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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
James B. Talmage
,
Mark H. Hyman
,
Christopher R. Brigham
,
Sarah H. Gulick
, and
Leslie Burton

Abstract

Patients with coronavirus disease 2019 (COVID-19) may have persistent symptoms beyond the normally expected illness resolution. This disease was not diagnosed before late 2019, and therefore, we have more limited experience in understanding all of its outcomes. Thus, clinical, functional, and permanent impairment assessment is challenging. Symptoms including fatigue, dyspnea, and cognitive difficulties have been referred to as “post-acute COVID,” “long COVID,” or “long haulers.”

Patients who present for assessment of causation, maximum medical improvement (MMI), and permanent impairment can be challenging. For some examinees, after 6 to 12 months without outgoing improvement and with appropriate investigation, treatment, and rehabilitation, the examinee can be considered at MMI. However, because this disorder is new and appropriate treatment may be unclear, the time to achieve MMI is less certain. Physicians may use approaches in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), to help define MMI. As science evolves, so will our understanding of how to evaluate chronic problems associated with COVID-19.

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