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Hani

School teachers

6 posts in this topic

Guys... Just wondering... In my previous PMPs exam which I failed, I had a pmp in which a 40 yo school teacher was sexually demanding etc. I got asked about the implications of her job on management. I thought maybe she has thoughts about harming someone at school and I said if so my obligations to protect the public would override the patient's right to confidentiality... In the last pmps exam which I think I will fail too, I had a 40 yo male teacher with symptoms suggestive of panic attacks/somatisation dx and I got asked the same question: what are the implications of his job on management? I said something like there might be reasons at work preventing him from going back... The examiner didn't look satisfied so I said something stupid like if he's getting angry at school or putting others at risk blablabla which didn't go well with the examiner AT ALL!

What is it with school teachers that has great implications on management? Both my parents are school teachers and I can't think of anything sensible!

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I guess it's to do with the following :

1) liaising with colleagues is more difficult, as it may lead to the teacher losing his/her job

2) The former PMP suggests mania/ Psychosis, the presence of may place school children at risk.This may be through sexual delusions or through Chaotic behaviour

3) Episodic panic may occur at school, with a potentially damaging impact on the teacher's relationship with the children.More seriously if it happens during a school trip, it may place the children at risk, due to poor supervision

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thats such bad luck - two schoolteacher pmps in a row

Guess its the mantra of risk answer??

remember you don't have to know all the answers, so hopefully your other two PMPs were ok??? Good luck, Hani

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I think initially try to treat her manic episode , possible MHA ? and admission , assess her intent of harming the another teacher

with her consent try to involve her husband in the management

Breaking the confidentialty only if I felt that the childern and/or the other teacher at high risk

Any other ideas with this lethal PMP

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(in terms of work related issue) - how about phased returns back to work... ::)

i mean while actively psychotic/manic priority is treatment - so down the MHA route if unwilling for volntary, but after recovery of episode... follow social inclusion agenda... reassess with Occie Health (assessment of risks) ... look at options for graded return, etc - the reality is most people with bipolar disorder are fine between episodes, right??? so she's got a right to go back to work once the relapse has been treated.

For the somatisation/panic guy I would - look at the impact of work on his symptoms, consider triggers and precipitating factors, if there are work related triggers (he may wish to do some bahavioural expreiments with his CBT therapist haha!!), take some time off, on a short term basis - and then once Sx improve re-evaluate his situation - patient choice, ur role is more like advice, advocate, etc

:-/

From what people say a lot depends on the examiners on the day.... not fair!!! >:(

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what do you mean by sexually demanding? demanding kids to have sex with her or what?

why she has been referred to the psychiatric service? are there other behavioural problems beside her sexual demand?

the key issues in this case are ethical: confendientiality /

duty to protect others,is she competnet to work?

clinical issues: is her behaviour driven by a mental illness which could be substance abuse, mania? medical causes, personality disorder, psychotic disorder, pedophilia,etc.

where to treat.

safety to go back to work.

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