Michael's Psychotic Depression

July 10, 2016 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
Name
Michael Richardson
DOB
29/03/1985 (31 years)
Occupation
Unemployed
History
My husband forced me to come see you as he thinks I can be fixed. That's not possible as there's no hope for me. For the last 3 months, I have known there's no point of living because I have nothing going for me. If directly asked, 3 months ago my best friend committed suicide. I sleep over 12 hours a day and wish I could sleep forever as that's the only time I get any peace. There's been ghosts hanging from the tree and they tell me that I will be joining them soon. I can feel that I am rotting inside and I can smell it too! My husband has said I am stupid and crazy, so I can't tell him what's going on. I only eat when he forces me and haven't been out of the house for weeks apart from today. I have planned to commit suicide during the weekend and ask the doctor if they know the easiest way to go. I have made no concrete plans yet. I deny all other symptoms.
Past Medical History
Asthma. Previously severely bullied as a child and considered suicide. Self harmed previously by cutting wrist but recovered from that with talking therapy.
Drug History
Salbutamol and steroid inhaler. Stopped taking them as there's no point. No allergies
Family History
Family history of asthma and hayfever. Uncle who went crazy but nobody talks about him.
Social History
Lives with husband and daughter. Husband has been looking after daughter as I am unable to. I do not drink or smoke. I do not have any friends to go out with or any support network.





Introduces self
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1

Confirms name & age of patient
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1

Explains reason for consultation & builds rapport
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1

Gains consent
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1

Asks open question
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1

Establishes duration of symptoms
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1

Establishes triggers/stressors/life events
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1

Asks for core symptoms: low mood, anergia, anhedonia
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1
2
Asks for biological symptoms: sleep, loss of libido, appetite
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1

Asks for cognitive symptoms: feeling hopeless, worthless, helpless, poor memory/concentration and guilty
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1
2
Asks if patient has ever felt elated
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1

Asks if experiencing hallucinations (visual/auditory/olfactory)
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1

Looks for any delusions and tests their conviction
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1

Asks about risk of suicide/self harm
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1

Establishes if anything could change their risk
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1

Establishes if patient is neglecting oneself or others
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1

Explores impact of symptoms on occupation
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1

Explores impact of symptoms on home and social life
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1

Explores the level of support
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1

Identifies if the patient has insight and willingness to accept treatment
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1
2
Looks for substance misuse
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1

Asks about previous medical & psychiatric history
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1

Asks whether patient is taking regular medication or has allergies
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1

Asks about family history of psychiatric or medical disorders
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1

Explores and responds to ideas
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1

Explores and responds to concerns
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1

Explores and responds to expectations
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1

Shows empathy
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1

Avoids jargon
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1

Summarises back to patient
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1

Thanks patient
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1

Patient global score
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1
2
Gives reasonable differential diagnosis (psychotic depression, psychosis secondary to psychiatric or drug cause, schizoaffective disorder)
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1

Summarises back to patient
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1

Thanks patient
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1