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WORK/PERSONAL CHALLENGES, IS THIS MIND MAP ACTUALLY HELPFULL IN EXAMINING…

- - - - translates into feelings of self
        
        evidently I would expect a Physio to be in reasonable shape/ level of fitness themselves
  - - - Sadness vs reactive to bad news vs full-blown depression??
  - - - even minor irritants seem to set of the course of rest of day
        
        Feel as if no time for false pleasantries --- oft time feel healthcare can come across as fake and have always tried to represent situations as they are
        
        am I still doing this or leaning into cognitive biases?
    - - Am I actually helping these patients? How much of it would simply improve with time?
        
        use outcome measures/Markers
        
        tell patients and self.
  - - - cannot remember the last time I woke up at the time of my alarm 06:30am (even on weekends)
  - - - Increased isolation of self
        
        Leads to guilt
        
        not responded to family despite knowing of difficulty faces with partner with late stage cancer and post -op recovery
        
        not responded to old work colleagues
        
        often not dealing with emails - though forcing self to tackle and prioritise those most important
  - - - Just too stupid for job?
        
        What if after trying to address everything little changes may mean I'm simply not able to do this
      - Brain fog??
        
        Delayed processing
        
        Cant think at times just vacant
      - Query alexithymia? (inability to feel / communicate emotions)
      - Decreased Attention/Focus
        
        Easily side-tracked off topic
  - - - Sleeping early
      - Cannot perform tasks work or personal life related otherwise would want to do
      - Needing to prioritise tasks more - unable to tackle the same volume at present therefore tackling the foremost difficult issues.
      - Unable to move out changing room approx. 30 mins
  - - - Potentially translating this into patient encounters- already agreed bleak situation many patients are in. Perhaps fixating/generalising my experience or other patients poor experiences onto others
        
        unfair for patients as yes some may not have rehab potential but need to make conscious effort for those who have a chance
    - - perhaps hyperfixation/thinking of the above - without doing anything about it
        
        hard to reflect on situations as CPD as constantly thinking about work and situations that go poorly
    - - feeds into decreased motivation
      - increasingly avoiding driving test
      - short-term relieves --- long term leads to stack of things to do
        
        Worsening feelings of being overwhelmed
        
        more procrastination/negative coping mechanisms
    - - confidence through floor - increasingly seeking reassurance despite knowing what I would do
    - - relative lack of caring (links to motivation)
  - - - feel stupid as result
        
        feeds into self-efficacy, guilt surrounding competency frustration etc
    - - struggling to even create thoughts at times
        
        vacant-like at times
        
        probably feels like hitting head against brick wall for senior.
    - - Heavy Drinking in late teens?? Potentially unlikely to be cause
  - - - Moderate - to -severe
    - - Severe (but borderline)
    - - Early morning rising particularly characteristic of depression supposedly
    - - On SIP
      - Struggled at Uni latter years significantly
  - - - there is real likelihood that my job is on the line but petrified I will lose my job
        
        feeds into prior period where in debt and struggling to afford basics, milk bread, eggs etc while awaiting work.
      - Worry that if the SSRI + lifestyle modification doesnt work may mean I am simply too stupid for the job.
    - - dissociative from struggles at work
      - put huge amount of volume into CPD in past with little objective payback
        
        Likely have gone for volume over quality hence frustration.
      - Inability to want to reflect given I am constantly thinking about situations repetitively though not necessarily documenting - potentially this more rumination???
    - - Feel as if will go away if work at it and muck through
        
        objectively recurrent issues/markers suggest likely not transient thing
      - Worked with People in past who were suicidal and could not possibly be me ( as no suicidal ideation)
      - Aware that everyday challenges often falsely pathologized as mental health issues
      - Not wanting to use as "get out of jail free card" so just need to focus on getting better and doing what I can.
    - - Prior fit active --- "practice what I preached"
- - - - Y-BOCS Outcome measure (Taken 2022) - only (Y) answers provided
        
        "Fear of harming self or others" (Y)
        
        "Fear of Responsibility for Terrible Events" (Y)
        
        See irrational Thoughts below ( Fire, drowning/flooding, robbery/theft/loss)
        
        Translating into patients - Noted Hypervigilance through supervision???
        
