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Patient Name: Sarah Wright Year of Birth: 1963 Occupation: Dentist Office Manager, Part Time Original Complaint (physical): Chest pains, sleep disorder, recovering from a heart attack. Original Complaint (psychological): depression, crying, panic attack symptoms, recurrant nightmares, confused speech. Brief Summary: Ms. Sarah Wright is very emotionally confused woman. She is in a loveless marriage and is serving as a nurse to the charismatic man who was her only true love. He is now dying of AIDs and, as it turns out, was also her husband's lover. I'm helping Sarah to reconcile her feelings and cope with her unusual situation. Total number of sessions: 14. Brief Impression: Sarah is terrified of a recurrence of her heart attack. She is feeling like she has lost control, an issue that she had been making some progress with prior to her heart attack. No evidence of alogia or positive formal thought disorder, although she reports incidents of confused speech. Tentative Diagnosis: Exogenous depression and panic attack/anxiety disorder. Current Medications: Sarah was on lorazepam (Ativan) and I switched her to alprazolam (Xanax) 1 mg. t.i.d. I cancelled the Xanax (1/13/97) and switched her to 50 mg. Sertraline (Zoloft), a serotonin reuptake inhibitor, once each morning. |
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