The following is my doctor's report in London: 

Dear Jadamba,

Please find attached discharge report from our team. I hope that you are settling back in okay in Mongolia.

With best wishes for the future,
Dominic

Dr Dominic Glover
Chartered Clinical Psychologist
Area 3 CMHT
Claybrook Centre
37 Claybrook Road
London W6 8LN

Wednesday 28 January 2009

 

Private and confidential

Dr Clubb

North End Medical Centre

211 North End Road

London W14 9NP

 

Dear Dr Clubb,

 

Re: Mr Jadamba Nyambayar  DOB: 04.12.1980

3 Lambrook Terrace, London SW6 6TF

 

I am writing to update you on Mr Jadamba Nyambayar’s contact with Area 3 CMHT, following his referral to us by Dr Muraro (Reader and Honorary Consultant in Neurology) on 8 May 2008. He has been seen for three psychiatric outpatient appointments, six psychology appointments, and was offered a vocational assessment. At his last appointment with myself last week he informed me that he was returning to his native Mongolia on 18 January on a permanent basis. We are therefore discharging him from the CMHT.

 

Reason for referral to the CMHT

The reason for Mr Nyambayar’s referral in May 2008 was because depression was thought to be a major component of his difficulties. Dr Muraro asked for an opinion on Mr Nyambayar’s likely mood disorder and advice on his treatment. Mr Nyambayar’s had presented with a primary complaint of memory disturbance, which he attributed to a head injury sustained in his early teenage years.

 

Psychiatric outpatient contact within Area 3 CMHT

Mr Nyambayar was assessed on 18 July 2008 by Dr Pardis Mostajabi (St1 to Dr Dale) and was commenced on a low dose of Citalopram (10mg). He was also referred to myself for a psychological assessment. Dr Mostajabi’s letter of 22 July summarises her initial assessment. He has been seen in psychiatric outpatients on two further occasions (5 September & 31 October). On 5 September, Mr Nyambayar reported feeling quite low and his Citalopram was increased to 20mg (please see letter dated 12 September). At his appointment on 31 October, he reported that he had been doing quite well and his mood was much more stable. He was to continue taking Citalopram 20mg (please see letter dated 4 November). He was due to be seen for a follow-up appointment shortly, but given that he was now returned to Mongolia, this will no longer be happening.

 

Psychology contact within Area 3 CMHT

I met with Mr Nyambayar for two assessment sessions on 3 September and 3 October 2008. We discussed his belief that he had a poor memory and where this idea came from; we also discussed his mood difficulties, including poor motivation and suicidality. At that time, he was enrolled on an English course at a local college, had a part-time job as a kitchen assistant, and reported that he was drinking 4-5 bottles of beer 2-3 nights per week. He also reported that he had pushed his girlfriend and had also hit a friend whilst under the influence of alcohol. He planned to stop drinking.

 

We have subsequently met for four treatment sessions (13.11.08, 27.11.08, 11.12.08 & 15.01.09). We developed a formulation highlighting the role of behaviour in the maintenance of his low mood and carried out a behavioural activation intervention. This has involved Mr Nyanbayar completing weekly activity schedules, noting the link between activity and mood, identifying avoidance patterns and implementing alternative coping responses, and scheduling in more activities that have a positive effect on his mood. He was able to observe that rumination, drinking and comparing himself to others had a negative effect on his mood, whereas seeing friends and going to the cinema had a positive effect. He has tried to do fewer of the former activities and to do more of the latter.

 

We have also discussed his memory in terms of two alternative possibilities, one being that there is an organic memory problem, and the other being that there is no organic problem but that his worry about there being a problem is causing him to selectively attend to anything he forgets and may in fact be interfering with his memory. We have discussed findings from his brain scans and a recent cognitive assessment in relation to these alternatives, and Mr Nyambayar’s conviction in his belief of there being an organic problem has decreased.    

 

Occupational Therapy contact with Area 3 CMHT

I referred Mr Nyambayar for a vocational assessment within the team on 6 November 2008, as at that time he was looking for work that would give him more enjoyment. However, he did not respond to the Occupational Therapist’s phone calls and was closed.

 

Other contact with services

Mr Nyambayar has also been seen by Dr Muraro and Dr Perry, who are neurologists at the Charing Cross Hospital. Dr Perry runs a specialist memory clinic. I understand that the results of an MRI brain scan carried out in October 2008 were normal. He has also been seen for a neuropsychological assessment by Dr Stephen Gunning (clinical psychologist), whose report states that Mr Nyambayar’s memory performance suggests no impairments.

 

Outcome

As reported earlier Mr Nyambayar decided recently to return to Mongolia and was returning there on 18 January. He has had a number of memory investigations carried out whilst he has been in the UK, which are consistent in finding no memory impairment.

 

In terms of the behavioural activation treatment for depression that I have carried out, Mr Nyambayar has engaged well with the treatment and has completed homework tasks that he has been asked to. His scores on the PHQ-9 have decreased from 16 (moderate-severe range) at the start of our sessions to 2 (normal range) at our last session and his scores on the GAD-7 have reduced from 14 (moderate range) to 0 at our last session.

