Independent Medical Psychiatric Examination

Following are excerpts from the examination documentation.

Date of Birth : 11/11/50

Date of Evaluation : 8/22/08

WCB Case Number : 00xxxxxxx

Carrier Case Number : 7xxxxxx

General Information Regarding Request for IME

xxx xxxxxxx requested that I perform a Psychiatric IME on Mr. xxxxxx xxxxxxx. Questions to be answered in the IME report include :

• Diagnosis / Prognosis?
• Need-Duration of Treatment?
• Is there a casual relationship?
• Return to work and/or normal daily living activities?
• Pre-existing conditions which may be having an affect on the claimant's recovery?
• Need for household help, ambulatory service, etc.? For how long/frequency?
• Need for medical testing, equipment, TENS unit, whirlpool, mattress, orthotics, etc.?
• Degree of Disability?
• Prior Medical History

Confidentiality

xxxxxx xxxxxx was informed that the purpose of the evaluation was to provide a comprehensive psychiatric evaluation report to xxxxx Associates. He understood that information obtained during our meeting and from review of records was not confidential. He was informed that doctor-patient confidentiality did not exist for this examination or for any testing that might be involved in this examination. Xxxxxx xxxxxx expressed an understanding of this and agreed, under these circumstances, to proceed with the examination.

Qualifications of the Examiner

The consultant is a licensed physician in the State of Florida, and is a diplomate of the American Board of Psychiatry and Neurology, and also a diplomate of the American Board of Forensic Medicine and diplomate of the American Board of Disability Analysts.

Persons attending the IME

Mr. xxxx xxxx was examined at the office of this consultant. Mr. xxx xxxxx (son of xxx xxxx) joined the examination to assist xxx xxxxx if he had any questions regarding the terminology used by this consultant. Mr. xxxx xxxx is from India. English is a second language for Mr. xxxxx. He was asked to inform this consultant if he did not understand any questions during the IME. Mr. xxxx xxxxx also provided additional information regarding xxxx xxxxx condition and behavior at home, and information regarding legal/litigation issues regarding xxxxx xxxxx.

Summary / Impressions

Mr. xxxx xxxxxx is a 57 year old, Indian male who was examined on 8/22/08. He was cooperative with the examination. I do not find any evidence which supports symptom exaggeration or malingering. Based on this examination, testing, review of medical and legal records, and my experience and training as a psychiatrist, I have developed various impressions regarding this individual.

#1. Diagnosis / Prognosis?

Mr. xxxx xxxxx fulfills the DSM-4-TR criteria for Major Depressive Disorder, single episode. He has no previous depressive episodes prior to the 2/15/07 accident. The current severity of his depressive episode is severe.

The symptoms which fulfill the DSM-4-TR criteria include :

• Depressed mood most of the day.
• Markedly diminished interest or pleasure in almost all activities.
• Significant weight loss and decrease in appetite.
• Insomnia nearly every day.
• Psychomotor retardation.
• Fatigue or loss of energy.
• Feelings of worthlessness and inappropriate guilt.
• Diminished ability to think or concentrate and indecisiveness.

Mr. xxxx xxxxxx also fulfills the DSM-4-TR criteria for Posttraumatic Stress Disorder. The traumatic event associated with his PTSD is the accident on 2/15/07. The PTSD is chronic since the duration has lasted more than 3 months.

The symptoms which fulfill the DSM-4-TR criteria include :

• He experienced an event that involved actual death and serious injury to the physical integrity of self and others. His response involved intense fear and helplessness.
• He has recurrent thoughts of the event.
• He has physiological reactivity on exposure to cues that symbolize an aspect of the traumatic event (driving).
• He has psychological distress at exposure to cues that resemble an aspect of the event (driving).
• He avoids activities that arouse recollections of the trauma.
• He has markedly diminished interest and participation in significant activities.
• He has feelings of detachment from others.
• He has difficulty falling asleep.
• He is irritable and has anger outburst.
• He has difficulty concentrating.

