis friends and weight gain on medication.
• Will accept multi-session FPE if explained as skills and support, not "family therapy because we're dysfunctional."
• Becomes defensive if lectured or told "high EE" jargon without explanation.

Marking grid (domains)

Pass requires non-blaming engagement, multi-session FPE offer, EE-aware collaboration, and confidentiality limits consistent with evidence-based FPE practice.[17][3]

Model communication fragments

Examiner notes

High-scoring candidates integrate hope, evidence-informed plain language (relapse reduction and adherence support from PE/family intervention syntheses), and practical structure without overclaiming cure rates.[3][5] Mention carer support needs and Sam's inclusion when possible. Screen briefly for home safety/coercion without derailing the station.