Can we close the barn door before the horses get out? A case study of high genetic loading and subsequent development of psychosis.

242 We would like to report on a 10 year old girl who was referred to a genetic study of schizophrenia in the Afrikaner population because of a high familial genetic loading. This patient subsequently at the age of 16 years was diagnosed with a psychotic disorder. The initial presentation at 10 years of age as well as the course of illness until the diagnosis of psychosis was made will be reported on. Possible predictors of the ultimate development of psychosis will be highlighted and the continuous follow-up of a high-risk case is emphasized. " A " was a 10 year old grade 4 pupil at a private school when she was referred to us. The mother was diagnosed with schizoaffective disorder, bipolar type and the father with paranoid schizophrenia. Anne's birth and milestones of development were normal. She was raised by a family member. Between 2 – 3 years of age she regressed emotionally, was not sleeping and eating well. She experienced the following early deviant behaviour during the first 10 years of her life: • Fear of the dark, • Struggled to socialize, • Experienced periods of extreme sadness, • Daydreaming, and • Odd behaviour. She was extremely fussy about the food she would eat. At one stage she was complaining of a terrible taste in her mouth and said she tasted her mother's illness. At school she struggled with reading, spelling and concentration. She failed her grade 2 school year. After the death of her mother and a close friend she became depressed and her school functioning declined even more. A child psychiatrist diagnosed a major depressive disorder and ADHD. She was prescribed citalopram 10 mg daily and methylphenidate. She became hyperactive on the antidepressant, which was subsequently discontinued. The methylphenidate was continued as the teacher could not cope with her in the classroom. She was lost for follow up for 5 years. At 16 years of age she presented to the state psychiatric services with further information: her highest level of school education was grade 7. She was staying at home with her caregiver. She could not function as a helper at a nursery school. Her menarche was at 11 years of age and she had a bisexual sexual orientation. She started smoking marijuana at 13 years of age and was involved in poly-substance abuse. This was discontinued 5 months prior to this consultation. She was …