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Effects of structured settings: An evaluation of individuals whose symp toms are controlled or attenuated by psychosocial factors must consider the ability of the individual to function outside such highly structured settings.
Effects of medication: Attention must be given to the effect of medication on the individual’s signs, symptoms, and ability to function. While psychotropic medications may control certain primary manifestations of a mental disorder, such as hallucinations, such treatment may or may not affect the functional limitations imposed by the mental disorder. Neuroleptics, the medicines necessary to control signs of an “amotivational” like syndrome, used in the treatment of some mental illnesses, may cause drowsiness, blunted affect, or other side effects involving other body systems. Such side effects must be considered in evaluating overall severity of impairment as well as the patient’s functional capacity.
Pain: The assessment of impairment due to the perception of pain, especially in circumstances in which the complaint exceeds what is expected based on physical findings, is complex and controversial. The perception of pain may be distorted by mental disorders. Pain may be an element in a somatic delusion in a patient with a Major Depression or Psychotic Disorder. It may become the object of an obsessive preoccupation or a chief complaint in a Conversion Disorder. The latter has been called “Psychogenic Pain Disorder” or “Idiopathic Pain Disorder,” but these terms often are used more loosely to describe any complaint of pain that is greater than the physician expects for the “normal” patient with the same physical findings. The more specific disorders with impairments are somewhat easier to evaluate than cases in which the perception of pain is said to have a “psychogenic component.” Such cases require specialized assessment, perhaps using a multidisciplinary, multispeciality approach.
Assessing Impairment Severity A method of evaluating psychiatric impairment: Solutions to the many dilemmas encountered in determining the degree of impairment resulting from a psychiatric illness can only be sought through the application of consistent and observable criteria that must be considered in relation to one another.
The table that follows, when used according to the best clinical judgment of the evaluator, will aid in the evaluation of an individual, and it should be used after all diagnostic, clinical, treatment and rehabilitation factors have been explored.
An example that follows the table gives the overall rating of a patient based upon the mental status and upon the current condition as observed by the calculator. The rating is based upon observed attributes and phenomena that are somewhat interrelated, and it necessarily must be considered to be somewhat subjective. Reduced ability to deal with activities of daily living and treatment potential may be considered in determining the severity of mental status.
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