To view original article click here
SSRI Stories Summary: An ordinary young man, KM, goes to his GP for pain from a car accident, and is prescribed psychoactive medications, starting with Dothiapin. After 5 months Zolpidem is added. A little over two months after starting Zolpidem, he becomes uncharacteristically aggressive and slaps a woman in line at a bank, and puts chewing gum in her daughter’s hair. After this, his GP prescribes citalopram for anxiety and insomnia. When KM reports anxiety and insomnia not improved, Paxil is tried. KM reports that he cannot tolerate Paxil, so the GP puts him back on citalopram. Seventeen days after this medication change KM complains to the GP about “abnormal extreme thoughts” which worry him. The GP does not suspect the SSRIs, so the medication is continued and KM is referred to a psychiatrist. After several visits, the psychiatrist discharges KM Aug 21, 2002. The discharge notes appear to indicate that the psychiatrist does not think that KM is mentally ill, or in need of medication. It is not clear if KM continues taking citalopram or stops taking it at that point. On Sept 9 he attends a job centre (he has lost his job), is verbally abusive and assaults a man. Two days later he murders a shopkeeper with a machete. When that happens, he is diagnosed with schizophrenia, and the potential role of the medications in his problems is never considered.
Last Updated: Friday, 25 April, 2003, 15:48 GMT 16:48 UK
A schizophrenic has been detained indefinitely under the Mental Health Act after he admitted killing a woman in a revenge attack.
Balbir Kaur’s husband had knocked Keith McDonald off his bike less than a month before she was killed with a machete at her Costcutter shop in Aston, Birmingham.
Birmingham Crown Court heard that police had been warned before the attacks that McDonald had threatened another shopkeeper with a machete.
The 26-year-old, of Hartington Road, in the Lozells area of the city, pleaded guilty in February to Mrs Kaur’s manslaughter on the grounds of diminished responsibility.
The court heard Mrs Kaur’s death was the culmination of a number of visits to the shop by McDonald, who was suffering auditory hallucinations.
He had demanded £300 compensation from the Mrs Kaur after her husband, Harkanwal Singh Poonia, collided with his bicycle in Clifford Street, Lozells
Mrs Kaur and another shopkeeper, Mohammed Jahinger, were attacked within minutes of each other at their premises in Aston and Lozells on 16 September last year.
Mrs Kaur, from Perry Barr, suffered massive head injuries and died in hospital while Mr Jahinger was slashed across the hand and neck as he dialled 999.
“Obviously there is concern that these matters had been reported to the police and the defendant had not been arrested,” he added.Mr Parker said an internal police investigation is now under way into the circumstances of the case.
Sentencing McDonald, Judge Richard Wakerley, QC, the Recorder of Birmingham, said treatment at a secure psychiatric unit was in the public interest and would also prevent any deterioration in the defendant’s condition.
The chairman of Birmingham’s Council of Sikh Gurdwaras, Sewa Singh Mandla, said: “We feel very much let down by the authorities.
“If they had acted upon the complaints made, then this incident would have been avoided.”
To view complete original report click here
Hundredfamilies.org — Birmingham and the Black Country NHS Report of the Independent Inquiry into the Care and Treatment of KM
Sept 02, 2005
Excerpts from official report:
SUMMARY OF EVENTS
KM attended his General Practitioner in November 2001 complaining of feeling depressed and anxious as well as having difficulty in sleeping. His symptoms did not improve and he was referred to Consultant Psychiatrist A, Northern Birmingham Mental Health NHS Trust.
On 28 May 2002, KM was assessed by a CPN, accompanied by a student nurse, who recorded in the CPA Assessment Summary ‘history of significant and unstable risk in relation to significant violence/harm to others’.
On 21 June 2002, the Senior House Officer, (SHO) assessed KM and following a discussion with the Associate Specialist, another appointment was made for 16 August 2002 when he saw the Associate Specialist. His mother accompanied him as suggested by the SHO. An appointment was also made for KM to attend the Early Detection and Intervention Team (ED:IT) on 12 August which he failed to keep.
KM’s mother told the Associate Specialist about the arguments which had taken place between KM and some of the local shop keepers. She was not unduly concerned about her son’s mental state and so he was discharged from the mental health services back to the care of his General Practitioner.
Some few weeks before the tragic incident KM and the victim’s husband, Mr. H, were involved in a collision. Mr. H agreed to pay for the damage to KM’s bicycle but, according to KM, the money was not forthcoming.
