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Case study 24 - psychiatric injury

Introduction

The claimant was involved in a rear end motor vehicle accident (MVA) resulting in neck and lower back pain.  A GP review resulted in prescription of analgesic medication and physiotherapy treatment.

The claimant did not return to work due to pain which caused financial problems.  This caused anxiety and arguments with the claimant’s partner. The claimant had one consult by a psychiatrist for symptoms of stress, depression and sleeping issues and was prescribed medication.

The Medical Assessment

The claimant was assessed approximately 9 months after the MVA.  The claimant reported ongoing pain, mostly in the lower back.  Mood was reported as being poor and sad, with mood becoming progressively worse associated with increasing frustration during the day.

The claimant was concerned with persistent symptoms of pain; they thought only of the accident when they drove.  No description of intrusive or recurrent memories of the accident or flashbacks. They remained cautious with driving, and upset about inability to work and earn money.

Clinical examination

Mental state examination

Well groomed, no demonstrated psychomotor agitation or retardation.  Sad affect during the interview.

No evidence of delusions, hallucinations or disorder of thought form.  No reported symptoms consistent with Posttraumatic Stress Disorder. Some reported feeling of hopelessness, denied suicidal ideation.

Cognitive function was intact, with fair insight and judgement.

Current Functioning

  • Shower and dress – not daily
  • Enjoys food and eats regularly
  • Visited friends less often and enjoyed their company less
  • Drives locally
  • Live with partner but argues more
  • Watches less TV and has lost interest in sports
  • Has not returned to work due to chronic pain

Summary of Documentation

No specific psychological or psychiatric reports.

Diagnosis

Adjustment Disorder with depressed mood, on the background of chronic pain.  The claimant’s symptoms do not support a diagnosis of Major Depressive Episode.

Minor Injury

Section 1.6(3) of the Act:

A Minor psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.

Part 1 clause 4 (2) of the Motor Accident Injuries Regulation 2017:

2) Each of the following injuries is included as a minor psychological or psychiatric injury for the purposed of the Act

a) acute stress disorder

b) adjustment disorder

3) In this clause, acute stress disorder and adjustment disorder have the same meaning as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

The following injury is a minor injury

  • An Adjustment Disorder with depressed mood