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Case File: Annemarie Ludford Garvey 1 - Intro

Ann
PRO
November 21, 2022

Case File: Annemarie Ludford Garvey 1 - Intro

We will rewrite this later, but for now, the following is the Introduction to our book, "Case File: Who is Anne - Understanding the Meaning of Life, Her Purpose, and How She Makes Sense of Their World." As of 11-21-22, it is about half written. Please keep coming back!

Ann
PRO

November 21, 2022
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  1. Case File: Who is Anne - Understanding the Meaning of

    Life, Her Purpose, and How She Makes Sense of Their World 1 | P a g e Case File: Who is Anne - Understanding the Meaning of Life, Her Purpose, and How She Makes Sense of Their World Patient location: In their home at Sandwich, Illinois a small farming town 60 miles SW of Chicago. Before the initiation of today's documented service, the patient or patient guardian verbally consented to virtual/remote treatment. The topics discussed are listed in the assessment & plan in this note. This telehealth visit was performed while writer was physically located at Provider- Based Clinic Mental Status Exam Appearance: casually dressed, glasses, good grooming, and hygiene and overweight ~280 lbs. Behavior: cooperative (pleasant), fair eye contact and good eye contact Speech: fluent, normal rate, tone, quantity, and volume Language: fluent, appropriate Mood: "feeling depressed", dysthymic, euthymic, frustrated Affect: full-range, mood congruent, appropriate, and reactive Thought Process: goal directed and linear Thought Content - denies suicidal ideation (SI) and homicidal Ideation (HI), no psychotic symptoms Perceptions: no disturbances reported Cognition: not tested
  2. Case File: Who is Anne - Understanding the Meaning of

    Life, Her Purpose, and How She Makes Sense of Their World 2 | P a g e Insight: good, age appropriate Judgment: good, age appropriate Reliability: reliable Current Risk Assessment Homicide Risk Factors: No Last Suicide C-SSRS Screening: Date: Screening Found 8/9/2022 Results: Calculated C-SSRS Suicidal Ideation Severity: Moderate Risk (8/9/2022 1:25 PM) Assessment/Plan 1. Recurrent major depressive disorder, in partial remission (CMS/HCC) Overview: Patient (pt) has had depressive symptoms (sx) since childhood connected to trauma. Had multiple psych admissions for SI +/- attempts by overdose. Last admission (+SI attempt) in 2003 following death of her father. Plan: - Continue current medications. Reviewed expected benefit and possible side effects (SE). Pt verbalized understanding. - Continue video visits given distance from her home and difficulty getting out of the house. - Reinforced activities that aid in grounding. Online journal assisting with daily structure. - Continue behavioral activation for depressive sx – staying active with daily journal/schedule, blocked time for projects. - Continue email as needed. Pt will call/write to writer (Dr. Robert Marvin) with updates as needed. 2. Dissociative identity disorder (DID) (CMS/HCC) Overview: Diagnosed when she was in her 20s. Significant past trauma - physical, verbal, emotional, sexual - from several family members. Reports approximately 20 alters ranging from infant to current age. Refers to herself as "we." Has been in therapy since late 20s. Significant number of inpatient
  3. Case File: Who is Anne - Understanding the Meaning of

    Life, Her Purpose, and How She Makes Sense of Their World 3 | P a g e admissions, 20+ when younger. Last admission was 2003 following death of father. She has continued with medications and outpatient therapy. She has made significant progress in therapy with daily schedules (using online tools), affect regulation/tolerance, and interpersonal interactions. Plan: - Continue intent-to-treat (IT) – focus on productivity (online projects), structuring time, improving coping skills, improving internal communication, processing of trauma, medical health, finances, family interactions and productivity. - Reinforced safety plan. - Will continue with structured Cognitive Behavioral Therapy (CBT) components as can be worked into schedule/sessions. - Continue to frame activities - balancing goals of therapy, personal/family goals. 3. Posttraumatic stress disorder (PTSD) Overview: See DID overview. Ongoing interpersonal and internal triggers. Assessment & Plan (A/P): See DID A/P. Education Provided The client has received other psychoeducation client/family education during today's session and verbalized understanding of education and/or training. Education/Instructions given to: Client Barriers to learning: None Content: Refer to note above Evaluation/Outcome: Verbalized understanding Current Health Issues: Mental health Problems: Dissociative Identity Disorder (DID) Severe Depression w/Suicidal Ideations - in Partial Remission
  4. Case File: Who is Anne - Understanding the Meaning of

