There are some key issues in conducting a consultative examination and completing the report. The claimants can request to have the consultative examination carried out by their own treating psychiatrists. The psychiatrist should specify his role in conducting the examination to dispel the myth that approval for disability is given by the physician.
The provision of adequate and comprehensive information that enables the DDS team to make a reasonable, prompt, and fair determination is a sine qua non and is dependent on the accuracy and completeness of patient records.
There are 9 categories under the mental disorder listings used in making such decisions. Each category refers to a disease process or disorder. Disability refers to the severity of restrictions and limitations of functioning criteria B that are directly related to criteria A. Each listing is further qualified by criteria A and B.
For organic mental disorders, schizophrenic, paranoia, and affective disorders, or other psychotic and anxiety-related disorders, an additional set of criteria criteria C may be used to meet the diagnostic and impairment-related restriction of functioning requirements. Disability is therefore met when criteria A and B are met, or when criteria C is met.
The report should be typewritten not handwritten. DDS jurisdictions usually provide dictations by phone. Again, the report should provide a longitudinal and current assessment of the case.
The pathogenesis of the disease is helpful in establishing the nature and duration of illness. General observations of the patient, his history, and any additional information required for that listing of diagnoses are other essential elements of the report. If there is a comorbidity, this should be stated.
This is especially important for the claimant who has several minor disabilities which, when taken together, may affect his ability to work. In addition, for consultative examinations, the number of appointments the patient has canceled and difficulties in keeping appointments may point to a diagnosis of an anxiety-related condition.
Prolonged treatment by a primary care physician may be a clue to chronic treatment-resistant depression. For criteria B, items are selected from 4 domains:. For these domains, the documentation must be sufficiently descriptive and explicit to permit an assessment of the appropriateness, independence, sustainability, quality, and effectiveness of these functions over long periods.
The examples of deficits in those domains must be tied directly to the mental disorder, rather than to circumstantial factors. Tony is 32 years old. He has been ill since age 22, when he was a second-year law student.
He came home and informed his parents that poisonous gases were being pumped into his room. He dropped out of school and made attempts to return to school but failed. He has remained paranoid; he keeps to himself and has been hospitalized 5 times. He was hospitalized 6 months ago when he became belligerent at work. He believed his supervisors were out to get him.
He has been on a combination of several antipsychotics to help reduce his hallucinations and delusions. His longest period of employment in 10 years was 3 months. By meeting 1 item from criteria A and 2 items from criteria B, Tony meets at least superficially the requirement for disability under the listing of schizophrenia.
Alternatively, criteria C may be used. The psychiatric report to DDS should include the date, time, and place of the assessment. It should conclude with a 5-axis diagnosis as well as a statement of daily activities. The report should not make any recommendation as to whether the application should be approved or denied. Instructions, scoring information, and interpretation guidelines are included.
These measures should be used to enhance clinical decision-making and not as the sole basis for making a clinical diagnosis.
Further information on these measures can be found in DSM—5. The measures can be broadly classified into four types:.
Buy Now. Shop the DSM—5 Collection. I agree. Functional Assessment should address treatment, ie, whether and how a functional impairment can be reversed. By employing the tools of a Functional Assessment, psychiatrists can introduce a more objective standard that is needed in disability evaluations and prognosis for a return to work.
For reader response s , please click here. Self—monitoring is another important domain germane to work capacity. June 14, Morrison, MD. Committee on Work and Organizations, Group for the Advancement of Psychiatry A year-old project manager presents with a 5-week history of sleep disturbance and other symptoms of generalized anxiety. Work-relevant functional impairment Functional Assessment should address treatment, ie, whether and how a functional impairment can be reversed.
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