Mental Status Exam

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K9
Regular Member


Date Joined Nov 2008
Total Posts : 263
   Posted 4/3/2009 2:42 PM (GMT -7)   
Has anybody heard of this? What's involved? Can it really assess "fibro fog?"
My disability insurance carrier has denied my claim AGAIN - long story - they refuse to recognize that I HAVE fibromyalgia, even though a rheumatologist diagnosed it.

Anyway, they say that while I "self report" cognitive impairment, "no mental status exam was performed".

???

I have a very high-stress job that entails being SHARP as a tack LATE IN THE EVENINGS. This has proved near-impossible over the past year. I sit there at meetings not having a clue what's going on half the time. It scares the hell out of me, actually.

Anyway, I wondered if anyone has heard of this kind of exam, and what it would be.
It seems like another bogus thing to deny my claim...
I have Fibromyalgia, and nothing else!
I take Lyrica 225 mg/day and Tramadol (150mg time-released) and amytriptilene 7.5mg


BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 4/3/2009 3:44 PM (GMT -7)   
I do these for a living, so I can give you a general idea.  Is this a MSE for disability? I'm guessing it is, but let me know the specifics (if you want).   MSE is a basic psychological test can be brief or more indepth to assess cognition, functioning, intellect, etc.--basically it's a diagnostic tool used to determine a possible psychiactic diagnosis, but also used for neurological workups.  Briefly, you're asked about orientation to time, date, place, sleep/appetite patterns, mood, observed affect by the examiner, thought content, thought process, perception (psychotic process), insight/judgment and other stuff.
 
MSE is standard proceedure in diability claims, especially in the appeal process.  BTW, I'm not a disability worker :-) .
 
Oh yeah, I have fibro and I'm not sure a MSE could accurately diagnose my daily struggles.

K9
Regular Member


Date Joined Nov 2008
Total Posts : 263
   Posted 4/4/2009 10:12 AM (GMT -7)   
That's the thing. I'm pretty darn sure that I would sail through this type of test with flying colours. Especially if I took it in the morning, and probably even afternoon. It's those 7-10pm meetings where I'm out to lunch. And anytime when I've overdone it the day before or whatever. I'm just worried that I wouldn't be tested under those conditions.

Thanks for your response.

I work as a minister of a large multi-staff church (senior minister). My job isn't really possible unless you're there 50 hours a week. Four of five nights I have business meetings, and I can't handle those anymore - for the past year. By "handle" I mean - I don't know what's going on and can't think properly ("fog" I guess is the best way to describe it).
I'm a Mensa member, so my IQ is about 140. But I don't operate like it is anymore! SOMETIMES I do, but as I said - late hours and late nights and I'm toast. I make no sense whatsoever, or else I don't contribute to the meeting in any meaningful way.
I'm working half-time right now, which means I prepare sermons (mostly at home) and worship services - this takes about 16 hours (normally)...and then I preach Sunday mornings. That's it. I can't do the rest.
The insurance company insisted on a diagnosis, and finally I got to a rheumatologist and she diagnosed me with "classic" fibromyalgia. I was shocked. I thought I just had chronic neck and back pain.
Sent in the letter, which detailed 18/18 FMTP (fibromyalgia trigger/tender points) and the Ins. co. came back and said "you have nonmalignant soft tissue pain" Well....congratulations to me, I guess!
Grrrrr....
Anyway, those are the specifics. I don't know if they want a MSE or not...they just noted in THEIR diagnosis that I didn't have one.
I have Fibromyalgia, and nothing else!
I take Lyrica 225 mg/day and Tramadol (150mg time-released) and amytriptilene 7.5mg


Agmaar
Regular Member


Date Joined Jan 2009
Total Posts : 376
   Posted 4/4/2009 11:09 AM (GMT -7)   
I've been looking into something similar.  You might want to consider an all up neuropsychological exam.  From what i can tell, it's assesses all facets of cognitive function and they are able to give recommendations based on what the tests show.  You might find this helpful - a similar topic i started over on the Lyme forum.  Maybe BigLucy can clarify this some  more.
 
 
I hear ya man.  I also used to function at a high level and now have all kinds of difficulties.  I'm an engineer and there are safety concerns with the work I do. I've been talking to both my psych ARNP and my Lyme doc (she primarily works with Fibro and Chronic Fatigue people).  They don't seem that concerned with the neuropsychological exam right now - lol ... I think they're trying to tell me that there are so many other real issues and they need to be addressed first.  I have neurologcial Lyme and there's anxiety, depression, fatigue, mood swings and all that besides any cognitive deficits.
 
I understand how frustrating this kind of thing is.  It's great that you are able to work part time.
Rich
 
Lyme, anxitey, depression, chronic C. Pnuemoniae
 
"... expect the unexpected ..."  (O. Wilde)
 
"I am an old man and have known a great many troubles, but most of them never happened." (Mark Twain)
 
 


pattipanda
Veteran Member


Date Joined Jan 2009
Total Posts : 1014
   Posted 4/4/2009 1:54 PM (GMT -7)   

Hey there K9 - Big Lucy & Rich,

Getting disability is a tough job.  I'm sorry you got denied AGAIN K9.

