Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches

2008 ◽  
Vol 13 (6) ◽  
pp. 1-7
Author(s):  
Norma Leclair ◽  
Steve Leclair ◽  
Robert Barth
Keyword(s):  
Mental Disorders ◽  
Behavioral Disorders ◽  
Psychotic Disorders ◽  
Behavioral Disorder ◽  
Behavioral Impairment ◽  
Central Nervous System Damage ◽  
Brain Functioning ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Mental And Behavioral Disorders

Abstract Chapter 14, Mental and Behavioral Disorders, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines a process for assessing permanent impairment, including providing numeric ratings, for persons with specific mental and behavioral disorders. These mental disorders are limited to mood disorders, anxiety disorders, and psychotic disorders, and this chapter focuses on the evaluation of brain functioning and its effects on behavior in the absence of evident traumatic or disease-related objective central nervous system damage. This article poses and answers questions about the sixth edition. For example, this is the first since the second edition (1984) that provides a numeric impairment rating, and this edition establishes a standard, uniform template to translate human trauma or disease into a percentage of whole person impairment. Persons who conduct independent mental and behavioral evaluation using this chapter should be trained in psychiatry or psychology; other users should be experienced in psychiatric or psychological evaluations and should have expertise in the diagnosis and treatment of mental and behavioral disorders. The critical first step in determining a mental or behavioral impairment rating is to document the existence of a definitive diagnosis based on the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The article also enumerates the psychiatric disorders that are considered ratable in the sixth edition, addresses use of the sixth edition during independent medical evaluations, and answers additional questions.

Commentary

2008 ◽  
Vol 13 (6) ◽  
pp. 8-8
Author(s):  
Richard T. Katz
Keyword(s):  
Mental Illness ◽  
Behavioral Disorders ◽  
Rating Scale ◽  
Behavioral Disorder ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mental And Behavioral Disorders

Abstract The author, who is the editor of the Mental and Behavioral Disorders chapter of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, comments on the previous article, Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches in this issue of The Guides Newsletter. The new Mental and Behavioral Disorders (M&BD) chapter, like others in the AMA Guides, is a consensus opinion of many authors and thus reflects diverse points of view. Psychiatrists and psychologists continue to struggle with diagnostic taxonomies within the Diagnostic and Statistical Manual of Mental Disorders, but anxiety, depression, and psychosis are three unequivocal areas of mental illness for which the sixth edition of the AMA Guides provides M&BD impairment rating. Two particular challenges faced the authors of the chapter: how could M&BD disorders be rated (and yet avoid an onslaught of attorney requests for an M&BD rating in conjunction with every physical impairment), and what should be the maximal impairment rating for a mental illness. The sixth edition uses three scales—the Psychiatric Impairment Rating Scale, the Global Assessment of Function, and the Brief Psychiatric Rating Scale—after careful review of a wide variety of indices. The AMA Guides remains a work in progress, but the authors of the M&BD chapter have taken an important step toward providing a reasonable method for estimating impairment.

Determining Impairment and Disability for Mental and Behavioral Disorders

2003 ◽  
Vol 8 (4) ◽  
pp. 1-11
Author(s):  
Norma J. Leclair ◽  
Steven W. Leclair ◽  
Christopher R. Brigham
Keyword(s):  
Mental Disorders ◽  
Behavioral Disorders ◽  
Supported Employment ◽  
Mental Health Program ◽  
Relevant Information ◽  
Behavioral Disorder ◽  
Behavioral Impairment ◽  
Rehabilitation Centers ◽  
Impairment Ratings ◽  
Mental And Behavioral Disorders

