Back to text of article | Info Centre Home | Contents | Search | eMJA Home

www.mja.com.au
© 1998 MJA

A 25-year-old single woman with a history of several hospital admissions for bipolar mood disorder was intermittently attending a community psychiatric service. She was taking lithium, but serum lithium estimations pointed to poor compliance with therapy, and she was becoming increasingly depressed.

The patient had a good longstanding relationship with her general practitioner, whom she saw for management of asthma and contraception, but there had been no contact between the general practitioner and the community psychiatric service. This changed when the general practitioner contacted the service psychiatrist and suggested collaboration.

Collaborative care arrangements

An agreement was negotiated between the patient, general practitioner, psychiatrist and a staff psychologist (the patient's case manager at the psychiatric service).

• The patient was to attend her general practitioner (initially every two weeks) to check on compliance with lithium therapy and side effects, and for support and encouragement to take responsibility for mental as well as physical health. She would see the psychologist at the clinic weekly for cognitive psychotherapy to treat depression and the psychiatrist every three months for consultative input.

• The general practitioner and clinic case manager agreed to discuss progress via telephone at two and six weeks and to contact each other immediately if a crisis arose.

Improved outcome

Over the next few months the patient's compliance with medication improved and her depression abated. The patient's case management was taken over entirely by the general practitioner, with reviews by the service psychiatrist every six months. The general practitioner now knew the psychiatric service and could obtain advice and assistance as needed.

Back to text of article . . .