Psychiatric Note DS RAMHP

**Diagnosis:** Major Depressive Disorder, Recurrent, Severe, with Psychotic Features. **Management Plan:** * Continue current medication regime. * Increase frequency of therapy sessions to twice weekly. * Referral to community mental health team for ongoing support. * Review of medication in one week. **Action for GP:** * Inform GP of diagnosis and management plan. * Request GP to monitor physical health and medication side effects. * Provide GP with a copy of this note. --- **Assessment:** Patient is currently sleeping in a homeless shelter and spends most of the day in the local library. Patient presents with low mood, anhedonia, and suicidal ideation. Functioning is severely impaired, with difficulty in completing daily tasks. Patient is currently taking Sertraline 200mg daily and Olanzapine 10mg nightly. Patient reports some improvement in mood but continues to experience psychotic symptoms. Patient reports suicidal ideation with a plan. Risk to self is high. Patient has agreed to increased monitoring and support. Patient has no previous convictions. Patient has limited social support, primarily relying on support from the homeless shelter staff. --- **Medication:** Sertraline 200mg daily, Olanzapine 10mg nightly. No known allergies. --- **Substance Use:** Patient reports occasional alcohol use, but denies use of street drugs. --- **Past Medical History:** Patient has a history of hypertension. --- **Past Psychiatric History:** Multiple previous admissions for depression. Previous trials of various antidepressants with limited success. History of ECT. --- **Mental State Examination:** Appearance: Dishevelled, appears older than stated age. Behaviour: Psychomotor retardation. Speech: Monotone, slow, and quiet. Mood: Depressed. Affect: Blunted. Thought Form: Linear. Thought Content: Delusions of persecution and worthlessness. Suicidal ideation with a plan. Perceptions: Auditory hallucinations. Cognition: Oriented to person and place, but not time. Insight: Limited insight into illness. Risk: High risk of suicide. --- **Formulation:** Biological factors: Family history of depression. Treatment-resistant depression. Psychological factors: Trauma history. Negative self-perception. Social factors: Homelessness, lack of social support. Current risk is high due to suicidal ideation and plan. Mitigations include increased monitoring, medication review, and referral to community mental health team.