Psych Station 5

Setting:

You are a junior doctor working in a GP practice. This patient has presented with fatigue and difficulty concentrating.

Name: Carol Jones

Tasks:

1. Take a patient history.

2. Give your diagnosis to the examiner.

2. Answer any questions the patient may have.

You are not required to examine the patient.

Briefing

Diagnosis: Depression
You are Carol Jones (59)
You have presented to the GP practice with fatigue and difficulty concentrating.

Appearance and Behaviour

Aim to limit eye contact, speak in a low monotonous voice.

Opening statement

“My daughter suggested I should come in as I’ve been feeling quite tired and am struggling to concentrate.”

Information to Give Freely

For the past 9 months, I’ve noticed I’m quite tired throughout the day despite sleeping a solid 10 hours every night. At work, I’ve noticed it takes me longer to complete relatively simple tasks, as I often lose my train of thought.

Presenting Complaint

Mood - I suppose I’ve been feeling a little down. If prompted: the last time I’ve had 2 or more consecutive months without feeling low was approximately 5 years ago, before my husband died, but the last 9 months have been significantly worse.
Sleep - I get a lot of sleep, at least 10 hours every night. If prompted: I don’t have any trouble falling asleep, or staying asleep. When I wake I do not feel refreshed, I’m already thinking about getting back to bed that evening.
Interest - I used to love to play bridge with my friends. But lately I just haven’t felt like going.
Guilt - No feelings of guilt.
Energy - My energy levels have been low over the last 9 months or so. I just don’t really feel like doing anything. I have to convince myself to get ready for work, and by the time I arrive at my desk, I’m exhausted.
Concentration: - This has been really troubling me. I used to be able to write my reports in my sleep! Now, it's taking me longer and longer to complete them as I lose my place or start thinking about another report. I’ve worked at this firm for almost 30 years now, but I am concerned that my slowed productivity might get me fired.
Psychomotor - Nothing noted.
Appetite - My appetite is good. If prompted: I have porridge with fruit for breakfast, fish and vegetables for my main meal in the middle of the day, and a light tea in the evening when I come home from work.
Suicide - no suicidal ideation. If prompted: my daughter is the main reason, I would never do that to her.
Anxiety - No issue with my nerves, or feeling irritable.
Mania - No feelings of grandiosity, flight of ideas, risky behaviour, or hyperactivity.
Psychosis - No visual/auditory hallucinations.
Obsessions/compulsions - No unwanted thoughts/images/impulses.

Past Medical History

Previous similar episodes - Losing my husband 5 years ago was very difficult, we were married for over 30 years. If asked: I believe my grief lasted approximately 3 months. By Christmas I was starting to get back to myself. I still miss him every day, but I have such fond memories to console me.
Other medical conditions - high BP

Forensic History

None

Drug History

Prescribed - Ramipril
Over the counter - None
Allergies - None

Family History

My sister has always suffered with her nerves. She’s never been in hospital, but I think she takes tablets.

Social History

Smoking - never
Alcohol - I do enjoy a glass of red wine in the evenings. If prompted: 2 6oz glasses every night.
Drugs - never used drugs Job - legal secretary
Home - lives alone in a house, fully independent
Trauma/childhoood - I have never experienced anything in my life that I would consider traumatic.

Systems Review

No systemic upset

Ideas / Concerns / Expectation

Ideas - I think I’m just getting old.
Concerns - I know my daughter is quite concerned that I might have dementia, but she worries about everything!
Expectations - I’d really like to make sure everything is alright and I suppose if there's something to help me feel a little less tired during the day, I wouldn’t say no.

Discussion / Questions

If not already addressed: Ask if there are any non-pharmacological options that might help.