Acute psychosis triggered by Brexit

This case report describes a man in his 40s who was brought to the emergency department in an acute psychotic state, three weeks after the EU referendum results in the UK

Political events can act as major psychological stressors and have a significant impact on the mental health of people, especially those with a predisposition to develop mental illness, a doctor has warned in the journal BMJ Case Reports.

The author treated a man who had a brief episode of acute psychosis, triggered by the 2016 Referendum on Brexit—the process of the UK leaving the European Union (EU).

His wife reported that since the EU referendum results were declared on 24 June 2016, he started spending more time putting his thoughts across on social media.

He found it difficult to reconcile with the political events happening around him, and became increasingly worried about racial incidents, explained Dr Mohammad Zia Ul Haq Katshu, Clinical Associate Professor at the Institute of Mental Health, University of Nottingham.

His sleep deteriorated. He saw his GP who prescribed mirtazapine 15 mg and zopiclone 7.5 mg at night, but his mental health continued to deteriorate.

He became paranoid that people were spying on him and became increasingly agitated at home, leading to the attendance at the accident and emergency department.

“He was suffering from paranoid (believed people were spying on him and planning to kill him), referential (believed that talks on radio and TV were targeted at him), and bizarre (believed the two ends of a mathematical equation emerged out of the two poles of earth rotating on its axis) delusions,” explained the doctor.

“He was hearing voices talking about him. He spontaneously mentioned that if he killed himself that would prove his love for his wife. He lacked insight into his mental state. He did not have the capacity to make decisions about his care.”

Later during his stay on the psychiatric ward, the man reported that he felt ashamed to be British. He described his family as ‘multicultural’. He said “I was looking at the electoral map of voting for the EU. I am in a constituency that reflects an opinion that is not for me”.

The patient was admitted to a psychiatric ward and because of high levels of agitation, he required rapid tranquilisation with intramuscular lorazepam on the ward initially.

He was commenced on olanzapine 10 mg at night, which was reduced to 7.5 mg because of excessive sedation few days later.

The man recovered completely and was discharged two weeks later. He was followed-up in the community, and olanzapine was gradually reduced and discontinued. He remained well up to the last contact with him in June 2019.

The patient had a previous history of a single similar episode, although of less severity, following work related stress, 13 years previously. He recovered completely within few days.

Acute and transient psychotic disorders present as brief episodes of psychosis often precipitated by stressful life events, explained Dr Katshu.

“Political events can act as significant psychological stressors and impact on mental health, especially in people with predisposing factors,” he said.

“Identifying early warning signs of acute and transient psychotic disorders, especially during stressful situations, can lead to early treatment and quick recovery, which is associated with a better long-term prognosis.”

See the full case report here

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