Case Studies

Mr K

During an emergency following an elective medical procedure, Mr K was administered a drug that caused him to experience a very severe anaphylactic reaction. Unfortunately, this was despite Mr K’s medical records indicating his allergy to the particular medication. His blood pressure dropped, he experienced bronchoconstriction and he became unconscious. There was indication that the supply of blood / oxygen to Mr K’s brain had been compromised for a period of approximately 10 minutes. Following a good physical recovery Mr K and his friends / relatives noted that he appeared very forgetful. Over time he became very anxious in certain situations such as meeting new people, or in supermarkets. A return to working as an Estate Agent was unsuccessful as Mr K was unable to meet the demands of a busy office and client list.

Neuropsychological assessment, as part of a clinical negligence claim, explored the reported changes to Mr K’s cognitive abilities and general psychological presentation. He was found to have significant difficulties in encoding memories in both visual and verbal domains, leading to poor ability to recall information, or even to recognise information he had previously been given. Whilst his general intellectual abilities remained good his concentration was also affected. These combined effects of memory and attention caused him considerable distress, and a growing fear that people would think he was ‘stupid’. This was identified in assessment as part of a presentation of clinically significant anxiety, which had caused Mr K to begin to avoid activities in which he thought his anxiety would increase, or his difficulties be ‘exposed’.

The assessment clearly detailed the range and extent of Mr K’s neuropsychological difficulties, and offered advice on means by which to manage them and minimise the impact of Mr K’s daily life. It also made recommendations for treatment of the anxiety disorder, and made comment on prognosis. A thorough psychological interview regarding Mr K’s background and a review of his medical records suggested the presentation of cognitive and emotional difficulties was new, and the assessment report considered issues of causation.

Miss B

Miss B was a pillion passenger on a motorcycle involved in a road traffic collision with a van. She suffered extensive damage to her legs and lesser injuries to her chest, having been trapped in the wreckage for a period of 25 minutes whilst the rescue team sought to free her without causing further injury. Her partner, the motorcycle rider, did not survive.

In the weeks and months that followed the injury and her bereavement Miss B began to experience a range of distressing psychological symptoms. Her sleep was interrupted by nightmares, and she felt at times that she was reliving her experience of being trapped. She was unable to approach the scene of the accident, and attempted to stay away from any reminders of it. Miss B began to find driving her own car difficult, needing at times to pull over to try and calm herself down.

Psychological assessment provided a broad overview of the nature and course of Miss B’s difficulties. Clinical interview and a range of psychometric assessments indicated a presentation consistent with a diagnosis of Post Traumatic Stress Disorder. Consideration of Miss B’s background indicated a pre-existing vulnerability to anxiety and depression.

The assessment was able to make recommendations that would help Miss B with some of her difficulties. Other psychologists were identified who worked with Miss B on her symptoms of trauma, employing a range of therapeutic techniques including exposure therapy and Eye Movement Desensitisation and Reprocessing. Cognitive Behavioural Therapy was used to address her anxiety whilst driving and being in busy places. All these interventions were embedded within the therapeutic context of traumatic grief, and an understanding of Miss B’s previous experiences of depression. Whilst the Psychological Report was able to comment on exacerbation of pre-existing symptoms, it was also able to identify which difficulties appeared to have developed as a direct consequence of the accident.

The psychological therapy was successful in resolving the symptoms of traumatic stress, and in working with Miss B’s low mood and anxiety. Whilst her grief remained beyond the end of the therapeutic work, over time Miss B found herself able to start rebuilding her life, spending time with her family and going out with friends.