Читать книгу Dynamic Consultations with Psychiatrists - Jason Maratos - Страница 59

Mrs. C presented to the hospital in July 2015 with low mood that had persisted since her husband's death in May 2015. Her husband had suffered a stroke in 2000, and Mrs. C had cared for him since that time. Her husband had entered a sub rented old age home in 2004, and Mrs. C used to visit him daily. Her relatives were critical of her because they implied that she should have looked after him at home with the help of the maid whom they had employed. Mrs. C's husband died suddenly within 3 days after admission to hospital where he developed fever and vomiting. After her husband's death, Mrs. C reported to have lost her reason for living. She felt she had done everything she wanted to do in this world already and her responsibilities had been fulfilled. She developed low mood and a loss of energy and interest. She had early morning waking and poor appetite.

After her husband's death, Mrs. C reported to have seen her husband's ghost twice at night but did not feel distressed because she felt it was her husband visiting her.

She felt helpless and had thoughts of pushing her husband out of a window and jumping out of the window after him. Her sister‐in‐law had also died around that time. Mrs. C was known to the mental health services for more than 15 years. Her sister‐in‐law had died around that time, leaving her 8‐year‐old nephew behind. Mrs. C claims that she only attended a psychiatric clinic once and was given antidepressants that made her drowsy and for this reason she did not continue with follow‐up. Since attending the hospital, she had tried various antidepressants, which she felt had doubtful therapeutic effect and considerable unwanted effects.

Mrs. C was limping and walking slowly supported by a walker. Mrs. C continued being worried about her progressive bilateral osteoarthritis of her knees, with varus knee, and back pain affecting her mobility. Mrs. C has suffered from dyspepsia, hypertension, hyperlipidemia, empty sella syndrome (which was thought to be nonsignificant at follow‐up), spinal stenosis with left foot drop, and obesity.

Mrs. C had been on a waiting list for total knee replacement since 2015 but claimed that she had been advised that she needed to wait until 2018 for it to be done. Last year, Mrs. C also developed hypertension and felt more concerned about her failing health. Her knee pain and poor mobility had limited her from pursuing her interests, such as hiking and doing volunteer work. However, old case notes reported she had previous plans of hanging herself in the mountain, but Mrs. C denied it during current psychiatric clerking. She claimed that since her husband's stroke, she had already completed the bank account rearrangements and written her final notes in case something was to happen to her.