MHM Magazine

14 | MENTAL HEALTH MATTERS | 2023 | Issue 1 MHM She is a dainty, petite woman. You notice her silver hair held tightly in a bun and her thin, soft fingers curled around the pen as she signs her details on the form. This is your first encounter with the 75-year-old lady, who appears apprehensive at the sight of a clinical office set within a psychiatric hospital. She wears a floral blouse and blue long skirt, cloaked by a white knitted jersey with simple, black, flat shoes. She appears young for her age. Her face creased with many years of living, shows a gentle demeanour, with carefully placed makeup and a smile that urges you to step forward, touch her shoulder and welcome her into your consulting room. You were expecting her. Two weeks back you received an email from one of the psychologists with whom you have an excellent clinical relationship. You highlight the important text. The email reads as follows: “Dear doctor Thank you for seeing my 75-year- old patient, Ms du Toit, who lives alone in a retirement village. She has been consulting with me for the past 6 months and seeing her GP regularly for general body aches, difficulty sleeping, poor appetite, and mild irritability (although you would not say this by looking at her). She has stopped visiting her friends, going to the shops, and partaking in any social engagements. She has told me that, for the last 8 months , she feels nervous spending time outside her home. She has a fear of falling, getting lost, and other drivers on the road, and making a fool of herself with friends. These symptoms appeared to have begun just after the loss of her husband of 42 years . She initially consulted with her GP as she was finding it difficult to fall asleep saying that as she climbs into bed her mind is racing with thoughts of the following day, and that she cannot stop thinking of her late husband, even wanting to ‘join him’. Eventually she falls asleep, but the night is restless, with frequent awakenings . She has begun to get into bed an hour earlier than her usual time and wakes up well before her alarm clock. But she feels exhausted in the mornings and for most of the day, taking a 2-hour nap in the afternoon - unusual for her. The GP decided to trial Benzodiazepines (Urbanol 10mg three times per day or as needed), with minimal response and, unfortunately sedation. Her body has begun to ache and she is battling to walk the distance of her home needing to sit and rest. Too often she has almost fallen , resulting in her clutching onto railings whenever she feels unsteady. She has begun to sit more frequently, watching anything on TV, to ‘take her mind off the day and what has to be done’. She finds she struggles to hold her teacup as her ‘ shaking has been getting worse ’. Importantly she has been experiencing episodic moments of being overwhelmed, short of breath, with a racing heart, and ‘stars’ in her vision . This passes after about 15 minutes but leaves her crying and lying on her bed. These ‘episodes’ have contributed to her avoiding social engagements and leaving her house altogether. She also finds she is short- tempered , and often gives up trying to make meals, both due to her loss of appetite and that she is battling to read the numbers on her oven and recipes she’s always used. Our journey together has been productive. She works hard and engages well in therapy. The GP has diagnosed generalised anxiety and depression, with panic attacks and agoraphobia. Kindly manage the patient further and provide me with feedback. Dr Kim Laxton Psychiatrist Gauteng A FACE OF ANXIETY