Tuesday, June 28, 2016

Cross Examining Psych Doctors - Tip #39-Two Steps To Interpreting an MMPI

The interpretation of an MMPI, an MMPI-2 or an MMPI-2-RF is a two-step process.  The first step involves interpreting the validity scales, which are used to determine if the individual has completed the test in an honest and straightforward manner that allows for the interpretation of the remainder of the scales.  Once that hurdle has been overcome, it is reasonable to interpret the patient’s clinical scale scores, which can provide information about any possible psychopathology and the individual’s personality characteristics.  If that hurdle of the validity scales is not overcome, no statements can be made about the clinical scales or the patient’s psychological status.
Check out my blog (http://drleckart.blogspot.com).  More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

Friday, June 24, 2016

Cross Examining Psych Doctors - Tip #38- The Wahler Physical Symptoms Inventory
The Wahler Physical Symptoms Inventory often appears in a psychological test battery of medical-legal evaluators in psychology and psychiatry.  In this regard, the Wahler is a self-report inventory in which the individual is asked to state how frequently they have a variety of physical symptoms or complaints such as "headaches, difficulty sleeping and backaches."  Unfortunately, a reading of the testing manual indicates that there are no validity scales for this instrument (Wahler, H. J., Wahler Physical Symptoms Inventory Manual, Los Angeles:  Western Psychological Services, 1983).  Accordingly, there is no way of detecting individuals who are endorsing complaints that do not exist.  In the absence of test results from the evaluator's battery that establish that the patient completed the testing in an honest and forthright manner, no conclusions can be drawn from the Wahler Physical Symptoms Inventory.  Additionally, the use of this test in a medical-legal examination is inappropriate as the presentation of the test items can be an encouragement to claim symptoms or complaints that do not exist.

Tuesday, June 21, 2016

Cross Examining Psych Doctors - Tip #37-Psychological-Sounding Diagnoses
Psychological evaluation reports often contain a section dedicated to a review of the patient's medical records.  That section usually reveals that physicians in a wide variety of medical specialties often make comments, and even diagnoses, in their records indicating that the patient may be depressed, anxious or was having other psychological problems or disorders.  However, with all due respect to my colleagues in the various medical fields, a psychological diagnosis offered by, let's say, an orthopedist, is no more credible than a psychologist's diagnosis of an orthopedic condition. 

Friday, June 17, 2016

Cross Examining Psych Doctors - Tip #36-Describing the Patient's Complaints

In a psychological examination report, it is simply not enough to provide a listing of the patient’s complaints or their direct statements.  Specifically, the doctor has to describe the qualitative nature of those complaints as well as their frequency, intensity, duration, onset and course of those complaints.  Think of this as a series of questions that have to be answered:  What does it feel like when you are depressed? (qualitative nature).  How often do you feel/think that way? (frequency).  How severe is this problem for you on a 10-point scale? (intensity).  When you feel depressed, how long does the feeling last? (duration).  When did you start feeling depressed? (onset).  Has your depression been getting better or worse and can you describe its presence over time? (course). One example, in cases where the doctor diagnoses some form of a Major Depressive Disorder, the provision of this information, especially the data about frequency, is quite crucial since eight of the nine complaints must be found to be present at least “nearly every day.”

Tuesday, June 14, 2016

Do Apricots™ Work? We Asked the Attorneys!

An Apricot™ describes a psych report’s flaws in jargon-free language, discusses specific techniques to Cx the doctor and provides multiple simple questions that get those flaws on the record despite the doctor’s resistant behavior. Apricots™ can be written in any medical discipline. When an Apricot™ is written in a psych case it can be used in personal injury, workers’ compensation, criminal cases, child custody cases or any other litigation where a psych doctor has written a report that the attorney thinks is not credible.

Friday, June 10, 2016

Cross Examining Psych Doctors - Tip #35-Measurements During a Mental Status Examination

A Mental Status Examination produces a set of observations of the patient that are made by the doctor, during their face-to-face meeting, using a relatively standard set of examining techniques and questions that yield easily reported upon objective data. Those doctor-made observations are called “signs,” and should not be confused with the patient-made complaints, since they are often different.  The nature of the techniques used by doctors is most easily understood in talking about the patient’s memory, concentration, insight and judgment.  These processes are easily measured during the course of a Mental Status Examination with such techniques as asking the patient to recall a series of numbers, asking them to count backward by 7’s or asking them to provide interpretations of proverbs or to describe in what way an elephant is similar to a whale.  For instance, if the doctor diagnoses some form of depression, individuals who are clinically depressed will often have signs, or observable behaviors, of dysfunctions in these areas.

Tuesday, June 7, 2016

Cross Examining Psych Doctors - Tip #34-Panic Disorder

A Panic Disorder is diagnosed correctly when the individual presents with recurrent and unexpected Panic Attacks.  These attacks must be shown to have been followed by one month or more of either persistent concern about having additional attacks, worry about the implications of the attacks or the consequences, or a significant change in behavior related to the attacks.  In addition, the DSM specifies that a Panic Attack is not a disorder in and of itself and is characterized by a discrete period of intense fear or discomfort in which four or more of 13 symptoms occur that develop abruptly and reach a peak within minutes.  These symptoms are: palpitations; a pounding heart or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded or faint; feelings of unreality or of being detached from oneself; fear of losing control or going crazy; fear of dying; numbness or tingling sensation and chills or hot flushes.