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

www.mja.com.au
© 1998 MJA

History

The parents of a 21-year-old female student consulted their family general practitioner, concerned that since breaking up with her boyfriend a few months previously she had been losing weight and attending less to her grooming. She had not been attending lectures lately, had become increasingly distant from friends and family, and had taken to isolating herself in her room. She had recently confided in her younger sister that she was receiving personal messages from songs on the radio confirming that her friends were conspiring against her. She had begun to suspect that someone was tampering with her food.

Intervention

She refused to come to see the general practitioner, so he arranged an urgent home visit that evening together with a female member of the local community mental health team. Though reluctant to talk to either of them, she agreed to a physical examination by the general practitioner, and some blood test investigations. Eventually, she also agreed to further home visits by the mental health professional, who tried to engage her patiently over a few days, gradually earning sufficient trust to take a history and to gain her agreement to bring a psychiatrist to see her and her family on a subsequent visit.

Organic illness and major depression were carefully excluded and a provisional diagnosis of early psychosis was made.

After detailed explanation to her and her family, low-dose antipsychotic medication was prescribed, further investigations were arranged via her general practitioner at her convenience, and the likelihood of a full recovery was discussed. Information sheets, further education, problem-solving and goal-setting sessions were provided for her and her family at their home. Personal counselling with the mental health worker continued, and access to group sessions with young people with similar problems was offered, focusing on the meaning to the individual of the experience of psychosis, her relationships, handling stigma ("what do I tell my family and friends?"), and returning to study or work with adequate support.

Regular clinical reviews and further prescribing were arranged on a shared care basis between the psychiatrist and the general practitioner. As there were no further symptoms or recurrence, medication was reviewed with a view to discontinuation after possible early warning signs unique to this individual had been defined together with her and her family. Further counselling was provided regarding the meaning of this episode to this individual and her family, and to help her discover what could be positively learned from this experience.

Back to article . . .