Michael Kilfoyle - Centrelink DSP Support Letter 09072019 2

Patient Name: Kilfoyle, Michael DOB: 11/12/1980
09/07/2019
Centrelink DSP Applications

QLD
To Whom it May Concern
Re: Michael Kilfoyle, 11/12/1980, 19 Lighthouse Drive BOYNE ISLAND QLD 4680
Diagnosis:
In my professional opinion, is fully diagnosed as follows:
DSM-5 F43.10 post-traumatic stress disorder
DSM-5 F34.1 Persistent depressive disorder, severe
DSM-5 F60.1 borderline personality disorder
Michael is a 38-year-old man who presents with at least a 15-year history of anxiety and post-traumatic symptoms.
Over the 3 years so he has experienced a significant worsening of his symptoms such that he had to resign from his work as a disability
support worker and is now on Centrelink New Start.
He tells me that he struggles to manage day-to-day with the level of anxiety that he experiences. He develops panic symptoms in public
places, finds supermarkets almost intolerable and is markedly low in mood.
He described himself as someone "drifting on a rock in space not knowing where he is going".
He describes a very traumatic past history. He was sexually abused by his swimming coach at the age of nine. His family then sent him
away to the Netherlands to try to improve his confidence between the age of 11 and 13, however, he fell into drug use and developed a
significant drug habit.
When he returned to Australia he had a significant problem with amphetamines, ecstasy and LSD which continued until he was around 25.
At the age of 19 during a psychiatric admission to the Gold Coast, he was sexually molested by a male nurse.
He has recently lost several close friends to cancer. In 2017 he came across a close friend who had hung himself using Christmas lights,
and he ended up having to cut him down and stay with the body.
Personal history
Michael was born in Gladstone. His father was a carpenter and his mother was a barmaid. His parents are still together and he has a very
strong connection with them.
Michael has one older sister, Amy who is 41, and also has an older half-sister who is 42 and was adopted out by his mother prior to her
marrying his father. He is in contact with her, but she is not in contact with their mother.
He describes his childhood as being reasonable, along with schooling up until the time when he went away to the Netherlands.
He eventually left high school in year 10, and in between his mental health and substance use problems was able to maintain employment,
for example working in a pharmacy.
More recently he became a mental health and disability support worker.
Michael has lived with a housemate, Jason for the past eight years. He describes their arrangement as supportive.
Past psychiatric history
Michael has a complex and extensive past psychiatric history.
He has had psychiatric admissions in the Gold Coast at the age of 19, and more than 10 admissions to the mental health unit in
Rockhampton over the years. He tells me that these admissions were in association with suicide attempts and overdoses.
He was diagnosed with ADHD as a child and treated with dexamphetamine from the age of five. However, he blames this on his
amphetamine habit and tells me that from around the age of 14 or 15 he began selling his dexamphetamine tablets.
He told me that he had been diagnosed with a borderline personality disorder but equally had run courses for DBT.
He told me that he had only previously been managed in the public mental health system, and had given up on that when he was recently
recommended to commence on lithium.
In the past, he has trialled paroxetine and sertraline and is currently taking venlafaxine. Up till last year, he was taking alprazolam 2 mg
twice daily, but due to the scheduling change, he has been switched to clonazepam 2 mg twice daily and describes no adverse effects from
this change.
He has seen a number of psychologists in the public system but is hoping to access EMDR via a visiting psychologist at your practice.
Past medical history
Michael has had trigeminal neuralgia since childhood and has regular injections into his trigeminal nerve. He has no other significant
medical problems.
Substance use history
Michael has a past history of polysubstance use between the age of 15 and 25. He tells me he has been clean for more than 10 years. He
smokes 30 cigarettes a day but drinks no alcohol and uses no illicit substances.
Mental state examination
Michael engaged well with the consultation and we developed a good rapport. He was overtly anxious and told me that he had not slept
much overnight worrying about the appointment. Despite this, he engaged well and was open and direct with his answers.
His talk was normal in rate and form with no evidence of thought disorder.
His affect was depressed. On the Beck Depression Inventory, he scored 53 indicating severe symptoms of depression. He has marked
biological symptoms including loss of appetite, disturbed sleep and lack of libido. He admitted to thoughts of wanting to kill himself with no
intent. I rated his suicide risk low.
On the Beck Anxiety Inventory, he scored 49, again indicating severe anxiety symptoms.
On the PCL–C PTSD checklist he scored 81 points indicating the very severe post-traumatic symptoms, and this checklist also confirmed
that he fulfilled all of the diagnostic criteria for PTSD.
There was no evidence of psychotic symptoms, he has good insight into his situation, his judgement is unimpaired and cognitively he is
intact.
Formulation
Michael is a 38-year-old man who had a very traumatic childhood, adolescence and early adulthood characterised by a neurodevelopmental
disorder (ADHD), sexual abuse in childhood and adolescence, and early polysubstance use.
More recently he has had a number of re-traumatising experiences including the suicide of a friend, and the death of three other friends
from cancer that appears to have markedly worsened his mental health.
He is completely disabled by intrusion symptoms from his PTSD, depression and marked anxiety. Protective factors include his willingness
to engage with help and to accept advice and support.
Assessment of Impairment
In my opinion, Mr Kilfoyle has a severe functional impact on activities involving mental health function.
(1) Michael has severe difficulties with most of the following:
(a) self care and independent living;
Michael needs regular support to live independently, he relies on his housemate, Jason, on a daily basis and would not be able to manage
independently without this continuous support. He requires constant support for basic activities of daily living.
(b) social/recreational activities and travel;
Michael travels alone only in familiar areas (such as the local shops or other familiar venues). He is extremely socially isolated, has great
difficulty leaving his home and is effectively housebound other than attending medical appointments.
(c) interpersonal relationships;
Michael has very limited social contacts and involvement with others. He is extremely disabled and socially isolated.
Michael often has difficulty interacting with other people and needs constant assistance or support from a companion to engage in social
interactions.
(d) concentration and task completion;
Michael has difficulty concentrating on any task or conversation for more than 5 minutes.
Michael has slowed movements or reaction time due to the effects of his medication.
(e) behaviour, planning and decision-making;

