ABSTRACT
A 26-year-old man is referred to the crisis intervention home treatment team by his community psychiatric nurse. He is interviewed at home in the presence of his wife and 3-year-old child. He has turned the house upside down as he is convinced that there is a microphone taping his family conversations. He has been hugging his child, crying inconsolably. He can hear some ‘young lads down the road’ talking about killing him and his family. He feels that TV programmes are discussing him and his family. He has taped newspapers on the windows and has set up trip wires at the front and back doors. He has not slept for 3 days and has been talking to himself. He was diagnosed with schizophrenia at the age of 20 and was under the care of the Early Intervention Team for 3 years. He was treated with risperidone and seemed to have responded well. However, he stopped taking his medication and had a relapse 2 years ago. He was assigned a community psychiatric nurse as his care coordinator. Risperidone was re-commenced but he continued to remain paranoid and suspicious. There was concern about the possibility of him missing medication, and he was switched to risperidone long-acting depot. This was continued for over 12 months but without a significant response. Risperidone was replaced with olanzapine but this also did not produce a significant response and was associated with weight gain of 3 stones. Olanzapine was discontinued 3 months ago and he was prescribed aripiprazole. His wife insists that he has been compliant, but over the last 6 weeks his mental state has deteriorated.
