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SSRI Stories Summary: PK has been under mental health services since 1983. Reference is made to a “conduct disorder” when he was a boy so the drugging probably started at that time. At the age of 26 he is diagnosed with paranoid schizophrenia by the NHS. On January 25, 1996 PK’s GP assesses him as paranoid without delusions, and with “moderate depression and retardation” and prescribes Cipramil (citalopram). Feb 10: Inpatient psychiatric notes indicate that he has been readmitted to hospital having been referred by his GP for reporting violent urges to attack people. GP continued the citalopram but has added Zuclopethixol and Diazepam. Two days later PK is making statements that indicate he is delusional. On Feb 13, in a library, PK grabs a stranger by the throat and slashes his face with a cut-throat razor. He is incarcerated.
From 2000 to 2002 he is maintained on Olanzapine and is reported to be doing well. He moves to outpatient status. However, he has “poor concentration, broken sleep pattern, lack of energy, a reduction in motivation and negative thoughts”. So, PK is started on Sertraline 50mg daily increased to 100mg after 1 week. On March 14, 2003 PK’s girlfriend reports that he is “not himself” and “something is not right with him”. On Mar 24 his father reports that he is withdrawn and seems unwell. The next day, March 25, PK stabs to death an older man who is walking his dog. In news articles there is no mention of the SSRIs. In both the independent review and the news, mental illness is blamed and the potential contribution of the medications is not considered.
Paul Khan, 34, stabbed retired accountant Brian Dodd more than 30 times in the head and neck as he walked his dog, leaving him unrecognisable to his widow Enid.
He pleaded guilty to Mr Dodd’s manslaughter on the grounds of diminished responsibility earlier this month and was sentenced at Mold Crown Court this afternoon.
Mr Justice Gibbs told him: “This was the ultimate horror, a savage and sustained killing completely at random on an unsuspecting and innocent member of the public.”
He ordered that Khan serve a minimum of six years before being considered for parole but stressed that he believed Khan should be in prison for much longer.
The attack on Mr Dodd, which took place in Prestatyn, north Wales, in March, happened six years after Khan slashed a man’s throat in a Cardiff public library.
Following that incident he was ordered to remain in a secure mental hospital indefinitely but was released in August 2000 after doctors recommended he could be cared for in the community.
However, by the time Mr Dodd’s killing, Khan had stopped taking his medicine and was seriously mentally ill, believing his psychiatrist was controlled by aliens and stockpiling weapons to protect himself.
Khan was seen by his psychiatrist two weeks before the murder and no problem was detected. He was also seen at home by a psychiatric nurse on the day before the killing but no alarm was raised.
Later that day, Khan stole his father’s car and drove to Ffrith Beach in Prestatyn where he attacked Mr Dodd, possibly because their dogs fought each other.
Khan was arrested three days later. The Welsh Assembly has launched an inquiry into why his condition was allowed to deteroriate while he was being cared for in the community.
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Independent External Review into a Homicide at Prestatyn, Wales on 25th March 2003
Commissioned by Cardiff Local Health Board
On 25th March 2003, PK, a Cardiff resident, killed BD, a retired accountant, by inflicting multiple fatal knife injuries on him at Frith Beach Festival Gardens, Prestatyn. He was initially readmitted on 30 March 2003 under Section 2 of the Mental Health Act, formally recalled by the Home Office on 31 March 2003 under Section 42(3) and redetained as a Section 37/41 patient. At his criminal trial in Chester Crown Court PK pleaded guilty to manslaughter on the grounds of diminished responsibility and was subsequently transferred to Ashworth Hospital, Liverpool.
At the time of the offence PK was under the care of the Community Forensic Psychiatric Team at Whitchurch Hospital, Cardiff and was living in independent accommodation. PK has a history of contact with mental health services since 1983. At the age of 26 he was diagnosed with paranoid schizophrenia.
