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JAMA Psychiatry Clinical Challenge
October 30, 2019

Treatment of First-Episode Schizophrenia in a Young Woman

Author Affiliations
  • 1Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, United Kingdom
  • 2Psychiatric Imaging Group, Medical Research Council, London Institute of Medical Sciences, Hammersmith Hospital, London, United Kingdom
  • 3Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
JAMA Psychiatry. 2020;77(2):211-212. doi:10.1001/jamapsychiatry.2019.3369

A 20-year-old woman was referred by her family physician to a community mental health team in London, United Kingdom. Her mental state had deteriorated progressively over the previous 12 months, following the death of her father. After a period living alone, she had returned to the family home 4 months prior to her presentation and had been noted to be socially withdrawn, preoccupied, and distractible. Her family physician, suspecting a depressive episode, had prescribed citalopram up to a dosage of 40 mg once daily, to no effect. Her family subsequently sought advice from the family physician when the patient was noted to be speaking to herself, expressing concerns about people meaning her harm, and professing the belief that she could hear other peoples’ thoughts.

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