On 9 September 2002, KM attended the Job Centre. Whilst waiting, he felt he was being ‘looked at’ which he did not like, resulting in him hitting another man who was also ‘signing on’. He was charged with assault and given bail.
On 16 September 2002, KM went to one of his local shops with a machete and fatally injured the shop owner, Mrs H. She was taken to a local hospital and then later transferred to the Queen Elizabeth Hospital where she died the following morning.
After he left that shop KM went to another shop, nearer his home, where he attacked and seriously injured another man, Mr. M. Later that day KM attended a local police station, and was arrested. He was charged with murder and ‘wounding with intent to do grievous bodily harm’. Consultant Psychiatrist B assessed KM, and found him ‘fit to be interviewed’. He was transferred to HMP Birmingham and then to HMP Woodhill. Having been further assessed by Consultant Psychiatrist B and the Consultant Forensic Psychiatrist, he was admitted on 17 April 2003 to the Raeside Clinic under section 48/49 MHA 1983. The following day he appeared in Court pleading guilty to manslaughter and grievous bodily harm. When sentencing KM on 25 April 2003, the Judge, QC said, ‘treatment at a secure unit was in the public interest’ and he has been detained since under Section 37/41 of the Mental Health Act 1983.
KM’S LIFE UNTIL 2002
[A rather ordinary life is described. Not an academic achiever, KM nonetheless took a catering course and got a job which he enjoyed, and had a girlfriend].
At the beginning of 2000 KM had a road traffic accident sustaining minor injuries causing pain in his back and shoulders. On 28 January 2000 he saw his General Practitioner A, who prescribed Ibubrofen, an anti inflammatory drug.
3 FEBRUARY 2000 KM went back to see his GP as he was still in pain…
MAY 2000 KM returned to see his GP complaining of insomnia and broken sleep. He denied having nightmares but was restless and unable to relax.
The GP recorded:
“Panic attacks occasionally. Happy at work. Single no girlfriend, had relationship for 3 years – broken up…. Family – mv-No psychotic illness. ME (medical examination) anxiety state with sleep disturbance”
He was prescribed Dothiapin 25mgs, to be taken four times a day.
He returned again 20 October 2000 and this time was prescribed Zolpidem 10 mgs. To be taken at night. The notes recorded
“ …. not sleeping – no domestic problems or at work. Not stressed at work addition explained treatment Zolpidem 10 mgs. Nocte…..”
12 JANUARY 2001 KM was convicted with two accounts of ‘Battery’. He assaulted two female customers, a mother and daughter whilst they were queuing at the bank. KM slapped the mother and put chewing gum in the daughter’s hair.
8 November 2001 KM attended his GP as he was still not sleeping. The GP recorded:
“single. On examination no relationship problems. Smoke—no. drinks about 4 units per week. Goes to bed at 3-4am, watching TV, playing video games. Advised about sleep hygiene”
On this occasion KM told his GP he had given up smoking. He was prescribed Citalopram, an anti-depressant.
20 November 2001 KM returned to see GP B as he was still having problems with sleeping and was irritable. The computer records states that they had a long chat resulting in GP B recording,
“anxiety and depression. Try Paroxetine”
6 FEBRUARY 2002 The police were called to the National Exhibition Centre by a Security Officer, who told them “a male was going berserk with a knife”. A member of staff was working in the kitchen laughing and joking with another staff member when KM grabbed her by the chest and held a knife to her throat for two minutes causing a red scratch to her skin.
11 February 2002 KM went back to see GP B as his symptoms were still present. He could not tolerate the Paroxetine and so his treatment was changed to Citalopram (an anti-depressant) 20mgs.
28 February 2002 KM returned to his GP. He was doing ‘ok’ on Citalopram but was now complaining of “abnormal extreme thoughts that he doesn’t like and tries to suppress. Willing to attend CMHT –refer”
4 March 2002 GP B wrote a referral letter to Consultant Psychiatrist A, based at HW House.
“I would be most grateful if you could see this 25-year-old gentleman who is complaining of symptoms which is suggestive of anxiety / depression.
He presented a few months ago requesting sleeping tablets for insomnia, which I declined. Since then he has continued to see me and is currently on Citalopram 30mg daily he seems to think that these are helping. However, he has problems with intrusive thoughts of an aggressive nature, which he recognizes as irrational and anti-social. But is concerned that he is having to battle with this.
