Craig Doherty, a 49-year-old man with Bipolar Affective Disorder and significant alcohol use, died by suicide on 14 January 2013. He had been admitted involuntarily to hospital in August 2012 for quetiapine overdose and alcohol intoxication, presenting with manic relapse. On the day of death, he was seen by his GP and mental health crisis team, both noting deterioration, paranoid delusions, and non-compliance with Olanzapine. Despite being assessed as requiring either hospital admission or supervised community treatment, he chose community-based medication supervision. He was assessed as denying suicidal ideation and appeared calm to multiple clinicians and police. Critical clinical lesson: Patients in acute manic relapse with paranoid delusions, medication non-compliance, and recent substance use require careful risk stratification; apparent calmness and explicit denial of suicidality may mask high suicide risk in this population.
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