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rajeevkrishnadas

60 yr old abuser

9 posts in this topic

A 60 year old man, brought with history suggestive of cognitive decline, brought to clinic by 30 year old married daughter, who is the primary caregiver, with whom the man lives. While taking the history, the daughter reveals that as a child, she was sexually abused once by this 60 year old man... How will you go about?????

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18 people and not one commented...

I will have a go; not because I know the answer, but maybe to stimulate the discussion..!

usual assessment re: cognitive decline...

check causes, past medical and psychiatric history, MMSE, investigations, radiology, diagnose...

does he need prescription?, need day hospital?, need adjustments and modifications at home?

carers' assessments?...

then about the daughter's claim...

difficult....

I think that issues include obviously whether she had ever discussed this with anyone, whether she has sought help, whether it happened to other members of the family, whether there is any point prosecuting, why is she mentioning this now....?

any point in receiving counselling?

random thoughts...

what are you thinking dorian?

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main issues

disclosure of sexual abuse

establishing the underlying cause for the cognitive decline

as there is disclosure we have to inform the social services as he might be having access to children and they need to invistigate these claims.

with regards to the cognitive decline my main differential diagnosis will be

organic- dementia, alcohol or substance misuse

psychotic illness- paraphrenia

depressive illness

phobic anxiety disorder

next is information gathering from as much sources as possible like GP, if known to the psychiatric services.

proceed to comprehensive history,mental state examination and physical examination.

management: investigations esp full dementia screen,gamma gt, urine drug screen. according to the results you go down the route of management.

it 12.30 Iam working 2morow, hell it is this ptsd :(

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Godzilla...

I was thinking in lines of what alwaleed said...

About disclosure...

Is he in contact with other children ???

Was it a one off incidence??? was he under the influence of substance at that time???

What happened after that??? was action taken???

How does the daughter deal with him now??? how has the relationship with him been over so many years???

Is there evidence of elder abuse... (her taking revenge)

If we do disclose to social services or the named nurse... what impact is that going to have in their relationship ????

And of course... like you said... about the cognitive deficits....

My one question would be... DO we report this guy... if it was a one off incident... but he is staying with his married daughter who has children...

What if the daughter asks us not to disclose the information to others...

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Surely the Children Act means that any risk to kids is paramount?

You have to act on the information given....

I think there are 3 things to consider-

Patient's needs- assessment, (full Hx and Exam, MSE incl full cognitive and frontal lobe, physical incl full neuro)

Priorities: is this a dangerous but curable illness, eg SOL that needs urgent action

Does this man have any frontal lobe lesion which may further disinhibit any tendency to paedophilia?

Daughter's needs- Is this a first disclosure? If so, further action, referral etc depending on what she wants. Does she have children/ contacts she is worried about? I agree about assessing the risk of elder abuse, too.

Children issues- are there any contacts with children? In theory, social services should be informed regardless of the daughter's wishes.

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Godzilla...

I was thinking in lines of what alwaleed said...

About disclosure...

Is he in contact with other children ???

Was it a one off incidence??? was he under the influence of substance at that time???

What happened after that??? was action taken???

How does the daughter deal with him now??? how has the relationship with him been over so many years???

Is there evidence of elder abuse... (her taking revenge)

If we do disclose to social services or the named nurse... what impact is that going to have in their relationship ????

And of course... like you said... about the cognitive deficits....

[highlight]My one question would be... DO we report this guy... if it was a one off incident... but he is staying with his married daughter who has children...

What if the daughter asks us not to disclose the information to others...

[/highlight]

According to birmingham course if there is a disclosure we should inform the social service 'even if it happened ten years ago'

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Godzilla...

I was thinking in lines of what alwaleed said...

About disclosure...

Is he in contact with other children ???

Was it a one off incidence??? was he under the influence of substance at that time???

What happened after that??? was action taken???

How does the daughter deal with him now??? how has the relationship with him been over so many years???

Is there evidence of elder abuse... (her taking revenge)

If we do disclose to social services or the named nurse... what impact is that going to have in their relationship ????

And of course... like you said... about the cognitive deficits....

[highlight]My one question would be... DO we report this guy... if it was a one off incident... but he is staying with his married daughter who has children...

What if the daughter asks us not to disclose the information to others...

[/highlight]

[highlight]According to birmingham course if there is a disclosure we should inform the social service 'even if it happened ten years ago' [/highlight]

Do we need her consent to inform the social services.

Also what is the standard scheme (Birmingham course) to deal with a disclosure?

Thanks

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But if it was only a one off incident and he has never ever done anything like that again, if the daughter has coped and is coping and the relationship is maintained as a normal one, she is not concerned anymore, then do we still need to inform the social service?

If yes why? whats the purpose of reporting it now?

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past history of risk is the best predictor of possible future risk...

what if he has done it many times and every different abused person is coping and are thinking it was an one-off?

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