Proverbs in a Mental Status Examination - Cross-Examining Psych Doctors, Tip #118

     One of the five basic sources of information that compose a credible psychological or psychiatric examination and report is a Mental Status Examination.  A Mental Status Examination is normally part of every face-to-face clinical interview during a medical legal evaluation.  In this regard, a Mental Status Examination produces a set of observations of the patient that are made by the doctor under reasonably controlled conditions, employing a relatively standard set of examining techniques and questions.  One of those examining techniques is to ask the examinee to interpret a set of proverbs.  For example, insight can be measured by asking the patient to interpret proverbs such as “a stitch in time saves nine.”  Similarly, judgment can be measured by simply asking the person what they would do if they found a child locked in a car on a hot summer’s day.   When reading a psych report you may notice that the doctor commented on the patient’s insight and/or judgment but did not provide any easily and normally obtainable observational data concerning those processes.  Accordingly, during a deposition an attorney should ask the doctor where in their report they cited their Mental Status Examination test results supporting their conclusions about the patient’s judgment and insight.

Serial 3s Task - Cross-Examining Psych Doctors, Tip #117

     When performing a Mental Status Examination during a psychological evaluation, the doctor may choose to have the patient count backward from 20 by 3s as a measure of their concentration.  This task is called a serial 3s task and can be done relatively quickly during a face-to-face interview.  The patient’s performance on a serial 3s task is a measure of concentration.  When a doctor chooses to use a serial 3s task to measure the patient’s concentration, it is imperative that they describe their observational data in their report of their Mental Status Examination. 

Serial 7s Task - Cross-Examining Psych Doctors, Tip #116

     A Mental Status Examination produces a set of observations of the patient, which are made by the doctor, under reasonably controlled conditions, employing a relatively standard set of examining techniques and questions.  Measuring and reporting on observational data of the patient’s functioning in the area of concentration is typically part of every Mental Status Examination report.  For example, one measure of concentration is to ask an individual to count backwards from 100 by 7s.  This is known as a serial 7s task.  The patient’s performance on this task is a measure of their concentration and, when administered by the doctor, the doctor’s observations of the patient’s performance should be described in their report of their Mental Status Examination.

Liens for psychological and psychiatric treatment
can be disputed!

If an inspection of the data in the psych doctor's report does not support the doctor's diagnosis, the conclusion is inescapable that the doctor's report does not support the doctor's diagnosis warranting the need for mental health treatment. At that point, it is reasonable to conclude that the doctor's liens are not supported by the doctor's report. 


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Dysthymic Disorder - Cross-Examining Psych Doctors, Tip #115

     According to the criteria found in the Diagnostic and Statistical Manual of Mental Disorders, a Dysthymic Disorder is diagnosed correctly when the individual presents with a chronically depressed mood that occurs for most of the day, more days than not, for at least two years.  During periods of depressed mood, at least two of the following additional symptoms are present:  poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.  When you find that a psych report lacks information supporting the diagnosis of a Dysthymic Disorder, the attorney should ask the doctor, where in their report they provided historical data demonstrating that the patient met the diagnostic criteria for a Dysthymic Disorder.

A Major Depressive Disorder with Mild Severity - Cross-Examining Psych Doctors, Tip #114

     A Major Depressive Disorder is a severe Mood Disorder that is characterized by a pervasive clinical depression and a series of associated symptoms.  The severity of a Major Depressive Disorder often mandates that the patient be given substantial anti-depressant medication, psychotherapy, hospitalization and possibly electroconvulsive shock therapy.  According to the criteria for Major Depressive Disorder found in the Diagnostic and Statistical Manual of Mental Disorders, if the patient presents with five or six symptoms, the diagnostic modifier “Mild” is used in specifying the disorder.  Doctors should be questioned on cross-examination when you find they do not provide information in their report supporting their conclusions about the severity of a Major Depressive Disorder.

Neuropsychologists - Cross-Examining Psych Doctors, Tip #113

Neuropsychologists have obtained either a Ph.D. or a Psy.D. in psychology and have taken additional postdoctoral training in the area of neuropsychology.  Neuropsychologists can provide information about how a neurological injury may affect and/or be affected by psychological variables.  They also can provide information about whether a patient’s difficulties are likely to be due to brain pathology or emotional factors.  Further, neuropsychologists typically administer a relatively large number of tests, called a battery, in a face-to-face manner.  Test batteries are sometimes designed by the neuropsychologist to answer specific questions and at other times standardized batteries are used.  In short, neuropsychologists are psychologists with advanced or postdoctoral training in evaluating brain functions and correlating specific cognitive and emotional impairments with specific brain pathology.