First-episode psychosis — KFP-style written assessment

KFP 1 (10 marks)

A 19-year-old apprentice has drifted apart from his mates over six months. His mother reports he has become suspicious, says workmates are "talking about him", stays up all night, and recently stopped his apprenticeship. She asks whether he is "just smoking too much weed" — he uses cannabis most days. ^{[12] [23]}

1. Name the symptom clusters present and give one example from each. (3) ^[12]
2. What is duration of untreated psychosis, and why does it matter for what you do today? (4) ^{[2] [3]}
3. His mother wants to know if this is just cannabis. Answer her with evidence. (3) ^{[23] [19]}

Model answers

1. Positive symptoms (persecutory ideation — beliefs that workmates talk about him), negative symptoms (social withdrawal, loss of connection with friends), and possibly disorganised/cognitive features (functional decline ending the apprenticeship). Naming the clusters frames the assessment and the referral letter. ^[12]
2. DUP is the time from first persistent psychotic symptom to adequate treatment. Longer DUP associates with worse outcome at 6 and 12 months across symptoms, functioning and quality of life, independent of premorbid adjustment; shorter DUP predicts greater antipsychotic response. Pooled mean DUP is about 61 weeks with median near 12 weeks — so today's consultation either starts the clock properly or extends it. Refer to an early-intervention service now. ^{[2] [3]}
3. Cannabis is neither the whole story nor irrelevant. Ever-use raises psychotic outcome risk (pooled OR 1.41), and daily high-potency use nearly five-fold (OR ~4.8). But primary psychoses arise without cannabis, and cannabis-induced psychosis itself relapses in 20% within two years (25.7% when cannabis-induced). The correct answer is assessment plus referral regardless of his use, and structured cannabis reduction as part of treatment. ^{[23] [19]}