Theory - Mental and Behavioural
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Theory - Mental and Behavioural “How to identify claimants likely to have a greater than 10% whole person permanent impairment” Dr Lana Kossoff CONSULTANT PSYCHIATRIST MAS ASSESSOR Motor Accidents Authority November 2007
Transcript of Theory - Mental and Behavioural
Theory - Mental and Behavioural“How to identify claimants likely to have a greater than 10% whole person permanent impairment”
Dr Lana KossoffCONSULTANT PSYCHIATRISTMAS ASSESSOR
Motor Accidents Authority November 2007
Outline
Psychiatric illness in general population.
Research of psychological outcomes after road traffic accidents.
What information is helpful for prior to the assessment.
What happens in the psychiatric interview.
What conditions are likely to exceed the 10% threshold?
What makes a thorough report?
Case Studies
Diagnosis
Any anxiety disorder 9.7% Panic disorder 1.3% Agoraphobia 1.1% Social phobia 2.7% Generalised anxiety disorder 3.1% Obsessive-compulsive disorder 0.4%
Any affective disorder 5.8%Any substance-use disorder 7.7%Any mental disorder 17.7%
Source: Australian Bureau of Statistics, Mental Health and Wellbeing: profile of adults, Australia, 1997 - 10,700 adults.
Prevalence of Mental Disorder in Australia, 1997
During 2003, 700,000 Australians consumed 8.3 million scripts for antidepressants.
Antidepressants in Australia
Zoloft - 2.5 million Cipramil - 1.74 million Efexor XR - 1.54 million Luvox - 349,835 Prozac - 349,190
Road traffic accident happens
Post-Traumatic Stress Disorder
Depression
Adjustment Disorder
Complicated Grief
Phobic Travel Anxiety
Generalized Anxiety
Common psychiatric disorders after road traffic accidents:
Road traffic accident outcomes
1,148 consecutive attendees at a hospital emergency department
(Mayou BJP 2001)
3 months 12 months
PTSD 22% 15%
Anxiety 17% 19%
Depression 4% 6%
Travel anxiety 21% 15%
NOT INJURED / NOT SERIOUS
Road traffic accident outcomes
SERIOUS (3+ NIGHTS IN HOSPITAL)
3 months 12 months
PTSD 33% 28%
Anxiety 20% 19%
Depression 12% 8%
Travel anxiety 28% 28%
1,148 consecutive attendees at a hospital emergency department
(Mayou BJP 2001)
Road traffic accident outcomes
Treatment occurs
Claimant comes to impairment assessment
Difficulties assessing psychiatric impairment
No laboratory tests for psychiatric illness.
Symptoms are subjective and easily learnt.
Financial incentive to maximise symptoms.
Psychiatric Impairment Rating Scale
Method of determining psychiatric impairment.
Based on functional capacities described in the AMA Guidelines.
Focus on the impact of a psychiatric condition on 6 areas of functioning.
Areas of Function derived from AMA Guides
Self Care and Personal Hygiene
Social and Recreational Activities
Capacity to Travel
Social Functioning (Relationships)
Concentration, Persistence and Pace
Adaptation (Work Capacity)
Percentages for impairment were assigned for loss of functional capacities such that they were equitable with percentages for
physical impairments.
Cases that exceed the 10% threshold
Threshold for non-economic loss > 10%.
Over the last 12 months, approximately 7% of MAS psychological assessments have exceeded the threshold.
70% were below the threshold.
23% had not stabilised, were unrelated to the accident or could not be assessed.
Cases that exceed the 10% threshold
Most common conditions exceeding the threshold:
Post-Traumatic Stress Disorder Major Depression Panic Disorder with Agoraphobia
Pre-Interview Information
Pre-accident psychiatric history including any prescribed meds.
Handwritten or typed process notes of GP - more useful than a report if readable.
Any previous psychiatric or psychological evaluations pre-accident and process notes if available.
