Presentation Information
[O-9-02]Unrecognized cases of psychosis in disability evaluations
*Brad Booth1,2, Dominique Bourget1,2, Sarah Mamane1,2 (1.Univ. Ottawa(Canada), 2.Royal Ottawa Mental Health Centre(Canada))
Keywords:
Forensic psychiatry,Disability evaluations,Psychotic disorders
Background:
Independent medical evaluations (IMEs) are often sought for determination of eligibility for disability benefits. At times, individuals with obvious or subtle psychosis present in the context of these IMEs. There is little literature on the topic. The current study reviews psychosis and schizophrenia spectrum disorders in IMEs for disability claimants.
Methods:
The authors completed a retrospective chart review of 705 consecutive disability independent medical examinations (IME’s) for disability dating back to 2010 drawn from forensic work by BDB. Data was extracted for patients who consented to research where a primary psychotic disorder was likely or suspected. Numerous standardized scales were administered and available for analysis, including validity measures.
Results:
Out of the approximately 705 consecutive IME, 27 (3.8%) were found to have a likely psychotic elements to their presentation, such as s schizophrenia spectrum diagnosis. Of this sample, 23 consented to use of their data in research. Nearly all were diagnosed with a new-onset psychotic disorder. The average patient had 2.5 comorbid DSM diagnoses suggesting high comorbidity. Many endorsed numerous psychosocial stressors.
Discussion:
Experts involved in IME’s and other forensic evaluations must be aware of the potential of unrecognized/subtle psychotic signs. In approximately 3.8% of a large disability evaluation sample, psychosis was the likely cause of disability. Many had not been recognized as being psychotic and were not on appropriate treatment. Once the correct diagnosis of psychosis or a schizophrenia spectrum disorder is made, the clinician can comment on the potential for improvement over a predictable course. The expert will be in a position to offer recommendations, such as pharmacological treatment, psychiatric and psychological follow-up, and other relevant advice.
Independent medical evaluations (IMEs) are often sought for determination of eligibility for disability benefits. At times, individuals with obvious or subtle psychosis present in the context of these IMEs. There is little literature on the topic. The current study reviews psychosis and schizophrenia spectrum disorders in IMEs for disability claimants.
Methods:
The authors completed a retrospective chart review of 705 consecutive disability independent medical examinations (IME’s) for disability dating back to 2010 drawn from forensic work by BDB. Data was extracted for patients who consented to research where a primary psychotic disorder was likely or suspected. Numerous standardized scales were administered and available for analysis, including validity measures.
Results:
Out of the approximately 705 consecutive IME, 27 (3.8%) were found to have a likely psychotic elements to their presentation, such as s schizophrenia spectrum diagnosis. Of this sample, 23 consented to use of their data in research. Nearly all were diagnosed with a new-onset psychotic disorder. The average patient had 2.5 comorbid DSM diagnoses suggesting high comorbidity. Many endorsed numerous psychosocial stressors.
Discussion:
Experts involved in IME’s and other forensic evaluations must be aware of the potential of unrecognized/subtle psychotic signs. In approximately 3.8% of a large disability evaluation sample, psychosis was the likely cause of disability. Many had not been recognized as being psychotic and were not on appropriate treatment. Once the correct diagnosis of psychosis or a schizophrenia spectrum disorder is made, the clinician can comment on the potential for improvement over a predictable course. The expert will be in a position to offer recommendations, such as pharmacological treatment, psychiatric and psychological follow-up, and other relevant advice.