Dear Dr Okonkwo,

I am writing to refer the above patient for psychiatric assessment.

Mrs Caldwell presented on 9 August with complaints of increasing anxiety, difficulty concentrating, and persistent feelings of nausea. She is displaying signs of paranoia. She reports this has been occurring for approximately four months with gradually increasing frequency and severity.

She is sleeping poorly. She reports waking between 3am and 4am most nights and being unable to return to sleep. She describes a persistent feeling of being watched which she acknowledges is irrational but cannot dismiss.

There is no history of psychiatric illness. No family history of note. She describes her husband as working overseas since early this year.

I have conducted standard blood work including thyroid function and B12. All within normal limits. I can find no organic cause for her symptoms.

I have increased her sertraline from 50mg to 100mg as an interim measure but I am not confident this is a pharmaceutical issue.

I would be grateful for your assessment.

Yours sincerely,