Page 108 - English For Nursing

many happy memories from his childhood and tried to spend as much time out of the house as possible. His
father had a temper, and while he was never physically abusive he did endure verbal abuse. He reported that
his father would often denigrate his sister, who left the home as soon as possible due to the verbal abuse. Jim

experienced significant verbal abuse from his father, abuse that would forever haunt him. He was able to
acknowledge that many of his negative feelings toward himself stem from years of abuse from his father. He
was unable to talk about much of it, as it caused significant pain and discomfort, which ultimately manifested
in increased symptoms and nightmares.
Jim reported that he saw a psychiatrist sometime in the early 1980s when he began taking medications.
He reported that “nothing worked” to alleviate his mental health symptoms. For the next 20 years, he avoided
treatment hoping he could manage his mental health on his own. After 2010, as his anxiety worsened and

the depression became more debilitating, he attempted counselling with a series of mental health therapists.
However, it did not work out. He elaborated that he was not yet ready to deal with the trauma of his youth
or his current feelings of anxiety. In 2011, he was hospitalized for the first time at University Hospital for
four days due to “suicidal ideation.” He entered the hospital with a plan to overdose and was admitted. In
2013, Jim was hospitalized at Memorial Hospital due to mental health symptoms. Notes indicate he was

“lethargic, presenting with flat affect.” Each time he left the hospital, he was unable to access mental health
treatment because when he tried he found himself overwhelmed by depression and anxiety. Due to his lack
of follow-up, Jim did not consistently take medications. When asked if medications help when using them as
prescribed, Jim reported “what’s the point…I ain’t worth nothing.”
Jim exhibited symptoms of anxiety disorder and major depression. He has reported that since 2014,
he could often feel himself falling into a “depressive slide”. In addition, he exhibited traits of a personality
disorder. He felt hopeless about his life and increased anxiety in certain situations. He reported that when he

was in this state he would not move for 3-4 days and he became more forgetful. In addition, he noted that
when he was feeling depressed, he had no interest in attending to hygiene activities that he otherwise took
pride in. Jim has had trouble sleeping due to his symptoms for years. He stated when he was really down, he
would not sleep at all. Jim frequently worried about the same thing over and over again, which made sleep
difficult. He stated, “Anxiety keeps me awake.” He worried about where he would go and where he would

sleep, even when he had a stable place to sleep. Additionally, Jim has had nightmares and invasive memories
of past traumas. He reported that he would wake up in cold sweats and could not remember dreams, but at
other times he recalled them vividly and they caused him significant distress. He had invasive memories of a
car accident where he awoke in the hospital choking on the tubes in his mouth. Sometimes his dreams would
center on “monsters” or “Stephen King-type horror shows” that left him panicked and fearful.
Adapted from
https://soarworks.prainc.com/sites/soarworks.prainc.com/files/MSR_Sample_Anxiety_Depression_REVISED_011717.pdf

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