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April 04 2015

Friday Factoids: Mandatory Psychological Testing for Disability Claims?

Author admin Categories Friday Factoids, Social 0 Comments

A new report from the Institute of Medicine (IOM) recommends broader standardized psychological testing for applicants that are submitting claims for mental health disabilities to the U.S. Social Security Administration (SSA) with the belief that incorporating additional psychological testing could improve both the accuracy and the consistency of disability determinations. In 2012 the SSA provided disability benefits to approximately 15 million adults and children. Proponents contend that mandatory psychological testing, validity based measures in particular, would result in significantly lower application approval rate, resulting in a substantial cost savings.

 

At the present, state agencies determine eligibility for disability based on medical records in addition to other evidence deemed relevant in an applicant’s case record. Standardized psychological tests that have been conducted are considered to be eligible material permitted for review within an applicant’s case file. Tests assessing validity can be used in conjunction with standardized psychological tests in order to assess whether the individual being evaluated is exerting a genuine effort and/or providing an accurate portrayal of their symptoms. While the SSA recognizes that utility and validity of psychological testing, it currently only requires testing to be conducted in cases pertaining to intellectual disability (ID), as an intelligence quotient (IQ) score is required in order to determine ID eligibility criteria.

 

Currently, SSA policy prevents requiring an applicant to submit psychological testing, but applicants (and their representatives) are permitted to submit psychological testing in support of their claims. It was recommended by the IOM that the SSA adopt a policy that incorporates mandatory standardized, non-cognitive psychological testing for all applicants that purport non-cognitive related impairments. It is their contention that testing should be required when the purported symptoms is based primarily on an applicant’s self-reported symptoms in the absence of objective medical evidence or longitudinal medical records that are considered sufficient to make a determination for disability. At the present, the IOM is gathering more information in order to more accurately offer an approximation of the cost savings that may be gained through mandatory incorporation of psychological testing in disability claims.

 

Faisal Roberts, M.A.

WKPIC Doctoral Intern

 

Nauert PhD, R. (2015). Report Urges More Psychological Testing to Determine Disability Claims. Psych Central. Retrieved on April 13, 2015, from http://psychcentral.com/news/2015/04/13/recommendation-expand-psychological-testing-to-better-determine-disability-status/83466.html

April 04 2015

Friday Factoids: Are Mental Practice Exercises Beneficial for Individuals that Have Experienced a Stroke?

Author Danielle McNeill Categories Blog, Current Interns, Friday Factoids 0 Comments

 

 

Results yielded from a new study conducted by Georgia State University indicates that a person recovering from a recent stroke should undergo both physical therapy and mental practice (also known as motor imagery) in order to gain the most optimal results. Motor imagery is a mental rehearsal of a motor action without actually performing the action (while physical therapy involves using repetitive, task-oriented training on the body part that is impaired). The combination of physical therapy and motor imagery should be used to improve motor movement, balance, and coordination in individuals that have suffered a recent stroke.

 

For participants, the researchers employed the use of 13 older stroke survivors in addition to 17 healthy control participants. The participants from the stroke group were placed in two groups: 1) motor imagery only; or, 2) motor imagery and physical therapy. The treatment was given within 14 to 51 days of the participants’ stroke; each participant experienced 60 total hours of rehabilitation. To assess the effectiveness of each treatment, the participants in the stroke group and the control group underwent functional magnetic resonance imaging (fMRI) scans before and after each treatment.

 

During normal brain functioning, there are multiple cortical areas of the brain that communicate with each other; however, following a stroke, these interactions are disrupted. After a stroke, there is damage to brain cells; it can take a long time for the neurons to grow back, if they grow back at all. Dr. Butler, a faculty member at Georgia State University, stated that when attempting physical therapy many stroke patients are unable to move at all. Therefore the treatment teams often incorporate motor imagery, as if the stroke patients simply think about moving that area of the body, it helps keep the neurons active near the area that died in the brain.  Results obtained from this study indicated that the individuals in the stroke group that participated in both physical therapy and motor imagery had a significant increase in the flow of information between several brain regions.

