Dr Teng Kiong Kek

Mt Druitt Medical Centre

253 Beames Avenue

Mount Druitt

NSW 2770

05.11.2024

Re: Kim Graham (DOB: 03.10.1971) NBM10953 Mental health assessment and review

Dear Dr Kek,

Thank you for referring Kim Graham to see me in March, 2024 for anxiety and depression, under a Wentworth Healthcare PTS plan. I am her allocated provider and write to provide you with an update at the end of this referral and to request an additional referral. Please refer to previous correspondence for her comprehensive mental health assessment.

Initial Presentation

At the time of her initial consultation, Kim reported difficulties since the death of her maternal grandmother (who died in January, 2024), who had been her primary carer from the age of 6 years old, when her mother ceased providing this role. Her Nan’s death has been a major trigger for a deterioration in her mental health because of Kim’s developmental history and CPTSD.

Kim reported increased anxiety, rising to frequent panic attacks, with “overwhelming fear; I can’t breathe; I think I’m having a heart attack.” She expressed having “an intense fear of death”. Kim’s panic attacks are characterised by shortness of breath and she stated feeling “as if I will die”. This has prompted her to go to hospital on numerous occasions, thinking that she is having a medical emergency. Kim states “I feel better inside my bubble,” which causes her to stay at home and not leave the house. She has a phobia of illness and dying and has anxiety going to new places and environments she doesn’t know. She has increased anxiety in crowds; is unable to fly as is “petrified of being stuck in a confined space for a long period of time”. She is unable to be in confined spaces, such as buses, trains; and has a phobia of elevators and of getting stuck.

Increased anxiety was affecting sleep, with reported chronic insomnia and not being able to sleep more than two hours at a time. Kim also reported reverse sleep cycle, where she is up at night unable to sleep; then sleeps in the day.

Kim has diagnosed depression, with chronic low mood and associated feelings of hopelessness and fear of the future. She is socially isolated, with a fear to leave the house. She reported crying continually and feels emotionally overwhelmed with minimal triggers. Heightened emotions have been evident during her consultations with myself.

16.04.24: K10 score: 42/50 – very high level of psychological distress

Medical history

Diagnosed with brain aneurysm, following an admission to Hawkesbury Hospital ED, with severe headache and vomiting in August, 2024. Her condition is currently being investigated with regards to treatment options.

Kim has physical health challenges that restrict her mobility and employment capacity, including:

Chronic neck and shoulder pain – can’t raise left arm above shoulder height

Dermatitis on feet – can’t wear shoes and gets aching, swollen feet

Irritable bowel syndrome

Arthritis, left arm and knees;

Reconstruction to right ankle in 2015 following fracturing both feet and elbow

Diabetes

High cholesterol

High blood pressure

Chronic insomnia and reverse sleep cycle

Allergies/anaphylaxis and hayfever

Chronic sinusitis

Obesity – was 123kg; currently 107kg

Recent positive occult bowel screen, requiring endoscopy and colonoscopy

AOD

Smokes cannabis to help with restless leg syndrome

Medication – needs clarification

Ozempic and diaformin (diabetes)

Somac

Zoloft

Mobic

Panadeine forte and tramadol for pain relief

Supports

Lives in public housing with her adult son, Brodie (age 25).

Currently on Centrelink benefits – job seeker/medical exemption and applying for the disability support pension (DSP). I provided a report to support her application, which has been submitted. She currently awaits the outcome from Centrelink.

Kim has an estranged relationship with her mother and has no contact with her father.

Update

Over the course of this plan, Kim continued to struggle with her bereavement, however over time, her symptoms have decreased, with some improvement in functioning. I observed her to be less emotional and able to talk of other things besides her bereavement, with improvement in mood at times.

In August 2024, Kim had an acute episode of anxiety, severe headache, vertigo and vomiting, requiring transfer to the Hawkesbury Hospital via ambulance for investigation and management. Brain scan revealed an aneurysm, which required follow up MRI at Mt Druitt.

This medical episode has had an adverse impact on Kim’s mental health. One of her biggest fears is death, and living with a brain aneurysm is contributing to chronic anxiety. Kim frequently feels overwhelmed, and her response is to isolate herself by staying at home. She reports low mood, and cries often in sessions when thinking of her condition. In the past, her Nan would have been her main source of comfort during difficult times, which further compounds her grief and loss.

Kim states that the sessions have been really helpful; she appreciates finding a mental health professional that she feels comfortable with and says that being able to talk about her grief, loss and concerns reduces her anxiety.

03.11.24: K10 score: 41/50. I consider there to be little improvement in K10 score due to her recent setback with aneurysm. Prior to that, Kim had made good signs of improvement.

Formulation:

52 year old divorced female, living with 25 year old son in DoH accommodation and on Centrelink benefits, presenting with anxiety and depression, in background of complex biopsychosocial stressors, including bereavement and adverse childhood events and recent diagnosis of brain aneurysm.

Impression:

Consider CPTSD; generalised anxiety disorder; bereavement;

PTSD.

Plan

Kim would like to continue seeing me. Her Extended PTS referral has concluded, and to continue, she will need a new referral. Dr Kek, could you please contact WHL intake line: 1800 223 365

Yours sincerely,

Michelle Hookham