AMA Guides® Newsletter - Issue Archive

Articles

1. Multiaxial Diagnosis of Mental and Behavioral Disorders

   Norma J. Leclair, Steven W. Leclair, Christopher R. Brigham

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.2002.NovDec01

   Abstract

   Most health care professionals who diagnose and treat mental disorders use the diagnostic criteria outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR), which uses a multiaxial system to ensure a comprehensive assessment and evaluation of the patient's presenting symptoms, general medical condition, psychosocial and environmental problems, and level of function. The five axes are mental disorders; personality and mental disorders; general medical conditions; psychosocial and environmental problems, and global assessment of functioning (GAF) scale. Psychosocial and environmental problems may affect diagnosis, treatment, and prognosis of mental disorders; the problems or stressors can contribute to the development of a mental disorder or can be the result of a mental disorder. The multiaxial assessment process should result in the following; documentation of the primary and any secondary mental and behavioral disorders; definition of physical disorders that may be present and indication if they are related to or influence the mental and behavioral disorders; identification of environmental stressors that may affect, contribute to, complicate, or exacerbate the mental and behavioral disorder; and a rating of the person's psychological, social, and occupational functioning. A table shows the GAF scale (ratings by deciles from 1 to 100; higher numbers indicate fewer problems) and does not include impairments that result from physical or environmental limitations.
   Show more

2. Clinical Update: Motivation and Impairment Evaluation of Mental and Behavioral Disorders

   Norma J. Leclair, Leclair Steven W., Christopher R. Brigham

   Pages 4–4, 16

   DOI: 10.1001/amaguidesnewsletters.2002.NovDec02

   Abstract

   According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), motivation is a need or desire that causes a person to act and may be a key factor in an individual's physical or mental impairment. Poor motivation can cause poor functioning, and personality characteristics and underlying character are important determinants of an individual's motivation to benefit from rehabilitation. Particularly because of the subjective and highly sensitive nature of most mental and behavioral disorders, examinees have multiple self-interests, and, when one party engages in activities that are inconsistent with the other's expectations, resolution may depend on the employee's and employer's shared perceptions that the return to work is positive and consistent with each party's self-interests, particularly if both believe this step will succeed. Participants are motivated by the real or imagined costs associated with the return to work, and examinees may have concerns about facing coworkers, losing benefits or wages, dealing with labor relations, or simply making a change. When determining an individual's degree of motivation to return to work, the physician should consider the following: the value or usefulness of returning to work; employer's and employee's perceptions of the potential for successful return to work; and the real and perceived costs of work return (functional renewal) for the individual.
   Show more

3. Common Tips for IMEs: Musculoskeletal Conversions: Musculoskeletal Conversions

   Christopher R. Brigham

   Pages 13–15

   DOI: 10.1001/amaguidesnewsletters.2002.NovDec03

   Abstract

   Most impairments are expressed ultimately as a whole person impairment, and the musculoskeletal chapters of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) include instructions for converting regional impairments to whole person impairments using a percentage relationship. This article presents an extensive table that incorporates the conversion factors for extremity and spinal impairments. Occasionally evaluators need to convert spinal impairments from whole person to impairment of the spine, a process that is explained in the AMA Guides, Section 15.13. The conversion factors differ depending on whether the impairment was obtained using the Diagnosis-related estimate (DRE) method or the range-of-motion (ROM) method. For example, a 5% whole person impairment is an 8% upper extremity impairment, a 9% hand impairment, 23% thumb impairment, 46% index/middle finger impairment, or 93% ring/little finger impairment. The same 5% whole person impairment would convert to a cervical spine impairment of 14% cervical spine if the DRE method were used and 6% if the ROM method were used. For the lumbar spine, this would convert to 7% lumbar spine impairment if the DRE method were used and 6% if the ROM method were used. The table in this article provides values for converting foot to lower extremity impairment and for converting whole person impairment to regional spinal impairment.
   Show more