Case 10: A man with a twenty-year diagnosis who no longer leaves his room

Case 10: A man with a twenty-year diagnosis who no longer leaves his room

A 41-year-old man, under psychiatric care for 20 years, who now does nothing but watch television and never leaves his room.

  • 2 min read
  • Checked 01 Nov 2026

The case

A 41-year-old man has carried a psychiatric diagnosis for 20 years. He has been admitted many times, some of them simply because he had no money. His sister looks after him; he has no one else. He keeps saying that a catastrophe is about to happen, without being able to say more, he hears voices, and he is sure that his organs have been replaced.

He takes his treatment passively, and he recently dropped out of the rehabilitation programme he had been placed in. His symptoms are under control for now, but he does nothing except watch television and does not leave his room.

Summary

Diagnosis

Schizophrenia, paranoid type, with a chronic continuous course. Paranoid is an ICD-10 subtype: ICD-11 has dropped the subtypes and describes the symptoms instead.

What points to it

  • Positive symptoms: auditory hallucinations, and delusions of impending catastrophe and a bizarre delusion that his organs have been replaced.
  • Negative symptoms: avolition, a stereotyped, empty daily routine and social withdrawal.
  • Twenty years of unbroken illness that has left him badly disabled socially: he could not manage alone without someone always looking after him, and hospital has become part of his life, with some admissions for want of money rather than for his symptoms.

Management

  • Review the antipsychotic: he still hears voices and holds delusions, so if two adequate trials of different antipsychotics have failed, offer clozapine.
  • Look for what makes negative symptoms worse and can be treated: depression, parkinsonian side effects of the medication, and an understimulating life.
  • Keep offering rehabilitation in a form he can manage: small, graded goals, occupational therapy, supported housing and, later, supported employment.
  • Support for his sister as his carer, and a plan for when she cannot care for him.
  • Yearly physical health checks: weight, blood pressure, glucose, lipids and smoking.

Outlook

Poor: a long continuous course with marked negative symptoms rarely ends in independent living. Good care can still reduce admissions and widen his life.