Dr Muna Amin

Leading Edge Family Medicine & Skin Care Clinic

118 Macquarie St

Windsor

NSW 2756

17.08.24

Re: Betina Calow (DOB: 17.06.1975) SOS4231 Review

Dear Dr Amin,

Thank you for referring Betina Calow for a Wentworth Healthcare PTS plan for therapeutic intervention for alcohol cessation and major depression in April, 2024. She had previous referrals to see me in December, 2019 and again in 2020 and 2021, as outlined below. I write to provide you with a review at the end of this latest plan.

Betina attended the first session of this plan on the 3rd of May, 2024. She attended weekly to fortnightly appointments with a total of eight sessions in this two-month period. Her review was held on the 5th of July, 2024.

Initial Presentation

At the time of her first consultation on this plan, Betina had just come out of Nepean Hospital’s Detox Unit (admission from 10.04.24 - 20.04.24) for medical detoxification from alcohol, and was on medication to help maintain abstinence. She had been sober for three weeks. Whilst in hospital, medical investigations discovered that Betina had heart failure and was being treated for that. She also had a deterioration in liver function, an enlarged liver and health challenges associated with alcohol abuse. Betina had insight that she needed to abstain from alcohol for life and was aware that drinking alcohol could be life threatening.

Betina reported feeling very fragile at that time. After three weeks of abstinence from alcohol, she was having to “face my feelings”, which had been blocked by alcohol for years. She was finding this overwhelming. She reported feeling “not good in myself; not good enough; scared of the unknown” and “not wanting to be here.” Betina reported suicidal thoughts of not wanting to be here, however Ruby is a protective factor and she is highly motivated to seek help, attend detox and get her life back on track.

Betina has a past history of traumatic life experiences that continue to impact her emotional wellbeing, including sexual assault, domestic violent relationships, and adverse childhood events.

Betina had a referral to psychiatrist, Dr Tanase, for formal diagnosis and treatment of ADHD, following discharge from the detox unit. I am unsure of the outcome of that consultation at the time of writing this report.

See previous correspondence for full mental health assessment; see ‘update’ below.

Physical health

Heart disease: Left ventricle and atrium dilated. Prognosis: won’t return to full capacity

Enlarged liver

AOD

Betina reported that over the past few years, she had been consuming 750mls of vodka and a bottle of wine per day. She said that she used alcohol to cope with stressors, to reduce social anxiety, to sleep and to “numb myself when I can’t deal with what’s going on.” Her family encouraged her to go to the detox unit

On discharge from Nepean Hospital’s Detox Unit, Betina was taking Campril and Maltrexone to manage her drinking.

Medication at time of referral as reported by Betina

Campral 333mg x 2 three times a day

Magnesium aspartate 500mg once a day

Mirtazapine 30mg once a day

Bisoprolol 2.5mg – ½ a tablet once a day

Naltrexone 50mg once a day

Sacubitril – valsartan 24/26 twice daily

Thiamine 100mg three times a day

Supports

Betina lives with her daughter, Ruby. They moved 1.5 years ago to a modern apartment.

Betina is an NDIS support worker with her own clients. Her recent deterioration in health resulted in loss of some clients and she was in the process of getting her work re-established.

Mental health history

May 2023: Overnight admission to Blacktown Hospital following an overdose.

December 2020: Attempted overdose.

At the appointment on the 16th of December, 2020, Betina reported an attempted overdose by taking 8 of her antidepressant medication on the 10th of December. It was the anniversary for her mother’s suicide, and she stated “I’d just had enough.” Betina reported attempting again on the 14th of December by taking 8 x 5mg diazepam and 7 x antidepressant medication. No medical intervention was accessed for these episodes.

January 2019: Nepean Hospital admission to AMHU and HDU after driving whilst intoxicated and subsequently “lay on road wanting to get run over.”

April/May 2019: Hills Clinic Kellyville – 21 day admission for alcohol. Dry until August 2019.

Mental health treatment plans with Michelle Hookham:

GP MHCP – 09.12.19.

SOS2653 – 20.02.20 – 20.04.20

SOS2786 – 21.04.20 – 21.06.20 - completed.

SOS3522 – 18.12.20 – 18. 02.21 – completed

SOS2990 – 21.05.21 – 21.07.21 – completed

SOS4231 – 29.07.21 – 29.09.21 – completed

NBM11399 02.05.24 – 05.07.24 - completed

15.04.20 K10 : 43; 08.07.20 K10 : 23

18.01.21 K10: 44/50 ; 17.02.21 K10: 49/50

21.05.21 K10: 48/50; 28.07.21 K10: 33/50

24.09.21 K10: 40/50

03.05.24 K10: 44/50; 05.07.24 K10: 31/50

Formulation

49 year old Caucasian, employed, single parent, living at home with 18 year old daughter, presenting with anxiety and low mood, with history of depression and ADHD and history of alcohol substance abuse, in background of complex trauma. Currently stable and continuing with her recovery.

Impression

Recovering alcoholic.

Consider: CPTSD

Update

A range of psychotherapeutic interventions were utilised to support Betina’s recovery. Over the course of this plan, she became more aware of underlying causes of emotional distress and developed insight around these, however found it overwhelming at times. Mindfulness practices were used to help with emotional regulation when difficult emotions arose. Betina came to identify an emotional vulnerability associated with coming off alcohol and living a sober life, with impacts of adverse life experiences below the surface. She stated “Now that I don’t have alcohol as a buffer, and ways to numb out emotional experiences, I’m feeling raw and exposed,” which we were able to explore further.

At the close of this referral, Betina continues to focus on her sobriety and had been decreasing Campril. Since the commencement of this plan, Betina has had two short relapses, but was able to get herself back on track within 48 hours. The most recent was triggered by feeling overwhelmed by financial stressors and the feeling of being ill equipped to deal with it practically. Also she had not taken her antidepressant medication for 4 days, which she is aware is an important part of her staying on track. She planned to fill her prescription and resume regular doses.

Overall, Betina reported “I feel a lot better; I'm able to cope with things in a practical way where i wasn't before. I'm doing lots of gardening; that makes me happy. Things are going well with Ruby. My house is clean, which makes me feel better.”

05.07.24: K10 31/50. (Was 44/50 at time of first consult of this plan), indicating significant improvement in psychosocial wellbeing.

MSE at review

Betina is taking care with her presentation, with good attention to hygiene and grooming.

She is keen to engage; good eye contact and rapport.

Bright and reactive.

Mood: “vague; happy; positive but I don't know why.”

Processing emotional challenges well.

No alteration in perception

Content: Denied suicidal ideation. Had occasional thoughts after relapse with drinking.

Good insight and judgement; aware of triggers for drinking and able to stop herself from full relapse.

Plan

Betina plans to continue to see me as a private client, should the PTS plans no longer be viable.

Regards,

Michelle Hookham