Dr Dalley

Glossodia Medical Centre

3/162 Golden Valley Drive

Glossodia

NSW 2756

21.01.2025

Re: Noah Godsell (DOB: 22.03.2000) Review

Dear Dr Dalley,

Thank you for referring Noah Godsell for a Wentworth Healthcare PTS mental plan for psychological support for mood dysregulation and suicidal ideation in August 2024. I write to provide you with a review at the commencement of his new referral, to report back on the previous referral.

Initial Presentation

At the time of his initial consultation in August, 2024, Noah reported having had a psychotic episode in June 2024, which he considered to be a drug induced psychosis. At that time, he reported feeling anxious and paranoid. He had thoughts that “people were out to get me; that I was being monitored (eg. Phone being tracked)”, and he felt aggravated by loud city noises and police cars. Three weeks prior to his first episode of psychosis (FEP), Noah had been diagnosed with ADHD by Dr Alexandra Krupinska and commenced dexamphetamine. He also had a history of recreational substance use, including regular cannabis use for the past five years. Following the FEP, Noah has mostly abstained from substance use.

Following his FEP, Noah returned to Sydney from Melbourne to stay with his family for support, where he recommenced coming to see me in person. He reported emotional dysregulation, from episodes of high anxiety and panic attacks, alternating with elevated mood and with low mood with suicidal ideation. He described his mood as “erratic; I’m crying every day.” His family were actively monitoring his wellbeing and had increased their support to ensure his safety.

During his assessment, Noah was observed to have pressured speech and flight of ideas; He stated, "I feel sped up; I can't control the inner monologue.” He spoke of existential questions that were preoccupying his thoughts and preventing sleep, including environmental catastrophe, climate activism and dystopia. He spoke of the intense driver to “save the world, but there is not enough time, so I have to be hyper-activist”. Some thoughts had a grandiose quality, such as "I can do something everyone else can't; I think I'm being prepared to be a public figure; I’ve got to save the world.” He was unable to sleep due to the activities of his mind, stating “I can't sleep as my brain sees it as the time to solve the world's problems.” He spoke of feeling disconnected; of existing ‘outside his body’, with difficulty grounding himself. Noah reported feeling restless and had been walking for miles every day.

Please refer to previous correspondence for Noa’s comprehensive mental health assessment. However, in short, my impression then, was that Noa had evidence of a previous 2 – 4 year history of symptomatology consistent with a presentation of mania or hypomania, with pressured speech, flight of ideas and grandiosity. Following medical treatment for a first episode of psychosis in June, 2024, Noah then presented with low mood, suicidal ideation and anhedonia. Whilst formal diagnosis is outside of the scope of my practice, I considered the following could be considered: affective disorders; situational crisis (life stressors); recovering from first episode of psychosis; substance use disorder; or trauma disorder.

06.09.24 K10 score: 34/50

Supports

As Noa’s recovery has progressed, they have moved from staying with parents in Gross Wold, to spending more time in Melbourne with their partner of 18 months, Dwayne.

Medication

TBC

Update

Over the past six months, Noa had a consistent period of improvement. By December, they were ready to start working towards resuming their life in Melbourne and was trying to establish a network of supports, including contact with Headspace. Noa reported good quality sleep and eating habits and described mood as “better; able to keep myself busy; more alert.”

As Noa’s mood stabilised and the psychotic symptoms reduced, they reported feeling tired and lethargic all the time, which was thought to be associated with medication. Noa discussed this with yourself, Dr Dalley, and the dose was reduced in December, which Noa was very happy about.

In December, 2024, Noa had early warning signs of relapse following recreational cannabis use. Noa reported paranoid thoughts and realised that the risk of substance use is too high and affirmed his resolve to abstain. I provided education about risk of relapse and substance use.

At the time of Noa’s review on the 10th of January, they reported feeling stuck in their life. Noa was reducing mirtazapine medication as directed, however continued to feel “very tired” and was sleeping 12 hours per day. Noa described their mood as “low”, with crying “for no reason”, with associated flat affect. Noa considered that lack of meaningful purpose and activity could be contributing and they were exploring opportunities for voluntary work or returning to the workforce. Seeing friends moving forward with their lives and relationship stressors have contributed to Noa feeling despondent about their own life trajectory. Thought form was logical and sequential and Noa was oriented to time, place and person. Noa denied psychotic symptoms and there was no evidence of alteration in perception. Noa denied thoughts of self harm or suicidal ideation.

10.01.2025 K10 score: 24/50 – significant improvement.

Assessment

Continuing to recover from psychotic/manic episode; currently in a more depressive cycle, however this could be attributed to change in medication and loss of meaningful purpose and activity in his life.

Plan

Fortnightly consultations, whilst still living between the Hawkesbury and Melbourne.

Gradual transfer of care to Headspace and other mental health supports preferred by Noa.

Yours sincerely,

Michelle Hookham