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Almost two-thirds of surgeon-instigated psychological referrals are for (correctly) suspected depression.

However, not infrequently, the surgeon has before him a patient for whom surgery went well, yet the patient is not mobilizing.

The patient returns to the surgeon repeatedly with unusual, unlikely, vague or even suspicious complaints. The patient may request more, different or specific medication. The patient may seek repeated reassurance that the surgical outcome was a success.

The patient may not respond to reassurance or attempts to put closure on care. He/she may not fully participate in physical or occupational therapies and may request second or third opinions. Often the surgeon does not know whether the patient has job skill sets that would permit alternate duty work.

In fact, such concerns are not surgical and do not fall within the surgeon's area of practice.

Are these patients simply depressed? Many are, but some are not. Some have increasing problems emerging with their employer, former coworkers or family. Giving up their physical complaints may represent relinquishing control. The injury has become a tool with which they attempt to solve other problems of living.

The surgeon's practice will not permit him to sit and ask probing questions that appear wholly unrelated to the orthopedic injury or surgical outcome. Indeed, the patient may be quite reluctant to talk about matters that are non-surgical even though these are the very factors that are impeding recovery and closure.

The surgeon is left with no viable option other than to leave the psychological probing to others and to focus upon the course of orthopedic care and recovery.

Tags: atlanta psychologist, chronic pain, david adams, depression atlanta, dr. david adams, georgia psychologist, pain psychologist, psychological, psychology, sexual dysfunction, somatoform, workers' compensation

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Mood Disorders

Personality disorder is the current terminology for what we once called character pathology. A personality is the sum total of how we think, feel and behave, and it is the foundation from which we operate both socially and occupationally.

A personality disorder, however, is a developmental defect. It disrupts how a patient deals with relationships, life's demands and how the patient perceives and reacts to stressors.

There are groups (called clusters) of personality disorders that represent the severity of this developmental defect. On the one extreme you may have a dependent personality disorder in which the individual is unable to deal independently with life and defers even minor decisions to others, continually seeking approval. On the other extreme are disorders such as paranoid personality disorder in which the individual lives a life of continual distrust of the motives of others. Suspicious and guarded, these latter individuals are watchful for even the slightest signs of betrayal.

About 10 percent of the population may have symptoms and signs of a personality disorder. It is generally believed that personality disorders are much more prevalent among injured workers, and, indeed, that the personality disorder may lead the person to a line of work in which injury is more probable. In either case, we are often dealing with a developmentally compulsive or negativistic or avoidant or even a chaotic individual. The injury did not cause this, but the personality disorder will definitely complicate the treatment of the patient.

Thus, it is imperative that we determine when a patient is responding inappropriately due to the co-existence ("co-morbid") personality disorder. We cannot change that disorder, but we can then base even orthopedic treatment upon the limitations imposed by the disorder.

Tags: atlanta psychologist, chronic pain, david adams, dr. david adams, georgia psychologist, pain psychologist, psychological, psychology, sexual dysfunction, somatoform, workers' compensation

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Personality Disorders

PTSD [posttraumatic stress disorder] can be an impressively disabling disorder with the injured worker awakened by frequent nightmares, plagued by intrusive thoughts of the accident, easily startled and attempts at avoidance of anything that reminds him/her of the injury. This can generalize in severe cases in which the individual may have lost a finger in an accident involving a specifically defective piece of equipment. Over time the patient cannot tolerate the sounds of similar or even remotely similar equipment. The patient may begin to avoid using knives, scissors or even using eating utensils.

However, not every trauma, even a severe trauma, results in PTSD. For a variety of reasons, some individuals are more prone to develop PTSD. Two individuals may encounter the same trauma; one develops the disorder and one does not. Additionally, the disorder may develop many months after the traumatic event (called delayed onset PTSD).

There are a variety of medications that will help the patient deal with not only the anxiety associated with the event but deal with anxiety over their own symptoms. That is, quite often patients develop "anticipatory anxiety" in which they become anxious as night falls, and they fear the occurrence of their nightmares.