I'm about to embark in the wonderful world of SSDI and I'm terrified.  I applied about 10 years ago.  My health issues were Lyme, CFS, Carpel Tunnel and 2 disk herniations.  I couldn't do many jobs since I couldn't sit for long periods or use my hands for long periods and my Brian Fog was horrible. I got denied,(but was told I was considered 30% disabled). I went to an attorney and was told to get a part time job and re-apply when I was over 50.  Long and short of it.. I actually got a lot better for a number of years....I went on to become the executive director of the local chamber of commerce a 50-60 hour a week job. Then last year I got pneumonia and never quite got over it.  I went through exactly what you're going thru k9 totally spacing out at meeting, living in a state of confusion.  I got to the point where I knew I couldn't continue my job, had a major anxiety attack and had to give up my job, last Oct.  I've been in a major flare pretty much the entire time since.  There's no way I could possibly work a job anywhere near the level I was before.  I don't even think I could be a greeter at Walmart (standing for hours shakehead ).  I also have a high IQ, 138.  I was reading in another post that said, a Dr. mentioned that FMS seems to strike intelligent, creative people.  I agree, many of the members of this forum are extremely smart and clever.  I know my intellectual mind is still reasonably intacted but my cognitive thought and hearing process has been effected by FMS.  Good grief, I know what day it is and who the president is.. but don't ask me an off the cuff question or where my coffee cup is. 

Anyway I guess what I'm trying to say is.. when it comes to a psych test I would have to tell the examiner I'm not the person I was a year ago and the anxiety of what I could do in the future, in a professional matter, is almost to the point of phobic. 

I'm wondering if you need to have a history of psych care to qualify in that area of the evaluation process?  My GP treats me for fibro and I haven't been to any other doctors.  Will I need to get a dx from others before I start the process of disability?

Oh by the way .. I'm almost 52 now so I wonder if the statement about being over 50 still stands.  My sister is on SSDI and she couldn't get approved till she was over 50 also.

Any thoughts?


Patti
 
Fibormyalgia, 4x Lyme Disease Survivor, Depression, Anxiety Disorder, Dyslexia, 2 Lumbar Disk Herniations, Allergies, Bi-lateral Carpal Tunnel, Psoriasis. 
Meds = Elavil, Tramadol, Xanax, Lipitor
"Shoot for the moon, even if you miss, you'll land among the stars" - author unknown


K9
Regular Member


Date Joined Nov 2008
Total Posts : 263
   Posted 4/5/2009 3:42 PM (GMT -7)   
Hi guys,
It was comforting to hear your stories, so thank you for that. I'm not sure what SSDI is, as I'm a Canadian. I think one can qualify as disabled through Canada Pension Plan (CPP) but that would be a full-time thing, I think.

I'm really hoping that aerobic exercise, slowly and gradually increased, will be the key to getting back my energy. I've had a major (14-hour) surgery just 2 months ago, so I had to go back to 1 1/2 minutes on the treadmill or bike to start! Now I'm up to 15 minutes, and when I can go 30 or 45 (every day) I think I will be a lot better. I'm also doing Pilates for core and back strength. Again, this is slow due to the surgery. I have a scar from hip to hip that isn't very forgiving yet.

Anyway, I pray and wait and hope and work as hard as I can on getting better.

Take care everyone.
I have Fibromyalgia, and nothing else!
I take Lyrica 225 mg/day and Tramadol (150mg time-released) and amytriptilene 7.5mg


Grailhunter
Regular Member


Date Joined Nov 2008
Total Posts : 159
   Posted 4/5/2009 4:18 PM (GMT -7)   
If your a Mensa member you have a hard core established IQ record. That test is grueling. Actualy 2 different test lasting 3 hours each. I took those test in my twenties. I didn't cut it. Only 137. 3 points short, GRRR!

Anyhoooooo, I do believe a 20 point drop in IQ is all by itself grounds for disability. And I know if I went to take a real IQ test today, my focus would be so bad I would be just staring at the paper half the time.

If your a Menza member, tell Social Security you believe you have had a substantial IQ drop and want to be tested for that. A real test would probably kill your ability to concentrate even on a good day.
Fibromyalgia, Chronic Fatigue, IBS, Diverticulitis, Costocondritis, Thorasic Degeneration, Mild Hypertrophic Cardiomyopathy, Mild Hilar Lymphodenopathy, Depression, Anxiety. Dyspnea. Disequilibrium.

Klonopin, Percocet, Baclofen, Ibuprofen, Valerian, Greens Plus, Magnesium, Vitamin C, COQ 10, B Complex, Niacinamide, Glucosomine, Condrotin, MSM, L-Carnitine, D-Ribose.


