First-episode psychosis — structured clinical viva

Assessment spine. Risk (suicide, violence, vulnerability), MSE with examples, collateral, substance timeline, DUP about 4 months of frank psychosis (already prognostic), capacity/legal status under local statute, and medical exclusion. Observations and glucose if not done; baseline metabolic panel and ECG before antipsychotic.^[2]

"Is this schizophrenia forever?" Answer with pathway language: this is first-episode psychosis; the operational label may evolve with duration; many people improve substantially with early multi-element care; avoid fatalism while remaining honest that some need longer treatment.^[1]

"Strongest tablet now?" FEP responds to lower doses; high-dose polypharmacy increases harm. Name a first-line plan (e.g. aripiprazole 10 mg daily) with monitoring. Clozapine is for treatment resistance after adequate trials, not automatic first dose.^[1]

Maintenance duration. After remission, early stop carries high recurrence risk; counsel continued treatment typically for at least 1–2 years with shared decision-making; any taper is supervised with early-warning plans.^[3]

University. Temporary adjustment may help; automatic abandonment is wrong. Offer IPS / supported education integrated with the team — vocational recovery is evidence-based, not a luxury after "full cure."^[4]

Evidence names for the examiner. Marshall/Perkins on DUP; OPUS; RAISE-ETP; Correll EIS meta-analysis; Zipursky discontinuation risk; Killackey IPS; family intervention evidence.^[1][2][4]