Michael’s behaviour, thoughts and conversation are significantly and frequently disturbed. He is highly anxious, has severe symptoms of
PTSD.
(f) work/training capacity.
Michael is unable to attend work, education or training due to ongoing mental illness. in my professional opinion, he is totally and
permanently disabled and has been for more than 2 years.
Yours faithfully,
Prof Richard Harvey MBBS (Lond.) MD (Lond.), MRCPsych, FRANZCP, FPOA, AMA(M)
Consultant Psychiatrist
Clinical Professor, Deakin University, Geelong
Provider: 2518614B
DICTATED AND ELECTRONICALLY TRANSCRIBED AND SIGNED TO AVOID DELAY
PO BOX 117, North Geelong, VIC 3215

Tel: 1300 617 685 Fax: 03 9923 6590 e-mail: richard@telepsychiatrist.online.
Secure communication preferred via Healthlink (EDI: telepsyc), Argus (ID: 3024422) or Medical Objects (ID: RH3221000QH).

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Patient Name: Kilfoyle, Michael DOB: 11/12/1980

Centrelink DSP Applications

To Whom it May Concern

In my professional opinion, is fully diagnosed as follows:

DSM-5 F43.10 post-traumatic stress disorder

DSM-5 F34.1 Persistent depressive disorder, severe

DSM-5 F60.1 borderline personality disorder

More recently he became a mental health and disability support worker.

Past psychiatric history

Michael has a complex and extensive past psychiatric history.

Past medical history

Substance use history

Mental state examination

(1) Michael has severe difficulties with most of the following:

(a) self care and independent living;

(b) social/recreational activities and travel;

(c) interpersonal relationships;

(d) concentration and task completion;

(e) behaviour, planning and decision-making;

(f) work/training capacity.

PO BOX 117, North Geelong, VIC 3215

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