Lynnwood
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Date Joined May 2005
Total Posts : 7019
   Posted 4/5/2009 8:08 PM (GMT -7)   
I had a similar issue where my disability insurance company requested proof of my cognitive impairment. They requested a "Neuropsychology Exam" which turned out to be an all day thing that measured all kinds of mind characteristics -- basically the long interactive version of an IQ test with a bit of hand-eye coordination thrown in. These are done by people who are board certified in clinical and neuro psychology, and their practices consist almost exclusively of these types of exams.

I too was worried that the test would not accurately reflect the kinds of issues I faced, esp when tired, stressed, etc. So I did something that I was assured was not wrong -- I intentionally had little sleep & high stress the 2 days before the test - I didn't eat well nor take my medications -- that way the testing accurately reflected how I am the majority of the time, or on days when I'm "off".

The results came back both good and bad -- good in that the disability insurance accepted them and granted the disability. Bad in that I now have documented results that show a 15-20 point drop in IQ. Fortunately I had a pretty good brain to start with, so I can function okay, but can no longer work in the career that was my love & my passion & my hobby.

I hope that helps, let me know if you have more questions I might be able to answer.

Lynnwood, Co-Moderator: Lupus Forum
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TarheelMama
Regular Member


Date Joined Mar 2009
Total Posts : 28
   Posted 4/5/2009 8:12 PM (GMT -7)   
been there done that, got denied again...  My doc said they hold my age and the fact that I've been to college against me...

BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 4/6/2009 11:52 AM (GMT -7)   
I call my brain "fog" lazy brain because the info is there but just takes awhile for everyhting to spark--I have it right now, so I'm kinda not sure what I want to respond to smilewinkgrin I believe someone wanted to know the difference between a MSE conducted by a mental health practitioner rather than neuropsych--neuropsych is primarily for organic disorders: dementia, diseases that caused cognitive impaiarment, tumors that are causing impairment, etc. you go to that kind of specialist to get a baseline diagnosis; expensive, very hard to get a referral, not a lot of hospitals will have a specialist on staff.
K9--I'm in the US so can't really address your questions about the world of disability and finances in Canada.  It's interesting to me that IQ has been discussed a lot, because I know a lot of people (through my job) with IQ's between 80-100 that are expected to work even though they have a lot of difficulty negotiating what is expected of them in the work place.  I have a friend who works for a clinic that assists people with developmental disabilities and she says if you don't have an IQ under 70 you won't get help from their facility (government standard), a lot of people you see on the streets are people with IQ's around 85, who just can't make it in our modern world.
 
Honestly, the people I see that do get disability benefits are people with severe mental illnesses, multiple hospitalizations, very low Acitivties of Daily Living standards (cannot shop for themselves, do laundry, keep appointments, clean--not that they have difficulties, they just can't).  The one thing that I've noticed about a lot of us here is that if we can, we do, and I'm thinking that may hinder chances of getting any type of assistance; we also may under report our level of daily functioning AND do underestimate that we are a very visual society, if you look physically good to a doctor, they sometimes question the severity of your report.  I was hospitalized for several weeks and hooked up to massive amounts of drugs, mainly steroids and every doctor that saw me kept saying how great I looked, rosey cheecks, etc. One resident said that people who are in the hospital don't look good and some doctors were questioning whether I should be there in the first place???? I also have Ulceratative Colitis and I was hospitalized that time because I was going to the bathroom 30 times a day and couldn't even hold in water.  I looked good because of the massive amount of drugs I was on and the IV diluaded I was given every four hours, DUH!
 
Anyway, I think I lost my point?  Or did I have one?  I'm at work right now, wishing I was at home, sleeping, and kinda feeling sorry for myself right now because this is my life.  Whatever.

K9
Regular Member


Date Joined Nov 2008
Total Posts : 263
   Posted 4/6/2009 6:28 PM (GMT -7)   
lol - thanks for your contribution. I could follow it fine!

Wow - I wonder if I have to go back and find my Mensa results from the early 70s! After a while, I did away with all of that and moved toward a "we're all equal" kind of posture in my life. Long story. Anyway, I think my IQ was about 145...so if I'm down to 125 I'm disabled? woo hoo! (Just kidding - I don't know what effect any of this has on IQ points)

But I'm totally with the poster who went to the test without taking the meds...I wouldn't either. Mainly cuz at night they wear off - and that's when I'm the "stupidest".

I'm a bit better these days anyway...we'll see
I have Fibromyalgia, and nothing else!
I take Lyrica 225 mg/day and Tramadol (150mg time-released) and amytriptilene 7.5mg


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7019
   Posted 4/6/2009 6:36 PM (GMT -7)   
The results have lots of different sections that explain more fully difficulties in different kinds of comprehension and response & memory skills. The IQ is just a small part of the entire report, and it's a functional change more than an actual change...meaning (at least to me) that if the illness were magically removed, the brain & cognition would be just hunky-dory.

Cheers,
Lynnwood
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