Presenting concerns

Marcus arrived on time and was forthcoming about the last six weeks. He describes waking at roughly 3am most nights and being unable to settle again, then feeling wired and flat by mid-afternoon. He no longer plays in the Thursday league he joined in 2023 and has stopped cooking, which he previously enjoyed.

He reports two episodes in the past month with chest tightness, shortness of breath and a sense that something was badly wrong; both resolved within twenty minutes. Appetite has dropped and he estimates losing 4kg without trying. He has been checking his pulse several times an hour.

Impact on functioning

He has missed three deadlines at work and describes falling behind on admin at home. His partner has noticed him withdrawing in the evenings. He has not told his manager, and while they speak most days, he has not raised it with his brother either — he links this to embarrassment and a sense that he should be managing better.

No current thoughts of self-harm. Denies alcohol use beyond one or two drinks on weekends. Sleep hygiene reviewed briefly; he keeps his phone on the bedside table and reads news after waking.