Chapter 14: Mental and Behavioral Disorders
Summary of Updates to AMA Guides Sixth Edition 2021
- Content update provides clarification and updated terminology around mental and behavioral health concepts to improve interrater reliability. Overview of updates to Mental and Behavioral Health Content:
- Change from DSM IV to DSM 5 terminology and methodology
- Newer editions of Assessment Tools and Tests
- Descriptions of Malingering and Motivation
- Removal of summaries of psychiatric diagnoses and conditions from the Glossary to mitigate discrepancies in a forensic setting
- Removal of GAF results in more accurate mental and behavioral health impairment ratings
- Minor editorial corrections to Lower Extremities and Spine and Pelvis content
Significant Changes to Content and Methodology
Changes to the AMA Guides Sixth 2021 which resulted in substantial changes of content, evidence, and impact to impairment ratings.
Mental and Behavioral Health (Chapter 14)
- Introduction and Sections 14-1, 14-2 and 14-3 rewritten to reflect updated thinking, specifically regarding the update from DSM-IV-TR to DSM-5 and definitions of motivation and malingering.
- Table 14-1 from AMA Guides Sixth 2008 has been eliminated as the Multiaxial System is no longer considered in DSM-5.
- Tables 14-2 and 14-3 from AMA Guides Sixth 2008 are now 14-1 and 14-2 and have been significantly revised to reflect updating testing tools.
- Global Assessment of Functioning (GAF) has been eliminated from impairment rating methods outlined in Section 14.5 and 14.6.
- Mental and Behavioral Disorder Examples (Section 14.7) have been revised to eliminate reference to the Axis’ and GAF in calculating impairment ratings. Impairment ratings reflected in these examples have been updated as applicable.
- References updated as applicable.
- Introduction
- 14.1 Principles of Assessment
- 14.2 Psychiatric/Psychological Evaluation
- 14.3 Special Features of the Mental and Behavioral Disorders Independent Medical Examination
- 14.4 Maximum Medical Improvement
- 14.5 Concepts for Impairment Ratings
- 14.6 Method of Impairment Rating
- 14.7 Examples of Impairment Ratings due to Mental and Behavioral Disorders
- Example 14-1: Impairment Due To Major Depressive Episode
- Example 14-2: Impairment Due To Schizophrenia
- Example 14-3: Posttraumatic Stress Disorder
- Example 14-4: Low Back Pain Associated With AN Adjustment Disorder
- Example 14-5: Complex Issues
- Example 14-6: Antisocial Personality Disorder And Substance Use
- Example 14-7: Schizophrenia, Severe
- 14.8 Appendix: Brief Psychiatric Rating Scale (Expanded Version)
- 1. Somatic Concern
- 2. Anxiety
- 3. Depression
- 4. Suicidality
- 5. Guilt
- 6. Hostility
- 7. Elevated Mood
- 8. Grandiosity
- 9. Suspiciousness
- 10. Hallucinations
- 11. Unusual Thought Content
- 12. Bizarre Behavior
- 13. Self-Neglect
- 14. Disorientation
- 15. Conceptual Disorganization
- 16. Blunted Affect
- 17. Emotional Withdrawal
- 18. Motor Retardation
- 19. Tension
- 20. Uncooperativeness
- 21. Excitement
- 22. Distractibility
- 23. Motor Hyperactivity
- 24. Mannerisms and Posturing
- References
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