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I now have, my copy, of a letter recently written to my gp, by Dr Kitty. It reads:

Dear Dr Hartman

Re: Yvonne...

Diagnosis: Schizo affective disorder

Medication: Trifluoperazine (reduced to 2mgs once daily)
Procyclidine 5mgs once daily- stopped today

I reviewed Yvonne with her care co-ordinator, Grace Isiaka in clinic today. She remains extremely well and has not had any problems since the last reduction in her Trifluoperazine dose. In October, it will be three years since her last admission and the last time she came off medication was unsupervised back in approximately in 2003, she relapsed approximately six months after abruptly stoppping it at that point. Previous supervised reductions have been more successful.

She is continuing to get side effects of the medication, mainly excessive lacremation and hypersalivation at night. We discussed the symptons she complained of in her last assessment, she reported that she does get some breast pain and breast enlargement, but the symptoms of Galactorrhoea are not current. This is something she has had when on high doses of medication in the past. She also reported that her periods are currently heavy and regular, and she has a diagnosis of fibroids. I explained that she has a normal prolactin level and we could predict that this had probably been raised in the past, when she had the milk discharge and the effect of this on mentruation would normally be to produce light and irregular periods.

We went over her early warning signs and these are isolation, spending 18 plus hours of sleep and neglecting her personal care. She does not return calls of professionals or friends and does not keep appointments. She is also calls regarding her benefits; saying that she is not disabled and therefore stops claiming money.

We also discussed the fact that Grace her care co-ordinator may be leaving to complete some training in a month or so time and this maybe an opportunity for Yvonne to think about coming from enhanced to standard CPA. We discussed the option of the the medication service, which means she could have face to face contact to pick up her medication. Grace and Yvonne will decide this in a further session together and I will review her again in four months time and consider making a further reduction to her Trifluoperazine dose at that point if all is going well.

In terms of other things, her work is going well and she is applying for a couple of additional positions; her son seems to have been allocated a social worker so things should get moving in her attempt to get more contact with him. In terms of her mental state today, there were no abnormal features and she was bright, socially appropriate and responsive in a very professional manner to a couple of telephone calls she received.

There are no current risk issues.

Many thanks

Yours sincerely

Dr Kitty Seed
Specialist Registrar....

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