Dr Helen Mitchell

64 Francis St

Richmond

NSW 2753

Dr Raymond Yeow

Advanced Medical Practice

Windsor

NSW 2756

18.02.2024

Re: Andrew Turtle(DOB: 30.11.1984) NBM7508 MHNIPs Review

Dear Dr Mitchell and Dr Yeow,

I write to provide you with a mental health review for Andrew Turtle, who has been seeing me for psychological support since April, 2022. He is currently under a Wentworth Healthcare MHNIPs plan and is seeing me weekly for ongoing support and relapse prevention. His plan is still current.

Over the past six months, his mood has been stable – see update below.

Diagnosis

Schizoaffective disorder (previously schizophrenia), Bipolar type

Current presentation and update

Andrew was discharged from the Hills Clinic on the 12th of February, 2024, following a voluntary admission after a deterioration in mental health (psychosis), triggered by returning to work. At the time of discharge, he reported feeling more stable, which was congruent with his presentation. During the admission, his mood stabiliser medication was changed from Lithium to Epilem, which Andrew reported a positive response to. However, that was followed by a period of mood instability, outlined in my previous report in May, 2024, where I requested a psychiatric review.

Andrew was reviewed by Dr Mitchell in May 2024, resulting in a change of medication. He has been significantly better since then. Within a week of the new medication regime, Andrew has had: a noticeable improvement in mood; a reduction in pressured speech; improved thought form (more sequential and less tangential); a decrease in grandiosity and improved sleep. These changes have remained consistent since then.

Along with the improvement, Andrew has had some unwanted side effects. In June 2024, I observed a restricted affect. Andrew was concerned about restless legs and weight gain and saw Dr Yeow in June to discuss his medication. In July, Andrew had one episode of paranoia, after not taking his Seroquel. He believed an intruder was in the house. He had insight to know it wasn’t real, however couldn’t stop the thoughts. He took some Seroquel, which resolved the episode. Apart from that time, Andrew has had no other psychotic symptoms. Andrew has also struggled with sleeping excessively and having difficulty waking up in the morning. We have discussed medication management and he has learned that if he takes his medication earlier and goes to bed on the first wave of tiredness, he wakes feeling better and doesn’t need the second dose of Seroquel.

In July 2024, Andrew had early warning signs of relapse. He reported increased spending and staying up late at night writing. I was able to coach him to set boundaries around his work; discuss strategies to slow down and decrease stimulation until the episode had settled. Within a week, he had stabilised.

By September, 2024, Andrew’s improvement continued, and I considered him to be the most stable I had seen him in years. He was talking about returning to work and I coached him in setting realistic goals to prevent relapse, included part-time work in relatively stress-free environments.

In November, his K10 score was 21/50, which was congruent with his presentation.

Throughout 2024, Andrew returned to cricket, both playing and coaching younger children. The games filled his weekends and he got a lot of satisfaction in the game. He also reconnected with Karen and their friendship has been a regular part of Andrew’s social life over the past 9 months. He celebrated his 40th birthday in November and hosted a party with friends and family. There are times where he would like his social connections to be better.

Andrew commenced 2025 with a strong focus to work on his Wellness Revolution. This is an enormous program that Andrew has written and created a comprehensive website for. We are systematically going through each week of the program, with the intention for Andrew to actually do the program; to implement and trial his own recommendations as a research component of developing the program further. He has also decided to revisit another piece of writing and database development on the mental health Lived Experience movement. I am monitoring his wellbeing for early warning signs of relapse, but at the time of this report, Andrew assures me that his writing productivity is within a healthy range.

Medication

TBC

Supports

Andrew lives in his own home, with his brother. He is on the DSP.

His parents and friend, Karen are key supports.

MSE (from first consultation)

Appearance: Caucasian male with black short hair and facial hair; less attention to hygiene and grooming than in the past.

Behaviour: Good eye contact; easy rapport.

Mood: “I miss being manic”

Affect: Congruent with mood.

Speech: normal rate tone and volume

Thought form: no formal thought disorder

Content: As stated above.

Cognition: Not formally assessed.

Perception: no alteration in perception at time of this report

Orientation: oriented to time, place and person

Insight: Has very good awareness about his mental illness.

Judgement: Andrew is learning his EWS of relapse and implementing strategies to remain well.

Formulation from initial consult

40-year-old male, on the DSP, living in his own home, diagnosed with schizo-affective disorder in background of childhood trauma and previous diagnosis of schizophrenia; currently stable.

Impression

Schizoaffective disorder; treatment plan working well

Side effects of weight gain and increased sleep.

Plan

Weekly consultations

Case management/care coordination as required.

Psychoeducation as needed.

Detection of early warning signs of relapse and early intervention.

Holistic health coaching via Andrew’s own program.

Regards,

Michelle Hookham