The Division Between Psychiatric and Neurological Practice Does Not Help Patients with Disorders That Span the Two

Abstract

IT is a 19-year-old student who presented to the psychiatric services during his first term at University with a 1-month history of altered mental state. His main difficulties were with sleep, poor concentration, low mood, and paranoid psychosis. His sleep complaint was of hypersomnia. Undisturbed he would sleep for up to 18 h each day. When he forced himself to wake up for lectures, he would then find himself irresistibly sleepy during the day. When awake he found that his concentration and attention were very poor and was unable to retain any information that was relayed in tutorials. His mood had deteriorated such that he got no enjoyment from social events, which he had previously looked forward to. He felt hopeless about his situation and had some thoughts that he might be better off dead and was contemplating suicide. His appetite was reduced and he had lost some weight. He had also developed paranoid thoughts that others were watching him, perhaps monitoring him through CCTV cameras, although he wasn’t 100 % convinced about this, and he was hearing whispering voices talking to him, speaking to him outside his head, although he couldn’t make out what they were saying.