Rambling on..

I would like to present the history of MRS X, a 55-year-old lady who was admitted four weeks ago due to alcohol dependent syndrome and low mood, with a 10-year history of depression, and a history of hysterionic personality disorder

History of Presenting Complaint

This is her second admission for alcohol dependent syndrome.

MRS X had her 1^st drink at 17, and admitted to “heavy drinking” since her first marriage at 19. She currently drinks 10-30 bottles of beer a day, mostly at night. Her last drink was 2 bottles of beer, the night before admission.

With regards to alcohol dependence symptoms,

She has developed tolerance, needing more than 20 beers to get intoxicated; she only drinks beer, showing a narrowed repertoire of drink. She denies any changed in her alcohol preference. She prefers to drink alone, but does occasionally drink with her friends. She still enjoys gardening and walking her dog. She has never tried to abstain from alcohol, and continues to drink despite the being aware of its negative effects. She admits to have a strong desire and losing control when having a drink. She had a road traffic accident 20 years ago due to drink driving. She does not take any illegal substances, and does not gamble. She has had no hallucinations or seizures.

With regards to her low mood; MRSX has no anergia and no anhedonia. Her appetite and weight is fine. She has sleeping problems, with difficulty falling asleep, and denies any early morning waking or disturbed sleep. Her libido is normal. She also admits to being in financial difficulty.

2 weeks ago she took an overdose of seroxat, and was admitted to SVUH A&E. She described the attempt as an impulsive one, with no prior planning, and with no intention to die. Her reasons for it were to “forget her difficulties” and as “a cry for help”. She immediately notified her family, after taking 20-30 pills. There was no will or suicide note. She felt regret for what she had done, and had no plans to commit suicide.

With regards to personal history

MRs X was abused and hit by her father when she was a teenager. She denied he drank. In terms of education, she got through high school, then married at 19.

Her relationship history reveals an annulled marriage, attributed to her alcohol problems. She has one daughter and currently maintains a good relationship with her.

Mrs X admits to having subsequent unstable relationships with many men throughout her life. She recently broke up with her long-term partner of 22 years, who had been living in Spain for the past 4 years. She feels that it has “somewhat” contributed to her excessive drinking

With regard to employment Mrs X has problems at work. She skipped a “few days” due to alcohol effects. She also has received multiple warnings due to poor performance. She attributes it to the new HR officer who does not like her.

Forensic history. She was arrested once due to drink and driving 8 years ago

In terms of patient insight, MRs X wants to change but NOT WILLING to fully give up alcohol. She is uncertain that abstinence is for her

She feels that her troubled life lead to drinking, and that her drinking has NOTHING to do with her troubled life.

She is willing to enter the rehabilitation programme to help her cut down on her drinking.

Management Plan

Biopsychosocial approach :

Bio : maintain the current medication, seroxat 30mg Daily

History of Depression was not clear, obtain more information, contact GP

Monitor withdrawal symptoms - tremors, seizures etc

Disulfiram/Acamprosate : consider, though patient does not want to completely abstain

Psychosocial

RPU, SMAG

CBT

Monitor emotional symptoms,

Psychoeducation on addiction (insight)

Collateral history from family.

Damn. I hate pysch