Friday, June 9, 2017

Primary Sleep Disorders - Cross-Examining Psych Doctors, Tip #87

Primary Sleep Disorders involve disturbances of sleep that are not due to another mental disorder, a general medical condition or a substance.  Primary Sleep Disorders are classified as either Dyssomnias, in which the person exhibits abnormalities in the amount, quality or timing of sleep, or Parasomnias, in which they show abnormal behaviors and/or physiological events during sleep.  When the doctor provides a diagnosis under this category, you should examine their report to see if the doctor provided information in their report about what the patient’s sleeping behavior was like prior to their reported injury.  If no such information exists in the doctor’s report then there is no basis for comparison and concluding that the patient’s sleeping behavior has changed after the claimed injury.

Pain Disorder Associated With a General Medical Condition - Cross-Examining Psych Doctors, Tip #86

The DSM-IV-TR is very clear in stating on page 499 that a Pain Disorder Associated With a General Medical Condition is a disorder in which there is pain that results from a general medical condition.  The DSM-IV-TR is also very explicit in stating, “This subtype of Pain Disorder is not considered a mental disorder and is coded on Axis III.”  Accordingly, if one is concerned with the possibility of an individual having had a psychological disorder, the specification of a Pain Disorder Associated With a General Medical Condition is clearly not relevant since this condition is not a mental disorder. 

Dissociative Disorders - Cross-Examining Psych Doctors, Tip #85

            According to the DSM-IV-TR, the Dissociative Disorders are characterized by prominent features of dissociation or a disruption in the integration of consciousness, memory, identity and/or sensation or perception.  In this regard, dissociation is the partial or total disconnection or dissociation between past memories, awareness of one’s identity, awareness of immediate sensations or perceptions, and the control of body movements.  All of these conditions are thought to be the result of traumatic experiences.  When you have a report where the doctor diagnosed a Dissociative Disorder you should review their report to determine if they discussed the qualitative nature, frequency, intensity, duration, onset and course of the patient’s complaints over time with regard to memory, identity, sensation or perception.  You should also review the Mental Status Examination report to determine if the doctor provided observational data in these areas from their face-to-face interview.