ptsd

PTSD is a compensable Occupational Disease if it is caused by

2 factors

Work related Traumatic event

Significantly Affects ability to work

Define Causality and

3 conditions

Relationship between cause and effect

Causal event is significant and probable to result in an effect and that person has that effect

= Significant Traumatic work event leads to PTSD experienced by the affected worker

Management

1. Immediate (3)

2. What happens post referral

3. What is the multidisciplinary approach here and the roles?

   Two role players and what they do

1.Post crises incident management

2.Initial assessment

3.Refer to psychiatrist within 3 months

Psychiatrist referral

Diagnosis is confirmed DSM 5

Psychiatrist initiates medication- only SASOP drugs allowed, review, monitoring

Multidisciplinary approaches

Psychotherapy by psychologist

Includes cbt, cpt, EMDR,, prolonged exposure

OT , workplace accommodations, RTW, multidisciplinary approaches, patient education and informed consent

Critical incident stress Management

1. Also known as

2. Purpose

Immediate psychological first aid

Gold standard for immediate post incident care

Can prevent PTSD development through early intervention

Typical Sequence of management after an incident

CISM

Refer to psychiatrist within 3 months

Evidence based pyschotherapy

Role of Psychiatrist

Makes diagnosis, plans treatment monitors, report to fund, expert medico legal opinion

Role of Psychologist

Psychotherapy

CBT, CPT, EMDR, Prolonged exposure

Define Significant Traumatic Event (5)

Exposure Linked to

Death

Serious injury

Sexual violence

Outside of range of usual human experience and makes majority of people distressed

Which criteria used to make the Diagnosis?

Who makes the diagnosis?

What time frame should referral be made?

Use evidence based DSM V criteria

Should be referred to a psychiatrist within 3 months for assessment and diagnosis

Diagnosis requires: NB don't only mention symptom criteria

1. Exposure to stressor (direct, indirect,witness, not media)

2. Typical symptoms of intrusion, avoidance, alterations in arousal and reaction,and negative cognitive function

3. Symptoms must persist for more than 1 month

4. Social and occupational function impacted

5. Not due to other causes such as substance, medicine etc

Mnemonic: Trauma1

T= Traumatic exposure

R= Re experience

A= Avoidance

U and M= unable to feel positive, memory/cognitive

A- Arousal

1 - 1 month

Depersonalization and de realization are also symptoms of ptsd

True

Depersonalization= detached, outside observer

Derealization= unreal experience, distorted

Define an Occupational disease

Arises in and out of the course of employees employment

Has a causal association with work and the employee contracted it because of their work

Compensable PTSD

Occupational injury or disease

Traumatic event is thus an accident or series of accidents

Only eligible for compensation if

3 points

1. Timeous submission

2. Occupational disease criterion

3. Significant event

If submitted within 1 year of diagnosis

PERTINENT WORK RELATED TRAUMA

AROSE OUT OF AND IN THE COURSE OF EMPLOYMENT

Acute stress disorder

1. Timeline

2. Symptoms

2 days to 1 month

PTSD sx plus dissociative sx

Acute PTSD time frame

1 to 3 months duration

Classic PTSD time frame

3 to 6 months post traumatic event

Delayed PTSD time frame

After 6 months

Chronic PTSD

Permanent

Received treatment for 24 months

COIDA pays for ASD

True or false

True

Treatment for Acute PTSD can be for upto 6 months

True or false

True

In what time frame should the Full criteria for PTSD diagnosis be made?

6 months

Define Permanancy of an impairment or disability

Why is this term preferred over MMI for psychiatric conditions

Impairment or disability is static or stabilized.

No further improvement expected with or without treatment within medical probability

The term permanency is preferred as it reflects the fluctuating nature of psychiatric conditions and better reflects long term impairment

Chronology

Define it

Medico-legal phenomenon

Sequential order or timing of the sequence of events(doesn't necessarily imply causation)

Chronology is necessary but not sufficient for causality

Temporaral relationship: timing link between cause and event. cause precedes the effect (implies causation)

Causality means one factor causes another

What is CAPS

Semi structured interview

Acute stress disorder and PTSD assessment

Different time spans post trauma

IME

What is it

Who does it and for what reasons

Who appoints

Independent medical examination

Non treating clinician

Legal, insurance or financial reasons

Appointment by CC

Man job specification or traumatic incident

Emotionally overwhelming event

Overpowers usual coping mechanisms

Disrupts physical and psychological function

MMI

Define

Maximum Medical Improvement

Reached on a date where Condition has stabilized. No further recovery or deterioration anticipated from the medical or surgical treatment available to them

Probability

Cause and effect likelihood more than 95%

OREP

Report

Profiles all hazards that employee is exposed to linked to the inherent job requirements , tasks and duties. Physical, chemical, biological, Ergonomics, Psychosocial

PTSD

Mental disorder

Pathological response to a traumatic event

Person experiences

-intrusive symptoms

-avoids stimuli

-increased arousal and reaction

-negative alterations in cognition and mood

Typical scenarios

Experienced, witnessed, learns of close friend, or experiences extreme exposure (not through media)

Affects their social and occupational function

Intense response