Case history

A 19 year old maths student was referred to the early psychosis clinic. Her flatmate, a medical student, feared the patient was hallucinating, paranoid, and suicidal. She had dropped out of lectures, constantly muttered to herself, and avoided standing near windows. She felt urges to throw herself off a high building and described visions of her own body “spread eagled in a pool of blood.” She vehemently refused a general practitioner’s emergency prescription of antipsychotic medication and would not attend the clinic.

Staff arranged a domiciliary assessment and were surprised when the patient let them in quite cheerfully. She had moved her wardrobe to block the window “as a safeguard.” The university maths department was a tower block, and the patient had horrified herself by thinking “what if I were to jump through a window?” She managed to distract herself by reciting tables and mathematical formulae, and spent her time at home catching up on lecture handouts via the maths department’s intranet. She avoided alcohol and medication in case her vigilance was reduced and avoided anywhere with stairs or …