Liaison Psychiatry Progress Note

Date and Time: 1 November 2024, 10:30 AM Contact Type: Clinic review Participants: Patient (Mr. John Doe), Dr. Sarah Miller (Psychiatrist) Background: Mr. John Doe, a 45-year-old male, presented for a follow-up review regarding his ongoing Major Depressive Disorder, recurrent severe, without psychotic features. He was initially diagnosed two years ago and has been managed in the community with psychotropic medication. He was referred to liaison psychiatry following a recent presentation to the emergency department with increased anhedonia and passive suicidal ideation, which he attributed to heightened work stress. Psychotropic medication: * Sertraline 100mg once daily * Quetiapine 50mg at night Review and discussion: Mr. Doe reported a fluctuating mood over the past month, with some improvement noted in the last week following a slight reduction in his work responsibilities. He described still feeling a significant lack of interest in previously enjoyed activities, though he has managed to attend a few social gatherings with encouragement from his family. His sleep has improved slightly, now averaging 6-7 hours, compared to the 4-5 hours reported at the last contact. Appetite remains stable. He denies active suicidal intent but acknowledges persistent passive thoughts, stating, "I just wish I could disappear sometimes." His wife has expressed concern about his withdrawal from family life and his general lack of energy. We discussed the importance of maintaining his medication regimen and exploring additional coping strategies for stress management, including a potential referral for cognitive behavioural therapy. Mental State Examination: Mr. Doe presented as casually dressed, maintaining fair eye contact but appearing somewhat fatigued. His psychomotor activity was slightly reduced. Speech was of normal volume and rate, but with reduced spontaneity. Mood was reported as "down" and affect was congruent but restricted. Thought content revealed preoccupations with work stress and feelings of inadequacy, with no evidence of delusions. No perceptual disturbances were elicited. He denied active suicidal plans or intent, though he endorsed passive ideation without specific means. Cognitive function appeared intact. Insight was fair, acknowledging his current difficulties and the need for ongoing treatment. Plan: * Continue Sertraline 100mg OD and Quetiapine 50mg ON. * Explore referral to Cognitive Behavioural Therapy (CBT). * Advise patient to increase engagement in pleasant activities, even if unmotivated initially. * Encourage open communication with his wife regarding his feelings and struggles. * Provide crisis contact numbers and advise presentation to ED if suicidal ideation escalates. Follow-up: Routine follow-up in 4 weeks in the outpatient clinic. Summary: Mr. Doe’s mood remains low with persistent anhedonia and passive suicidal ideation, though some mild improvements in sleep and social engagement were noted, and the plan includes continued medication, a CBT referral, and close monitoring.