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Chapter 14, Mental and Behavioral Disorders, focuses on the particularly challenging process of evaluating a person with a mental or behavioral disorder. This chapter is unique: It does not include numeric impairment ratings because no precise methods exist for assessing impairment in mental disorders. This article focuses on the process of gathering qualitative data and relevant information to substantiate the behavioral impairment assessment, for which the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR) is used. Impairment ratings in the AMA Guides reflect “consensus-derived estimates that reflect the severity of the impairment and the degree to which the impairment decreases an individual's ability to perform common activities of daily living [ADL]” and designates four relevant areas to consider: ADL; social functioning; concentration, persistence, and pacing; and deterioration or decompensation in complex or work-like settings. The validity of an impairment classification depends on the process used to collect and analyze the data, including clinical treatment records, hospital discharge summaries, community mental health program activity reports, patient and family interviews, reports from work evaluation or rehabilitation centers, supported employment records, and workplace evaluations. Defining maximum medical improvement in patients with mental and behavioral disorders is difficult and, in some instances, may be impossible.

Multiaxial Diagnosis of Mental and Behavioral Disorders

2002 ◽  
Vol 7 (6) ◽  
pp. 1-3
Author(s):  
Norma J. Leclair ◽  
Steven W. Leclair ◽  
Christopher R. Brigham
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Behavioral Disorders ◽  
Health Care Professionals ◽  
Environmental Problems ◽  
Assessment Process ◽  
Behavioral Disorder ◽  
Presenting Symptoms ◽  
Five Axes ◽  
Mental And Behavioral Disorders

Abstract Most health care professionals who diagnose and treat mental disorders use the diagnostic criteria outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR), which uses a multiaxial system to ensure a comprehensive assessment and evaluation of the patient's presenting symptoms, general medical condition, psychosocial and environmental problems, and level of function. The five axes are mental disorders; personality and mental disorders; general medical conditions; psychosocial and environmental problems, and global assessment of functioning (GAF) scale. Psychosocial and environmental problems may affect diagnosis, treatment, and prognosis of mental disorders; the problems or stressors can contribute to the development of a mental disorder or can be the result of a mental disorder. The multiaxial assessment process should result in the following; documentation of the primary and any secondary mental and behavioral disorders; definition of physical disorders that may be present and indication if they are related to or influence the mental and behavioral disorders; identification of environmental stressors that may affect, contribute to, complicate, or exacerbate the mental and behavioral disorder; and a rating of the person's psychological, social, and occupational functioning. A table shows the GAF scale (ratings by deciles from 1 to 100; higher numbers indicate fewer problems) and does not include impairments that result from physical or environmental limitations.

Errata

2008 ◽  
Vol 13 (2) ◽  
pp. 5-5
Keyword(s):  
Psychotic Disorders ◽  
Pain Syndrome ◽  
Vestibular Disorders ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Neurologic Disorders ◽  
Upper And Lower Extremities ◽  
Impairment Ratings ◽  
Extensive List ◽  
Mental And Behavioral Disorders

Abstract Although most chapters in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, instruct evaluators to perform impairment ratings by first assigning a diagnosis-based class and then assigning a grade within that class, Chapter 13, The Central and Peripheral Nervous System, continues to use a methodology similar to that of the fifth edition. The latter was criticized for duplicating materials that were presented in other chapters and for producing different ratings, so the revision of Chapter 13 attempts to maintain consistency between this chapter and those that address mental and behavioral disorders, loss of function in upper and lower extremities, loss of bowel control, and bladder and sexual function. A table titled Summary of Chapters Used to Rate Various Neurologic Disorders directs physicians to the relevant chapters (ie, instead of Chapter 13) to consult in rating neurologic disorders; the extensive list of conditions that should be addressed in other chapters includes but is not limited to radiculopathy, plexus injuries and other plexopathies, focal neuropathy, complex regional pain syndrome, visual and vestibular disorders, and a range of primary mood, anxiety, and psychotic disorders. The article comments in detail on sections of this chapter, identifies changes in the sixth edition, and provide guidance regarding use of the new edition, resulting in less duplication and greater consistency.

