Case 27 - The psychotic arsonist who burned his house and tried to burn himself

Summary

Patient Intake

• 48-year-old man diagnosed with paranoid schizophrenia and alcohol dependence (now in a controlled environment) with a 23-year history of alcohol abuse and relapse, and a 16-year history of psychotic illness

• Referred by his treating psychiatrist for expert psychopharmacological consultation because the patient continues to have symptoms despite heroic treatment with antipsychotics

• Multiple prior psychiatric hospitalizations with history of poor compliance

• Predominant symptoms are persecutory ideation, ideas of reference, auditory hallucinations, and disorganized thinking with history of suicide attempts

• History of thrombocytopenia, considered a contraindication for clozapine by medical consultants

• History of alcohol and marijuana abuse

• At least one first degree relative with a psychotic illness

• Current hospitalization resulted from an incident in which the patient believed that his family was being abused via the internet and thus he needed to burn down his house to stop it, which he did, plus dousing himself with gasoline intending to commit suicide but was unable to successfully light himself on fire

• Arrested and convicted of the acts but found not criminally responsible by reason of insanity and admitted to a forensic facility