Dr Vivien Sharma

Mt Druitt Medical Centre

253 Beames Avenue

Mount Druitt

NSW 2770

20/05/2025

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

Dear Dr Sharma,

Thank you for referring Kim Graham to see me in March, 2024 for anxiety and depression under a Wentworth Healthcare PTS plan. I write to provide you with an update at the end of her second referral (previously via Dr Kek) and to request an additional one. Please refer to previous correspondence to Dr Kek for her comprehensive mental health assessment and below for an update.

Initial Presentation

At the time of her initial consultation in April, 2024, 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 was a major trigger for a deterioration in her mental health because of Kim’s developmental history and CPTSD.

At that time, 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 were 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 was 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 had anxiety going to new places and environments she doesn’t know. She reported increased anxiety in crowds; was unable to fly as is “petrified of being stuck in a confined space for a long period of time”. She was unable to be in confined spaces, such as buses, trains; and had 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 was up at night unable to sleep; then sleeps in the day.

Kim was diagnosed with depression, with chronic low mood and associated feelings of hopelessness and fear of the future. She was socially isolated, with a fear to leave the house. She reported crying continually and felt emotionally overwhelmed with minimal triggers. Heightened emotions were 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

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).

Has recently been approved for the Disability Support Pension (DSP).

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. I observed her to be less emotional and able to talk of other things besides her bereavement, with an overall improvement in mood. Unfortunately, chronic health problems have caused setbacks, which adversely affected Kim’s mood.

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. A brain scan revealed an aneurysm, which required follow up MRI at Mt Druitt. This medical episode had an adverse impact on Kim’s mental health. One of her biggest fears is death and living with a brain aneurysm contributed to heightened anxiety.

December 2024 was a challenging time for Kim as it was the anniversary of her Nan’s death. However, she was able to express her feelings, cry and laugh about good times with her Nan, demonstrating a significant improvement in mood associated with grief and loss.

January 2025: Kim experienced gastrointestinal upset, with nausea and vomiting for an extended period. In February, she was advised to stop Ozempic, with good effect; You referred Kim to see a psychologist, Mavis for a formal diagnosis for her DSP application, and she had three sessions with Mavis, who affirmed a diagnosis of CPTSD.

February 2025: Kim had a setback following the news that Dr Kek had to retire for medical reasons. He had been her and her Nan’s GP for decades and Kim experienced it as another loss of key supports in her life. She was able to speak with him by phone, which she appreciated; Kim’s Zoloft was decreased from 200mg to 150mg. She had an episode of low mood associated with difficulties getting accepted for the DSP.

March 2025: Kim’s DSP application was approved, which was a huge relief for her; Kim presented to hospital with exacerbation of chronic neck pain. She has since had 2 cortisone injections, which are helping.

May 2025: Kim reported a setback in mood, triggered by Mother’s Day, bringing up feelings of loss with regards to her Nan and also the estrangement with her own mother.

Whilst Kim’s mood has improved over the past six months, her overall functioning continues to be poor, due to chronic physical health problems, which adversely affects her mood.

03.11.24: K10 score: 41/50.

14.05.25: K10 score: 31/50 – showing improvement in psychological distress.

Formulation:

53 year old divorced female, living with 25 year old son in DoH accommodation and on the DSP, 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;

Plan

Kim would like to continue seeing me. I have spoken with the intake office at Wentworth Healthcare and her referral has been extended. At this time, there is no further action from you required.

Yours sincerely,

Michelle Hookham