A chronic psychotic: a longitudinal perspective

Psychiatric illnesses involve complex interpersonal and biological processes that combine to produce certain clinical signs and symptoms of psychopathology on which psychiatric diagnostics are based. Nevertheless, the clinical presentation of some psychiatric disorders may vary from patient to patient or at different points in time on the same patient. The following case history serves to underscore the importance of the multi-axial approach in combination with longitudinal follow-up when an attempt is made to understand fully complex individuals. In particular, this case involves, at the minimum, the complex interweaving of a psychosis not easily subsumed under either pure schizophrenia or pure affective disorder together with substance abuse. It is the analysis of the serial unfolding of psychopathology that the authors feel will lead to a more comprehensive and better diagnostic formulation of an individual patient.