Psych CASC / OSCE · General adult psychiatry — psychotic disorders
Explain first-episode psychosis and treatment — CASC communication station
MRCPsych/FRANZCP-style communication station: explain FEP diagnosis in plain language, outline antipsychotic and psychosocial plan, discuss early intervention, address cannabis, and check understanding.
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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 early intervention clinic. [1]
Candidate instructions. Explain the working diagnosis of first-episode psychosis to the parents, outline the initial treatment plan (medication and psychosocial), discuss cannabis, and respond to prognosis questions. Check understanding. The examiner plays both parents. [1]
Candidate scenario
Your patient, age 20, has a working diagnosis of first-episode schizophrenia spectrum psychosis after medical exclusion. He has started aripiprazole 10 mg daily.[1] He smokes cannabis nightly. Parents ask: "Is this schizophrenia forever? Will the drugs change his personality? Should he stop university?" [1]
Marking domains
- Empathy and structure
- Accurate plain-language explanation of psychosis and dopamine treatment
- Balanced prognosis (treatment works; early care matters; not inevitable deterioration)
- Cannabis counselling without blame
- Shared decision-making and safety-net
- Checks understanding [1]
Reveal assessor key
Open and agenda-set. Thank them for coming; name the time; ask their main worries first. [1]
Explain diagnosis. "First-episode psychosis means a break from shared reality — for example fixed false beliefs and hearing a voice commenting on him — lasting long enough and severe enough to affect study and relationships. We use the term spectrum carefully; some people recover fully, others need longer treatment. We avoid premature fatalism."[2]
Explain treatment. Medication reduces the intensity of dopamine-driven positive symptoms for many people. Aripiprazole is a common first choice with relatively favourable metabolic profile; early side-effects can include restlessness (akathisia). We also offer talking treatments, family education, sleep and routine support, and help to stay in education — coordinated specialty care improves outcomes versus fragmented care.[1]
Cannabis. Cannabis, especially frequent high-THC use, can trigger and worsen psychosis. Stopping is one of the highest-yield steps he can take. [1]
Prognosis. Many improve substantially with early treatment. Longer untreated psychosis associates with poorer outcomes — seeking help now matters. University may need temporary adjustment, not automatic abandonment. [1]
Close. Summarise, invite questions, provide written information and crisis contacts, arrange review. [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