 

We are now closing his case at Area 3 CMHT. Please feel free to contact us should you have any questions. 

 

Yours sincerely,

 

 

 

Dr Dominic Glover

Chartered Clinical Psychologist

 

Cc:    Dr Hina Rauf, ST1, Area 3 CMHT

          Mr Jadamba Nyambayar (to be emailed to jadamba_n@yahoo.com) 

 

1.   Depakene, 300 mg 2 times a day for 3 months.
2.   Piracetam 20% - 5.0
      Natrium Chloride 0,9 % - 200.0      (5 day injection)
3.   Glycene 0,1
      1 tablet 2 times a day for 25 days, under the tongue
4.   Vitamin B complex
EEG was ordered again after 3 months following the treatment and the
following medications were offered:

1.    Neurotam 0,4
      1 capsule 2 times a day, for 1 month
2.    Lidaza 2.0       10 day injection
3.    Amitriptilin 25 mg
       ½ tablet once a day after 8 pm, for 20 days
4.    Glycene 0.1
Unfortunately, after the treatment I didn’t notice or feel any
improvement or advance in my memory. Therefore sometimes I’m not sure
I would like to know how I can be diagnosed correctly. The followings
are my symptoms I have noticed.
• I find it hard to retrieve information I know.
• I always forget the names, places or information but when they are
said I start to remember.
• It’s been always complicated to find some of my friends’ apartments.
• It’s been always hard to find places where I’ve been for 2 or 3 times before.
• I forget or can’t remember general knowledge or information that people can say without any problem.
• Sometimes I forget something I planned to do.
• I can’t remember the words, names and numbers, just said to me.
• It’s been always complicated to store any new information and recall them.
• I always have a problem in recalling when someone’s birthday or any special event is.
• Sometimes I stop what I was doing and resume previous activities. I also stop what I was doing and start doing     different thing and I’m surprised why I’m doing different thing.
• I do things slower than anyone does.
• When writing something, I miss or leave letters out of some words or
write different letters instead of the letters I’m supposed to write.
• Sometimes I write repeating one word 2 twice in one sentence.
• I do things in disorderly or in disorganized way.
• I always hide things from myself. I can’t find or remember the
place where I put or keep something. For example, a few days ago I looked for a receipt of letters I sent to my sister in USA. I looked for it everywhere it could be. I couldn’t find it and then I thought that I just threw it away. But I accidentally found it.
• I can’t understand the meaning of sentence at first reading, so I repeat reading 3 or 4 times to get it.
• I often say something mixing it up with another thing. For example: 

Hi,

There are a number of people who may have mild traumatic brain injury (mTBI) after a car accident. The injury may not show up on scans, but people with mTBI do experience slower processing speed, poorer memory and some concentration difficulties. feeling tired more easily is also common.

Sometimes the thinking difficulties resolve over weeks/months, but if you continue to experience these changes for a longer period, it would be better to make minor rearrangements to your lifestyle (e.g. keeping pen and paper handy to write down things to remember, using your mobile phone for appointment reminders etc). 

If the changes are more serious (e.g. difficulty holding a job), then it would be important to seek a neuropsychological assessment. 

Hey :) I was in a car accident on April 3 2010.We were going down the highway about 160 kms/hr.The driver slowed to 110 km/hr because there were two cars coming on the other side of the highway.The driver looks at his gf and smiles and wiggles the steering wheel.She then(DRUNK!!!) pulls the steering wheel to the right.We almost then went into the slushy frozen ditch but the driver tried to gain control.Then again almost went into the ditch on the other side of the highway(the left),the driver overcorrected and we were going sideways on the highway until the front passenger side wheel caught in the ditch.The vehicle whipped around...almost doing a 360 then lifted off the air.We were airborn rolling(rolled about 4 times) the vehicle was smashed.all the windows were out and all of the doors were crunched shut.I WAS THE ONLY PERSON NOT WEARING A SEATBELT OUT OF THE ENTIRE Dodge Durango!!!!

There was me(the sober babysitter)the 2 jack asses in the front and their 2 children right beside me.(the kids were fine...not a scratch!!! :) ) The drivers head was bleeding(smashed his window with his head),the woman who caused the accident had BROKEN HER ARM !!! KARMA),and THOUGHT I had a big cut on the top of my head (but I didnt).My head was covered in "eggs"and it had looked like some huge giant had put his lips around my head and gave me a HUGE hicci on the top of my head!!!Since that accident,there are many things and even people who I dont remember.I even forgot some basic math .... like fractions ... some of my favourite recipies ... etc.and this is coming from somebody who once had a photographic memory...not anymore.I havent felt right since that accident and suffer with neck pain 24/7 since that day.But...what I was getting to was that our memories are stored in the front cerebral cortex on the outer layer of our brain,and if it gets damaged,well thats were are memories are stored.Sometimes it comes back sometimes it doesnt.With all of our medicein and science theres still alot we need to find out about our brains..sugnificant being we are...:) dont you think..we heal so miraculously!

