Chapter 21 - Psychiatric Conditions

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21.01 - Assessment of Psychiatric Disability

  1. In assessing psychiatric disability the following are among the factors requiring consideration:
    1. that many psychiatric diagnoses are simply brief description of objective medical findings and of subjective symptoms elicited at the time of a single examination.
    2. The nature of a psychiatric disorder is such that its severity can be measured only indirectly and by reference to subjective criteria, including effects on lifestyle. Greater weight is given to the pattern of illness over a period of time than to findings at a single examination, as these may reflect only a time of either brief exacerbation or remission.
    3. The assessment tables have criteria with multiple elements to define the degree of severity of the psychiatric condition. Most of the elements need to be satisfied in order to award the particular assessment level. It is not necessary for every element at a given level to be satisfied in order to assess at that level, although the majority of the elements should be present. A single element from a given level is not sufficient to award assessment at that level .
    4. When applying the tables only the effects of the psychiatric conditions are to be taken into account. For example inability to work, reduced participation in recreational activities and increased family conflict may all be present but not necessarily consequences of the psychiatric conditions.
    5. that changes in psychiatric terminology in recent years requires interpretation.
    6. that, especially in later life, new psychiatric conditions may arise which may be modifications of the pensioned psychiatric condition or may be entirely unrelated in origin. The interaction may worsen, ease or even obliterate the pensioned condition. Assessment should then be based on the worsened state of the pensioned condition or on the pensioned condition prior to obliteration or alleviation, whichever is more favourable to the pensioner.

21.02 - Assessment of Stress and Anxiety Disorders

For assessment purposes the term Stress and Anxiety Disorders includes Post Traumatic Stress Disorder, Somatization Reactions, Anxiety Reactions, Depressive Reactions, Adjustment Disorders, Phobic Reactions, Psychophysiologic Reactions, Obsessive- Compulsive Reactions, Conversion or Hysterical Reactions, Muscle Tension Headaches and Psychoneurosis

Table To Article 21.02 - Assessment of Stress and Anxiety Disorders
Level Clinical Findings Subjective & Objective Data Functional Effects Treatment and Prognosis Reactions to domestic, social & leisure situations Socioeconomic status including occupational effects
Level 0- 5% Subjective - Intermittent psychiatric symptoms, past history of psychiatric illness which has resolved or is in remission. Objective - Nil or rare signs of stress Minimal or no interference with aspects of living. No treatment is sought or recommended. Unaffected or minor effects. None or minor interference with work or occupation.
Level 10% Subjective - Psychiatric disorders which are very mild, but sufficient to warrant a psychiatric diagnosis. Objective - Others may notice only occasional disturbances of behaviour or emotion. Minimal or no interference with most aspects of living. Nil to minimal, no regular treatment sought and follow up by GP only. Minimal or no effects. Minimal or no interference with work or occupation.
Level 20% Subjective - Mild but regular psychiatric symptoms which tend to cause subjective distress when symptoms occur. On most occasions veteran is able to distract him/ herself from this distress. Objective - Others would notice occasional disturbances of behaviour or of emotion. Minor interference in some aspects of living. Well controlled by maintenance or intermittent therapy. Transient over- reaction to untoward events. Occasional friction with family, friends and colleagues. Some effect in this area, but relatively mild. Exacerbations of symptoms may require short periods (i. e. days) off work.
Level 30% Subjective - Recurring symptoms causing mild or episodic distress. Patient pre-occupation with symptoms is apparent. Objective - Symptoms of mild neurosis becoming more persistent. Minor findings. Distress is apparent. Minor interference in everyday situations. Symptoms readily controlled by medication; or medication recommended and occasional therapy required. Episodic family discord with some reduction in social contact and recreational activities. Effects require some longer periods (i.e. a week at a time) off work.
Level 40% Subjective - Frequent symptoms causing persistent distress. The patient will sometimes be unable to distract him/herself from the distress that the symptoms cause. Objective - The distress is apparent and/or the patient's preoccupation with the symptoms is noticeable to astute observers or persons familiar with the patient. Moderate interference with function in everyday situations. Psychiatric treatment, at least as medication, has been tried or recommended. Periodic counselling from licensed counsellor is being provided or has been recommended. Frequent discord with family, friends and colleagues. Noticeable reduction in social activities. Symptoms causing effects on performance at work, requires longer periods (i.e. greater than a month) of absences necessary.
Level 50% Subjective - Persistent symptoms causing considerable distress. Objective - Obvious continual distress. The level and frequency of symptoms causes major difficulties in everyday functioning. Continuing need for medication and psychiatric care. Continuing conflict with family, significant reduction in social and leisure activities. Frequent lengthy periods of absence from work.
Level 60% Subjective - Symptoms which are persistent. The patient will often be unable to distract him/herself from the distress that the symptoms cause. Objective - The distress is quite apparent and the patient's preoccupation with the symptoms is evident. Marked interference with function in everyday situations. Psychiatric treatment, at least as medication, has been instituted or deemed necessary with regular counselling from licensed counsellor. Marked social withdrawal. Major difficulties at work, lengthy periods of absences necessary.
Level 70% Subjective - Very severe frequent symptoms causing considerable distress. Relief from the distress is difficult to achieve even with a high level of support and reassurance. Objective - Major psychotic symptoms appearing intermittently. Level and frequency of symptoms causes major difficulties in everyday functioning, but not so severe as to be totally disabling. Need for intensive specialized psychiatric therapy on an outpatient basis, including medication and/or inpatient care for short periods. May have had transient certification. Permanent family discord. Marked social withdrawal. Loss of interest in most recreational pursuits. An employed claimant will have had major difficulties which may have required job modification or restriction of career opportunities with probable job loss resulting.
Level 80% Subjective - Severe psychiatric impairment with persistent symptoms. Objective - There will be overt evidence of the disease, chronic psychotic illness. May be able to continue to function but with gross restrictions. Longer periods of inpatient hospital care are necessary. Long-term, high dose, psychotropic drug regimes will have been started. Reacts adversely to all input. Deteriorating family function with strong possibility of estrangement. General social withdrawal. Loss of interest in leisure activities. Unable to work, or if still working will be losing considerable time as a result of health - could lead to job loss or marked change in profession.
Level 90% - 100% Subjective - Very severe symptoms of psychiatric illness. Objective - The presence of psychiatric illness is evident. Profound psychiatric impairment. Virtually all recreational, social or otherwise purposeful activities abandoned. Continuous psychiatric treatment is essential, with a need for long periods in hospital and marked social support. Markedly dysfunctional. Profound psychiatric impairment. Virtually all recreational, social or otherwise purposeful activity abandoned.

