Diagnostic conundrum: lessons from the man who accidently set fire to his home.

A 62-year-old man presented to psychiatric services with a 3-month history of a range of symptoms which included obsessional thoughts, self-neglect, lack of mental flexibility, reduced ability to plan, organise and follow instructions, reduced capacity to empathise and disinhibition. He also accidently set fire to his house. Overall these findings are compatible with a dysexecutive syndrome. This man has a significant history of polysubstance misuse and chronic hepatitis C infection. Neuroimaging revealed an acquired traumatic brain injury which could account for his dysexecutive syndrome. The patient was managed in a holistic manner. A community psychiatric nurse was allocated, he had social services input and he was started on trazodone. He is currently housed in short-term housing and is awaiting a long-term residential placement. 2016 BMJ Publishing Group Ltd.