Any information related to earlier accident or workers compensation claims.
Accident
A description of accident and its severity.
Ambulance report.
Initial medical assessment.
Hospital notes if available.
If referral made, further psychological notes.
Psychiatric Assessment
1 - 2 hour duration - claimant’s history.
History of pre-accident functioning.
Must include a developmental, pre-existing medical and psychiatric and substance use history.
Observations of affect and behaviour and their consistency with the history.
History of psychological symptoms since the accident.
Do they fit the usual course of a psychological condition?
Psychiatric Assessment (continued)
Is there a diagnosis?
Has there been appropriate treatment?
Has the condition stabilised - if not, what further treatment is required?
How has the accident impacted on functioning and work?
Is apportionment required for pre-accident illness?
PIRS Rating
Tell me how you spend a day? A weekend?
How often do you see others outside the family?
Do you drive?
What work have you had since the accident?Is it consistent with observations at interview?
open ended questions if possible
as detailed as possible in the event that surveillance is later provided
Good Psychiatric Report
Concise - no jargon.
History with headings.
Thorough mental state examination.
Critically evaluates the history with known psychiatric symptoms and usual presentation.
Reasoned argument as to whether there is a DSM-IV-TR diagnosis and multi-axial formulation.
Why stabilised.
Clear reasons for impairment rating.
Case Study 1
Past psychiatric treatment?
Please refer to
Please refer to
Case Study handout:
Case Study handout:
MrMr Brian SMITHBrian SMITH
He denied any earlier history of psychiatric difficulties, treatment or any prescription of psychotropic medication.
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
SELF-CARE AND PERSONAL HYGIENE
CLASS 1 No deficit, or minor deficit attributable to the normal variation in the general population.
CLASS 2 Mild impairment: Able to live independently, looks after self adequately, although may look unkempt occasionally, sometimes misses a meal or relies on take-away food.
CLASS 3
Moderate impairment: Can’t live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) x 2 – 3 per week to ensure minimum level of hygiene and nutrition.
CLASS 4 Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.
CLASS 5 Totally impaired: Needs assistance with basic functions, such as feeding and toileting.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
SOCIAL AND RECREATIONAL ACTIVITIES
CLASS 1 No deficit, or minor deficit attributable to the normal variation in the general population. Goes out regularly to cinema, restaurants or other recreational venue. Belongs to clubs or associations and is actively involved with these.
CLASS 2 Mild impairment: Occasionally goes out to social events without needing a support person, but does not become actively involved: e.g. Dancing, cheering favourite team.
CLASS 3 Moderate impairment: Rarely goes to social events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.
CLASS 4 Severe impairment: Never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.
CLASS 5 Totally impaired. Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
TRAVEL
CLASS 1 No deficit, or minor deficit attributable to the normal variation in the general population. Can travel to new environments without supervision.
CLASS 2 Mild impairment: Can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.
CLASS 3 Moderate impairment: Cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.
CLASS 4 Severe impairment: Finds it extremely uncomfortable to leave own residence even with trusted person.
CLASS 5 Totally impaired: Cannot be left unsupervised, even at home. May require two or more persons to supervise when travelling.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
His relationship is severely strained, with separations from his wife.
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
SOCIAL FUNCTIONING
CLASS 1 No deficit, or minor deficit attributable to the normal variation in the general population. No difficulty in forming and sustaining relationships, eg partner, close friendships lasting years.
CLASS 2 Mild impairment: Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
CLASS 3 Moderate impairment: Previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.
CLASS 4 Severe impairment: Unable to form or sustain long term relationships. Pre-existing relationships ended, eg lost partner, close friends. Unable to care for dependents, eg own children, elderly parent.
CLASS 5 Totally impaired: Unable to function within society. Living away from populated areas, actively avoids social contact.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
3 His relationship is severely strained, with separations from his wife.
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
3 His relationship is severely strained, with separations from his wife.
Concentration, Persistence and Pace
He is not able to focus to read and has observable concentration difficulties.
