Questions to the interviewed person are listed here only for scenario 3
The parents of a 19-year-old man are concerned about the way in which their son has changed over the past 6 months. Half a year ago, he successfully passed his ‘A’ levels with good marks, he had several hobbies that he pursued, and he had friends and, at times, also a girlfriend.
Since then, he has started to isolate himself, and he spends a lot of time in his room, having locked himself into it. Initially, he had tried to find a job but he has given this up now. He has also given up his hobbies and hardly sees his friends any more. During the daytime, he mostly keeps his windows closed and the blinds down. At night, his parents noticed that he keeps the light on and paces up and down in his room. He has become hostile towards his parents. He appears suspicious towards them and talks as little as possible. Furthermore, he suspiciously checks the food that his mother prepares for him, only eats it in his room and has even mentioned fears that the food may be poisoned. He has lost a significant amount of weight, however, not to an extent where his health would obviously be at risk. There is no evidence of suicidal thoughts or aggressive behaviour towards others. There is no evidence of alcohol or drug misuse, either. Over the last few months, his parents and the community psychiatric nurse, whom his GP involved, have made several attempts to persuade him to be treated by a psychiatrist, but these attempts have all failed.
A 33-year-old single translator suffered from an acute phase of schizophrenia 3 years ago and needed to be treated in hospital. With the help of medication and psychosocial intervention, she became free of symptoms, was discharged from hospital and returned to work. Her psychiatrist prescribed her medication to prevent a relapse, but 9 months after her discharge from hospital, she stopped all her medication because she felt so well. Three months later, she resigned from her job because of conflict with colleagues at work. She now lives with her 74-year-old mother again. Their relationship has always been close but difficult. Last year, this led to increasing tensions, which led to the patient ordering her mother around in an inappropriate manner and even hitting her on several occasions. When talking to the GP, she stated that she had to hit her mother because she would not obey her. At the time, she appeared agitated, her speech was incoherent, it was not always possible to follow what she was saying and she had religious delusions. There was no other evidence of suicidal ideas or aggression towards others. At the time, the patient appeared well kempt, and the apartment was very clean and orderly. When the GP put to the patient that she might have become ill again, she called this a “ridiculous suggestion.” She refused to be admitted to a hospital or to take the medication that she used to take after her first hospital admission. Other relatives and her community psychiatric nurse tried in vain to persuade her to seek help. Her mother appeared scared and helpless when the GP visited them.
A 38-year-old trained mechanic, divorced 10 years ago, has been living on Disability Living Allowance for the last 5 years. He no longer has any contact with his ex-wife or family, his parents are dead and he has no siblings. Seven years ago, he became ill with schizophrenia for the first time. Since then, he had to be admitted to a psychiatric hospital three times, the last time being 4 years ago. Whenever he was ill, he heard voices, and he believed that he was being persecuted by organised criminals and alien powers. Furthermore, he consumed huge quantities of alcohol to cope with his anxieties. After treatment with anti-psychotic medication and psychosocial intervention, his delusions and hallucinations disappeared, but he was left with a certain apathy and loss of interest. Three years ago, the patient stopped all treatment and contact with psychiatric services. He would not see his GP or psychiatrist any more, and he also stopped taking medication. He still lived in his own flat but stopped all contact with friends and acquaintances, and he ceased to pursue his hobbies. He only rarely left his flat to buy food, but he solely ate bread and tinned food. He began to become very suspicious towards other people; he increasingly appeared unkempt and neglected, with his hair and beard growing unattended and his clothes unwashed and shabby. When other people in the house alarmed Social Services, they found his flat in a very bad and neglected condition, with heaps of papers, empty tins and other rubbish piled high. It was, however, difficult to prove that there was any direct risk to his health by eating unhygienic food. There were no reports of suicide attempts, deliberate self-harm or aggression towards others. Judging by the beer bottles lying around, he appeared to be drinking on a regular basis but not in extreme quantities. The patient declared that he was not willing to be assessed or treated or take any prescribed medication. His speech was slightly incoherent and he appeared quite hostile. He hinted towards evil powers that were responsible for the dismal state that the world was in and who were after him. There were several visits from community psychiatric nurses, psychiatrists and social workers, but he always refused any help.
Would you want this man to be admitted to a psychiatric hospital and his flat be cleaned and made hygienic even against his will? If you have said “no,” would you change your mind if:
There were serious threats to the patient’s independence and finances, with his illness deteriorating further, e.g. loss of his flat because of unpaid rent.
There were significant medical dangers should he be left to himself, e.g. an existing heart disease for which he would refuse treatment.
You discovered that the patient’s children would be interested in contacting him again should he be able to give up his suspicion against them, which is probably due to his illness.
You discovered that, when the patient was last treated in hospital, he was only treated against his will for a few days but then accepted treatment voluntarily and continued to take his medication independently.