A man with congenital abnormalities and psychotic symptoms

doi:10.1136/bmj.a2706

Published 10 December 2008, doi:10.1136/bmj.a2706
Cite this as: BMJ 2008;337:a2706

Endgames

Case Report

A man with congenital abnormalities and psychotic symptoms

Toral Thomas, specialist trainee¹, Balasubramanian Saravanan, specialist registrar and research psychiatrist¹^,2, Fiona Blake, consultant psychiatrist¹

¹ Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, ² Institute of Psychiatry, King’s College, London

Correspondence to: T Thomas toral.thomas@cpft.nhs.uk

The first 150 words of the full text of this article appear below.

A white man in his 20s came to the attention of psychiatricservices because of repeated acts of genital mutilation, oftenin the context of alcohol and opiate abuse. He first presentedin his late teens with psychotic symptoms, which included persecutory,somatic, and bizarre delusions, and he had attracted a varietyof diagnoses. However, these assessments seem to have been cloudedby his longstanding use of illicit substances.

He had been born with a cleft palate and showed developmentaldelay, particularly of speech. His family struggled with hisbehaviour. He could not cope with mainstream schooling, andearly records noted an IQ of 68, indicating a mild learningdisability.

1 What is his possible diagnosis?

2 How would you set aboutconfirming the diagnosis?

3 How would this affect your managementplan?

1 Patients with schizophrenic symptoms with a history of delayedmotor development, early onset of the disorder, . . . [Full text of this article]