Dysthymic Disorder can only be diagnosed after an injured employee has been depressed for ~2 years. Major Depression is more frequently diagnosed after injury than this Dysthymic Disorder. Which is worse? Dysthymic (pronounced: diss-thy-mick) Disorder consists of waxing and waning depressive symptoms spanning a two year period. If a person has a situational depression as a result of an event in the past six months, it is called “Adjustment Disorder with Depressed Mood” and most often subsides as the event becomes further in the past. While the word MAJOR in Major Depressive Disorder sounds significant, those with a major depressive episode often recover quickly and may not be disabled by their symptoms. During the course of a recent study, the patients with dysthymic disorder had more symptoms, functioned worse, and were significantly more likely to attempt suicide and be hospitalized than were patients with episodic major ...
I have had injured workers who complain of severe headaches and say they cannot work. Often these individuals have had no head injury. The neurologists seem to feel the headaches are disabling. There is an article in the journal Headache with a lengthy discuss of depression and anxiety as being among the psychological symptoms that accompany frequent headache and headache-associated disability. The presence of psychological comorbidity (that is, concurrent anxiety and depression as well as headache) with headache predicts a longer lifetime duration of headache and a poorer prognosis for headache reduction. Subjects who had headaches more than 4 days a week and those with headache-associated activity limitation for 3 or more days a week showed significantly greater depression and anxiety. Anxiety and depression were not believed to result from or cause the headaches but to co-exist in many headache sufferers. ...
I have found that when an injured worker claims to have psychological problems as a result of physical injury, they often then are not compliant with a psychological referral. There are those patients for whom domestic violence may be the main issue. This violence can arise from substance abuse after injury and/or frustration in dealing with pain. The pattern goes as follows: There is a violent outburst. The patient (chiefly male) then asks their case manager, adjustor or primary provider for a psychological referral. The referral is made, The abused spouse feels "reassured" that the injured worker is no longer violent. The pressure/urgency for the appointment is removed, and the patient then fails to show. Most people are not skilled at identifying domestic violence. Recent research indicates that even after 3 hours ...
If someone truly does need psychotherapy following injury, what are the current standards of care...and why? For most injured workers, emotional upheavals are transient and tied to pain, economic changes, relationship pressures and fears of the future. The current treatment paradigm enforced by managed care is short-term -- a few sessions to relieve symptoms and quick termination. This treatment model assumes that emotional upset usually resolves quickly, especially with help. Patients may return for additional sessions if there is a recurrence of difficulty. For some patients, this model works quite well, is cost-effective, and avoids the stigma of mental or emotional problems. Even psychotropic medication can be added to the package, given the availability of relatively safe and efficacious selective serotonin reuptake inhibitors (SSRIs). The prescription most often comes from the patient's primary care physician. ...
“If depression is caused by a chemical imbalance in the brain, then how can it possibly be tied to injury?" Depression, that occurs after injury, is not at all related to the injury. The depression may have existed for a considerable period and simply not been detected. Individuals with recurrent major depression have a series of major depressive episodes and will continue to have these episodes. Some personalities are more prone to these. There is a form of mild-to-moderately depressed mood, however, that does occur in some people after injury. This is “situational” depression and is tied to realistic worry, fear, pain, and uncertainty. This is called an adjustment disorder. There is also a form of depressed mood that is diagnosed when a person has had moderate depressive symptoms spanning at least two years. This is called dysthymic disorder as we have discussed in the past. The physical symptoms, ...
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