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< | OS was convinced his wife was or had been unfaithful with the husband of her sister. The conviction persisted over years, fluctuating in severity of preoccupation, sometimes aggravated by alcohol, leading to disharmony within the marriage, with a tendency for OS to be critical of the wife in her appreciation of him, in comparison to her appreciation of others. One of their three children was severely disabled from birth. The disharmony led to the wife considering divorce and separation, but nothing came of that. He also acknowledgedthat he had 'dreams'which showed OS standing over the brother in law in a pool of blood. he has aslo assaulted his wife ,sometimes afteralcohol,There may as well or may not have been some indications of depression about this time He gave an explanation as to how he thought the conviction arose. he believed because he had called his wife 'fatty' on occasion, that this would have pushed her into a relationship with someone else. On one occasion the wife thought he had treid to smother her. A forensic opinion was sought and agreed this was an obessively overvalued idea rather than a delusion. Following an attempt at reconciliation with the brother in law during an extended family celebration - that the matter could now be put behind them - the brother in law replied that OS should recognise to the brother in law, that there had been nothing between the brother in law and OS wife - so that there never had been anything to be put behind them - OS became enraged , expleted and lunging at his throat , with a broken glass, injured the brother in law so that he needed 30 sutures. The psychiatric service is criticised fro not getting 'collateral accounts - of continued acusations - and fro not seeing the wife separately to get the same observations.The mental health Trust is criticiised as a whole for inadewqqute leadership and poor supervision, and for relying toomucj#h on locum appointments. Some weeks after the completion of sessions with the Psychologist , OS stabbed his wife many times. Psychiatric Reports to the Court put in mitigation on account of his mind being disturbed but without recommending any hospital consideration - there was no established medical mental illness, that could be dealt with, OS was sentenced for homicide to eight years in prison, extended on appeal to life imprisonment. Comment Abnormal jealousy has always been a difficult diagnosis to apply or manage. One is always apprehensive about the outlook for the wife . A consultant here ruminated in hindsight that he might have told the wife - this degree of jealousy never goes away - so leave . The first thing is to eliminate any underlying 'medical mental illness' - schizophrenia or affective illness, usually depression. It is not clear that this was achieved here. The progress of the jealousy needs to be matched against what is going on otherwise. If it waxes and wanes with sleep disturbance affective illness is to be tried as a working diagnosis. Here the GP initially gave OS a tricyclic prescription, but as often with GP management of psychiatric cinditions the dosage was tentaive and insufficient for proper trial. A proper and appropriate trial is an adjunct to deciding about diagnosis. A consultant tried medication for schizophrenia but also in a half hearted way in insufficent dosage or duration to call it a diagnostic trial. Making a connection between calling his wife fatty as the start of her alleged extramarital goings on seems more like schizophjrenia and in some support there is a hint of a more elaborated paranoid outlook when he commented to a clinical psychologist that he had received phone calls with a background noise but no voicing, on occasion. Many of the Inquiry Reports fail to settle a diagnosis, as though this is a lesser consideration; diagnosis does underpin a working conclusion for continuing care. without one there is no general clinical lead. If this had been labelled 'pathological jealousy' - that it was 'pathological' would have been a worry to be borne in mind It would be proper and useful, having made Inquiry an obligation, for the NHS management to put in place an adequate follow up appreciation of outcome in terms of subsequent behaviour and diagnostic revision or confirmation. The Panel spoke with OS, werenot impressed that he was unguarded, and their quotations do not suggest an enduring illness. The Panel appreciates the difficult and unsettled setting within which all had to work, but is still surprised at the absence of any mutual support or coherence in team working and cross relationships within this institution. It is rightly surprised at the absence of any continual risk appraisal and coreectly in concluding that the wife ( and others ) should have been seen on their own more . Perhaps an absence of social work in this institution. Nevertheless, nobody really knows what there is to do or to be doing with people who have this enduring condition. The hindsight comment is relevant.
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