Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Depression and Culture

The greatest value of a thorough psychological examination on a patient who insists that they have no psychological issues is to determine functional capacity.

Without a doubt, it would be _functional capacity._

Unquestionably, patients are sent to determine if they:
a. Are truly in chronic pain
b. Are depressed and/or anxious
c. Have PTSD
d. Have bizarre thinking, compulsive behavior and/or obsessive thought
e. Whether their problems are pre-existing or injury-related
f. Can remember, concentrate and make decisions
g. Are suspicious and distrustful, angry and aggressive
h. Have a host of other emotional and mental problems

However, after they drive two hours to the office, spend 5+ hours here and then drive two hours back, those 9+ hours become a test of functional capacity.

Occasionally, but rarely, there is a patient who physically and emotionally cannot complete the examination.

But many, even those with significant work-restrictions, work for hours without a break, without complaint and often using the injured arm, shoulder or hand for which they have work restrictions. They sit for hours on end and, yet, their restrictions state that they _cannot sit or stand for longer than ten minutes._

The psychological exam becomes a measure of functional capacity.

Does this mean that the patient is faking/malingering? Not always. It most often means that the restrictions were assigned without observing the patient doing the very tasks for which the restrictions were assigned.

The functional capacity to complete a lengthy psychological exam is extremely important data to be considered when helping them return to work.

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