CASC: Explaining family EE and stigma after first-episode psychosis

Candidate instructions

You are the psychiatry registrar in early-intervention clinic. Priya, 52, is mother of a 22-year-old recently discharged after first-episode psychosis. She is exhausted and says he is “lazy and doing this for attention.” He delayed help for months fearing workplace stigma. Your tasks in 10 minutes:^[10][14]

1. Engage collaboratively; validate carer burden without colluding with pejorative labels.
2. Explain in plain language how critical/hostile climates and blaming explanations relate to stress and relapse risk (high EE concepts without jargon dump).
3. Reframe negative symptoms as illness-related rather than wilful laziness (attribution work).
4. Address stigma: public/self stigma and why delayed help-seeking is common; offer one practical disclosure/support idea.
5. Agree one concrete next step (e.g. family psychoeducation session) and briefly screen risk (home conflict, patient self-harm/violence, carer burnout). Station rewards skills + alliance, not lecturing the mother as “the cause.”^[9][11][13]