‘Anthony’ You have been dispatched to a 38-year-old male with behavioural disturbance who lives at home with his father. The father has called the ambulance service. On arrival you are met by the father and taken to the rear courtyard where Anthony is pacing. You see some upended (but not broken) garden furniture and pot plants. Anthony’s father informs you that Anthony has never been violent, but he has never seen him this agitated before. Furthermore, Anthony has always been polite and usually can be supported well at home, but today he has been unable to get Anthony inside after almost 5 hours of pacing. Anthony has a diagnosis of schizophrenia. Anthony’s father provides you with a packet of medication which is prescribed by a GP (olanzapine 10mg). Anthony’s father normally gives Anthony his medication each evening and had thought he was taking it, however he hands you 2 loose tablets which he found in his bedroom that morning. Anthony continues to pace around the garden. He does not appear to be distressed by your presence but he does not respond to your questions and he initially refuses to sit for you to take a set of vital sign observations. He appears disheveled, wearing dirty old clothes, Anthony’s father tells you that he tries to help Anthony by encouraging and supporting a routine that includes self-care and grooming but sometimes the lack of hygiene is normal for him. His hair is shoulder length and uncombed, he has a long full-faced beard, and you notice heavily nicotine stained fingers on his right hand. He is moderately obese. You notice that he has a productive cough with used tissues, sputum and other evidence almost everywhere you look.
1) Your partner advises that he has met people like Anthony before and it is probable that he is having a relapse of schizophrenia due to medication non-adherence. You tend to agree, but what other potential differential diagnosis might you consider?
2) Discuss the additional risk factors of someone with schizophrenia who smokes 30 cigarettes a day.
1) Under what circumstances can Anthony refuse to come to hospital?
2) Under what circumstances can you force Anthony to come to hospital?
3) If you do not think that you have the right or ability to bring Anthony in an involuntary capacity, what else could you do to assist him?