In true cases of PTSD, the patient may be embarrassed by their own symptoms, fearing that others will ridicule their avoidant or anxious behavior.

With regard to treatment, there are desensitization procedures that will reduce the individuals anticipatory and reactive anxiety. But not all patients are responsive to psychological care. They may only partially invest in the treatment process, not fully comply with what they are instructed to do, and when they are being financially compensated for their symptoms, they are not always faithfully honest about the severity of the symptoms.

Much depends upon the patient's intentions with regard to their job: Do they plan to, wish to, or work toward returning to the job? Or has the injury become their exist strategy to a job they did not like, help briefly or for which they had grown weary? Again, it is important to determine the patient's motivation before assessing whether care will benefit them."

Tags: atlanta psychologist, chronic pain, david adams, dr. david adams, georgia psychologist, pain psychologist, psychological, psychology, sexual dysfunction, somatoform, workers' compensation

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Psychological Treatment

Research indicates that people with generalized anxiety disorder can, indeed, develop a major depressive disorder.

Allow me to outline generalized anxiety disorder:

• Excessive anxiety and worry about a number of events.
• Difficulty controlling this anxiety
• Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension and sleep disturbance

Symptoms of major depressive disorder include:

• depressed mood
• markedly decreased interest in almost all activities
• significant weight gain or loss, sleeping too much or too littler
• notable agitation or slowing
• loss of energy
• feelings of worthlessness
• decreased ability to concentrate or make decisions
• preoccupying thoughts about death

The co-existence of both disorders (referred to as "comorbid") can be a significant impairment in even daily functioning.

These symptoms are not difficult to detect, and the disorders are not difficult to diagnose. If they are not addressed, the course and rate of recovery from a physical illness will be significantly prolonged."

Tags: atlanta psychologist, chronic pain, david adams, dr. david adams, georgia psychologist, pain psychologist, psychological, psychology, sexual dysfunction, somatoform, workers' compensation

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Mood Disorders

The patient is melodramatic and flighty. The patient is not malingering, not consciously attempting to deceive. Years ago, this was referred to as the revealing-concealing hysteric. They are shallow and attention seeking. They need to be the center of attention, and they are often seductive with rapidly shifting superficial emotional expression. They make those who are attempting to assist them very uncomfortable.

They are excessively emotional, and you will often feel that they are seductive and inappropriately affectionate. This seductive behavior is often inappropriate to the context and can be displayed in doctor's offices, in physical therapy and in the workplace. You find them initially charming and open, but their need to be in emotional command of the situation will quickly be wearing. You will be uncomfortable with their seemingly excessive flattery and/or need to bring gifts or other signs of "just too much" affection.

They will be very dramatic in their presentation of psychological and physical symptoms. Their symptoms seem theatrical, and their attachment to you and others is superficial and rapidly shifting and shallow. They may seem concerned about impressing you and attempt to extract from you compliments on how they look and how well they are dealing with the discomfort from their injuries.

You may feel embarrassed with the degree of their emotionality, but realize, they are not at all embarrassed. You will note that these emotions have no depth even though they are extreme. They may engage in elaborate explanations of their emotions, but you will note an absence of insight. They simply are unaware or unconcerned with the impact that they are having upon you or others.

More troubling is that they are very suggestible and even the slightest reference to what their symptoms could mean, even if this suggestion is provided by another patient, immediately leads to excessive alarm and even more drama. Sobbing, laughing too quickly and too loudly and other attempts to hold them as the focus of everyone's attention will eat up your time and patience.

These are histrionic personalities, and they may account for as many as 10-15% of those in psychological care and likely 5+% of those in the health care delivery system since physical complaints become a welcome environment for their unbridled emotionality.

You cannot reassure, dissuade or otherwise alter their behavior. You can best contain the behavior by making interactions brief, follow an agenda and be based upon exchange of data, not responding to the excessive emotionality.

Tags: atlanta psychologist, chronic pain, david adams, dr. david adams, georgia psychologist, pain psychologist, psychological, psychology, sexual dysfunction, somatoform, workers' compensation

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Personality Disorders