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A 39-year-old man had been under treatment for schizophrenia for 10 years at his local mental health clinic. His illness developed over eight months and was characterised by increasing hostility, irritability and a withdrawal from friends and family. He became implacably convinced that certain political figures and union leaders were attempting to "freeze" his thoughts and paralyse his arms and legs by directing miniature laser pointers towards him as he went about his daily business.

These delusions were soon accompanied by auditory hallucinations -- mainly of aggressive men who constantly harangued him about his "inadequacies" -- especially his physical appearance. Early in his illness, he resigned from his job as a printer, moved out of his flat, and saw his wife only infrequently. During the first four years of his illness he had several severe exacerbations which involved three suicide attempts and five hospitalisations. He had been treated with a variety of conventional antipsychotic medications -- including high-dose haloperidol and trifluoperazine.

By the tenth year of his illness, his delusions and hallucinations, although still present, were well controlled. At this stage, his main disabilities related to his poor motivation, limited coping skills and the fact that his insight, though reasonably good, could deteriorate at times. Because of the stability of his symptoms, he was transferred from the mental health clinic to a "shared care" program in which his primary management was undertaken by a general practitioner who saw him every three to four weeks. She monitored his use of low dose haloperidol, diagnosed and managed his type II diabetes (with diet and glipizide), helped him deal with insomnia and encouraged him to retain contact with friends and community support groups.

Six-monthly psychiatric consultations provided by the local mental health clinic assisted in the early diagnosis of mild tardive dyskinesia, in the transfer of therapy from haloperidol to olanzapine and in the assessment and treatment of a secondary depressive episode for which the differential diagnosis was an exacerbation of his negative symptoms.

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