Case Vignettes

Case vignette 1Case vignette 2Case vignette 3Case vignette 4Case vignette 5Case vignette 6Case vignette 7
A 40-year-old woman with complaints of unexplained weight loss and difficulty maintaining sleep.

She recently noticed a sense of being easily overwhelmed by day to day events. She noticed high levels of ‘worry’. This was diagnosed as Generalised Anxiety Disorder. The appropriate diagnosis leads to therapy and provision of strategies to reduce the worries and the associated anxiety. The medication review was also helpful to reduce the worries.

A 35-year-old man with long history of temperamental problems reports difficulty tolerating people in general.

He becomes easily angered sometimes for trivial reasons causing disruption to his relationships. On assessment reported his thoughts run a million miles an hour in an episodic fashion. He was assessed to have Bipolar Mood Disorder after several assessments. He showed dramatic improvement on treatment with lithium.

A 46 year old truck driver suffered a massive cardiac arrest. He claimed permanent injury through his superfund for total permanent disability.

A 46 year old truck driver suffered a massive cardiac arrest. He underwent triple bypass surgery. He was generally a robust person; however his energy levels declined gradually after the accident. He spent the next 6 months in bed. He started believing that he had no energy left due to his decreased cardiac function. His cardiologist believed that the degree of cardiac injury did not explain his degree of impairment.

The truck driver claimed permanent injury through his superfund for total permanent disability. He was referred to IME. During the IME it was noted that he suffered from adjustment disorder.
An appropriate attribution was made for the adjustment disorder. Treatment was initiated. Afterwards it was observed that the treatment uplifted his energy, mood and capacity.

A 32-year-old woman, working as a receptionist in a federal government office, lodged work injury claim for bullying and harassment.

A 32-year-old woman, working as a receptionist in a federal government office, lodged work injury claim for bullying and harassment. The claim was complicated as the claim originated within a few months of her having her first baby.

During the independent medical examination it became clear that she was suffering from postnatal depression before and during the period of the alleged bullying and harassment. Although there were industrial issues, these did not fully explain the extent of depression

During the IME it was noted that, the recovery was delayed due to excessive focus on the industrial issues and lack of adequate treatment of her postnatal depression. The independent medical examination revealed the diagnosis of postnatal depression.

It was observed that the claimant had increased interpersonal sensitivity, which partly explained the difficulty that she had in managing workplace relationships. Based on IME recommendations adequate treatment with antidepressants was initiated, which led to reduction in interpersonal sensitivity. This allowed her to mediate new industrial arrangements.

She returned to work within a few months of the initiation of treatment.

A 45-year-old University lecturer claimed ‘income protection insurance’ due to depression caused by increasing workload issues.

A 45-year-old University lecturer claimed ‘income protection insurance’ due to depression caused by increasing workload issues. She claimed that she was ‘permanently impaired’ as return to work would lead to relapse of Depression.

An independent medical examination was organised to look at her levels of impairment and whether she was permanently impaired.

On careful examination and history, it was revealed that she had pre-existing episodes of depression in the past in the context of increased work load, and that she had recovered from those episodes successfully. In addition, she also suffered from chronic inflammatory bowel disease as well as diabetes.

An independent medical examination led to the assessment that she had a pre-existing condition and capacities to cope with the university work were adequate. Modifications were recommended and she was certified fit to return to work.

A 23 year old nurse is ‘notified’ to nursing registration authority due to possible impairment of her capacity from illicit drug use.

A 23 year old nurse is ‘notified’ to nursing registration authority due to possible impairment of her capacity from illicit drug use. There are issues related to amphetamine binges and non-performance at work place. An IME is organised to better understand the impact of drug use on her capacity to practice nursing ‘safely’.

The IME clarifies that she has background personality issues which explain the motivations for the drug use .Furthermore, a comprehensive recommendations are made to address both the personality and drug abuse issues. The IME also recommended the most realistic drug monitoring protocols.

A 50-year-old tax office worker, who had difficulties in arriving at work on time.

A 50-year-old tax office worker had difficulties in arriving at work on time. which was slowly decreasing his work performance. This eventually led to performance issues on her work output. Subsequently, this led to increased levels of supervision. After a few years of non-improvement of work performance, ‘fitness of duty’ concerns were raised.

In the due course, an independent medical examination was organised. It was suspected that she had clinical depression and hence faced difficulties with waking up in the morning. This led to non-performance at work. In addition, she had not responded well to psychiatric treatment and psychological counseling.

Independent medical examination ascertained the levels of depression and reasons for non-performance at work. However, on careful history taking and analysis of the mental state, it turned out that she was not clinically depressed. Her fatigue and lack of sleep were related to primary insomnia and sleep apnoea syndrome. The diagnosis of which had been missed for years.

The above understanding led to appropriate referral to sleep physician and ENT surgeon for correction of the problem.