Dr Marie Tan-Paredes

My Health North Richmond

Level 1, North Richmond Village

6-16 Riverview St

North Richmond

NSW 2754

17.09.2025

Re: Kim Rogers (DOB: 06/04/1958) NBM10693 review

Dear Dr Tan-Paredes,

Thank you for referring Kim Rogers for a GP MHCP in February, 2024 and subsequent Wentworth Healthcare PTS plan for “opinion and management of chronic anxiety, depression, PTSD and ADHD”.

Kim attended her first appointment on the16th of February, 2024. She had fortnightly consultations over the following six months, and you provided her with an additional plan in June, 2024, after which she has attended monthly consultations. Her review was on the 15th of August, 2025 and I write to provide you with a review of her care, at the close of referral.

Please see previous correspondence for comprehensive mental health assessment.

Initial Presentation

At the time of her initial consultation, Kim reported a history of anxiety, stemming from multiple psychosocial stressors. She reported feeling stressed, with easy rise to anger, frustration, and stated “I have no patience; everything gets to me.” She stated that she doesn’t hesitate to “tell people off; I just say what I think without caring.” She then regrets it later and experiences low mood. Anger is triggered by other people’s driving; and people not doing things correctly. When anger is particularly heightened, Kim reported thoughts of wanting to “rip my hair out and bang my head against something.”

Background: Kim reported difficulties stemming from her previous marriage, in which she was victim of D/V over years, including verbal, physical abuse and coercive control. At that time, Kim reported feeling too scared to leave and lived in fear for a long time. She continues to feel angry about the abuse and guilt for the impacts experienced by the children’s witnessing of the D/V.

Kim reported an over active mind, with frequent changing of thoughts, from subject to subject. She stated “I can’t switch off worrying about unimportant things. She felt overwhelmed with her workload, and weighed down trying to fit everything in. This was affecting her mood, which she described as “depressed; on the point of crying.”

Kim reported that the symptoms of ADHD included: can’t switch off; doing multiple things at the same time; can’t concentrate; don’t remember things when under pressure; chop and change in conversations; can’t sit still; fidget. I also question if these symptoms could be associated with PTSD.

Kim likes to go to the gym and keep fit, however with age-related changes to her physique and decreased motivation, she has recently been feeling too tired to work out, which was affecting her mental health and mood.

16.02.2024 K10: 30/50

Mental health history

Diagnosed with ADHD by Dr Mallick on 28.10.2021

Had suicidal ideation during D/V marriage, however children were her protective factor.

Medical history

Hypertension

Osteoporosis

Vaginal prolapse

Bladder repair December 2023

Fractured foot 2022 some reduction in mobility

Breast tumour (fibro adenoma) age 17 (benign)

History of varicose veins

Menopausal hot flushes

Recurrent sinus infections and ear infections.

AOD

3 glasses of wine per night.

Medication – from previous report (may have changed and need TBC)

Vyvanse 40mg – 50mg daily, but stopped taking in March 2024 due to side effects (from GP referral) of increased anxiety and abdominal cramping.

Antidepressant medication – weaned off as reported side effects of ‘unable to think clearly’

Coversyl 5mg tablet daily

Prolia 60mg/l IM every 6 months

Recently commenced on Sertraline, which Kim reports is helping her feel better, but is affecting her weight.

Supports

Sees psychiatrist, Dr Mallick at SJOG.

Works as a disability carer; also on Centrelink benefits as needed.

Has 4 children: Aleisha (44) (has PTSD – police force); Renwick (39); Leander (36) (has OCD and bipolar disorder); Brianna (35) (has anxiety and ADHD)

Has a male friend who she sees once a week.

Lives by herself in own home.

Update

Kim had been making steady progress with her recovery throughout 2024 and 2025, including improvement in mood and motivation. She was engaging in an online course to upskill and be able to work as a medical receptionist and had resolved stressful work issues with her employment agency, culminating in a change in agency.

Unfortunately, in December 2025, Kim was victim of a scam and lost a substantial amount of money. This caused considerable distress, including low mood, self-reproach, increased anxiety and anguish. She felt ashamed and did not want to tell her family, however did speak with one of her daughters who is in the police force, for guidance about how to manage the situation. She continues to dwell on the impact of that, however it is becoming less of a daily focus with time.

Kim has had three motor vehicle accident in the past year, which she informed me were not her fault, but did cause distress and financial stress. Subsequently, her daughter does not allow Kim to drive her children anywhere, which Kim says adds to her depression.

One of Kim’s daughters moved to the south coast in 2024, which caused some sadness, as she is close with her children and enjoys spending time with her grandchildren, however has come to terms with it quite well.

At the time of her review in August, 2025, Kim reported that she was doing well. She had chosen to leave the online course as it was causing too much stress and she no longer considered pursuing that career path. She felt relieved to stop and certainly looked more relaxed in consultations. Her mood was bright and reactive.

Kim had relationship issues with partner over the past six months, however they have resolved and she felt more optimistic about their future.

Kim continues to struggle with memory lapses and frequently forgets words in sentences. It would be worth following up with cognitive assessment if this deteriorated further.

Kim would like a medication review. She has weaned herself off ADHD and antidepressant medication two years ago, but is unsure if it would help her anxiety and ADHD symptoms to recommence. She does not consider that the ADHD medication made a significant difference at that time and she didn’t like the side effects of psychotropic medication. I have recommended that she discuss this with you and/or her psychiatrist.

15.08.2025: K10 score: 31/50

MSE

Behaviour: settled in sessions; good eye contact and easy rapport. I have not seen overt signs of restlessness or hyperactivity during any session.

Mood: “I feel better”

Affect: congruent with mood; reactive; laughing and smiling; definitely brighter and calmer

Thought form: Logical/sequential, with some pauses in sentences to reflect on the word.

Speech: normal rate, tone and volume

Cognition: not formally assessed, however Kim appears to be having memory lapses, with frequent need to pause mid-sentence to think of the word. On explorations, she stated that she has short and long-term memory recall difficulties. She has developed a habit of "waiting for my mind's eye to see it, picture a place to remind me."

Perception: No alteration in perception at time of report

Insight: developing insight about mood irritability and reactivity to triggers

Judgement: seeking help when needed

Formulation:

67 year old Caucasian woman, living in own home and working as a disability support worker, presenting with anxiety, depression, ADHD and PTSD in background of complex psychosocial stressors, including previous domestic violent relationship, currently stable and doing well.

Impression:

Anxiety

Trauma disorder

Cognitive/memory lapses

Alcohol dependence

I question if the symptoms she considers are associated with ADHD could be more related to PTSD and have recommended practices for emotional regulation techniques.

Plan

At the time of her review, Kim reported feeling well and no longer in need of further sessions. Should she need further support at another time, I would be happy to see her. I have also recommended she has a medication review for reasons outlined above.

Yours sincerely,

Michelle Hookham