Residual Functional Capacity - Adult Anxiety Related Mental Disorder (Page 2 of 7) in pdf

1. A comprehensive mental status examination which generally includes a narrative description of

appearance, behavior, and speech; thought process (e.g., loosening of associations); thought content

(e.g., delusions); perceptual abnormalities (e.g., hallucinations); mood and affect (e.g., depression,

mania); sensorium and cognition (e.g., orientation, recall, memory, concentration, fund of information,

and intelligence); and judgment and insight. The individual case facts determine the specific areas of

mental status that need to be emphasized during the examination.

2. Psychological testing. Reference to a "standardized psychological test" indicates the use of a

psychological test measure that has appropriate validity, reliability, and norms, and is individually

administered by a qualified specialist. "Qualified" is defined as a specialist currently licensed or

certified in the State to administer, score, and interpret psychological tests and have the training and

experience to perform the test.

Psychological tests should the specialist's observations regarding the patient’s ability to sustain

attention and concentration, relate appropriately to the specialist, and perform tasks independently

(without prompts or reminders). The test results should include both the objective data and any clinical

observations.

Neuropsychological assessments. Comprehensive neuropsychological examinations may be used to

establish the existence and extent of compromise of brain function, particularly in cases involving

organic mental disorders. Normally, these examinations include assessment of cerebral dominance,

basic sensation and perception, motor speed and coordination, attention and concentration, visual-

motor function, memory across verbal and visual modalities, receptive and expressive speech, higher-

order linguistic operations, problem-solving, abstraction ability, and general intelligence.

In addition, there should be a clinical interview geared toward evaluating pathological features known

to occur frequently in neurological disease and trauma; e.g., emotional lability, abnormality of mood,

impaired impulse control, passivity and apathy, or inappropriate social behavior. The specialist

performing the examination may administer one of the commercially available comprehensive

neuropsychological batteries, such as the Luria-Nebraska or the Halstead-Reitan, or a battery of tests

selected as relevant to the suspected brain dysfunction. The specialist performing the examination must

be properly trained in this area of neuroscience.

Considerations of Mitigating Factors

Chronic mental impairments. Particular problems are often involved in evaluating mental

impairments in individuals who have long histories of repeated hospitalizations or prolonged outpatient

care with supportive therapy and medication. If the patient’s life structured in such a way to minimize

stress and reduce symptoms and signs this should be noted. The patient may be more impaired for

work symptoms and signs would indicate.

Effects of structured settings. Chronic mental disorders, overt symptomatology may be controlled or

attenuated by psychosocial factors such as placement in a hospital, halfway house, board and care

facility. Highly structured and supportive settings may also be found at home. Mental demands from

these environments may reduce overt symptoms and signs of the underlying mental disorder while the

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