Cognitive-behavioural assessment and treatment of maladaptive help-seekingbehaviour in a patient with schizophrenia

Objective: Maladaptive help-seeking behaviour in psychiatric patients is a significant problem for public mental health services, yet it is not addres sed in the mainstream literature. We present a report on the successful tre atment of a person with schizophrenia who displayed this common dilemma for patients and clinicians. Clinical picture: A 31-year-old man with borderline intellectual functionin g had a 10-year history of schizophrenia marked by negative features. He fr equently presented in crisis to public mental health services, the local ho spital, and his general practitioner; this resulted in excessive use of ser vices, including admissions. Treatment: The patient was reassessed from a cognitive-behavioural perspect ive rather than a syndromal perspective. Specific behaviours were modified, cognitions were identified, challenged and restructured, and other service providers were provided with an alternative to admission or acute communit y care. Outcome: At 24 months the maladaptive behaviour remains in remission. Conclusions: Behavioural problems in persons with chronic schizophrenia may be effectively treated by reconceptualising the behaviour as distinct from the major diagnosis.