[Patients with a chronic recurring psychosis in general practice: the need for close follow-up]

Three patients, a man aged 45, and two women aged 48 and 51 years, were suffering from chronic recurring psychoses for which they were taking medication. Their general practitioner was alerted to signals of psychotic relapse by the first patient himself and for the other two patients by the next of kin. The first two patients decided to discontinue their medication, one because he wanted to live 'a normal life' and the other because she thought the medication made her gain weight. The third patient had a psychic decompensation because her son had decided to live on his own and because she had also moved. The first two patients were successfully treated by restoring their medication, although the second patient also had to be referred to a psychiatrist. The third patient had lost confidence in the general practitioner, and was eventually admitted to a psychiatric clinic for treatment. Nowadays, increasing numbers of chronic psychiatric patients are living outside of hospitals. The adequate response of general practitioners to psychotic relapse in such patients warrants regular contact to evaluate the patient's network and to detect a relapse in an early phase. A proactive attitude and being adequately informed by locum general practitioners are also important. The extent to which the patient cooperates will depend upon the quality of the patient/general practitioner relationship.