Dr Neil Holden - QBE

MECHANISMS OF STRESS-RELATED ILLNESS TYPE A PERSONALITY PRESSURE OF WORK MANAGEMENT PRESSURE HARRASSMENT/BULLYING ACCIDENTS/ASSAULTS AT WORK FATALITIES IN THE COURSE OF WORK2

TYPE A PERSONALITY ‘THE DRIVEN PERFECTIONIST SELF-INDUCED STRESS PREVENTIVE ROLE OF MANAGEMENT LEADS TO FIBROMYALGIA/ANXIETY/DEPRESSION3

PRESSURE/HARRASSMENT FAILURE TO COPE WITH ABNORMALPRESSURES LEADS TOFIBROMYALGIA/ANXIETY/DEPRESSION4

ACCIDENTS AT WORK/FATALITIES ACUTE PSYCHOLOGICAL SHOCK POST-TRAUMATIC STRESS DISORDER ADJUSTMENT DISORDERS DEPRESSIVE DISORDERS ANXIETY STATES5

DIAGNOSES OF STRESS REACTIONS NB. MENTAL ILLNESS IS PROBABLY ACONTINUUM6

ACUTE PSYCHOLOGICAL SHOCK A NORMAL REACTION IN ANABNORMAL SITUATION SHAKING/PALPITATION/JELLYLEGS/NAUSEA/VOMITING LASTS AROUND 48 HOURS MAY BE DELAYED7

POST-TRAUMATIC STRESS DISORDER LIFE-THREATENING EVENT INCREASED AROUSAL AVOIDANCE HYPERVIGILANCE RELIVING EXPERIENCES8

ADJUSTMENT DISORDERS NORMAL OR ABNORMAL? TIME LIMITATION9

DEPRESSION NOT JUST MISERY OR SADNESS ABNORMAL QUALITY OR SEVERITY USUALLY BIOLOGICAL SYMPTOMS ‘REACTIVE’ OR ‘ENDOGENOUS’10

ANXIETY TYPICAL CORE SYMPTOMS PANIC PHOBIC OBSESSIVE COMPULSIVE11

FIBROMYALGIA SOMATOFORM DISORDER FLITTING ACHES AND PAINS CHRONIC FATIGUE TREATMENT ISSUES ? CAUSATION12

Somatoform/PsychosomaticDisorders• Fibromyalgia• Chronic Fatigue Syndrome• Irritable Bowel syndrome• Atypical facial pain• Pelvic Congestion Syndrome• Repetitive Sprain Injury• etc13

PSYCHOLOGIST OR PSYCHIATRIST? Psychologist Psychiatrist Primary Qualification Psychology Degree (3y) Medical Degree(5-6y)Secondary QualificationClinical Psych Diploma(3y)Post-grad psychiatry(6y) Expertisemeasurementphenomenologypsychotherapydrug treatmentpsychotherapies Particular strengths Neuropsych assessment psychiatric illness Origins Based in research clinical med practicephilosophy14

PHENOMENOLOGICAL APPROACH v. CRITERIAAPPROACH Checklists offer black/white answers andtherefore, at face value has an advantage for theBritish Judicial system. Seems like hard evidence,but not validated for the purpose of litigation.Litigants can still exaggerate to support their claim. Phenomenological approach uses searchingsupplementary questions to seek out the truenature of the symptom, rejecting the symptomsclaimed by the patient but not truly experienced15

EXAMPLES OF COMMONLY USEDSCALES PTSD CHECKLIST BECK HOROWITZ IMPACT OFEVENT SCALE16

TREATMENT ISSUES(1) ANTIDEPRESSANTS COGNITIVE BEHAVIOUR THERAPY/EMDR REHABILITATION MEASURES17

TREATMENT ISSUES(2) EARLY ACCEPTANCE OF THE NEED FORTREATMENT ANTIDEPRESSANTS - ? NO COST COST OF CBT - £120 assessment and £100per session thereafter - Usually 6-12 sessions. WOULD IT BE WORTH OFFERINGTREATMENT ROUTINELY?18

TREATMENT ISSUES(3) BUT ?LIKELIHOOD OF FAILUREWITH LITIGATION ONGOING LOSS OF EVIDENCE FROMGP NOTES19

REHABILITATION EARLY ENGAGEMENT WITH CARING HRAPPROACH/OCCUPATIONAL HEALTH GRADED RETURN TO WORK EARLY RESOLUTION/CLOSURE OF ISSUES A LITTLE EARLY GENEROSITY COUNTERSA LOT OF LATER ANGER20

FUNCTIONAL OVERLAY AND HOW TO SPOTTHE MALINGERER DIFERENTIAL DIAGNOSISMALINGERING – CONSCIOUS ELABORATION FOR FINANCIALGAINFACTITIOUS ILLNESS - CONSCIOUS ELABORATION FOR ITSOWN SAKEFUNCTIONAL OVERLAY – SUBCONSCIOUS OR CONSCIOUSEXAGGERATIONHYSTERIASOMATISATIONSICK ROLE BEHAVIOUR21

METHODS OF DETECTING CONSCIOUSEXAGGERATION• INCONSISTENT OBJECTIVE RECORDS• VAGUE AND INTERNALLY INCONSISTENTACCOUNTS• VIDEO SURVEILLANCE• EXAMINATION – ILLNESS BEHAVIOUR MENTAL STATE COGNITIVE STATE e.g. Concentration, immediate recall, STmemory22