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
CONCENTRATION, PERSISTENCE AND PACE
CLASS 1 No deficit, or minor deficit attributable to the normal variation in the general population. Able to pass a TAFE or university course within normal time frame.
CLASS 2 Mild impairment: Can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to thirty minutes, e.g. then feels fatigued or develops headache.
CLASS 3
Moderate impairment: Unable to read more than newspaper articles. Finds it difficult to follow complex instructions, eg operating manuals, building plans, make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.
CLASS 4
Severe impairment: Can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.
CLASS 5 Totally impaired: Needs constant supervision and assistance within institutional setting.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
3 His relationship is severely strained, with separations from his wife.
Concentration, Persistence and Pace
3 He is not able to focus to read and has observable concentration difficulties.
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
3 His relationship is severely strained, with separations from his wife.
Concentration, Persistence and Pace
3 He is not able to focus to read and has observable concentration difficulties.
Adaptation
He is not currently capable of working more than 1 – 2 days a week.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
ADAPTATION
CLASS 1 No deficit, or minor deficit attributable to the normal variation in the general population. Able to work full time. Duties and performance are consistent with the person’s education and training. The person is able to cope with the normal demands of the job.
CLASS 2
Mild impairment. Able to work full time in a different environment. The duties require comparable skill and intellect. Can work in the same position, but no more than 20 hours per week. E.g. No longer happy to work with specific persons, work in a specific location due to travel required.
CLASS 3 Moderate impairment. Cannot work at all in same position. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different, eg less stressful.
CLASS 4 Severe impairment: Cannot work more than one or two days at a time, less than twenty hours per fortnight. Pace is reduced, attendance is erratic.
CLASS 5 Totally impaired. Cannot work at all.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Post-Traumatic Stress Disorder Major Depression Alcohol Abuse
Psychiatric Treatment Zoloft 200mg Psychiatric – Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 He is less motivated around the house to assist his wife. He maintains self-care. He sometimes requires to be pushed to perform tasks of daily living.
Social and Recreational Activities
3 He pushes himself to go out and seldom leaves the house. He feels detached from others. He has few interests, other than watching football and the television.
Travel
2 He is able to travel, but is wary and watchful in a car. He is not able to drive a truck.
Social Functioning
3 His relationship is severely strained, with separations from his wife.
Concentration, Persistence and Pace
3 He is not able to focus to read and has observable concentration difficulties.
Adaptation
3 He is not currently capable of working more than 1 – 2 days a week.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Classes in Ascending Order:
2 2 3 3 3 3
Median Class:
3
Current Impairment Rating
Aggregate Score Impairment:
2+ 2+ 3+ 3+ 3+ 3 = 16
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Current Whole Person Impairment:
17%
Aggregate Table:
Aggregate Score: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Class 1 0 0 1 1 2 2 2 3 3
Class 2 % 4 5 6 7 7 8 9 9 10
Class 3 % 11 13 15 17 19 22 24 26 28 30
Class 4 % 31 34 37 41 44 47 50 54 57 60
Class 5 % 61 65 70 74 78 83 87 91 96 100
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH Current Impairment Rating
Please refer to further Case Study handout for Mr Brian SMITH:
The notes of his General Practitioner The notes of his Psychologist
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH Current Impairment Rating
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
Restricted to going to the hotel.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
No difficulties.
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
Relationship is severely strained – self-harm.
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
3 Relationship is severely strained – self-harm.
Concentration, Persistence and Pace
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
3 Relationship is severely strained – self-harm.
Concentration, Persistence and Pace
Mistakes in log book.
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
3 Relationship is severely strained – self-harm.
Concentration, Persistence and Pace
3 Mistakes in log book.
Adaptation
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
3 Relationship is severely strained – self-harm.
Concentration, Persistence and Pace
3 Mistakes in log book.
Adaptation
Missing days at work. Performance impaired.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Psychiatric Diagnosis Major Depression Alcohol Abuse
Psychiatric Treatment 40mg Lovan Psychological Treatment
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 Needs to be encouraged in self-care. Sometimes stays in bed.
