presentation

Client is a 44 yo MBF with marital discord, daily THC use, TMS (Transcranial Magnetic Stimulation) treatment DX: F31.63 – Bipolar Disorder, Current episode mixed, severe, w/o psychotic features Rx: Adderall XR 20 mg Allergies: N/A Client is a 44 yo MBF whose husband of 20 yrs left in January 2024. Seeking to gain clarity. Currently getting a divorce. Her boxer also had a brain tumor and underwent treatment for weeks. SHe caught him cheating but admits she was able to do whatever she wanted to and. She also just lost her mom to death. Client self rpts: decreased appetite, trouble concentrating, difficulty sleeping, SIB episodes leading to her Husband needing to take FMLA every 3 mos, low motivation, fatigue/low energy, anxiety, fear, hopelessness, depressed mood, hormone-related problems, angina or chest pain, bone or joint problems, infertility. Some grief/ loss issues re: never conceiving. She miscarried in 2008. She has done DBT in the past and has been DX with OCD Personality D/O. Her mom died 05/18/2018 with multiple health issues including sepsis. Her mom lived with them for 8 yrs. She has also had multiple deaths in her family around her mom’s death including one of her brothers. She rpts her husband would always explain away fishy situations but has never taken responsibility for cheating even when caught. She put a tracker on his phone after some change in his behxs leading her to believe he was cheating. She has gone to arbitration for 5 hrs and had an agreement but he left refusing to sign anything. She has not worked in years but recently got a job at FedEx working nights and UPS driving (begins tomorrow). Her dad has given him $50K to payoff bills. Her husb has been physically abusive with her – she rpts an incident where choked her in the tub after confronting him about cheating. Some rapid pressured speech, tearful crying spells, rambling, rumination. She is doing TMS and her last use was 2 days ago. Past medications Focalin and Klonopin. She has Klonopin as PRN but has not taken it. She rpts no nightmares, difficulty sleeping or cigarette use since her husband left. She rpts last episode of SIB yesterday due to feeling trapped and anxious and hitting herself. Her last episode of SI thoughts/ behx is unknown. Client is rather attached to her MD and unwilling to get treatment from anyone else.