Schizophrenia: the role of the family doctor and the use of compulsory admission

Abstract

Introduction: Schizophrenia is a syndrome characterized by changes in thinking, mood and behaviour. Patients with this disorder lack insight into the disease, which often leads to non-adherence to treatment and worsening of symptoms. Compulsory admission is a last resort in these situations. Because of the difficulty in assessing these patients, close monitoring by the family doctor is required. Thus it is possible to assess the effects of the disease and permit timely initiation of psychiatric treatment. Case description: A 48 year-old woman, divorced, unemployed, and living alone, who was diagnosed with schizophrenia at age 30, consulted her family doctor with persecutory delusions and delusional interpretations. Over a period of four months, she consulted with her family doctor for the same reasons, with a progressive deterioration in her condition. The situation evolved to a state of aggression with immediate danger to herself and others. Because she refused the necessary treatment, the health authority was contacted to arrange for compulsory admission. Comment: Schizophrenia is a highly debilitating disease. When not under control, exacerbations in clinical status are difficult to manage. Portuguese law permits compulsory admission. The family doctor has health resources available and a privileged knowledge of the patient and the family, which can be used effectively to manage psychiatric deterioration.