When an employee of the Federal Government such as a Postal Worker, IRS Worker, or Military Support Services becomes injured they are immediately flung into an arena which is dark and confusing.  Most injured workers are not aware of how complex and how diversified the system is.  Most practitioners do not accept or work within the parameters of the Department of Labor, Federal Workers’ Compensation Program, (OWCP).  An injured worker is assigned a case worker who is marginally aware of their medical condition.  The injured worker is trying to interpret the regulations as are federally mandated. 

 When an individual has a severe physical injury, it is medically probable that they will also have a psychological trauma such as depression, anxiety, chronic, pain and insomnia.  All of which will decrease a person’s self-esteem.  These issues are in need of psychological treatment.  The first course of treatment should be Cognitive Behavior Therapy.  Treatment helps an individual understand their symptoms and the causes.  If in addition to therapy severe sleep disorders and clinical issues exists this raises the possibility of psychopharmacology being a supplemental treatment. 

 An injured worker must search out individuals to treat them so that they can remain functional in their families and eventually return to some gainful employment.  This is the role of a treating psychologist. Our function is to help an injured worker understand their limitations, disabilities, and learn to cope with those limitations.  It is necessary to provide substantial support while maneuvering through the complex medical/legal system.

 A Cognitive Behavior Therapist is a fundamental necessity in helping to manage pain.  The other alternative is to use pharmaceuticals which are marginally effective and most often have to be increased in dosage.  It is necessary for an injured worker to understand that in the Federal Workers’ Compensation System, chronic pain management is not considered a disability.  Psychological factors such as depression, anxiety, insomnia, and low self-esteem are compensable and approved for treatment.

There are many more calls and referrals regarding children with Attention Deficit Hyperactivity Disorder, which is a form of Obsessive Compulsive behavior of children.  In April 2010 a study appeared in Health Day News of 304 youths found to have ADHD symptoms.  The finding was that these symptoms are more common in children and teens with high or low activity levels of the neurotransmitter serotonin.  The children blamed themselves for conflict between their parents.  This study would indicate that there is an interaction of genetics and psychology which may be the root cause of Attention-Deficit Hyperactivity Disorder (ADHD).

 In this study it states “To date, studies have mostly focused on the effects of genetic and environmental influences on ADHD separately,” wrote Molly Nikolas of Michigan State University.  She states, “Our work examines interaction between the specific gene variant and a family environmental risk factor in order to determine the roles in the development of ADHD via behavioral and emotional disregulation in children.”  The genetic region examined by the researchers is the 5 HTTLPR, which is responsible for the regulation of the production of the protein that transports serotonin.  Previous studies have linked this area to a number of personality traits and neuropsychiatric disorder.  Again, “Overall, these results complement growing evidence suggesting that 5 HTTLPR variants confer a liability for ADHD that is activated in particular environments, rather than conferring risks for ADHD directly.”  This study was published on April 15, 2010 in the Journal of Behavioral and Brain Functions. 

 This finding indicates that simply medicating children for the sake of controlling their behavior may not be the best way to treat them for this disorder.

Currently a new evaluation has been made available by Western Psychological Services, which is intended to measure children and adolescent’s problems by incorporating a self-report of moods and anxiety disorder, including problems associated with OCD related behaviors.  Studies have shown that children tend to report higher levels of Obsessive Compulsive Disorder related symptoms than their parents. Children especially report symptoms of Obsessive Compulsive Disorders, especially mental symptoms such as obsessive thinking, and compulsive tendencies.  This test is a valuable aide both in confirming and ruling out the presence of obsessions and compulsions, and in understanding the child’s experience of his or her symptoms.  This evaluation is a useful tool in assessing many apparent disorders that children are currently suffering.

Dr. Frank Lucchetti is pleased to announce the availability of the Millon Behavioral Medicine Diagnostic Inventory to assess psychological factors that can influence the course of treatment of medically ill patients.

 Sir William Osler, the imminent nineteenth century clinician, said, “The good physician will treat the disease, but the great physician will treat the whole patient.”  The MBMD ™ (the Millon Behavioral Medicine Diagnostic) Inventory is designed to provide the critical psychological information doctors need to treat the whole patient.  We must understand that psychological and behavioral factors play a potential role in the presentation or treatment of almost general medical condition.  The use of this diagnostic tool is reserved for those situations in which the psychological factors have a clinically significant effect on the course or outcome of the general medical condition, or place the individual at a significantly higher risk of an adverse outcome.

 Psychological and behavioral factors may affect the course of almost every major category of disease, including cardiovascular conditions, dermatological conditions, endocrinological conditions, gastrointestinal conditions, neoplastic conditions, neurological conditions, pulmonary conditions, renal conditions, and rheumatological conditions.

 The MBMD is a tool which can be useful in the integrative treatment of individuals who had substantial medical conditions, chronic pain, and are deciding on major surgical procedures.  This tool, along with appropriate psychological intervention can be a cost effective and useful treatment in recovery, and the management of physical disabilities.  This tool is now an integral part of treatment in my psychotherapy practice.