Ms. Meyers Case Study Answers
MENTAL STATE EXAMINATION AND INTERVIEW:
On examination, Ms Meyers presented with long blond hair held back in a pony tail. She had evident scars on her upper back and arms with vivid tattoos on her right forearm and right lower leg. There were remnants of nail polish evident. She looked older than her stated age.
She complained of discomfort in her lower back. She was an animated historian who gave a detailed and expansive history of her perspective on her current difficulties. There was no evidence of psychomotor retardation. She was not agitated. She did complain of lower back pain but was able to sit throughout a length interview. Her affect was reactive. She evidenced no emotional distress. Her affect was incongruent to hr mood which she described as depressed and anxious.
I note that her attention and concentration was satisfactory at the course of a lengthy interview but I do note that Ms Meyers struggled with specificity of dates.
Her executive cognitive functions were intact.
She impressed as a woman of low to average intelligence. She did not impress as a particularly psychologically …show more content…
sophisticated woman.
I note her premorbid personality traits of perfectionism as still evident as given by her description of her difficulties at home with her daughters and the arguments around house work.
SECTION C: DIAGNOSIS
In my opinion, Ms Meyers presents with a chronic adjustment disorder with mixed anxiety and depressed mood. The differential diagnoses to consider are a major depressive disorder or pain disorder associated with a psychological condition and a general medical condition.
I note that a commentary has been made by various orthopaedic surgeons as to the disparity between the pathology and her response to the pain which is suggestive of a maladaptive response to a chronic physical injury. I note Ms Meyers' history of pre-existing perfectionistic personality traits and her more recent history of a pattern of avoidant coping.
I note that she has a significant longitudinal history of both depression and anxiety as recorded in her general practitioner's notes with episodes of depression and anxiety recorded in 2004, 2008 and 2011. I note her pre-existing history of neck pain dating back to 2007 and neck and back pain recorded dating back to 2011. I note that she was being prescribed narcotic medications for pain management in February 2011. I note that her general practitioner records that she had been intolerant of antidepressant medications in the past but had had some success when she was a psychologist in 2008.
I note that in her interview with me Ms Meyers did not report any pre-existing psychiatric history prior to the aftermath of the incident on 23 October 2012. This mirrors her failure to report any previous psychiatric history to colleagues, Dr Braganza, Dr McAulay and Dr Wittington. I note that Dr Stratton did not record whether or not Ms Meyers had any previous psychiatric history. This failure to report her pre-existing psychiatric history may have been deliberate but may have also reflected Ms Meyers' fixed focus on the incident of October 2012 as the primary causation of all of her subsequent psychological difficulties.
I note that there have been a significant number of aggravating factors after the driving incident.
Ms Meyers was unhappy with a suggestion that she retrain, felt that she was disrespected and treated poorly by colleagues when she went into alternative duties, alleges that one of her supervisors was intimidating in a way he treated her when discussing the need for retraining, believes that she was misdiagnosed by the initial independent medical examiner and believes that as a consequence of that alleged misdiagnosis that her orthopaedic condition has worsened. There is then material that suggests that her relationship with her partner began to deteriorate very rapidly and Dr Wittington notes the upset and hurt that Ms Meyers felt when her partner did not consider that she was well enough to work and would not put her name forward for various
positions.
Finally I note that there has been ongoing tension and difficulty with Ms Meyers and her children, she reports a feeling of guilt that she has become so dependent on them, fear that they may abandon her and stressed and strangled in the relationship given her [unclear] and demands that they manage the household according to her level of satisfaction.
SECTION D: QUESTIONS
Therefore, in response to your questions, I am able to provide the following answers:
1. What are the circumstances of the accident as described to you by the claimant? Is the mechanism of injury consistent with the psychological symptoms allegedly suffered by the claimant?
The circumstances of the accident as described by Ms Meyers are detailed in the body of my report. In my opinion, the psychological symptoms allegedly suffered by the claimant are not consistent with the mechanism of injury as presented by her to me. Ms Meyers asserts that all of her psychological symptoms are sequelae of the accepted work-based accident. In my opinion, there are a number of other significant contributing factors which explain the persistent nature of her disorder.
2. Does the claimant suffer from a psychological or psychiatric condition? If so, what is the nature, extent and consequences of such condition and does this condition arise from the alleged driving event at work on 23 October 2012? What in your view is the relevant psychiatric diagnosis related to the alleged event of 23 October 2012?
In my opinion, the most likely diagnosis for this lady is an adjustment disorder with mixed anxiety and depressed mood. It could also be argued that she has a comorbid DSM-V diagnosis of somatic symptom disorder, with predominant pain, persistent in nature. An adjustment disorder is diagnosed when an individual develops emotional behavioural symptoms in response to an identifiable stressor occurring within three months of the onset of that stressor. The symptoms or behaviours are clinically significant as evidenced by marked distress that is [unclear] proportion to the severity or intensity to stressor, taking into account the external context and cultural factors that might influence symptom severity and presentation and the symptoms are causing significant impairment in social, occupational or other important areas of functioning. A somatic symptoms disorder is diagnosed if one or more somatic (i.e. physical) symptoms that are distressing or result in significant disruption of daily life associated with the diagnosis are obsessive thoughts, feelings or behaviours related to the somatic symptoms or associated with health concerns as manifested by at least one of the following:
On examination, Ms Meyers presented with long blond hair held back in a pony tail. She had evident scars on her upper back and arms with vivid tattoos on her right forearm and right lower leg. There were remnants of nail polish evident. She looked older than her stated age.