    Life, Her Purpose, and How She Makes Sense of Their World 4 | P a g e Posttraumatic Stress Disorder (PTSD) Physical Health Problems: Diabetes Diabetic Nerve Disorder Severe Obesity High Cholesterol or Triglycerides Fatty Liver History of Bleeding Ulcers Underactive Thyroid Chronic Kidney Disease (3A) Sleep Apnea Dizziness Heart Disease Due to Blocked Artery Nonobstructive Atherosclerosis of Coronary Artery Chronic Bilateral Low Back Pain Degenerative Arthritis – Lumbar (L) – Sacrum (S) (Bilateral Facet Arthropathy) Subluxation at L3-4 and L1-2 with Flexion/Extension Vascular calcification with postop change in the pelvis. Disk Bulging L1 – S1 Varying Degrees of Stenoses Including Severe Spinal Canal Stenosis at L4-L5 and Moderate Spinal Canal Stenosis at L3-L4 ## Current Medications Please review your medications and verify that the list is up to date. **Call 911 if you have an emergency.** ### methylphenidate 20 MG tablet Commonly known as: RITALIN Take 1 tablet (20 mg total) by mouth 3 (three) times a day. ### Escitalopram 20 MG tablet
  5. Case File: Who is Anne - Understanding the Meaning of

    Life, Her Purpose, and How She Makes Sense of Their World 5 | P a g e Commonly known as: LEXAPRO Take 2 tablets (40 mg total) by mouth 1 (one) time each day. ### gabapentin 300 MG capsule Commonly known as: NEURONTIN Take 2 capsules (600 mg total) by mouth 4 (four) times a day. ### buPROPion SR 150 MG 12 hr. tablet Commonly known as: WELLBUTRIN SR Take 1 tablet (150 mg total) by mouth 3 (three) times a day. ### risperiDONE 2 MG tablet Commonly known as: RisperDAL Take 1 tablet (2 mg total) by mouth every night. ### busPIRone 15 MG tablet Commonly known as: BUSPAR Take 1 tablet (15 mg total) by mouth 4 (four) times a day. ### calcium carbonate-vitamin D 600-200 MG-UNIT tablet Take 1 tablet by mouth daily. ### Vitamin D (Ergocalciferol) 50 mcg (2,000 units) capsule Take 1 capsule by mouth daily. (patient notified to take 2600 units daily via OTC supplements) ### Vitamin B-12 CR 1000 MCG Tablet CR Take 1 tablet by mouth daily. ### Nitroglycerin 0.4 MG sublingual tablet Commonly known as: NITROSTAT Place 1 tablet under the tongue every 5 minutes as needed for Chest pain. DO NOT EXCEED A TOTAL OF 3 DOSES IN 15 MINUTES ### isosorbide mononitrate 30 MG 24 hr. tablet Commonly known as: IMDUR Take 1 tablet by mouth daily. ### albuterol 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs into the lungs every 4 hours as needed for Shortness of Breath or Wheezing.
  6. Case File: Who is Anne - Understanding the Meaning of

    Life, Her Purpose, and How She Makes Sense of Their World 6 | P a g e ### Insulin Glargine (1 Unit Dial) 300 UNIT/ML pen-injector Commonly known as: TOUJEO SOLOSTAR Inject 54 Units into the skin daily. ### FreeStyle Libre 14 Day Sensor Misc. 1 every 14 days. ### Ozempic (0.25 or 0.5 MG/DOSE) (1.34 mg/ml) 0.25 or 0.5 MG/DOSE injection Generic name: semaglutide(0.25 or 0.5 mg/DOSE) INJECT 0.5 MG SUBCUTANEOUSLY ONCE A WEEK (EVERY 7 DAYS) ### acetaminophen-codeine 300-30 MG per tablet Commonly known as: TYLENOL NO.3 Take 1 tablet by mouth at bedtime as needed for Pain. ### ranolazine 500 MG 12 hr. tablet Commonly known as: Ranexa Take 1 tablet by mouth in the morning and 1 tablet before bedtime. ### levothyroxine 125 MCG tablet Take 1 tablet by mouth daily. ### metformin 1000 MG tablet Commonly known as: GLUCOPHAGE Take 1 tablet by mouth 2 times daily. ### pantoprazole 40 MG tablet Commonly known as: PROTONIX Take 1 tablet by mouth daily. ### atorvastatin 40 MG tablet Commonly known as: LIPITOR Take 1 tablet by mouth nightly. ### Pen Needles 32G X 4 MM Misc. Use once daily with Toujeo. ### aspirin 81 MG chewable tablet Chew 81 mg by mouth daily.