Case 25: A man followed by the mafia after his partner’s sudden death
A 38-year-old man who, days after his partner's sudden death, became sure that the mafia is after him and that people around him are planted to watch him.
- 2 min read
- Checked 01 Nov 2026
The case
A few days after his partner died suddenly, a 38-year-old man became tense. He struggles to fall asleep and wakes several times in the night. He has grown silent and gloomy and will not go out, because he is convinced that the mafia is hunting him for information about his partner's business dealings. On an outing with relatives he told them that he could pick out stand-ins posted to watch him, and business contacts from years ago who had been sent to remind him of old deals.
Summary
Diagnosis
An acute paranoid psychosis, in ICD-10 an acute and transient psychotic disorder with an acute stressor.
What points to it
- Delusions of persecution and harm: the mafia wants him.
- A delusion of staging, that people around him are actors set up to watch him, and delusional misidentification, seeing old business contacts in strangers.
- A sudden onset and quick worsening, with fear that fits the delusions.
What else it could be
Grief brings low mood and poor sleep, so ask about a depressive episode with psychotic features. Exclude alcohol and drugs, and physical causes, as in any first psychosis. Check with the family what is known of the partner's business: the belief becomes clearly delusional with the staging and the misidentifications.
Management
- Assess suicide risk: he is bereaved, frightened and psychotic. Ask about suicidal thoughts and about any plan to defend himself against his "pursuers".
- An antipsychotic, at home or in hospital depending on how reliably he takes it and how risky his behaviour is.
- Support with the bereavement once the psychosis settles.
- Psychoeducation for him and his relatives on the early signs of relapse.
- After full recovery, continue a low dose for one to two years, then withdraw it gradually under close review.
Outlook
Good. In his favour are a clear trigger, delusions that stay with the loss and with real people and events, an acute onset, fear that fits the delusions, and a first psychosis at a relatively late age.