Marceau inquest: killer's GP reveals details of medication increase

Akshay Anand Chand making a first appearance in court charged with the murder of Christie Marceau. Photo / New Zealand Herald

Akshay Chand's GP has spoken about his dealings with the teenager in the weeks before he killed Christie Marceau.

And he has revealed that he increased the dosage of the antidepressant the soon-to-be-killer was taking in a bid to help the youth feel better, faster.

Dr Ajay Makal gave evidence at the inquest into Christie's death in the Auckland District Court today.

Chand stabbed Christie to death in her North Shore home in November 2011.

He was on bail and facing charges at the time for earlier kidnapping, assaulting and threatening the 18-year-old.

He was granted bail despite "vigorous" opposition from police and a pleading letter to the court from Christie, who was terrified Chand would come after her.

Judge David McNaughton granted Chand bail on October 5, 2011, and he killed Christie on November 7 - 33 days later.

Today Makal told the inquest, before Coroner Katharine Greig, that he first saw Chand the day after he was released on bail.

Before meeting Chand he familiarised himself with clinical notes relating to the youth including a discharge summary from North Shore Hospital dated September 6, 2011.

Chand was arrested at the hospital for the initial assault on Christie.

Christie Marceau, killed by Akshay Chand 2011. Supplied picture

After kidnapping her, threatening grievous bodily harm and assaulting her with intent to rape, Chand had tried to overdose on multivitamins and was admitted to hospital.

Makal said the discharge summary noted "no known medical or mental health problems and no known previous self harms".

It also stated that Chand had "undiagnosed depression"; felt isolated from his mother; had "a lack of social support and issues with family"; had a "strong feeling of helplessness and lack of career/life options"; had "suicidal thoughts" that were previously monthly but were now happening daily; and was "ambivalent but willing to seek help".

The plan listed in the summary was for mental health services to follow up on Chand with "daily telephone contact".

He was also prescribed the antidepressant citalopram.

"Mr Chand indicated that the specialist had recommended that he continue taking this medication, but had not given him a repeat prescription," Makal told the inquest.

Chand told Makal the citalopram had made him feel "a lot better" and he thought his mood had lifted.

"He was finding interest in things," Makal said.

"He reported that he had no problems with sleep and he clearly denied any thoughts of harming himself or others."

Chand saw the GP again on October 19.

This time his mother sat in on the appointment as Makal "wanted to get her involved in his care".

"He requested a repeat prescription. He reported feeling better and mentioned that he would like to increase his dose, as he felt that he needed a higher dose to feel fully better.

"At this point he had been on this medication for about four weeks."

Chand told Makal that his appetite and sleep "were good".

"He said he had to stay home until the next court hearing. He mentioned getting bored at home and that he was just listening to music and watching movies.

"During the consultation I asked whether he had any thoughts of harming himself or others and he clearly denied such thoughts."

A protest was held after Christie's death around bail laws, after the launch of the Christie's Law campaign. New Zealand Herald photograph

Makal told the inquest that he first read about the initial offending against Christie on October 13 before he saw Chand the second time.

He said reading the medical notes provided to him - faxed to his workplace by mental health staff - were "not significant" to his treating of Chand.

"I do not believe that reading the notes changed my management plan for Mr Chand at that time."

Before Chand left Makal gave him a laboratory form to have a test to check for side effects of his medication and a new prescription.

He prescribed Chand a higher dosage of citalopram.

He planned to review the dosage in a month and told Chand to come back and see him when the medication ran out for a follow up.

Makal told the inquest that he had no knowledge of "any other arrangements that were in place to monitor and provide oversight of Mr Chand's mental health issues while he was on bail".

His medical centre was not contacted by other mental health staff dealing with Chand's case, or prison authorities regarding "oversight" of the offender while he was on bail.

"I was not aware of the nature and adequacy of the assessments undertaken for court purposes relating to the granting of bail," Makal said.

"My knowledge of Mr Chand's mental health issues was based on information provided by Mr Chand and his mother until more information was made available following his discharge by the mental health services crisis team.

"I did not identify any signs or symptoms of psychosis in my assessments of, or my interactions with Mr Chand, nor was there anything in the mental health assessments conducted while [he] was in custody that concerned me regarding his mental health status and in particular his own safety or his risk to others.

"He had been accepting of help attending his scheduled appointments and seemed to be responding well to antidepressant medication."