Here's the long story.. what do you think of this patient and this case? It's not a professional presentation, so don't complain! A person I know went abroad to study and enrolled in a school. She's 18 years old. There was some bullying going on with prank phone calls/texts..etc. Person was a straight A student before that, but failed this year of school abroad and didn't get enough points for college. A year later, I join her in the same school, and I also hear some of the prank calls on her phone.. ignore it. Near the end of this year of school (which she is repeating) her mother dies unexpectedly.. she's upset because she believes her mother was upset with her for failing the previous year. Over the next few years, she gets episodes where she suspects people who're speaking to other people are actually referring to her. This "paranoia" increases over around 4 years until she reaches a stage where she confronts people angrily for having talked about her, although they haven't. She is restless, unable to sleep, has decreased appetite, is suspicious of every single text message, and believes people she knows whom she meets in the streets were sent there on purpose to follow her. She can't concentrate on studies, and is anhedonic, has poor memory, makes a lot of connections between things.. when she talks does not allow anyone to interrupt her. Eventually, she became floridly psychotic, started calling relatives long distance saying someone is giving them instructions on what to say to her.. she said burnt toast at the canteen was given to her on purpose, and car garages refused to take her car in on purpose, that there were cameras monitoring her in her apartment, and she whispered as she spoke because there were microphones around. She was seeing a psychotherapist, and GP, who referred her to a psychiatric hospital where she was prescribed Olanzapine and told it would be better if she goes back home to her family (since she was abroad). Back at home a psychiatrist at a private clinic diagnosed her with schizoaffective disorder (by now she was 24 years old), and gave her Risperidone depot as well as Olanzapine oral. She stayed on them for 4.5 months but had severe side effects, like parkinsonian symptoms, increased prolactin, amenorrhea, sedation, somnolence, and increased weight. She was changed to aripiprazole, and by now she was taken to see a psychotherapist in another private clinic to treat her in conjunction with the medication. The psychotherapist at the new clinic said it would be best if the patient saw the psychiatrist in the same clinic as the psychotherapist, instead of using two clinics. Of note, this new clinic is specialized in child psychiatry, but don't mention it to all patients. The new team of psychotherapist-psychiatrist said that schizophrenia is a wrong diagnosis and she has depression because she went to a new country and her mother passed away..etc. They stopped the antipsychotic medication abruptly (she was on aripiprazole for a week at this time), and commenced her on 35 mg venlafaxine which was increased to 75. The psychotherapist said it's definitely not schizophrenia because she conducted IQ tests on the patient, and the patient was very intelligent. She then enquired about the patient's childhood and seemed to focus on the fact that she was a straight A student, and orderly. She said that the patient probably has mild autism (I'm thinking probably because she's specialized in child psychiatry!). They were informed that there is a family history of "odd behavior" and rubbish-talk by the grandmother and aunt of the patient, which is probably undiagnosed schizophrenia. The psychotherapist said they were probably depressed as well. Since the patient became sedated and calm after taking the antipsychotics in those 4 months, she was normal and she remained off them for 7 or 8 months as she was being treated for "depression" in this new clinic. After having studied psychiatry, I became suspicious of this diagnosis and of the abrupt stopping of antipsychotics (which ideally should be continued for a year or two at least), I informed relatives of the patient to return her to the first psychiatrist, and he was disappointed as well and said that the doctor in the new clinic should have at least even called him to ask what the patient was like when psychotic.. it's like someone with hypertension taking antihypertensives then seeing a new doctor and the new doctor says you have no high blood pressure, stop your medication it's wrong diagnosis. So the old doctor has called her in again and she will resume low dose antipsychotics as per the original treatment plan, to prevent future relapse. So, what do you people here think of this case, and do you agree that this new clinic negatively affected her prognosis by stopping medication for 8 months? Also are they irresponsible for not calling the first doctor, and accepting an adult patient when they're specialized in child psychiatry? Also in outruling schizophrenia based on an IQ test although they were told of a family history and florid psychosis. Is this a malpractice case?