        Excessively Bothered by Things not sounding just right" (Y)
        
        How Much time Occupied by thoughts? (<1 hour answer)
        
        Sticking point as to why never sought help discussed with family advised not to pathologise normal behaviour
        
        saw in DSM (V) needs to be > 1 hour per day for diagnosis
        
        if >20 minutes to leave house at worst though surely if leaving home few times in day would be > 1 hour??
        
        Severity Questions
        
        How much control over these thoughts? How Successfully can you ignore when occurs
        
        Little control rarely able to stop or ignore even then only with much difficulty
        
        Context: Unable to sleep without checking oven 16 times to ensure off for example - despite knowing it is off
        
        How much distress, anxiety, or upset do these thoughts cause you?
        
        3 often discuring and difficult to manage
        
        cannot sleep, leave property or move on with rest of day until complete
        
        How much do the thoughts interfere with social school or work function
        
        Definite interference but manageable
        
        repetitively reading emails, articles essays in excess approx 10 times etc to soothe thoughts
        
        Cheking locks, stove, appliances, emergency brakes faucets etc (Y)
        
        Checking nothing terrible will happen (Y)
        
        cannot leave home or areas where card used for example without checking
        
        Checking did not make a mistake (Y)
        
        often fully aware have not made mistake but repetitive checking to soothe
        
        Needing to repeat routine activities or boundary crossings (Y)
        
        Need to read or re-write (Y)
        
        Counting compulsions (Y)
        
        at worst would count in excess 20 times hob per bout, if distracted from routine would need to start again
        
        Ritualised Activity of daily living routines (Y)
        
        Asking for Reassurance (Y)
        
        often ask partner to check for me to spare the bother
        
        Need to do something until it feels "just right" (Y)
        
        Needing to touch, tap or rub object multiple times (Y)
        
        Pervasive "slowness" with tasks (Y)
        
        Avoiding reading or writing because it may bring on the urge to repeatedly read or re-write (Y)
    - - several symptoms here seem to correlate?
        
        repetitive behaviour/self soothing behaviour
        
        speech through child hood ( would overtly repeat phrases had just said aloud
        
        Eventually just would mutter underneath breath though friends have noted even into early 20s still do it.
        
        specialist interests
        
        Literal thinking
        
        hyper fixation on details - situations or contexts
        
        inability to see bigger picture.
        
        Specialist interests ? hard to differentiate from normal behaviour
      - However - no social difficulty nor sensory like issues therefore unlikely
  - - - checking I have my debit card whenever I need to make a payment
      - Checking the door
      - Checking bag and clothes packed on the way to work
    - - would help to explain hyperfixation on medical issues and relative inability to be reassured.
    - - spent 2.5 hours fixated on topic of whether could have OCD or not
- - - - improving ++ though at times reasoning off
    - - improving ensuring to know especially where relevant times come up or D/C suggested, Physio specifically requested, ambulance transport etc.
    - - improving ++
  - - - Need to be more proactive in organising leave
      - not responding to emails within 2-3 days (expectation for MSK was that day)
      - struggling with admin tasks
    - - withdrawn
      - could discuss and plan better with HCSWs
      - past: struggle to concisely convey handovers
    - - taking too long with patients
      - 10 patients per day by end of MSK
  - - - particularly Social history
    - - use of prior reference lists/prompts for assessments
- - - - had always been the "stable" supportive figure prior
  - - - ashamed as result
  - - - Family history of alcoholism
        
        prior hospital admission+++
        
        Memory of Grandmother (Traumatic)
        
        Relationship with Father soured
        
        struggled to see me like this given his experience with father's alcoholism
        
        Has this affected my development? Prefrontal cortex reasoning short-term memory etc.