Social and Recreational Activities
2 Restricted to going to the hotel.
Travel
1 No difficulties.
Social Functioning
3 Relationship is severely strained – self-harm.
Concentration, Persistence and Pace
3 Mistakes in log book.
Adaptation
2 Missing days at work. Performance impaired.
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Classes in Ascending Order:
1 2 2 2 3 3
Median Class:
2
Pre-Accident Impairment
Aggregate Score Impairment:
1+ 2+ 2+ 2+ 3+ 3 = 13
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH
Pre-Accident Impairment:
7%
Aggregate Table:
Aggregate Score: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Class 1 0 0 1 1 2 2 2 3 3
Class 2 % 4 5 6 7 7 8 9 9 10
Class 3 % 11 13 15 17 19 22 24 26 28 30
Class 4 % 31 34 37 41 44 47 50 54 57 60
Class 5 % 61 65 70 74 78 83 87 91 96 100
Pre-Accident ImpairmentCASE STUDY 1
Psychiatric Impairment Rating
Brian SMITH
Subtract pre-accident impairment from current impairment:
17%
(current)
–
7%
(pre-accident)
Impairment due to Subject Motor Vehicle Accident:
(17% - 7%)
= 10%
CASE STUDY 1Psychiatric
Impairment RatingBrian SMITH Impairment due to subject accident
Case Study 2
Please refer to
Please refer to
Case Study handout:
Case Study handout:
Ms Vera NIKOLOVIC
Ms Vera NIKOLOVIC
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
She denies strain in the relationship with her husband and son despite her mild anxiety.
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
1 She denies strain in the relationship with her husband and son despite her mild anxiety.
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
1 She denies strain in the relationship with her husband and son despite her mild anxiety.
Concentration, Persistence and Pace
She enjoys watching Serbian videos but states that there are mild memory problems consistent with anxiety.
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
1 She denies strain in the relationship with her husband and son despite her mild anxiety.
Concentration, Persistence and Pace
2 She enjoys watching Serbian videos but states that there are mild memory problems consistent with anxiety.
Adaptation
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
1 She denies strain in the relationship with her husband and son despite her mild anxiety.
Concentration, Persistence and Pace
2 She enjoys watching Serbian videos but states that there are mild memory problems consistent with anxiety.
Adaptation
Psychological factors do not interfere with her capacity to work. Rather, it is linguistic skills and lack of certification and limited work opportunity.
Psychiatric Diagnosis Adjustment Disorder with Anxiety and Depressed Mood
Psychiatric Treatment Aropax 20mg bd, counselling 3 visits to a psychiatrist
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI%
+ + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
1 She is motivated to perform household activities. She shops and cooks.
Social and Recreational Activities
2 She states that she goes out walking. She has contact with a Serbian neighbour. Her social sphere is limited as she has only recently migrated.
Travel
1 There are no deficits with travel. She is cautious walking on a pedestrian crossing. She has never held a driver’s licence. The family do not own a car.
Social Functioning
1 She denies strain in the relationship with her husband and son despite her mild anxiety.
Concentration, Persistence and Pace
2 She enjoys watching Serbian videos but states that there are mild memory problems consistent with anxiety.
Adaptation
1 Psychological factors do not interfere with her capacity to work. Rather, it is linguistic skills and lack of certification and limited work opportunity.
