Clinical Case 7

Tessa is a 20 year old, who has been brought to the ED by her mother, Jane, late one evening.

Jane tells you that over recent weeks Tessa’s behaviour has been becoming increasingly odd.  Jane has noticed that Tessa has been muttering to herself, appears very distracted and keeps looking out the windows.  Tessa appears very distressed.

Tessa has no history of any psychiatric disorders, isn’t on any medications and denies any substance misuse. Tessa has not wanted to see a doctor, but has reluctantly agreed to attend ED with her Mother tonight.

You agree with Jane, Tessa appears very distracted and is muttering almost continuously to herself.  Tessa manages to tell you that she has been hearing voices telling her to kill herself. Tessa has also become paranoid about gangs trying to kill her, although she doesn’t know why they would want to, or who might be in these gangs. You are unable to get much more information from her. Jane tells you that Tessa has stopped taking care of herself and isn’t eating much at present.

Tessa’s behaviour has been very upsetting for the whole family and Jane doesn’t feel that she can cope with Tessa at home any longer; the other children are afraid of her.

Tessa’s distress worsens when you ask her if she would be willing to come into hospital for a little while and she shouts “No, no, no” whenever the word hospital is used.

You ask psychiatry liaison to review Tessa as you suspect this is a first episode of psychosis, possibly schizophrenia.