21.03 - Assessment of Major Affective Disorders

For assessment purposes the term Major Affective Disorders includes Manic- depressive Psychosis, Manic Disorder, Major Depressive Disorder, Bipolar Disorder, Unipolar Depression and Endogenous Depression.

Guidelines for assessment of the Major Affective Disorders are contained in the table to Articles 21.03 and 21.04.

21.04. - Assessment of Schizophrenic Disorders

For assessment purposes the term Schizophrenic Disorder includes Schizophrenia, Catatonic Schizophrenia, Paranoid Schizophrenia, Hebephrenic Schizophrenia, Simple Schizophrenia, Schizo- affective Disorder, Schizophreniform Disorder, Paranoid Disorder and Paranoia.

Table To Article 21.03 and 21.04 - Assessment of Major Affective, Schizophrenic and Other Psychiatric Disorders
Level Clinical Findings Pattern Last 5 Years Treatment Indicated Last 5Years Recent Situational Factors History of Socioeconomic Impairment, Long Term
0-5% History of single episode nil to minor or occasional symptoms on close exam. Stable Nil to minimal. N. A. None
10-20% History of multiple episodes or mild chronic impairment. Minor signs and symptoms on exam. Infrequent overt disturbance, nil past 5 years. Functions reasonable between exacerbations. Well controlled by maintenance or intermittent therapy. ---- Slight
25-40% Thought and mood disturbance obvious to close contacts and on formal exam. One or two exacerbations past 5 years, minor continuing impairment. Regular follow-up with partial success outpatient less that 1 per 2 months, inpatient once in 5 years. ---- Moderate
50-70% Thought and/ or mood disturbance obvious to casual contacts. Major psychotic symptoms and signs on formal exam. More than 2 exacerbations past 5 years. Moderate disturbance between episodes. Regular follow- up with poor response. Moderate disturbance between episodes. ---- Severe
75-100% Severe, chronic psychotic signs and symptoms or severely regressed after florid psychosis. More than one major episode per year or continuously severely disturbed. Social isolate. Continuous treatment and/ or supervision. Institutional care. ---- Total

21.05 - Assessment for Chronic Organic Brain Syndromes

For assessment purposes conditions encompassed are those mental and emotional disorders arising from known physical, chemical, toxic or metabolic disruptions of brain tissue which result in permanent disturbance for the complex integration of cerebral functions. The most common causes are trauma, and the so- called degenerative conditions such as Alzheimer's Disease and Cerebro- Vascular Insufficiency.

Common diagnostic terms are Dementia, Organic Amnesia, organic Hallucinosis, Organic Delusional Syndrome and Organic Personality Syndrome.

Table To Article 21.05 - Assessment of Chronic Organic Brain Syndrome
Level Clinical Findings Adaptability to Situational Changes Need for Supervision
0-15% Recent memory, judgement and orientation intact for usual daily activities. Minor defects of recent memory, judgement or orientation on formal examination. Minor difficulties in unusual circumstances. Nil
20-40% Mild deficits in recent memory, judgements or orientation for usual daily activities. Temporary disorganization with acute situational changes. Has difficulties with any changes in routines. Intermittent in special circumstances.
50-70% Defects in recent memory, judgement, orientation and behaviour obvious to casual associates. Prolonged difficulties in comprehending situational changes. Disorganized or shows indifference. Some for daily activities.
75-100% Gross impairment of memory, judgement and orientation necessitating constant care and/ or supervision. None Constant
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