Avoiding Psychiatric Disability Overdiagnosis (Part 2): Improving Diagnosis and Assessment of Mental Health Disorders and Psychiatric Work Disability

Given the increase in psychiatric occupational disability claims over the past 20 years, better patient psychiatric assessment and management is critical. To minimize iatrogenic psychiatric disability and maximize positive outcomes, it is important to understand the issues involved and establish better procedures for diagnosing conditions and assessing any associated impact on function. This second article in a three-part series focuses on ways to improve the diagnosis and assessment of mental health work disability.

Evaluating Post-COVID-19 Conditions

Persistent symptoms, physical signs, and abnormal test results after acute coronavirus disease 2019 (COVID-19) illness have emerged as a significant problem in the current and ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus pandemic. Finding a rational balance between compelling subjective symptoms and limited objective findings in patients with post-COVID-19 conditions is challenging. We advise caution in adopting attributions, explanations, and management strategies, and especially in conferring formal disability status, for these disorders until we understand them more completely. The prevalent uncertainties threaten both overevaluation and overtreatment, with substantial personal and societal consequences, and all stakeholders need to be both intellectually open and cautious going forward. This article highlights several concerns in evaluating and treating patients with enduring COVID-19-related illness.

Psychological Effects of COVID-19 and Preliminary Treatment Recommendations

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus affects the mental health of many. Isolation, fear of infection, and social distancing may affect psychological functioning. Research continues to evolve and reveal the psychological symptoms reported by coronavirus disease 2019 (COVID-19) patients. Depression, anxiety, posttraumatic stress disorder (PTSD), and psychosis have been reported in the literature for COVID-19 patients. Potential preliminary treatment recommendations include various forms of psychotherapy, such as dialectical behavioral therapy, mindfulness-based cognitive therapy, and cognitive behavioral therapy. More research should be done regarding other additional treatment recommendations that may facilitate psychological healing in COVID-19 patients.

Opioids: Current Science

Evidence shows that chronic opioid therapy is usually not beneficial; weaning patients off opioids many times results in less pain and better function, and opioid-induced hyperalgesia is real and frequent. Further evidence suggests that surgical outcomes are better if patients are weaned off opioids before surgery, and that the chronic use of opioids may adversely alter the assessment of maximum medical improvement (MMI).

Avoiding Psychiatric Disability Overdiagnosis, Part 1: General Disability and Occupational Disability—Going Beyond Medical Impairment Assessments

Claims of occupational psychiatric disability have increased considerably over the past 20 years. To avoid psychiatric disability overdiagnosis, it is important to improve the clinical assessment of mental health work disability. This article discusses general disability issues and their impact on individual well-being, social participation, and frequently associated poverty. It defines the difference between impairment assessment and disability assessment, explores three common disability models, and raises issues about psychiatric disability and its potential overdiagnosis.

Treating Physician vs Independent Medical Evaluator

Who is in the better position to evaluate, the treating physician or an independent medical examination (IME) physician? A treating physician has a patient-advocate role because he or she has a doctor-patient relationship with the patient/claimant. Unlike the treating physician, an IME physician does not have a doctor-patient relationship, and can, therefore, provide an impartial evaluation necessary to assess the extent to which the patient/claimant is impaired or disabled from functional activities of daily living.