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How Are Axis Figured In To Decisions?


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2 replies to this topic

#1 nyc-vet

 
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Posted 02 December 2009 - 02:44 PM

I'm trying to help someone do a notice of disagreement for depression. The veteran was increased from 10% to 30% but we believe it should be higher.
We were reading over the physical exam at the doctor diagnosis.

This is what it states in the diagnosis section.

Multiaxial diagnosis:
Axis I: Adjustment disorder with mixed anxiety and depressed mood (309.28)
Axis II: Defered 799.9
Axis III Deferreed to medical evaluation
Axis IV: Social isolation, unemployment, chronic concerns about pain and the negative impact of this on their energy level, low energy, health difficulties, marital conflicts
Axis V: GAF 52

How does the Axis figure into the decision? I wonder if the GAF score is what made it 30%.

Within the diagnostic impression section they say "it would appear that these distresses is chronic and would appear that the veteran would have a difficult time obtaining and maintaining employment given their physical complaints and current level of distresses.


Do you believe this is grounds for a notice of disagreement and request a higher rating? I also wonder if they bothered to read the notes in detail.



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#2 carlie

 
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Posted 02 December 2009 - 03:04 PM

I have borrowed this wonderful information from
another web site, authored by Patrick428, who also
posts at Hadit on rare occassions.
I do not think he will mind me sharing this information
with you and I take no credit for writing it.
Hope this helps a vet.
carlie


So to start with I will describe many common terms needed to be understood and given examples when warranted.

R/O (Rule Out): Is a term found on either Axis I or II saying that there is not enough evidence to support the diagnosis at this time.

Deferred: Is a way of a clinician saying, "I just met you and I am not sure if you have this or not." Usually found when the patient has first entered the mental health system or has been out of the mental health system for a long period of time.

Secondary: Disorders that have manifested because of the first or primary disorder and also contribute to the severity of the primary disorder.

A full diagnostic example is as follows. There are varieties of how they are written, but this is the universally accepted model:

Axis I: Major depression, recurrent without psychotic features (Primary)
Generalized Anxiety Disorder (Secondary)

Axis II: Borderline Personality Disorder or None

Axis III: Ulcers and heart problems (usually medical problems that contribute to the mental disorder)

Axis IV: Psychosocial Stressors: Lose of employment and child abuse
Severity: 1 None; 2 Mild; 3 Moderate; 4 Severe; 5 Chronic

Axis V: Current GAF: 50
Highest GAF past year 60

GAF : Is referred to as Global Assessment of Functioning. This is a scale from 1 - 100 suggesting a pattern of behavior at any given movement in time. GAF is a fluid score and is never static (think of your blood pressure when applying GAF). The lower the score more problematic behavior becomes.

91 - 100 Not much happening and you can tolerate most stress very easily. (Blood pressure normal)

81 - 90 Some minor setbacks, maybe late bill that was not paid causing a flurry of minor stress, but is usually resolved. (Blood pressure slight elevated, but returns to normal rapidly)

71 -80 Minor problems within the home (work) and some stress that is enduring, but usually dealt with. They called about the bill that you forgot to pay (Blood pressure slightly elevated).

61 - 70 Minor to moderate problems such as not having the money to pay the bill and you are under pressure by your creditor to pay it. (Blood pressure is elevated and in need of attention).

51 - 60 Your being sued for not paying your bill, and your wife or husband has announced they are tired of living this way. Your kids do not know who you are anymore. (Blood pressure above 140/90 and dual medications are needed).

41 - 50 Wife or husband announces they are leaving and the bill collector has placed a lien on your property. You have called your creditor and your spouse idiots and you say to hell with them. (Blood pressure is severe and strong doses of medication are needed)

31 - 40 You threaten to kill your creditor and your spouse and everyone around you is against you. (Blood pressure is in the stroke range).

21 - 30 You bought a weapon and can of gas and your going to resolve the issue once and for all. It causes you to be either incarcerated or committed. (Blood pressure is causing severe chest pains and your stroking).

