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A 17-year-old unemployed youth was brought to his general practitioner with increasing social withdrawal of eight months' duration and two weeks of erratic behaviour and being inappropriately argumentative. At the first interview he was coherent and denied any perceptual disturbances or delusions.

The general practitioner had known the family for several years and concurred with the parents' observations. He reassured them that he would investigate the change.

On reassessment six days later, the discussion moved to the young man's peer contacts and he spontaneously admitted to an increasing use of cannabis and auditory hallucinations which persisted for days after having smoked cannabis.

Concerned about the possibility of prodromal schizophrenia, the general practitioner organised a referral to a psychiatrist. On presentation, the young man refuted the history, admitted to cannabis use, but stated that this had decreased because of the increased vigilance of his family. He denied any specific symptoms of schizophrenia, including hallucinations, but was unable to explain his withdrawal and lack of motivation.

The interview with parents focused on the resentment that the young man felt towards them and their recent increased control of his activities and finances. The father revealed that the patient's brother, who was living in another State, had suffered from schizophrenia and that this was the major fear of the family. The pros and cons of intervention were discussed in view of their son's reluctance to be followed up. Resources for further information about schizophrenia were provided. The general practitioner was informed of the additional history and outcome of the assessment.

Five months later the young man presented again, this time with clear features of disorganised schizophrenia. Treatment with low dose trifluoperazine was begun and some of the young man's symptoms began to resolve, but he developed marked problems of akathisia and remained amotivational. The general practitioner contacted the psychiatrist, who recommended either low dose propranolol to reduce the akathisia, or a change of medication to risperidone, given the continuation of negative symptoms.

At reassessment three weeks later, the patient spontaneously acknowledged his auditory hallucinations and clear paranoid delusions in relation to his parents. The parents reported his increased spontaneity and the return of his sense of humour.

Risperidone treatment continued and the young man became involved in a technical education course. Several months later he again began to behave erratically. On review he admitted to increased use of cannabis and non-compliance with medication as he had felt well. His medication was adjusted to provide symptom control.

He was reluctant to be involved with the local psychiatric team but was agreeable to seeing his general practitioner. He attended every two or three weeks for the next two months, then monthly. He remained symptom-free while the importance of compliance with medication and abstinence from cannabis was reinforced.

A year after the initial consultation a gradual withdrawal of medication was undertaken. His mental state was monitored by his general practitioner and at the end of two years he remained free of symptoms.

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