Mr. xxx xxxxxx may fulfill the DSM-4-TR criteria for Cognitive Disorder Not Otherwise Specified. He has no previous episodes of cognitive problems prior to the 2/15/07 accident.

The symptoms which fulfill the DSM-4-TR criteria include; He has cognitive dysfunction presumed to be due to the brain trauma which occurred to him in the 2/15/07 accident.

I documented "rule out" this diagnosis because currently I am not able to determine if his cognitive problems are symptoms of Major Depression and/or PTSD, or if they are a separate disorder, i.e. Cognitive Disorder NOS.

The most accurate way to make this determination is by utilizing Neuropsychological testing. Mr. xxxxx did participate in Neuropsychological testing in May of 2008, by xxx xxxxx, Ph.D. I recommend that a copy of this report be obtained. Hopefully, the information found in Dr. xxxxxxx's report will assist in determining whether Mr. xxxxxx does or does not have a Cognitive Disorder.

It is my opinion that Mr. xxxxx has a good prognosis if he obtains appropriate psychiatric treatment. Without appropriate treatment, I am concerned that his psychiatric conditions will continue to worsen.

#2. Need-Duration of Treatment?

Mr. xxxxx requires appropriate psychiatric care by a licensed psychiatrist. I recommend he be prescribed antidepressant medications to treat his depressive and anxiety symptoms. While there are many FDA approved antidepressant medications which can be tried, I recommend he receive a trial of Cymbalta at 60-120 mg. daily. Since Cymbalta is approved for Depression, Anxiety and chronic pain conditions, he may receive benefits in his psychiatric and pain conditions.

He may also benefit from a trial of a psychostimulant medication (Ritalin, Dexedrine, Adderall, and Vyvanse) or Provigil to improve his problems with attention span, concentration, slowness of thought and memory.

Once he responds to a medication, I recommend he take the medication for at least one year. Most patients with the duration and severity of symptoms Mr. xxxxxx has, will require several years (2+) of medication treatment.

I also recommend Mr. xxxx participate in weekly to biweekly psychotherapy with a licensed Master's level or Ph.D. level therapist. I recommend he participate in cognitive/behavioral therapy to reduced depressive and anxiety symptoms. If the Neuropsychological Testing is consistent with a Cognitive Disorder, therapy focusing on his cognitive problems may be more beneficial than traditional psychotherapy. The duration of psychotherapy should last approximately 3-6 months.

#3. Is there a casual relationship?

Based on the information provided by Mr. xxxx and the information I have reviewed, it appears there is a direct casual relationship between the accident on 2/15/07 and the diagnosis of Major Depressive Disorder, PTSD and a possible Cognitive Disorder. I do not find evidence supporting any diagnosis or symptoms, prior to the 2/15/07 accident.

#4. Pre-existing conditions which may be having an affect on the claimant's recovery?

I do not find any evidence that supports any pre-existing conditions which have an affect on Mr. xxxxxxx's recovery.

#5. Return to work and/or normal daily living activities?

Mr. xxxxxxx is currently totally disabled from working as a limousine driver. Since Mr. xxxxx has not had appropriate psychiatric treatment, it is my opinion that it cannot be determined if his psychiatric problems will lead to temporary or permanent disability.

#6. Degree of Disability?

Please see #5.

#7. Need for household help, ambulatory service, etc.? For how long / frequency?

Mr. xxxxx does not need household help or ambulatory service. He lives with his family, who are willing and able to assist him. In addition, participation in household activities will be therapeutic for Mr. xxxxxxa.

Mr. xxxx does not need any further medical testing. As I have previously documented, I recommend you obtain a copy of the Neuropsychological testing which has already been performed.

#9. Prior Medical History

This is documented in the body of this examination report.

I declare that the information contained in this report and its attachments, if any is true and correct to the best of my knowledge and belief, except as to information that I have indicated I have received from others. As to that information, I declare that the information accurately describes the information provided to me and, except as noted herein, that I believe it to be true.

I declare that the diagnosis and impressions in the IME are all within a reasonable degree of medical certainty.

To see the resume of the expert associated with this case study, see the link below.