11 - 20 The best you can do is verbally babble and drool on yourself. (Blood pressure has caused a stroke).

0 - 10 You are no longer with us as you now live in a parallel universe. (It does not matter now).

It is not my intention to make light of the scale, but I wish to show the reality of the levels.

Axis I. A grouping of mental syndromes from a common etiology or pathology. What is usual found on Axis I disorders are: Mood, Sexual, Psychotic Substance Abuse, Child Disorders (except Mental Retardation), and Organic Syndromes (e.g.,Depression caused by a stroke).

Axis II. Are disorders of the Personality and Mental Retardation. Here Personality Disorders in Cluster A, B, and C are found.

Cluster A. Disorders deemed to be problems associated with peculiar behaviors(Schizoid).

Cluster B. Disorders where the individual violates the right of other people and often has little regard for others (Antisocial).

Cluster C. Disorders where dependency and inability to fit in socially with others is the common theme(Avoidant).

Personality is how one perceives, relates, and thinks about the environment and of oneself.

Personality Disorder is a maladaptive problem with the personality that causes extensive interference and ability to function in society. This is a pervasive pattern of behavior manifesting itself in the early development of an individual and prevents the individual from functioning normally in society.

Illusion: An illusion is a visual perception or misinterpretation of something real.

Hallucination: A hallucination is a false perception of a sensory experience (tactile, visual, auditory, taste, smell, or in body experience).

Delusion: Is a false belief carried to an extreme.

Psychotic. Loss of touch with reality

Depersonalization: Feelings of detachment from others. Feelings like being one's own dream.

Affect: Mood behaviors. Moods can be blunted, flat, inappropriate, labile (frequent mood changes), and restricted.

PTSD: Post-traumatic Stress Disorder. Can come in forms of mild, moderate, severe, chronic and delayed. May be seen on Axis I written as: PTSD, Chronic and Delayed.

Psychiatrist: Is Medical Doctor who specializes in mental illness and uses medications for its' treatment.

Psychologist: Is a person who performs psychological testing, assessment, and therapy.

M.S.W. Master's in Social Work and usually coordinates community-based programs and also performs therapy. But is restricted to therapy only.

Psychological Battery includes:

Personality Inventory (MMPI, etc)
Intelligence Scale (IQ test Wechsler or Stanford-Binet)
Neurological Tests (Bender-Gestalt, Wechsler Memory Test, etc).
Mood Inventories (Depression Scale; Anxiety Scales)
Trauma Scales (Mississippi, TSI)
Mental Status Examination
History

Mental Status Examinations:

Mini Mental Status exam - 20 minutes
Full Mental Status Examination - 1 hour

Specialized Tests as warranted for the purpose of narrowing the cause of many problems.

I am sure I left a few things out, but wanted you to have a general idea of the COMMON terms seen. In 98% of cases this is the information seen by the patient. Therapy modalities vary with each practitioner and as is often the case a practice or clinic is staffed with practitioners with like ideas of therapy. It should not be construed simply because a Psychiatrist or Psychologist is licensed that they are specialist in every aspect of mental illness. This is not true.

When either suggests they can handle any your problems regardless of your disorders, then seek other help. To find a good therapist this is a good rule of thumb:

1. Ask around
2. Ask your medical physician who is good at what you need to deal with.
3. Ask the local Psychology or Psychiatric Association for a referral
4. Call the respective State Board and check for Board Certification and Credentials.
5. Call the national associations ( both APA's) and get advice
6. If you are in the VA system and do not like the practitioner you have, request another.
7. Talk to other vets about their experience if they share it. Remember this is probably the most unreliable referral.
8. READ AND DON'T ASSUME
9. RESEARCH YOUR DISORDER
10. ASK QUESTIONS (Practitioners are not mind readers).

I hope this will help out in many ways. It is not all inclusive and I will from time-to-time add information that is either brought to my attention or comes to light..

Patrick

#3 SANDMAN

 
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Posted 02 December 2009 - 04:12 PM

Carlie,

Great find, that really makes it easy for us JARHEADS to understand.
Thanks, SGT Sandman




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