 

It’s interesting that simply thinking about something can produce such beneficial and even tangible outcomes. What other areas of health can this notion be applied towards?

 

Faisal Roberts, M.A.

WKPIC Doctoral Intern

 

Pedersen, T. (2015). Both Physical Therapy, Mental Practice Important in Stroke Recovery. Psych Central. Retrieved on April 13, 2015, from http://psychcentral.com/news/2015/04/13/both-physical-therapy-mental-practice-important-in-stroke-recovery/83468.html

 

 

April 04 2015

Friday Factoids: An Influence in making Doctor Appointments: Loneliness?

Author Danielle McNeill Categories Friday Factoids, Mental Health and Wellness 0 Comments

 

A new study conducted by researchers at the University of Georgia’s College of Public Health found that the frequency of physician visits correlated with chronic loneliness in the elderly population. These findings are suggestive that creating interventions for elderly loneliness may significantly reduce physician visits and, correspondingly, health care costs. That begs the question of why. Is it that loneliness is detrimental to one’s health? Is it that if someone is lonely “reasons” to visit the physician may be influenced simply by to sheer longing for human contact? Perhaps a combination of the two? Or perhaps something else entirely?

 

The study examined senior citizens living in the general community and not those in a retirement community. The study relied on data collected in 2008 and 2012 by the University of Michigan’s Health and Retirement Study, a national survey of Americans that were over the age of 50. In order to assess loneliness, participants completed a survey examining their feelings regarding lack of companionship and social/emotional isolation. To meet the criteria for “chronic loneliness,” participants had to be identified as lonely in both years of the study (2008 and 2012, respectively).  The researchers reviewed responses from 3,530 of adults over the age of 60 that lived in the general community. The results are suggestive that chronic loneliness was significantly associated with the number of visits to the physician, although it did not appear to correlate with hospitalizations. 

 

These findings may implicate that the actual loneliness (as opposed to the detrimental impact of loneliness on health) plays a role, as the participants may have made an appointment with their physician because it is usually someone that they have known for years–and with whom they have built a relationship–therefore providing an element of sought after socialization. (As opposed to going to a hospital in which one typically does not know the staff there or which doctor they will be assigned). That is not to proclaim that the members of the elderly population malinger their symptoms in order to have an excuse to socialize with their physician; rather, it may be a confluence of variables, including the possibility of subconsciously generating reasons to visit a physician in order to alleviate loneliness. What do you make of these findings? Do you have any theories to explain it? Finally, hopefully we are spurred to facilitate meeting needs and helping a population to improve quality of life – can you think of any interventions to target loneliness in the elderly population?

 

Faisal Roberts, M.A.

WKPIC Predoctoral Intern

 

Nauert, R. (2015). Loneliness Drives Elders to Physician Offices. Psych Central. Retrieved on April 3, 2015, from http://psychcentral.com/news/2015/04/03/loneliness-drives-elders-to-physician-offices/83119.html

March 03 2015

Friday Factoids: Cambodians Have No Word for Depression

Author Susan Vaught Categories Blog, Continuing Education, Current Interns, Friday Factoids, Mental Health and Wellness, Resources for Interns 0 Comments

Mental health issues are a part of our existence and are experienced globally. The descriptions, terms, and phrases used to communicate these experiences are influenced by culture and often altered by the process of translation.

 

For example, Haitians who are feeling anxious or depressed may use the phrase reflechi twop, which means “thinking too much.” In the Cambodian Khmer language, there is not a direct translation for depression, so someone suffering from depression may instead say thelea tdeuk ceut, which literally means “the water in my heart has fallen.”

 

The World Health Organization has made global access to mental healthcare one of its key goals. As these services become more widely available and embraced by different cultures, providers should become increasingly mindful of cultural nuances that can color the ways in which people approach and respond to treatment.

 

Reference
Singh, M. (2015). Why Cambodians Never Get Depressed.

 

Graham Martin, MA
WKPIC Doctoral Intern

 

March 03 2015

Friday Factoid: Schizophrenia . . . Or Malingering?

