Psychological Testing (California)

This category is for the discussion of medical issues specific to workers' compensation.

Re: Psychological Testing (California)

Postby cmunday on Tue Apr 22, 2014 12:11 pm

Vampire

If the "jerky behavior" consistently interfered with work or relationships then I would consider apportionment. The patient whose history includes multiple jobs lost because he got into disagreements with his boss, the patient who's had four marriages and each one ended with the spouse saying "I can't take your controlling behavior". Remember we now have the GAF which considers social and occupational functioning and if the personality style has consistently interfered with such functioning then I think apportionment may well be appropriate independent of a formal diagnosis of a personality disorder. While it is relatively rare, I have had patients who gave me such candid histories probably not realizing they were sort of implicating themselves as the culprit.
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Re: Psychological Testing (California)

Postby psych74 on Tue Apr 22, 2014 7:21 pm

I do not find it rare for applicants to tell me things that, on one hand, might not be
in their best interests from a med-legal perspective. On the other hand, if an applicant
can be honest about themselves, I find it far easier to believe what they might be
saying about a co-worker/supervisor/work situation, etc..

The applicant who is creating a real problem for themselves is the one who
deliberately misrepresents their history (and you have records that disprove same).
Then, I find myself channeling Columbo, "I'm a little confused, you told me that you
have never been arrested; but, the records mention 3 DUIs..."

Given that there can no longer be brand new derivative psychiatric claims (physical-psyche),
so many of the recent PQME/AME cases fall into the, "he said, she said..." category that require
as much data as possible about how the applicant functions and has functioned in as many
areas of their life as possible.

A sense of humor and irony helps a lot.
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Re: Psychological Testing (California)

Postby vampireinthenight on Wed Apr 23, 2014 8:08 am

Remember we now have the GAF


That's a good point.

many of the recent PQME/AME cases fall into the, "he said, she said..." category that require
as much data as possible about how the applicant functions and has functioned in as many
areas of their life as possible.


Yes, I end up with a lot of these cases. From an investigative standpoint, it is really hard to get data on a persons social (or even work) functioning outside of the present situation. There just aren't enough resources to go like Columbo and interview everyone in their past. Hence the realistic necessity of the testing.

So, before any testing and before interviewing family or acquaintances, are there certain techniques in an interview with an individual to get indicators of interpersonal problems? I feel like I get the same canned responses when I ask about relationships with family or friends: "Fine, no problems."
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Re: Psychological Testing (California)

Postby suekarp on Thu Apr 24, 2014 6:23 am

As a lay person, it always surprises me that the injured worker has absolutely no issues in life outside of work until the industrial injury.

I always expect to see testing done, although I usually cannot make heads or tails of the results. Dr. Munday and any of the other professionals, can you give us poor lay folks a couple of examples where psyche testing is NOT necessary? Thanks.
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Re: Psychological Testing (California) (California)

Postby appliedpsych on Thu Apr 24, 2014 7:31 am

On any medical-legal case, I cannot think of ANY reason not to do testing.

It is our method of coming up with a scientific rating approach to a set of problems that cannot be objectively described by any other method. It gives a method to help provide the substantial medical evidence required in such cases. Without it, I think that one side or the other could argue that the lack of testing does not provide substantial medical evidence.

The testing can be of use to either side. For example It of course will help give the applicant side a level of intensity of the psychological symptoms of the IW. It can help the defense as well because it can also show that there are some IW's who while having a psych claim, show absolutely no level of elevated clinical scales, and thus any proof of mental health effects and compensability for that is moot.

Med-Legal testing should always use objective tests such as the MMPI-2, PAI, MCMI3, MBMD, P3, etc where validity and malingering scales are built in. While simple inventories such as the Beck Scales can help on the treatment end, I would not use them on a med-legal case.
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Re: Psychological Testing (California)

Postby jobmdpsych on Fri Apr 25, 2014 8:13 am

If the person already had extensive psych or neuropsych testing recently, and nothing has changed much in their condition, there's little point in repeating it. However, in most cases, it makes sense to do it. Projective testing is better than self-report inventories although they can be useful in a before and after sense. Also, if the claimant is better, they can verify reduction in symptoms. Self-report inventories in work comp context may have some false positives but very few false negatives. The opposite of fit for duty.
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