Major Depressive Disorder - most of the day, nearly every day - Cross-Examining Psych Doctors, Tip #78

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a Major Depressive Disorder is a severe Mood Disorder that is characterized by a pervasive clinical depression and a series of associated symptoms.  In order to diagnose this disorder correctly, the patient must present with either 1) depressed mood, or 2) markedly diminished interest or pleasure in all, or almost all, activities.  In addition, both criterion 1 and/or 2 must be present “most of the day, nearly everyday.”  If the doctor has not provided information in their report indicating that the patient had criterion 1 and/or 2 “most of the day, nearly everyday” then the patently obvious conclusion is the there is no agreement between the doctor’s history of the patient’s symptoms or complaints and the DSM criteria for a Major Depressive Disorder.

Instructions for Finding out if an MMPI-2 T-Score is Possible - Cross-Examining Psych Doctors, TIp #77

As I mentioned in Tip #56, the MMPI-2 is the most frequently used version of the MMPI.  In this regard, you should examine the MMPI-2 scores provided by the doctor in their report to determine if the scores are possible for the patient based on their gender.  The numbers within the table appearing on pages 54 and 55 of the MMPI-2 testing manual contain all of the possible T-Scores that can be gotten on the MMPI-2.  Those tables are reproduced in my newsletter from May, 2010, available for download at my website, www.DrLeckartWETC.com.  Once you have determined that the doctor has reported a score that is not possible it is reasonable to conclude the doctor has made a monumental error in the scoring and/or the reporting of the patient’s MMPI-2 scores.  Clearly, in this instance something is serious amiss with the doctor’s methodology.  However, regardless of how this error was made, it is obvious that such an error constitutes a substantial flaw in the doctor’s report.

Observations of Pathological Anxiety - Cross-Examination of Psych Doctors, Tip #76

Pathological anxiety can be observed in a variety of ways during a face-to-face interview.  Specifically, pathologically anxious individuals typically can be observed to exhibit a variety of narrative statements that express danger, threat, unpredictability, uncertainty and/or terror.  Moreover, on direct observation their behavior is often characterized by jumpiness, restlessness, hand wringing, a strained voice, tremulousness, tension, motor hyperactivity, fidgeting, autonomic hyperactivity, vigilance, scanning and/or poor reality testing.  In assessing the credibility of a psych report, you should check to see if the doctor provided a description of any such observations or any of the patient’s narrative statements supporting a pathological anxiety in their report.

Observations of Clinical Depression - Cross-Examining Psych Doctors, Tip #75

Depression can be observed in a variety of ways during a face-to-face interview.  Specifically, clinically depressed individuals typically present with narrative statements such as those that express feelings and thoughts of worthlessness, hopelessness, helplessness, incompetence, self-reproach or guilt, pessimism, failure, anhedonia, lowered self-esteem and/or demoralization.  These individuals also frequently exhibit cognitive dysfunction in such areas as memory, concentration or attention, insight and judgment.  In assessing the credibility of a psych report, you should check to see if the doctor provided a description of any such observations or any of the patient’s narrative statements supporting a clinical depression in their report.

The Symptoms Checklist-90-R (SCL-90-R) - Cross-Examining Psych Doctors, Tip #74

The Symptom Checklist-90-Revised (SCL-90-R) is simply a symptom checklist in which the individual is presented with a list of symptoms or complaints that they can either endorse or deny.  However, this test has no method for detecting an individual who is attempting to embellish or simulate their complaints.  Further, the use of a symptom checklist is inappropriate in a medical-legal examination where the presentation of the list itself can be an encouragement to endorse items that do not reflect the individual’s status. 

“Rule Out” Diagnoses - Cross-Examining Psych Doctors, Tip #73

            When reading a psych report you may find that the doctor provided “Rule Out” diagnoses.  “Rule Out” diagnoses are used only when there is diagnostic uncertainty.  With all due respect to the psych doctor who authored the report with “Rule Out” diagnoses, this indicates that they are unsure whether these diagnoses truly exist.  Accordingly, it is unclear why a doctor would chose to write a comprehensive report without obtaining sufficient information to be certain about their diagnosis.  However, it is clear that by adding “Rule Out” diagnoses to their diagnostic categories, the doctor has clouded the issue concerning the patient’s psychological state.