Dr Marie Tan-Paredes

My Health North Richmond

Level 1, North Richmond Village

6-16 Riverview St

North Richmond

NSW 2754

06.02.2024

Re: Ebony Zecevic (DOB: 03.02.2000)

Dear Dr Tan-Paredes,

Thank you for referring Ebony Zecevic for a GP MHCP in August, 2023 and subsequent Wentworth Healthcare PTS plan for “opinion and management of chronic anxiety and depression”.

Ebony attended her first appointment on the 6th of September, 2023. She had a total of five appointments and has made significant progress in her recovery and no longer requires psychological support. I write to provide you with a review of her care.

Initial Presentation

At the time of her initial presentation, Ebony reported not feeling happy. She recognised that she was falling back into “old habits”, including not wanting to get out of bed; not wanting to go to work. She reported increased anxiety with a panic attack the previous week. She had thoughts of wanting to be in a coma to give herself a mental break. She described her mood as “down in the dumps”, she had no energy and reported feeling “stressed and overwhelmed; I have meltdowns a few times a week, with crying and flashbacks from early life.”

Ebony expressed feelings of worthlessness and feeling “not good enough”. Making mistakes was a trigger for panic and increased anxiety.

Stressors included:

Living with her partner’s parents, which she described as a ‘toxic environment’

Loss of deposit on home due to complicated land purchase situation

Relationship stress due to living with his parents

Moving from Jervis Bay to Hawkesbury, and loss of close friendships as a result

Adverse life events intruding on thoughts

Mental health history

Attempted overdose age 14. Parental/step-parental discord a causative factor.

Depression age 15 “a hole; no way out; dark; numb; tired; blank; do nothing; not in body.” Coped with binge drinking to pass out.

Other major contributing events: sexual assault as young adult whilst intoxicated. Stated that she went into shock and blocked it out. Had not dealt with this. Panic attacks from this time, (2017), with insomnia and flashbacks. Had therapy for a while.

Developmental history

Grew up in Jervis Bay.

Described childhood as “tough”

Parents separated when she was age 7. Moved in with mother’s new partner for 6 years.

Struggled in school and left in Year 11 to commence work.

Family history

Mother: bipolar disorder and depression

Medical health history

Chronic cystitis since childhood (E Coli attached to bladder wall). Treated recently with Uromune.

Age 6 – 7 thrush and UTIs

Age 14 – 15 UTIs, monthly, increasing to weekly.

AOD

Binge drinking age 15 – 16 as coping strategy

Medication

No psychotropic medication

Supports

Works in administration for gymnastics coaching.

Update

Ebony has engaged well in all sessions. She has been able to gradually open up and process traumatic life experiences, which has helped her process parts of her life for the first time. She has become aware that she was afraid to release emotions, but that was making her unwell. And now that she is expressing them, she is feeling some relief. We have explored strategies to manage anxiety, and early warning signs of relapse, with good effect.

Ebony stopped sessions in October due to financial stressors. Discussed with GP and plan changed to WHL plan, which commenced on the 15th of November, 2023. By the beginning of December, Ebony reported improvement. She stated “I’m feeling a lot better; I’m not stressing; I’ve not had any nightmares; I have more energy back; I’ve been working 6 days a week.”

I last spoke with Ebony on the 31.01.24. She stated “I’m doing really well; I feel much improved and no longer need consults.” She had been on a holiday with her partner, they had become engaged and they were taking steps to move into their own accommodation.

Formulation:

23 year old employed Caucasian female, living with her fiancé and his parents, presenting with anxiety and depression in background of complex psychosocial stressors and past history of adverse childhood events and sexual assault as an adult.

Impression: consider

Situational crisis.

PTSD

Plan

The referral has been closed. Ebony will get back in touch if and when she requires additional psychological support.

Yours sincerely,

Michelle Hookham