Tom, schizophrenia

Tom is 52-year-old Caucasian male who currently lives in supported accommodation in an inner-city suburb of a metropolitan city and has a diagnosis of schizophrenia. Tom was diagnosed with schizophrenia in his mid-twenties following the birth of his daughter and the subsequent relationship breakdown between him and his daughter’s mother. Tom has a family history of mental illness – his mother was diagnosed with schizophrenia but died from a heart attack 15 years ago, and his maternal aunt has bipolar affective disorder. Tom has never met his father nor knows who his father is. Tom is supported by the National Disability Insurance Scheme (NDIS) and his care coordinator Julie from the local community mental health team as Tom is on a community Treatment Authority under the Mental Health Act 2016 (Qld).

Tom does not have any contact with his daughter, Amelia, who is now 28-years old, or any other family members. Tom has minimal social supports outside of his care coordinator and the NDIS, he is unemployed and spends most of his time at home listening to the radio. Tom has a history of substance use including amphetamines and heroin and reports his substance use was frequent in his twenties and last used methamphetamines 2 months ago. He reports sporadic use over the past 20 years. Tom has a cognitive impairment which is a result of trauma he experienced in utero, he is unable to read or write and he feels shame regarding this.

Tom was discharged from the mental health unit 2 weeks ago after a 2-month long admission for commencement of clozapine on the background of increasing auditory hallucinations which were commanding in nature. Tom commenced a new medication during this admission, clozapine, however he self-ceased five days ago as he reported it was giving him constipation and he was not sure why he was taking it.

Tom’s care coordinator Julie is a mental health nurse, and on her last home visit to Tom one day ago, she observed a deterioration in his mental health. Tom was wearing a stained black shirt and pants, Julie noted that Tom was wearing the same clothes as when she visited the week before and he appeared disheveled and has tattoos on his arms. Tom did not have eye contact with Julie and was sitting facing away from Julie during conversation. Julie noted Tom had a blunted and reduced range of emotions, it was difficult to have a conversation with Tom as he appeared distracted, often pausing mid-sentence, and requiring questions to be repeated on multiple occasions. Tom’s responses were monotone and often brief in conversation and did not directly relate to the question asked. Tom disclosed he was hearing voices that were commanding him to stay home and to not trust other people. Tom reported the voices were derogatory towards him, telling him he is “worthless” and “not good enough for other people”. Tom became increasingly withdrawn as he was asked more about his experience of hearing voices. Tom reported his mood to be low and that he was experiencing thoughts of wanting to end his life if he had access to the means to do this.

Julie discussed Tom’s deterioration in his mental state with the mental health team and Tom agreed to present to hospital for admission to stabilise mental state and review medication regime

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