A Major Neurocognitive Disorder is a relatively new disorder that appears in the DSM-5, which was published in 2013. According to a reading of pages 602 to 605 of the DSM-5, a Major Neurocognitive Disorder is correctly diagnosed when the individual presents with a substantial impairment in cognitive performance that is measured by the examining physician’s administration of neuropsychological tests or “another quantified clinical assessment.” Thus, when you are reading a psych report where the examiner diagnosed a Major Neurocognitive Disorder you should immediately look to see if the examiner discussed the administration and results of neuropsychological tests or “another quantified clinical assessment.” If you find that the examiner has declined to discuss any of these measures, you should question the doctor about their omission on cross-examination.
Tuesday, October 31, 2017
Tuesday, October 24, 2017
The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) was published by the American Psychiatric Association in 1994. The DSM-IV became obsolete when the DSM-IV-TR was published in 2000. The “TR” in DSM-IV-TR stands for Text Revision. Most recently, in May, 2013, the DSM-5 was published. While many of the diagnoses and the diagnostic criteria for disorders have remained the same with each revision of the DSM, substantial differences definitely exist between the manuals. Typically, many of the substantial differences are outlined on multiple pages in the later sections of the manuals. Moreover, when you are reading a psych report, find the area in the report where the doctor stated which version of the DSM they used in arriving at their diagnostic conclusions. When doing so, if it becomes clear that the doctor simultaneously used two different versions of the DSM in evaluating the patient and producing their report you should question the doctor about that substantial flaw on cross-examination.
Objective psychological test data is clearly needed in medical-legal psych reports where the first responsibility of the examiner in either psychology or psychiatry is determining the credibility of the patient's complaints and clinical presentation. In this regard, the principal method for assessing that credibility is an objective psychological test battery containing such instruments as the Minnesota Multiphasic Personality Inventory (MMPI) and the Cattell Sixteen Personality Factor Test (16PF) that are capable of generating test scores providing information both about the patient's credibility and any possible psychopathology. Typically, objective psychological test scores are the only information collected by an examiner that is open to public inspection and can be presented to the court in an objective and generally numerical fashion. Therefore, when you come across a psych report and find that the doctor declined to give any psychological tests, not only is that a clear failure by the doctor to assess the patient’s credibility, but they should be questioned about that substantial flaw on cross-examination.
Tuesday, October 3, 2017
Every validity and clinical scale performance on the Minnesota Multiphasic Personality Inventory (MMPI) is described with a T-Score. All T-Scores on the validity scales and the clinical scales on the MMPI have a mean of 50 and a standard deviation of 10. In this regard, it should be noted that it is universally accepted that T-Scores of 65 or larger are clinically significant or interpretable. There are many books and journal articles on the MMPI that make this point. In this regard, one of the validity scales on the MMPI is the F(Back) Scale or what is often called the F(b) Scale. The F(b) Scale is a validity scale that is analogous to the F Scale, except that the items on the F(b) Scale are placed in the last half of the test, hence the name “F(b)” representing an F-like scale at the back of the test. A score of 65 or higher on the F(b) Scale is indicative of a high probability the patient was trying to appear to have symptoms that do not exist. In these situations, you should look for the place in the doctor’s report where he/she discussed that the patient’s F(b) Scale score showed they were attempting to simulate symptoms, or what some mental health practitioners would call “faking” or “Malingering.”
The Minnesota Multiphasic Personality Inventory (MMPI) is the keystone of all clinical psychological test batteries where the major question concerns the presence or absence of a Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis. In this regard, the MMPI is considered the gold standard for psychological test batteries in medical-legal cases because it is capable of providing information not only about psychopathology but about the test-taker’s basic personality, their attitude and credibility, as well as how they are functioning in the world. The MMPI was published in 1943 and has been widely researched for over 70 years. In 1989, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was published in response to a growing demand for an MMPI with updated wording and phrasing. Subsequently, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), that was created from the MMPI-2, was published in July, 2008, in part, to correct some problems identified with the MMPI-2. When you are reviewing a psych report it is important to determine which MMPI was used by the examiner and to obtain the patient’s MMPI test scores from the doctor if those scores do not appear in the report.
Cross-examining a psych doctor is typically no simple task. You definitely don’t want to add unnecessary challenges to the cross-examination process. Therefore, during cross-examination it is imperative that you confirm that the doctor is using the same copy of the report that he/she submitted to the court. If even one word is different it could mean that a sentence or a whole section might have an entirely different meaning than what was originally produced by the doctor. Further, allowing the doctor to use a different copy of their report will cause significant confusion during the cross-examination process and result in a delay in the proceedings. Thus, if it is discovered that the doctor is operating from a different copy of their report than what was originally submitted to the court, despite however minor the differences are portrayed, you should immediately halt the cross-examination and insist that the doctor use the official version of his/her report to testify. Otherwise you are comparing apples and oranges.
Medical-legal psych reports can be lengthy and expensive. They can also contain multiple inconsistencies, flaws, or as some might call them, ERRORS! Those inconsistencies are often confusing and typically decrease the report’s credibility. Knowing how to identify inconsistencies in psych reports may require a special skill set that can be acquired from experience reading psych reports written for the courts or perhaps from completing a graduate degree in the mental health field. When you have a problematic psych report but you don’t have a graduate degree in the mental health field and/or extensive experience reading psych reports, no need to fret. Simply take advantage of the self-help resources I provide for free on my website (http://drleckartwetc.com/freeresources) to help you identify inconsistencies in psych reports and question the doctor on cross-examination.