Classes in Ascending Order:
1 1 1 1 2 2
Median Class:
1
Psychiatric Impairment RatingCASE STUDY 2
Psychiatric Impairment RatingVera NIKOLOVIC
Aggregate Score Impairment:
1+ 1+ 1+ 1+ 2+ 2 = 8
Current Whole Person Impairment:
1%
Aggregate Table:
Aggregate Score: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Class 1 0 0 1 1 2 2 2 3 3
Class 2 % 4 5 6 7 7 8 9 9 10
Class 3 % 11 13 15 17 19 22 24 26 28 30
Class 4 % 31 34 37 41 44 47 50 54 57 60
Class 5 % 61 65 70 74 78 83 87 91 96 100
CASE STUDY 2Psychiatric
Impairment RatingVera NIKOLOVIC Psychiatric Impairment Rating
Case Study 3
Please refer to
Please refer to
Case Study handout:
Case Study handout:
MrMr John FARMER
John FARMER
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
Mr Farmer was previously in a stable relationship. After the accident, his irritability precipitated conflict and a period of separation.
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
3 Mr Farmer was previously in a stable relationship. After the accident, his irritability precipitated conflict and a period of separation.
Concentration, Persistence and Pace
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
3 Mr Farmer was previously in a stable relationship. After the accident, his irritability precipitated conflict and a period of separation.
Concentration, Persistence and Pace
Mr Farmer was unable to read due to poor concentration. He spent most of his day staring at the television or the wall, thinking about his son.
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
3 Mr Farmer was previously in a stable relationship. After the accident, his irritability precipitated conflict and a period of separation.
Concentration, Persistence and Pace
3 Mr Farmer was unable to read due to poor concentration. He spent most of his day staring at the television or the wall, thinking about his son.
Adaptation
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
3 Mr Farmer was previously in a stable relationship. After the accident, his irritability precipitated conflict and a period of separation.
Concentration, Persistence and Pace
3 Mr Farmer was unable to read due to poor concentration. He spent most of his day staring at the television or the wall, thinking about his son.
Adaptation
Mr Farmer was unable to work at all following his son’s death.
Psychiatric Diagnosis Complicated Grief Reaction
Psychiatric Treatment Psychiatric Treatment Endep 50mg, Melleril 50mg
CASE STUDY 3Psychiatric
Impairment RatingJohn FARMER
Classes in Ascending Order: Median Class
Aggregate Score Impairment: Total WPI% + + + + + = %
Category Class Reason for decision Self Care and Personal Hygiene
2 In view of Mr Farmer’s psychiatric symptoms, some deficits in self-care were expected. He sometimes missed meals, and he did not care significantly about his personal appearance.
Social and Recreational Activities
3 Mr Farmer no longer went out to social events. He rarely left the house, unless he was helping his fiancée with her shopping. He continued to have some interest in gardening and fishing around the property.
Travel
3 Mr Farmer did not leave his house on his own. He let his driver’s licence lapse, and his fiancée accompanied him to doctors’ appointments.
Social Functioning
3 Mr Farmer was previously in a stable relationship. After the accident, his irritability precipitated conflict and a period of separation.
Concentration, Persistence and Pace
3 Mr Farmer was unable to read due to poor concentration. He spent most of his day staring at the television or the wall, thinking about his son.
Adaptation
5 Mr Farmer was unable to work at all following his son’s death.
Classes in Ascending Order:
2 3 3 3 3 5
Median Class:
3
Psychiatric Impairment RatingCASE STUDY 3
Psychiatric Impairment Rating
John BUTCHER
Aggregate Score Impairment:
2+ 3+ 3+ 3+ 3+ 5 = 19
Current Whole Person Impairment:
24%
Aggregate Table:
Aggregate Score: 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Class 1 0 0 1 1 2 2 2 3 3
Class 2 % 4 5 6 7 7 8 9 9 10
Class 3 % 11 13 15 17 19 22 24 26 28 30
Class 4 % 31 34 37 41 44 47 50 54 57 60
Class 5 % 61 65 70 74 78 83 87 91 96 100
Psychiatric Impairment RatingCASE STUDY 3
Psychiatric Impairment Rating
John BUTCHER
Dr Lana KossoffConsultant Psychiatrist
MAS Assessor
November 2007