She complained of discomfort in her lower back. She was an animated historian who gave a detailed and expansive history of her perspective on her current difficulties. There was no evidence of psychomotor retardation. She was not agitated. She did complain of lower back pain but was able to sit throughout a length interview. Her affect was reactive. She evidenced no emotional distress. Her affect was incongruent to hr mood which she described as depressed and anxious.
I note that her attention and concentration was satisfactory at the course of a lengthy interview but I do note that Ms Meyers struggled with specificity of dates.
Her executive cognitive functions were intact.
She impressed as a woman of low to average intelligence. She did not impress as a particularly psychologically …show more content…
sophisticated woman.
I note her premorbid personality traits of perfectionism as still evident as given by her description of her difficulties at home with her daughters and the arguments around house work.
SECTION C: DIAGNOSIS
In my opinion, Ms Meyers presents with a chronic adjustment disorder with mixed anxiety and depressed mood. The differential diagnoses to consider are a major depressive disorder or pain disorder associated with a psychological condition and a general medical condition.
I note that a commentary has been made by various orthopaedic surgeons as to the disparity between the pathology and her response to the pain which is suggestive of a maladaptive response to a chronic physical injury. I note Ms Meyers' history of pre-existing perfectionistic personality traits and her more recent history of a pattern of avoidant coping.
I note that she has a significant longitudinal history of both depression and anxiety as recorded in her general practitioner's notes with episodes of depression and anxiety recorded in 2004, 2008 and 2011. I note her pre-existing history of neck pain dating back to 2007 and neck and back pain recorded dating back to 2011. I note that she was being prescribed narcotic medications for pain management in February 2011. I note that her general practitioner records that she had been intolerant of antidepressant medications in the past but had had some success when she was a psychologist in 2008.
I note that in her interview with me Ms Meyers did not report any pre-existing psychiatric history prior to the aftermath of the incident on 23 October 2012. This mirrors her failure to report any previous psychiatric history to colleagues, Dr Braganza, Dr McAulay and Dr Wittington. I note that Dr Stratton did not record whether or not Ms Meyers had any previous psychiatric history. This failure to report her pre-existing psychiatric history may have been deliberate but may have also reflected Ms Meyers' fixed focus on the incident of October 2012 as the primary causation of all of her subsequent psychological difficulties.
I note that there have been a significant number of aggravating factors after the driving incident.
Ms Meyers was unhappy with a suggestion that she retrain, felt that she was disrespected and treated poorly by colleagues when she went into alternative duties, alleges that one of her supervisors was intimidating in a way he treated her when discussing the need for retraining, believes that she was misdiagnosed by the initial independent medical examiner and believes that as a consequence of that alleged misdiagnosis that her orthopaedic condition has worsened. There is then material that suggests that her relationship with her partner began to deteriorate very rapidly and Dr Wittington notes the upset and hurt that Ms Meyers felt when her partner did not consider that she was well enough to work and would not put her name forward for various
positions.
Finally I note that there has been ongoing tension and difficulty with Ms Meyers and her children, she reports a feeling of guilt that she has become so dependent on them, fear that they may abandon her and stressed and strangled in the relationship given her [unclear] and demands that they manage the household according to her level of satisfaction.
SECTION D: QUESTIONS
Therefore, in response to your questions, I am able to provide the following answers:
1. What are the circumstances of the accident as described to you by the claimant? Is the mechanism of injury consistent with the psychological symptoms allegedly suffered by the claimant?
The circumstances of the accident as described by Ms Meyers are detailed in the body of my report. In my opinion, the psychological symptoms allegedly suffered by the claimant are not consistent with the mechanism of injury as presented by her to me. Ms Meyers asserts that all of her psychological symptoms are sequelae of the accepted work-based accident. In my opinion, there are a number of other significant contributing factors which explain the persistent nature of her disorder.
2. Does the claimant suffer from a psychological or psychiatric condition? If so, what is the nature, extent and consequences of such condition and does this condition arise from the alleged driving event at work on 23 October 2012? What in your view is the relevant psychiatric diagnosis related to the alleged event of 23 October 2012?
In my opinion, the most likely diagnosis for this lady is an adjustment disorder with mixed anxiety and depressed mood. It could also be argued that she has a comorbid DSM-V diagnosis of somatic symptom disorder, with predominant pain, persistent in nature. An adjustment disorder is diagnosed when an individual develops emotional behavioural symptoms in response to an identifiable stressor occurring within three months of the onset of that stressor. The symptoms or behaviours are clinically significant as evidenced by marked distress that is [unclear] proportion to the severity or intensity to stressor, taking into account the external context and cultural factors that might influence symptom severity and presentation and the symptoms are causing significant impairment in social, occupational or other important areas of functioning. A somatic symptoms disorder is diagnosed if one or more somatic (i.e. physical) symptoms that are distressing or result in significant disruption of daily life associated with the diagnosis are obsessive thoughts, feelings or behaviours related to the somatic symptoms or associated with health concerns as manifested by at least one of the following: