A father had the first known case of Brexit-triggered psychosis, a psychiatrist revealed yesterday.
The patient, in his forties, was so ill following the referendum he tried to burrow out of hospital with his bare hands.
He even feared that one of his wife’s relatives was going to shoot him with a heat-seeking missile.
The patient heard voices in his head, suffered hallucinations and delusions, was increasingly worried about racial incidents and said he was ashamed to be British following the 2016 poll.
The man, who was unidentified in the case report, said he felt ‘ashamed to be British’ and that he lived in an area which didn’t represent him. His mental illness developed within three weeks of the EU referendum on June 23, 2016 (stock image)
The patient, in his forties, was so ill following the referendum he tried to burrow out of hospital with his bare hands (stock image)
The patient from Nottingham, whose anonymity has been protected, 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.’
All but one council area of Nottinghamshire voted Leave.
He was eventually diagnosed with acute and transient psychotic disorder (ATPD) – a mental illness characterised by a sudden onset of symptoms and complete recovery within three months.
In a report of the case published yesterday, his psychiatrist, Dr Mohammad Zia Ul Haq Katshu, said it was ‘the first case of ATPD precipitated by Brexit’.
WHAT IS ACUTE AND TRANSIENT PSYCHOTIC DISORDER?
Acute and transient psychotic disorder (ATPD) is characterised by the onset of delusions, hallucinations and ‘severe disruption of ordinary behaviour’ that do not continue into the longer-term.
These symptoms can develop quickly – within weeks – and recovery can be similarly rapid. Temporary breakdowns only happen to between four and 10 people per 100,000 each year.
Usually complete recovery can be reached within a few months, often within a few weeks or even days.
It is defined in the International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization (WHO).
If the disorder persists for longer, it would require a change in classification.
WHO says it may or may not be linked to stressful events preceding the onset of symptoms by one to two weeks.
Acute schizophrenia-like psychotic disorder is a sub-category of ATPD.
According to WHO, it is diagnosed when the psychotic symptoms justify a diagnosis of schizophrenia but have lasted less than a month.
Symptoms which persist longer would change the diagnosis to schizophrenia.
Psychosis can be triggered by a pre-existing mental health condition, such as schizophrenia, extreme stress, physical health conditions, such as malaria or a brain tumour, or substance misuse.
Anti-psychotic medicines are usually recommended as the first treatment, the NHS says.
They work by blocking the effect of dopamine, a chemical that transmits messages in the brain.
While they may reduce anxiety within a few hours, it could take several days or weeks to have an effect on symptoms such as hallucinations.
Writing in the journal BMJ Case Reports, Dr Katshu added: ‘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. He became increasingly worried about racial incidents.
‘His sleep deteriorated.’
The man became agitated in hospital and attempted to dig through the hospital floor to ‘get the hell out of this place’.
The patient believed he was being spied on and that talks on the radio were directed at him.
Dr Katshu, a consultant psychiatrist and associate professor at the University of Nottingham, said political events could act as ‘major psychological stressors’.
He wrote: ‘His mental health deteriorated rapidly following the announcement of the results, with significant concerns about Brexit.
‘He presented as agitated, confused and thought-disordered.’
The psychiatrist also said he had ‘auditory hallucinations and paranoid, referential, misidentification and bizarre delusions’.
The patient described his experiences as ‘intense periods of accelerated thinking’, of ‘being distracted and consumed by my own thoughts’, and of ‘a series of theatrical episodes of which I am at the centre’.
He said: ‘In one scenario I remember lying on my bed on the top floor of our house with my arms and legs spread-eagled.
‘I was convinced one of my wife’s relatives was going to shoot a missile at me using heat-seeking technology and I wanted to provide him with the best possible target.’
The man also said he had family issues, and Dr Katshu said it was possible that – along with work-related stress – this had contributed to his illness.
He recovered within a fortnight after treatment with the anti- psychotic drug olanzapine.
The patient had experienced a similar episode 13 years previously following work-related stress.
IN HIS OWN WORDS: THE MAN WHOSE PSYCHOTIC EPISODE WAS ‘TRIGGERED BY BREXIT’
‘The best way that I can describe my experiences of psychosis are as intense periods of accelerated thinking, of being distracted and consumed by my own thoughts, and of a series of theatrical episodes of which I am at the centre, sometimes featuring friends or relatives from my own past.
‘Some of the scenarios occurred just as daydreams which dominated my concentration and other times the situations were brought to life through hallucinations or by me misinterpreting what I was seeing or hearing.
‘Although each scenario seemed random, most of them were connected somehow in my own mind and all I believed to be real.
‘In one scenario I remember lying on my bed on the top floor of our house with my arms and legs spread-eagled.
‘I was convinced that one of my wife’s relatives was going to shoot a missile at me using heat seeking technology and I wanted to provide him with the best possible target.
‘That evening I was paralysed by the choice of which bedtime story I should read to one of my children because in my mind there was a right book and a wrong book depending on whether I would die that night or a subsequent night.
‘This was in the summer of 2016 and, as well as my own anxieties about Brexit, it was also a time when a friend of mine was experiencing immense anxiety about what was happening around him in the US and we were talking together on social media about racial issues.
‘I remember having a desire to see Facebook providing better tools for people in this plight, so I set about designing an algorithm that would connect users’ emojis to their own cultural experience.
‘The idea got as far as a complex ‘join the dots’ diagram on a piece of paper. I think my wife destroyed it because of the extent to which it was preoccupying my mind and exacerbating my psychotic state.
‘At work I was in the middle of an installation and I remember hearing the TV on in the background. I started to believe that I was under surveillance.
‘I remember my ears pricking up when a voice said, ‘he’s very observant’! I remember driving and hearing the radio presenters talking about me as if they could see me and knew what I was thinking.
‘Many times, during these scenarios, I felt quite petrified. At one point when I was being held in a hospital interview room, I believed that we were in the basement of a tower block that was going to be pulled down in a 9/11 style attack.
‘I spent the entire time studying the walls and exit doors and watching people through the narrow window in the fire door to try and work out whether they were entering or evacuating the building and if there was any hope of escape.’
Source: BMJ Case Reports