Psychiatric
Worker's Compensation Disability Evaluation Outline:
RETURN TO BASIC SKILLS WORKSHOP 1.
History a)
Medical and collateral record review b)
Reason for the evaluation c)
Presenting problem in patient’s own words d)
History of the presenting problem (1)
New or recurrent problem? (2)
Static or changing? (3)
Impact on home and work functioning? 2.
Social history a)
Family’s socio-economic status b)
Role of work in family life 3.
Educational history a)
Detail elementary, middle, and high school b)
Strong and weak subject areas c)
Relationship with teachers d)
High school drop outs at increased risk 4.
Employment history a)
Job types b)
Performance level c)
Length of employment d)
Reasons for prior changes in employment e)
Job satisfaction at the time of injury 5.
Current income sources: impact of illness a)
Evaluate for primary gain in maintaining disability if receiving benefits b)
If no benefits, motivation to forgo treatment and return to work prematurely,
inviting further injury 6.
Past medical history 7.
Current medical problems and names of physicians 8.
Medications 9.
Substance use/abuse history 10.
Legal problems 11.
Past personal psychiatric history a)
Hospitalizations: Complaint, dates, hospital, duration, outcome b)
Outpatient history: Complaint, dates, treating professional, duration, outcome 12.
Family psychiatric history a)
Suicide attempts b)
Depression c)
Anxiety Disorder d)
Alcohol and substance abuse 13.
Developmental history a)
Family structure (1)
Parents together or divorced; stepparents (2)
Nature of patient-parent relationship (3)
Birth order; relationships with siblings (4)
Neglect or abuse history; duration and severity b)
Work role models: Parent work history c)
Age when patient began work: Premature responsibility increases disability risk d)
Illness history in family or patient e)
Relationship with authority figures f)
Peer relationships: Best friend? g)
School experiences (1)
Academic performance level through grades (2)
Last grade completed (3)
Strong and week subject areas h)
Dating experiences; marital history 14.
The “typical day” a)
Narrative description of how the day is spent b)
Time of arising; napping; time of retiring c)
Activities of daily living: who performs, changes since illness onset (1)
Bill paying (2)
Meal preparation (3)
Laundry (4)
Housecleaning 15.
Mental status examination a)
Appearance and behavior b)
Mood and affect c)
Speech and thought content d)
Preoccupations, suicidal or homicidal ideation e) Cognitive functioning: orientation, fund of knowledge, memory testing, abstract thinking, judgment, insight 16.
Psychological testing a)
MMPI-2, MCMI-3, Rorschach, TAT b)
When should testing be requested? (1)
To clarify ambiguous or complex diagnoses (2)
To compare with previous test results (3)
To assess for neuropsychological impairment (4)
To help resolve diagnostic disagreements between clinicians (5) To assess for malingering 17.
Summary and discussion a)
Logically synthesize all information obtained (1)
Present explanation of symptom/illness development (2)
Developmental psychodynamic factors which may be re-enacted (3)
Neurobiological and genetic factors (4)
Environmental factors b)
Temporal relationship between events and illness; degree and duration of
impairment; use of appropriate rating systems 18.
Multi-axial DSM IV diagnoses a)
Current standard for psychiatric diagnosis b)
Utilize 5 axis format for listing diagnoses, important psychosocial and
environmental problems, and GAF (1)
Valuable as a means of measuring change over time between evaluations (2)
Changes in degree of disability |