TEST CASE 1

Benjamin is a 28 year old single left hand dominant man who worked in a factory manufacturing
windows. 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 and
used his left hand to feed the saw with timber. He accidentally pulled the circular saw down on
his 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 pain
and discomfort and by the limited function of his hand. He was referred to a psychologist. He
continued 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 psychiatrist
and placed on antidepressant medication.

SUBSEQUENT WORK HISTORY

He returned to work after six months and was very apprehensive about going back into the
workplace. 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 to
work especially when he could hear the sound of machinery. He was embarrassed about the
appearance 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 because
he is left hand dominant. He continues to be embarrassed by the appearance of the hand and
conceals his hand as much as possible.
He has developed a fear of saws and power equipment. He is jumpy and on edge and easily
startled. He has nightmares and flashbacks to the accident at least weekly and he does not like
watching 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 his
time in his room. His self-esteem and self confidence has dropped. He has not been able to
resume playing sport. He continues to see his psychologist weekly and his psychiatrist every
month. He takes medication for pain, anxiety and depression. He has been drinking more
alcohol 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 the
interview. His hand is significantly disfigured. Initially he talks in a matter-of-fact way about
his injury and the consequences of the injury. There is no evidence of any psychosis or delusions
or hallucinations. He becomes tearful during the course of the interview when describing his
future. He cannot remember significant details of the accident. He has difficulty preventing
intrusive 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 the
managing 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 and
attempting to touch her breasts. He was also making sexually suggestive remarks, asking about
her sex life and telling her about his own sex life. On several occasions she asked him to stop
this 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 anything
and told her that he would blame her for pursuing him. Over the next few weeks he did not
speak 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 broke
down 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 anti
depressant medication and continues to use that medication. She feels there has been little real
change 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 on
the family changing their clothing when they come home. She has problems with memory and
concentration and continually ruminates about what happened at work. She has nightmares and
flashbacks 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 coming
towards 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 difficulty
with motivation and spends much of her time in bed. She has begun believing that her husband
may 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

She came into the interview with her husband carrying a bottle of water. She appeared to be
hyperventilating during the interview. She was highly anxious and jumping from one subject to
another. She was tearful when describing the assault. She blamed herself for not having dealt
with the situation better. She was wearing casual clothing and appeared unkempt. She held onto
her husband’s hand throughout the course of the interview. She appeared miserable and
depressed.

TEST CASE 3

Eric is a 27 year old ex-motor mechanic who lives in supported accommodation. He had been
living with his parents and is single.

THE ACCIDENT

He was involved in a transport accident four years ago. He was a front seat passenger wearing a
seatbelt in a car being driven by a friend. That had both been drinking during the evening. The
car ran into a tree. His friend was killed. He suffered serious head injuries and a fractured right
femur.

HOSPITAL TREATMENT

He had surgical treatment for the fractured femur. He was transferred to a rehabilitation hospital.
He remained in post traumatic amnesia for seven weeks. He had significant problems with
balance and was slow and very confused. He slowly improved at the rehabilitation hospital but
reached a plateau after four months and there has been little change since then.

SUBSEQUENT PROGRESS

He returned to live with his parents but they had difficulty coping with his behaviour. He was
erratic, abusive and had difficulty managing his finances. He attempted a return to work but was
unable to cope despite support from his boss. He was unmotivated and had forgotten how to do
most of the procedures he already knew and needed constant supervision and made a number of
expensive mistakes. He ceased work and has not been back to work since then. He remained in
his room and was not showering or changing his clothing. His case manager arranged for him to
move to supported accommodation where he has cares for two hours a day and his finances are
managed by the Guardianship Board.

CURRENT CONDITION

He has gained a good deal of weight and spends most of his days in his room watching television
and DVDs. He has difficulty following conversations and forgets words. He has to be reminded
to shower, shave and change his clothing. He has to be supervised when he is cooking because
he forgets to turn off the stove and taps. He has not returned to driving. He has no friends. He
smokes excessively and there are concerns about him causing fires with his cigarettes. He drinks
to excess at times. He has no memory of the accident but continues to be very anxious when
travelling by car. He is upset seeing or hearing accidents on television. He has been upset by the
death of his friend.

MENTAL STATE EXAMINATION

He was a short obese young man who was accompanied by his carer. He could remember little
about his past before the accident. He spoke slowly in a dull monotone and seemed to forget
where he was. He had difficulty finding words. He was not orientated in time or place. He
walked slowly with a slightly ataxic gait. He complained of pain at the fracture site when the
weather changed. He was at times inappropriately laughing and disinhibited. He did not
complain of depression.

