Embed Doc
Copy Link
Readcast
Collections

CommentGo Back

Download

TEST CASE 1

Benjamin is a 28 year old single left hand dominant man who worked in a factory manufacturingwindows. He lived with his parents. He socialized with friends.

THE INJURY

He was injured when using a circular saw. He controlled the circular saw with his right hand andused his left hand to feed the saw with timber. He accidentally pulled the circular saw down onhis first three fingers of his left hand and partially amputated his second and third fingers and badly injured his thumb. He was horrified to see the damage to his hand.

INITIAL TREATMENT

He was taken to a nearby hospital and he has had several operations on his fingers since then.

SUBSEQUENT PROGRESS

He had nightmares and flashbacks to the accident and was frustrated and upset by ongoing painand discomfort and by the limited function of his hand. He was referred to a psychologist. Hecontinued to have hand therapy for six months but reached a plateau where there was no further improvement. His psychological symptoms persisted and he was also referred to a psychiatristand placed on antidepressant medication.

SUBSEQUENT WORK HISTORY

He returned to work after six months and was very apprehensive about going back into theworkplace. He was placed in the office by had difficulty coping with that because of his lack of experience and interest. He avoided going into the factory itself and was uneasy when going towork especially when he could hear the sound of machinery. He was embarrassed about theappearance of his hand and concealed his hand as much as possible. He ceased socialising.

CURRENT CONDITION

He has been left with a disabled and disfigured left hand and is limited in what he can do becausehe is left hand dominant. He continues to be embarrassed by the appearance of the hand andconceals his hand as much as possible.He has developed a fear of saws and power equipment. He is jumpy and on edge and easilystartled. He has nightmares and flashbacks to the accident at least weekly and he does not likewatching people working in dangerous situations.He is miserable, frustrated, irritable, agitated and unsociable. He is frightened for his future .He has always done physical work and he is not sure about retraining.

He continues to live with his parents and has become socially isolated and spends most of histime in his room. His self-esteem and self confidence has dropped. He has not been able toresume playing sport. He continues to see his psychologist weekly and his psychiatrist everymonth. He takes medication for pain, anxiety and depression. He has been drinking morealcohol and smoking more cigarettes.

MENTAL STATUS EXAMINATION

He is a gaunt thin man who looks older than his stated age. He conceals his hand during theinterview. His hand is significantly disfigured. Initially he talks in a matter-of-fact way abouthis injury and the consequences of the injury. There is no evidence of any psychosis or delusionsor hallucinations. He becomes tearful during the course of the interview when describing hisfuture. He cannot remember significant details of the accident. He has difficulty preventingintrusive thoughts about the accident. He is upset with reminders of the accident.

TEST CASE 2

Diana is a 35 year old married woman with two children who has worked as a secretary for themanaging director of a small company. She was there for two years. He sexually harassed her soon after she started. The harassment consisted of touching her buttocks, brushing past her andattempting to touch her breasts. He was also making sexually suggestive remarks, asking abouther sex life and telling her about his own sex life. On several occasions she asked him to stopthis behaviour but there was no change. There was no personal or family history of physical or psychological illness.

THE INJURY

The injury occurred eighteen months ago when her boss asked her to work back near the end of the financial year. He came into her office, locked the door and attempted to embrace her. She pushed him away and left. The next day he threatened her with dismissal if she said anythingand told her that he would blame her for pursuing him. Over the next few weeks he did notspeak to her directly, he was rude and abusive. She was dreading going to work, not sleeping,losing weight and felt nauseated. She began experiencing panic attacks. One morning she brokedown in tears and saw her general practitioner and was placed off work and referred to a psychologist.

SUBSEQUENT PROGRESS

She has remained off work since then. Her husband has been supportive. She was placed on antidepressant medication and continues to use that medication. She feels there has been little realchange in her symptoms since she stopped work.

CURRENT SYMPTOMS

She has lost weight and has difficulty sleeping and wakes up feeling unrefreshed. She has become very fearful and has to check and recheck to make sure doors and windows are locked.She keeps all the blinds closed during the day. She washes her hands repeatedly. She insists onthe family changing their clothing when they come home. She has problems with memory andconcentration and continually ruminates about what happened at work. She has nightmares andflashbacks to the apparent assault. She wakes up in a panic at night. During the day she becomes fearful when she sees trees moving and has a brief illusion that someone is comingtowards the house.She continues to have frequent panic attacks and is fearful leaving the house. She blames herself for what happened and talks about suicide. She is lethargic and withdrawn. She has difficultywith motivation and spends much of her time in bed. She has begun believing that her husbandmay be involved in another relationship although he denies this and she believes his denials but becomes very fearful when he is home late from work for any reason.

MENTAL STATE EXAMINATION