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Sarah H. Gulick
,
Steven Mandel
,
Edward A. Maitz
, and
Christopher R. Brigham

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus affects the mental health of many. Isolation, fear of infection, and social distancing may affect psychological functioning. Research continues to evolve and reveal the psychological symptoms reported by coronavirus disease 2019 (COVID-19) patients. Depression, anxiety, posttraumatic stress disorder (PTSD), and psychosis have been reported in the literature for COVID-19 patients. Potential preliminary treatment recommendations include various forms of psychotherapy, such as dialectical behavioral therapy, mindfulness-based cognitive therapy, and cognitive behavioral therapy. More research should be done regarding other additional treatment recommendations that may facilitate psychological healing in COVID-19 patients.

in AMA Guides® Newsletter
Steven Mandel
,
Edward A. Maitz
,
John E. Gordon
,
David Massari
,
Joely Esposito
, and
Heidi Mandel

Abstract

The authors respond to an article, Assessing Mild Traumatic Brain Injury, that appeared in the November/December 1998 issue of the Guides Newsletter. The authors of the article referred to several shortcomings of neuropsychological assessment; specifically, they questioned the ecological (real-world) validity of such testing for less severely impaired individuals. The authors of the letter agree that neuropsychological testing may underestimate problems with attention, concentration, and memory that patients experience in real-world settings. The letter writers identify research that indicates a correlation between neuropsychological test findings and an individual's ability to perform in a work environment, and they emphasize the need to consider the individual's environment before determining the degree of functional impairment based on neuropsychological test findings. The letter writers also suggest that evaluators use recently developed measures of malingering in test batteries, and they dispute the existence of an “overreliance on technicians for test administration.” The authors of the original article respond that questions of ecological validity are less relevant when neuropsychologists do not generalize from test scores to real-world performance. The authors of the article mention their work in detecting malingering and report only preliminary and variable success. Finally, the authors of the original article note that limited space precluded discussion of all the issues raised by the letter's authors.

in AMA Guides® Newsletter
Restricted access
Sarah H. Gulick
,
Steven Mandel
,
Edward A. Maitz
,
Christopher R. Brigham
, and
Lorne K. Direnfeld

Abstract

Physicians performing impairment evaluations on patients with cognitive complaints and possible central nervous system disorders should perform a clinical mental status assessment. Assessing cognitive complaints efficiently, in a systematic and supportable way, can be challenging. The AMA Guides to the Evaluation of Permanent Impairment specifies that objective criteria are important to consider when assessing impairment. Physicians may choose to use standardized cognitive screening tests (cognitive screeners) as a relatively quick, practical tool to initially assess patients and aid in decision making. Several cognitive screeners will be discussed in detail below. A patient's performance on such tests may indicate that more comprehensive testing is needed. Cognitive screeners have limitations and are not designed to assess symptom validity or the extent to which psychological factors may contribute to cognitive complaints. Comprehensive neuropsychological assessment may be indicated in these situations and when the screeners demonstrate findings of potential concern help define MMI.

in AMA Guides® Newsletter