He has a normal premorbid personality, and no past medical history of note. Thank you very much for seeing him”
18 MARCH 2002 GP B wrote a further referral letter to Consultant Psychiatrist A, based at HW House. He said:
“I would be most grateful if you could see this 25-year-old man with symptoms of anxiety and depression. He presented with this problem around November of last year, complaining of insomnia. Later it became apparent that he was having intrusive thoughts for which he recognized as abnormal and extreme. These are causing him some distress and I have started him on Citalopram 20mg daily. He has a past medical history of asthma. I would be grateful if you would kindly see him and advise”.
23 MARCH 2002 KM went to Mr. M’s shop, brandishing a knife and threatened the staff.
18 APRIL 2002 KM failed to surrender to custody – appeared at Solihull Magistrates Court and was fined £20 plus £20 costs. The Court requested a Pre-sentence Report for the next hearing on 21 May 2002.
8 May 2002 Following a visit to the Perry Barr Probation Office a Pre-sentence Report was completed for the Court. It contained details of the offence in February 2002 and stated that KM intended to plead guilty.
KM’S CONTACT WITH MENTAL HEALTH SERVICES IN 2002 In the section headed ASSESSMENT OF RISK OF HARM TO THE PUBLIC AND THE LIKELIHOOD OF REOFFENDING, the report states: “although it would appear KM does not have much of a criminal history, it is a little concerning that this is the second time he has been convicted of an offence of Common Assault. Although KM considers himself to be a fairly tolerant person, he does admit that when he suffers persistent taunts of unacceptable behaviour or language, this does make him angry and he would like the opportunity of work being undertaken with him to teach him alternatives other than to break the law. Without such work, I do believe there could be a risk of KM re-offending if he is placed in a similar situation again which could also, of course, pose a risk of harm to the public Although KM is currently receiving medication for depression, he is adamant there is no risk of self harm”…
29 May 2002 KM kept the appointment for a preliminary assessment at HW House. A Community Psychiatric Nurse (CPN) conducted the assessment accompanied by a nursing student, who wrote the notes:
“…The plan of action which has been made known to KM and to which he is agreeable is that he should undergo a further assessment and in the meantime continue the medication prescribed by his GP. He will also have to keep off the cannabis which usually make the paranoia worse”.
18 JUNE 2002 Whilst he was waiting to ‘clock off’ KM had a verbal altercation with a fellow worker and pushed him over some pallets causing injuries to his head and wrist. KM was not arrested on this occasion as the victim did not press charges…
Sometime in June KM went to Mr. M’s shop, reportedly ‘spoiling for a fight’ which again Mr. M said he reported to the police.
21 August 2002, the Associate Specialist wrote:“…..As you are aware, at our last assessment we had difficulty to draw a conclusion as to whether [KM] was suffering from mental illness or not. When I enquired of his mother she believed he is keeping fine apart from him loosing his temper [sic] quite easily. She hasn’t noticed any abnormal behaviours or gestures in him… When I saw him today he was casually dressed, pleasant, quite relaxed and stable in mood. His speech and mood were normal. There were no overt psychopathological symptoms. In today’s assessment along with his mother, I couldn’t find any clear psychotic symptoms in him. It appears to me that he is a person who has a paranoid personality. I don’t think he needs pharmacological intervention at this stage. Therefore, following discussion with his mother, I have discharged him from our clinic but please do not hesitate to contact us again if you think we can help him”.
[note: the discharge note appears to indicate that KM did not need to continue taking citalopram (Celexa) although because this had been prescribed by his GP it is impossible to be sure. We know, however, that on Sept 11, he was either on Celexa or in withdrawal. – SSRI Ed]
9 SEPTEMBER 2002 KM was no longer employed because of his poor time-keeping. KM attended the Job Centre. Whilst he was there he was verbally abusive to another man and assaulted him. Another man went to apprehend KM and was also assaulted by him. The police were called, he was arrested and later charged with ‘battery’…
11 September 2002. 16 SEPTEMBER 2002 KM went back to Mr. H’s shop at about 11.52 hours. KM was seen to be holding a machete and swing it [sic]hitting Mrs H several times. In all he hit her about six times before she fell to the floor…. she died the following day at 11.45 hours. KM was seen still carrying the machete when he entered Mr. M’s shop. He was shouting and was heard to say “I hate you.” He struck Mr. M on the back of his neck and his left hand for which he required hospital treatment. At the same time two Police Officers were patrolling the area and were flagged down by a passer-by and went to the aid of Mr. M. At 19.50 hours that evening KM, accompanied by his father and uncle went to a local police station after having been persuaded by his sister and father to give himself up. When KM was arrested and read his rights, the Police Officers asked him if he understood, to which he replied “yes”.