Rating Physical Residuals of Breast Disfigurement

2018 ◽  
Vol 23 (3) ◽  
pp. 10-13
Author(s):  
Stephen L. Demeter
Keyword(s):  
Behavioral Disorders ◽  
Psychological Evaluation ◽  
Left Breast ◽  
Sexual Life ◽  
Skin Disorders ◽  
Double Lumen ◽  
Sixth Edition ◽  
Warm Sensation ◽  
One Year ◽  
Mental And Behavioral Disorders

Abstract A 48-year-old woman was working as a hostess in a lounge and was struck in the chest when a fight arose; afterwards, she noticed discomfort and a warm sensation in her left breast, which over the course of months remained smaller and also became distorted in comparison with her previous size, shape, contour, and comparison with her right breast. Ten years previously, she had received double lumen prostheses (saline on the outside and silicone gel on the inside). One year later she was found to be at maximum medical improvement (MMI) and described no signs or symptoms although her sexual life reportedly changed, with less frequency and satisfaction. Tables present the fifth edition criteria for rating permanent impairment due to skin disorders; fifth edition criteria for rating permanent impairment due to facial disorders and/or disfigurement; and sixth edition criteria for rating permanent impairment due to mammary disorders. Section 10.9 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, mentions that coexisting psychiatric impairment would be rated using the mental and behavioral disorders chapter, which contains one reference to cosmetic abnormalities and requires a “severe cosmetic deformity with no ability to lactate.” Thus the only way to provide an impairment rating using the fifth edition for this individual is to perform a psychological evaluation; in the sixth edition, it is the only permissible rating.

Mental disorders in patients with tuberculosis

2020 ◽  
pp. 24-31
Author(s):  
Andrey Rashchupkin ◽  
Vitaliy Maksyutov
Keyword(s):  
Mental Disorders ◽  
Behavioral Disorders ◽  
Clinical Picture ◽  
Mental And Behavioral Disorders

Mental and behavioral disorders, as well as tuberculosis, are included in the list of socially significant diseases. In this regard, the topic of studying the clinical picture of mental disorders that occur in patients with tuberculosis is always an urgent topic.

Psychopharmacotherapy in a Multy-type Hospital

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P. Pyrkov
Keyword(s):  
Mental Disorders ◽  
General Hospital ◽  
Psychotic Disorders ◽  
Psychiatric Service ◽  
List Type ◽  
Psychiatric Facility ◽  
Amnesic Syndrome ◽  
Number Of Patients ◽  
Short Time ◽  
Mental And Behavioral Disorders

Introduction:The increasing number of patients with comorbide mental disorders, who were staying in multy-type hospitals, necessitates the organization of psychiatric service, which includes psychopharmacotherapy.Results:Observations were performed during 25 years in a multy-type emergency hospital.Indications for psychopharmacotherapy were:1.Organic (somatogenic) mental disorders (F06) - 61%, among them are: organic delirium ((F05, 8) - 25%, organic hallucinosis (F06.0) - 10%, organic amnesic syndrome (F04) - 27%, organic anxiety phobic disorder with agitation (F06.4) - 9%.2.Mental and behavioral disorders due to psychoactive substance use (F10 - 19%, F10.03 -12%, F10.31 - 6%, F11.21 - 1%.3.Neurotic depression with suicidal behaviour (accomplished parasuicide) (F43, 24) - 1%.4.Anorexia nervosa (F50.0) - 3%.5.Dementia (F00-F02) - 16%.The examination showed that short-time (up to 10-15 days) psychotic disorders could be reduced with parenteral introduction of the Diazepam 2ml 2-3 times/day.The use of Nootropics (Pyracetam 20% 10-20ml, Cerebryl 250ml iv) and B vitamins stimulated reduction of psychosis.Any of patients wasn't moved to the residential psychiatric facility.We didn't use neuroleptics cause their iatrogenic activity by organic psychosis and incompatibility with some somatotropic medicaments, employing by multiplex somatic disorder.Conclusion:Optimization of the psychopharmacotherapy in general hospital requires a regular psychiatrist on its staff. The treatment of the patient in the general hospital seems to be economic and moral effective.

Sign in / Sign up

Export Citation Format

Share Document