[First Incident 1996: Bad reaction to citalopram, withdrawal leads to delirium-pyschosis-triggered assault]
5 January 1996 – A discharge report indicated that PK’s first psychiatric admission to Whitchurch Hospital was voluntary following referral from his GP. The impression was “a 26 year old man with poor impulse control leading to a forensic record, who presented with a history of auditory hallucinations but in whom there was no objective evidence of serious mental illness. There may be evidence of a post-traumatic stress reaction but this would be better managed as an outpatient.” He was discharged on 8 Jan 96. (Discharge summary 10 Jan 1996 by SHO to CP1)
25 Jan 1996 – CP2’s letter indicated that on assessment, PK reported a 4-month history of depression following his release from Dartmoor prison. He was seen with a friend of 16 years standing who confirmed she had never seen him like this. Mental State examination revealed moderate depression and retardation. He was not hearing voices at this time and his previous auditory hallucinations were considered typical of depression. He admitted to paranoid feelings but there was no evidence of delusions. He was prescribed Cipramil [citalopram] 20mg daily. (Letter to GP1 from CP2 25 Jan 1996)
10 Feb 1996 – Inpatient psychiatric notes indicated that following referral from his GP for violent urges, PK was readmitted to hospital. He experienced urges to attack people and described auditory hallucinations. The GP had started him on Zuclopethixol 10mg bd, Cipramil 20mg od and Diazepam 5mg tds. (Inpatient psychiatric notes – 10 Feb 1996)
11 Feb 1996 – Inpatient psychiatric notes indicated that PK was refusing medication and denied any psychotic phenomenon. Later that day self-discharged against medical advice. (Inpatient psychiatric notes – 11 Feb 1996)
12 Feb 1996 – Inpatient psychiatric notes indicated that the GP phoned the ward saying PK requested readmission. PK was expressing intrusive thoughts telling him to harm people. He was spoken to on the phone when he said “satellite TV owes me money” and “I want to kill my mother and father, my mother puts things in my food”. Following discussion with the Specialist Registrar on call it was felt that the picture was more of personality disorder with no mental illness. He was to be followed up in Outpatients. (Inpatient psychiatric notes – 12 Feb 1996)
13 Feb 1996 – A psychiatric report indicated that whilst in a public library PK grabbed a stranger by the throat and slashed the victims face with a cut-throat razor, leading to a 12cm laceration. He was remanded to HMP Cardiff where he spoke of believing he was being followed by MI5, voices telling him to stab people, Martians following him, thoughts being put into his mind via satellite, and headaches due to the microwave. He also said that Martians had given him the razor and that he felt it had been a cry for help because people were ignoring his complaints
[Second incident: Sertraline leads to murder]
3 April 2000 – The Home Office emailed a statement opposing discharge – “The Home Secretary is pleased to note the progress PK has made. However discharge at the present time would be premature. PK has only just started a limited amount of unescorted leave to the local area and the Home Secretary would like to see testing on increasing periods of unescorted and overnight leave successfully completed before agreeing a discharge plan.”
9 July 2002- The outpatient notes stated that PK was reasonably well. No evidence of psychosis. However reported being disturbed by noise, especially at night by children and cars in the street. Olanzapine changed to 10mg nocte.
1 Aug 2003 – The Home Office requested, via email, the Social Supervisor’s progress report addressed to SW3.
6 Aug 2002 – A letter from CP1 regarding outpatient review stated PK was going through a depressive spell with low mood, diurnal variation in mood, poor concentration, broken sleep pattern, lack of energy, a reduction in motivation and negative thoughts. No psychotic features evident. Diagnosed with post psychotic depression and started on Sertraline 50mg daily increasing to 100mg after 1 week. He remained on Olanzapine 10mg daily and depot depixol 80mg fortnightly. (Letter to GP from CP1- 7 Aug 2002)
14 March 2003 – A psychiatric report indicated that the last date that PK’s girlfriend reported seeing him. She stated that she felt he wasn’t himself and that something was not right with him. (Psychiatric report dated – 1 Oct 2003)
24 March 2003 – A psychiatric report indicated that PK’s father reported that he had visited PK on 24th March and had noticed that he had lost his appetite and that he was quiet and distant. These were familiar indications that PK was not well. His father told him to contact his nurse. (Psychiatric report dated – 1 Oct 2003)
24 March 2003 – Hand written CPN notes stated CPN2 received a telephone call from PK at approximately 10.30-11.00am. PK informed him that his father had told him off and that he should be visited at home. As CPN2 was in the area he was able to see PK within the hour.
PK was alone in his flat and he informed CPN2 that his father had told him off for not eating enough food and that his father and mother thought he was becoming unwell. PK was noted to be a bit quiet, but otherwise there was no cause for concern. PK asked for his medication to be reduced. [It wasn’t] PK phoned his father and at the request of CPN2 attended the flat.
The issues that had raised concerns over PK’s health were discussed, in particular PK’s father’s belief that he wasn’t eating enough. CPN2 noted that PK was a big man who would often eat normally in his presence.
It was decided that the best course of action would be for PK to attend at Whitchurch Hospital the following day for an appointment with CP1. CPN2 had no concerns relating to PK’s mental health. He did not notice any change in his behaviour to what he was like normally on his visits.
25 March 2003 – A psychiatric report indicated : HOMICIDE OFFENCE: On the morning of 25 March 2003 (actual time not specified) an elderly gentleman received at least 28 stab wounds to the head, neck and chest whilst walking his dog in Festival Gardens, Prestatyn. The victim died of his injuries. Several eyewitnesses reported seeing a man fitting PK’s description walking his Rottweiller dog in Festival Gardens at that time. The Ford Mondeo was also seen in the car park. There was considerable forensic evidence linking PK to the offence.