Wow, I'm not alone. In June 2009 I turned off my computer and went to bed like always, except I woke up in the hospital! I remember fuzzily waking up and asking the people who were treating me why I was there, and they told me I was involved in a car accident. After a week in intensive care I gradually regained my consciousness and alertness. I was told then that apparently I lost control of the car for some unknown reason, hit a boy who unfortunately died, and hit the car in an electric tower.

I can't be sure whether I hit my head in the accident or not, but a tongue injury tells my I probably did hit my head and bit my tongue. Long story short, I'm now quite forgetful; I can't keep a short list of items in my head for more than a few seconds. I forget people A LOT! I spent six months in prison for "causing an accident that resulted in the death of a person", and I've been out for less than a year, yet I remember very few people from prison. It has affected my work, though not severely.

 Also, there is a general and constant feeling of fogginess as the poster above me described. I am no longer capable of deep concentration. At least not nearly as much as before.  I always feel as if I'm watching myself live instead of actually living. When I'm somewhere, I don't really feel that I'm actually THERE, but more like I'm watching my surroundings in a TV screen or something.

 I'll try exercises like the poster above me suggested - anything to get back my sharp clear alertness. 

I was involved in a car accident two weeks ago. While stopped at a light, I was hit pretty hard from behind which caused me to hit the car in front of me. I think this "double hit" may have caused the whiplash to be worse. I still feel some mild soreness in my neck, but the main problem is with my memory and also a feeling of fogginess and a lack of ambition. It's not seriously interferring with my job. I can still get things done, but I feel myself straining to remember certain things like dates, and I feel less secure about my memory, I seem to be more easily distracted as well. One thing that seems to increase my sense of alertness is exercise. After a little workout I feel much better. I'm going to continue exercising and hope that this fogginess goes away. Other people have written that it can take a few weeks, months, or years (yikes!) to get back to normal. Keep moving and don't give up!

 i have same problem  i end up rear ending a guy but at the same time i hit my head on the sterring colum, and i had short-term memorey loss, trying to remebering names little things i hate it. it was so hard and, i had whip flash also. I just hope it's not permnit for me  how can i fix it. sincerly love me tender

I was 8 years old when I was hit by a car while riding my bike home from school. I have no memory of my past but enjoy like to the fullest. Once in a while someone will say something that will trigger a thought or a memory.

Just for the record, I was in coma in Toronto Hospital for almost six months and when I awoke I had no recollection of the accident, I did not recognize my parents, friends or even myseld. I had to learn who my parents were and so on

I lost control of my car the other night on black ice' hitting into traffic lights and railings. I bumped my head very hard on the steering wheel' i was wearing my seat belt.  I had total memory loss but still managed to drive my car on 3 wheels for a least 5 mile without knowing! The police found me sat in my car round the corner from where i lived 12 yrs ago!! I cant remember even hitting the traffic lights never mind driving to where i was found' but i can remember everything before the accident ie; where i had been' i even remember travelling down the road towards the lights!! I was taken to hospital and stayed there for the night (No Xrays) just woken every hour and checked' sent home the next morning with 2 massive black eyes' a massive bump on my forehead and briusing to my chest.  Its been 3 days now since the accident and im suffering short memory lost' finding it very hard to concentrate on this typing' usually i would of typed this in seconds but it seems i cant even remember where the keys are!! If anyone else as ever had a similer incident please reply to my post. Thanks 

I am also very interested more information.  I too was in a car accident in March/07.  I was stopped at a red light when the van coming toward me in the oncoming traffic did not stop, she ran the red, hit the back end of the car pulling out on the green, causing the van to spin and slam into me.  Since then, I have been experiencing memory loss and forgetfulness.  It is very frustrating when you cannot remember from one minute to the next or where you even are when driving somewhere.  :(

soon2b,

 

I wish I was posting an answer for you, but I am hoping that either you have found an answer elsewhere, or someone new on this site may have one for us both.

 

I was involved in a car accident 6/22/09 and it has been less than two weeks but I'm finding my sympoms become more and more evident. Here's what happened:

 

I was stopped at a stop sign, and another sedan was stopped behind me. The third vehicle was the at fault, he didn't expect to stop, braked late, and hit the middle vehicle, which hit me. Luckily, I was the only one injured in the accident. My head hit the headrest pretty hard, and I felt some neck and back pain/tenderness but refused medical transport that day (I had my 3 year old son in tow). The next morning I absolutely had to go to the ER, was there for 5 hours and had an exam and x-rays. Doc said I had whiplash and a strange curvature in my neck, and sent me home with 10mg Flexeril and 600mg Ibuprofen every 8 hours.

 

Not only do I find that the medication is completely necessary, but I find I am having issues with short-term memory and depression. I'll admit, I've been depressed in the past, but before this accident I was doing so well, I wasn't nearly depressed.

 

I will continue my research, as I may be seeing a Neurologist if the Spine Center I visit today doesn't have any direction/answers for me. Good luck, and please update me if you learn anything helpful.