PSYCHOEDUCATION

Relevant CanMEDs Domains: Communicator, collaborator, medical expert, professional

Mr G is a 40-year-old married man of North African descent. He has migrated to New

Zealand with his family this year. He was referred by his GP for psychiatric assessment.

Mr G presented in a stable mental state and there was notable polypharmacy including
three antipsychotic medications, two antidepressants and one anticholinergic medication.
(Haloperidol IMI weekly, paliperidone IMI and amisulpride PO, Duloxetine, fluoxetine and
biperiden).

Limited information was obtained regarding the past psychiatric history as Mr G had
concerns his immigration status may be affected by his disclosure of mental health illness to
staff. The working diagnosis is schizoaffective disorder in remission.

Examination revealeddyskinetic movements of the shoulders, wrists, hands and periorbital

area. Mr G was aware of these movements however he was not distressed or functionally
impaired by these.

Psychoeducation was undertaken with the aim of building on his current understanding of
his condition as well as the reasons he was prescribed each medication. This collaborative
approach to psychoeducation is essential for Mr due to prior knowledge in the medical field
and the 20 years managing his illness.

Psychoeducaiton was delivered relating to the risks of polypharmacy. This included

discussion of relevant guidelines in the treatment of schizoaffective disorder highlighting the
balance of optimal antipsychotic burden and therapeutic effect. In addition, awareness of
increased serotonergic burden which can result in serotonin syndrome.

Psychoeducation around extrapyramidal side effects given planned changes in medications

and tardive dyskinesia which is most likely due to his multi-year history of haloperidol use.
His history of polypharmacy was also addressed as a contributing factor to tardive
dyskinesia. During changes in medication that risk of Relapse was discussed Mr G and his
wife And strategies to mitigate the risks were discussed including careful monitoring of early
warning signs. .

Mr G was also able to advise his early warning signs and this informed our discussion of
future management principles in the context of reassuring appropriate confidentiality would
be maintained to improve treatment alliance and help seeking behaviour. Mr G has a
supportive partner and is also able to identify early warning signs.
Mr G’s understanding of his personalized management plan allowed improved management
through rationalisation of current medication. This was in the form of dose reductions and
removal of haloperidol.