Author Susan Vaught Categories Continuing Education, Current Interns, Friday Factoids, Resources for Interns 0 Comments

Recently, the man charged with murdering Chris Kyle, a U.S. Navy sniper whose autobiography inspired the film American Sniper, was said to have faked schizophrenia.  Yet, the defense expert witness testified that the accused had paranoid schizophrenia and exhibited signs that could not be faked (Herskovitz, 2015).

 

So the question arises, how does one distinguish feigned psychosis from the authentic experience of psychotic disturbance?

 

First, it is important to understand that malingering is an intentional and voluntary deception for secondary gain by fabricating or grossly exaggerating psychiatric symptoms (American Psychiatric Association [APA], 2013).  Also, becoming familiar with the diagnostic criteria for Schizophrenia Spectrum and Other Psychotic Disorders is needed to recognize thought-disorder-based psychosis.  Additionally, understanding the cluster of symptoms and how they contribute to psychosocial impairment is necessary when assessing psychosis (Richter, 2014).

 

Malingered psychosis is skewed to the presentation of positive rather than negative symptoms of schizophrenia (Resnick & Knoll, 2008).  Specifically, those who malinger are found to show higher proclivity of bogus symptoms, suicidal ideation, visual hallucination, and memory problems (Cornell & Hawk, 1989, as cited in Richter, 2014).  A sudden onset of positive symptoms, with no history of negative or chronic symptoms may indicate possible malingering (Richter, 2014).

 

With schizophrenia, the experiences of tactile and olfactory hallucinations are rare, tend to be intermittent and correlate with existing delusions (Richter, 2014).  Possible malingering is suspected when hallucinations are “continuous or not associated with delusions” (Richter, 2014, p. 216).  Also, no indications of developed coping strategies for hallucinations are common with malingered psychosis (Richter, 2014).  Individuals who malinger report visual hallucinations more often (Richter, 2014).  Of note, genuine visual hallucinations tend to be in color, are of normal sized people, may appear suddenly, and do not change if eyes are open or closed (Caldwell, 2009; Resnick, 1997; as cited in Richter, 2014).  Auditory hallucinations are most common in schizophrenia, and usually are clear, with both familiar and unfamiliar voices of male and female type (Richter, 2014).  Malingered command hallucinations are presented as terrifying and overpowering, with the inability to resist compliance (Richter, 2014).  They are also characterized as being dramatic, with stilted language, as well as continuous and presented without association to delusional thought (Richter, 2014).

 

Delusions as presented by the malingering person often have a sudden onset or termination and the individual eagerly discusses the content (Richter, 2014).  Malingering is suspected when disclosure of persecutory nature occurs in the absence of paranoid behavior (Richter, 2014) and when bizarre, atypical delusions are presented without disorganized thought (Resnick & Knoll, 2005; as cited in Richter, 2014).  In general, the absence of disorganized thinking is often associated with malingering (Richter, 2014).

 

Furthermore, individuals who malinger initially show treatment compliance, yet become difficult, often accusing the clinician of believing their symptoms are being faked (Resnick & Knoll, 2008).  Moreover, highly social behavior is largely inconsistent with the negative symptoms of schizophrenia and would suggest malingering if observed.  Overall, the negative symptoms (anhedonia, alogia, avolition) are often not consistent with malingered psychosis, but are replaced by bizarre positive symptoms (Richter, 2014).  The above material offers a brief synopsis of characteristics consistent with malingered psychosis, for a more comprehensive review and discussion of assessment strategies please see Richter’s (2014) article listed below.

 

References:
American Psyciatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Herskovitz, J. (2015, February 20). Accused in U.S. sniper’s murder faked schizophrenia:  psychologist. Reuters, retrieved from http://news.yahoo.com/accused-u-snipers-murder-faked-schizophrenia-psychologist-172922927.html

Richter, J. G. (2014). Assessment of malingered psychosis in mental health counseling.  Journal of Mental Health Counseling, 36(3), 208-227.

 

Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee

 

 

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