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CSME|CAPDA Medico-Legal Summit - Dr. Sherese Ali
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Motivational Factors in Psychiatric Disorders after Motor Vehicle Accidents: The role of litigation
Dr. Sherese Ali, MD FRCPC

Clinical tradition and experience may suggest that litigation is the driving force behind complaints of PTSD and significantly affects clinical presentations of psychiatric illness, lead to increased symptom reporting and symptom magnification, with the additional possibility of secondary gain. Clinical paradigms would also suggest that the converse may hold true, and that a favorable end to litigation may be followed by symptom alleviation and resolution of affective disturbances. Although a number of researchers have investigated the effects of litigation on symptom presentation and an individual’s willingness/ability to return to work with varying results, one of the largest bodies of work to date, following a group of 171 MVA accident survivors at three-year follow-up, found no differences in symptom presentation between the 96 individuals who were involved in MVA-related litigation and the 75 who had not filed claims. At six-year follow-up, 81 of the 96 individuals pursuing litigation were located and re-assessed. Sixty-nine of the 81 cases had been settled but there were no dramatic improvements in physical complaints, mental state, or social functioning among those with settled cases compared to those whose cases were still active. These data have been largely replicated in an Australian sample of 106 MVA survivors. Moreover, studies have repeatedly shown that litigation has a negative impact on recovery with profound psychological consequences for plaintiffs and defendants alike, and litigation is often an additional stress to whatever issues produced the lawsuit. Studies have shown a bidirectional relationship between depression and litigation, that mental health conditions might increase the chances for litigation and that the presence of litigation is associated with worsening depression. Although it is always possible that an individual involved in an MVA may be less than genuine when describing symptoms attributed to the MVA, there is not enough evidence to support the notion that litigation is associated with conscious, deliberate attempts at deceit. The evidence to date indicates that the overall experience of the accident in these types of patients is one of prolonged suffering and significant disability, whether or not that disability is perceived as “genuine,” or as having an organic basis. If somatization or malingering is suspected, it would seem to be related to unconscious cognitive processes which are part and parcel of the symptomatology of the overall suffering of these patients

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