Reason for Seeking Health Care

Reason for Seeking Health Care
Patient Initials: J S Gender: M/F/Transgender M Age: 29 years Race: White Ethnicity: German
Reason for Seeking Health Care: The patient admitted to “experiencing regular upsetting thoughts” and “feeling like I am not in control of my actions.” His anxiety and restlessness were interfering with his relationships and work. The patient informed me: “I am seeking help because I fear I might hurt myself or my sister.”
HPI: John is a 29-year-old white male who has been struggling with mental health issues after getting into a serious car accident that left his wife and daughter died five months ago. The patient states that he has “not been acting like himself” since the accident. He confesses that he has “trouble believing it really happened” and feels especially guilty for being behind the steering wheel. He remembers arguing with his wife as they were returning from her parents-in-law: he does not recall what they were arguing about, but he does remember turning to his wife before they were t-boned by a speeding dumper truck. The patient has recurrent flashbacks of “the car launching sideways into the air and rolling several times before I passed out”. He later woke up in a hospital bed where the bad news was broken to him: “my dear wife and child were dead, they didn’t survive the trip to the hospital.” The patient has since been having uncontrollable thoughts about the accident: a week after the event, he resumed drinking and smoking marijuana (he had managed to stay clean for 18 months after his wife insisted that he seek treatment for his concurrent alcohol and marijuana abuse). He attributed returning to his “old ways” as a means of coping with the constant intrusive thoughts and distressing dreams of his family dying. He reported that after the accident, “I couldn’t hold it anymore, I can’t live with my thoughts. I knew drinking would not bring back my family. I have to get ‘high’, man, to wake up in the morning and go to work, I just have to be ‘high’”. He admitted to immersing himself in work immediately after the funeral without allowing himself enough time to mourn: “I kept myself busy to keep ‘bad’ thoughts away. I am also behind on several business loans I took last year”. He was either at work, at home, or at the bar, but mostly he kept to himself: “I just wanted to be alone. I snap at anyone around me. I am not in control of my emotions and find myself being insensitive to my workmates and parents in law nearly every time. Everyone was understanding at first, but I feel like they are tiring of me”. He does not report having any other social support except his twin sister. She lives in the same area and is credited with being patient with him, even helping with the housework. She has been driving him to work every morning: “I became fearful of driving, and my twin sister picks me up to work. I take the bus home in the evening”. His sister advised him to see a mental health specialist after he admitted to feeling guilty about surviving the accident. The patient did not have any history of mental h...