title: [Reactive anxiety crisis and chronic adjustment disorder: a unique case of work injury and suspected occupational disease].
abstract: The present study aims to describe a case of work injury and occupational disease which is unique for the type of disease diagnosed, conditions of onset and mode of management by INAIL (Italian National Institute of Insurance for Injuries at Work and Occupational Diseases). A worker, after a verbal animated dispute with some collegues and superiors, had an acute psychiatric agitation attack and went to the nearest emergency room, where he was subjected to clinical exams. No neuropsychiatric alteration was found, but the physicians diagnosed an anxiety crisis reactive to the work environment. Consequently, the medical certificate for work injury was edited and sent to INAIL. The worker has been off work for 110 days because of a anxious and depressive syndrome, due to the verbal conflict. In a later assessment, INAIL recognized only the first 30 days of the employee's time off as injury at work, while judging the following period off work as related to affectivity disturbance due to common disease, not related to work environment. The following year, "anxious-depressive syndrome" is worsened and attributed by the same worker to the recurrence of acts of persecution and discrimination against him at work. For this reason he applied for recognition of occupational disease diagnosed as "Chronic Adjustment Disorder with prolonged depressive reaction and somatic anxiety, which developed into a protracted conflict marked the employment situation". INAIL rejected that request, but in the same year the employee has submitted the complaint for "mobbing". Even this request was rejected. Literature shows many examples of traumatic events during working activities which cause psychiatric disturbances. These events include industrial disasters, explosions, transport and mining accidents, accidents in psychiatric units with high risks of assaults, armed conflicts, war, assault and sexual assault, natural disasters. Victims show symptoms of acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). Cases of acute stress disorder resulting only from verbal conflict recognised as work injury aren't currently described. This case opens new perspective for the occupational physician in the assessment of ASD as work injury and of PTSD as professional disease, suggesting to put more attention to psychiatric health of workers.
authors: Giuseppe
authors: G
authors: Taino
authors: Cristina
authors: C
authors: Pizzuto
authors: Cristina
authors: C
authors: Pezzuto
authors: Ennio
authors: E
authors: Pucci
authors: Marcello
authors: M
authors: Imbriani
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control*; D000208:Acute Disease; D000275:Adjustment Disorders / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D000328:Adult; D001007:Anxiety / Q000209:etiology*; D002908:Chronic Disease; D003863:Depression / Q000209:etiology*; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D017132:Workplace / Q000523:psychology