Introduction:

Primary health care (PHC) workers are responsible for diagnosing and treating psychiatric disorders, as well as referring some instances to secondary care. The Mental Health Law (Law no. 36/98) sets out the principles for mental health policy and regulates the involuntary hospitalization of people with mental illness. It is the responsibility of the family physician to identify such situations and activate the “emergency assessment warrant”.

Case description:

The case concerns a 50-year-old female patient with a history of attempted suicide and followed up in psychiatry. In a scheduled psychiatry appointment, the patient reported anxiety and night-time agitation, and therapeutic adjustment was made with subsequent reevaluation. Due to persistent symptoms, the therapeutic plan was adjusted again. Later, she sought care from her family physician reporting noncompliance with treatment and worsening symptoms of irritability and auditory hallucinations in the form of a single voice with instructions for self- and hetero-aggressive acts. The patient was referred to the emergency department, evaluated, and received a new therapeutic adjustment and a recommendation for an earlier psychiatry appointment for reassessment. In a subsequent appointment with the family physician, it was identified suicidal ideation, self- and hetero-aggression, and acoustic-verbal pseudo hallucinations, and a new visit to the emergency department was proposed, which the patient refused. Given the context, the family physician activated the “Mandado de Condução à Urgência” which the patient understood and accepted. During hospitalization, a new therapeutic plan was implemented, resulting in remission of self and hetero-aggressive ideation and auditory pseudo hallucinations, as well as improvement in mood and reduction of anhedonia and depressive cognitions.

Comments:

This clinical case represents shared management of patients with psychiatric illness between PHC and psychiatry, as well as the importance of monitoring therapeutic response, reinforcing the need for improved coordination among various levels of care to ensure more effective information sharing and better care for patients with psychiatric disorders.

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