Causation of an acute episode

This is usually a readily understandable matter in clinical practice. The usual model of multifactorial causation applies, with predisposing, precipitating, and perpetuating factors. Important examples are as follows:

• poor compliance with medication; e.g. because of side-effects

• dropout from follow-up; e.g. after moving house

• substance misuse; e.g. alcohol or illegal drugs

• accommodation problems

• relationship problems

• contact with criminal justice system.

In most cases, the precipitating cause will be obvious; attention to the symptoms will be important, but the immediate problem causing the worsening of symptoms needs also to be addressed.

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