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Case study 2 : Aaron

It was after a year into my core training in Psychiatry that I admitted Aaron (name changed) during one of the on-calls.

This gentleman was in his late 50s and was very quiet when he was brought in.

It was an emergency admission where the local police had to bring him into the hospital following requests from Aaron’s colleagues.

Aaron was an Indian immigrant who had been living & working in Ireland for over 20 years.

He was a popular & successful physicist who was widely respected for his wisdom & dedication to work.

He was single (never been married) and had no friends outside of work.

His relationships with his relatives in India were estranged for years.. so initially we struggled to find a next of kin to put down in his notes.

However, he had been living comfortably in his luxury apartment for years…almost like a hermit.

This man had gradually lost interest in his work and began looking disheveled.It was becoming increasingly evident to everyone at work that he was not paying attention to his personal hygiene.His colleagues tried to help him but he was proud to accept help or even admit that something was wrong with him.

Days and weeks passed.He didn’t show up at work and his work mates visited him but he never let them inside his apartment.He hadn’t washed for months and had evidently lost a lot of weight.He wasn’t eating or showering.. so what was he really doing then?

He was preoccupied with writing letters - to the political leaders apologising for ‘the’ war! He believed that there was a war that had started and that somehow he was the reason for it. He was so convinced of this that he was punishing himself by not eating.How did all this start? Nobody knows for sure.. but possibly Severe Depressive disorder which when untreated brought on psychosis for this patient.

During the admission, he was trialed on a few medications before changes began to be seen.

During my ward rounds,I just sat there at his bedside and he’d not answer any questions.Zero eye contact and flat affect (no expressions)

After a few months, he started responding to treatment and began speaking.

Initially he spoke about how he didn’t like the hospital food and later he started talking about cricket, his favourite sport.

I can never forget the advice my mentor gave me about this patient.

He said that we must consider trialing him on antidepressants before he goes home.

I learnt that when highly intellectual or accomplished individuals develop psychosis, it is important to understand that once psychosis is successfully treated - they may struggle with moderate to severe depression for a lengthy time afterwards.Most of the time it is because of their inability to accept that they suffered from a condition like psychosis - activities that nurture their self worth is crucial during rehabilitation.

Therefore for complete recovery, it is important to plan very early on…what to expect in each individual’s outcome & help them with rehabilitation without delays.

Early signs of psychosis(not an exclusive list):

1.Worrisome fall in work performance or studies.

2.Difficulties in thinking clearly & concentration.

3.Paranoid ideas,suspiciousness

4.Decline in self care or hygiene

5.Trouble with communication (this must be a new issue)

6.Withdrawing socially;spending more time alone.

7.Unusual overly intense new ideas,seeing things,hearing things,responding to external stimuli (which is not visible to anyone else)

8.Confusion when figuring out reality from fantasy.

Possible causes:

A. Immigration-related stressors can increase suicidal ideation and risk due to the distress associated with cultural stress, social marginalization and intergenerational conflicts.Anything that predisposes an individual to Depression can potentially contribute to psychosis.

Studies show that Immigrants experience psychosis at rates 2-5 times higher than non-immigrants (discrimination and social exclusion may lie at the heart of the immigrant psychosis problem)

B.Social Isolation

C.Substance Abuse(LSD,amphetamines etc)

D.Severe depression (as in the case study above)

E.Bipolar disorder

F.Stress or traumatic experience

G.Brain tumour,stroke

H.Side effect of some prescribed medications

I.Few medical conditions (eg:Parkinson’s disease)

**Medications known to reduce the effects of dopamine in the brain also reduce the symptoms of psychosis.

‘People with psychosis have a higher than average risk of self harm and suicide’

***Note***: This is a mental health awareness post.Anyone presenting with these symptoms will need evaluation and treatment from specialist medical practitioners.Also note,Rapid transformational therapy is contraindicated in psychosis.

The mental health charity Mind has information on ways to help yourself cope during a crisis. Use the NHS 111 online service or call 111.Seek help from GP or go to A&E.

If it is a mental health emergency-call 999.

*helpline applicable to UK residents only

With love & gratitude,



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