TEST CASE 4

Fred is a middle aged divorced man living in a stable defacto relationship who had worked in a
number of different jobs in the past including real estate, financial management, and had a
background in banking. He had started his own import business which had done very well at
first before he was undercut by competitors and a major customer became bankrupt owing him
more than $100,000. He became quite desperate and for several months was able to ward off
bankruptcy by borrowing extensively and was cutting his prices to retain customers and to move
stock.

THE INJURY

He was declared bankrupt and his house was sold. His partner remained supportive and they
were forced to move to a rented flat. He had been extremely active until the bankruptcy when he
fell in a heap. His long term general practitioner was very concerned by the change in is
behaviour. He was placed on antidepressant medication but refused to take this. He spent his
days in bed, he could not sleep at night, he lost interest in his grooming and had no libido. He
was drinking heavily and at times gambling unwisely. His WorkCover claim was accepted. He
had no other source of income.

SUBSEQUENT PROGRESS

There has been little change in his condition. He has refused to take antidepressant medication
and has not wanted to see a psychologist or psychiatrist. There has been some talk about
separating from his partner.

CURRENT CONDITION

He had gained a good deal of weight and was comfort eating. He had difficulty sleeping and was
resting during the day. He did not seem interested in his appearance. He did not want to see his
children and was irritable with them. He was irritable with his partner at times although she was
very understanding and supportive. She became frustrated by his continual ruminations about
the business failure. He did some housework, cooking and shopping. He continued to look after
the family finances. He continued to gamble to excess at times and was drinking heavily
occasionally. He avoided social outings and felt ashamed of his financial failure. He drove
locally most days. He became tearful at times.

MENTAL STATE EXAMINATION

He was a heavyset short bald man who was unshaven and appeared dishevelled. He had a
sombre manner and was sighing repeatedly. He spoke in a monotone. He gave a confused
history and at times was unresponsive to questions that were asked. He seemed to be ruminating
about his business failure and was preoccupied with his financial concerns. He was irritable at
times during the interview. He appeared well orientated to time, place and person and there was
no evidence of any psychotic features. He described himself as having always been cheerful and
optimistic in the past.

TEST CASE 5

Harry is a 34 year old formwork carpenter living with his girlfriend. He had enjoyed motorcycle
riding, hunting, fishing and water sports. There had been no personal or family history of any
physical or mental illness.

THE INJURY
He slipped and fell two metres from scaffolding banging his head against a brick wall and
landing awkwardly on some concrete rubble. He was in severe back pain and could not stand.
He was shocked and shaken and taken by ambulance to hospital.

HOSPITAL TREATMENT

He had a number of investigations and was kept in a hospital as there were several vertebral
fractures. He was treated with analgesic medication and became acutely psychotic and was
paranoid, delusional and actively hallucinating. He was treated with anti psychotic medication .
He was discharged home after three weeks bed rest during which time his psychotic symptoms
were still present but had diminished. He was referred to the psychiatric department at the
hospital and continued to be reviewed by that department.

He also had physiotherapy once his fractures healed.

SUBSEQUENT PROGRESS

He continued to complain of mid thoracic back pain but had no radiation of pain. His back was
stiff and he had difficulty bending and lifting and problems with sleep. The major concern was
that he continued to be psychotic and he delusions, hallucinations, and ideas of reference. On
several occasions he attempted suicide and was hospitalised. He gained a good deal of weight.
He became morose and spent most of his time lying on the couch. He had not returned to work.
He continued to have regular psychiatric treatment.

MENTAL STATE EXAMINATION

He was accompanied to the interview by his girlfriend. He appeared withdrawn and suspicious.
He kept looking around the consulting room and at one stage asked if the interview was being
recorded. He sat away from the window. He was distracted and appeared to be responding to
internal stimuli. He was able to give account of his injury. He was able to give a good account
of his physical symptoms and continued to complain of pain with restricted movement of the
back and limitation in his activities. He admitted to experiencing persecutory command
hallucinations telling him to harm himself. He avoided watching television because messages
were being passed to him through the television set. He was uneasy walking down the street as
he felt people could read his thoughts. He was orientated to time, place and person. He was
depressed about his condition. He was using antidepressant medication, anti psychotic
medication, and analgesics. He had stopped having physiotherapy. He saw his psychiatrist every
month. The CAT team had been involved in the past.