Session 10 Handouts

CWCDAA : Vladimir Bokarius, MD, PhD, QME
http://cwcdaa.org/Bios/Vlad_Bokarius.html
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VLADIMIR BOKARIUS, MD, PHD, QME
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VLADIMIR BOKARIUS, MD, PHD, QME
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2970 HILLTOP MALL ROAD, SUITE 101
RICHMOND, CA 94806
(855) 779-2763 PHONE/FAX
[email protected]
Dr. Vladimir Bokarius is a 4th generation physician, who has dedicated his life to
treatment of patients with chronic pain and emotional concerns. Dr. Bokarius graduated
from medical school in Russia, and completed his residency and fellowship in Psychiatry
at Cedars Sinai Medical Center in Los Angeles, after immigrating to the United States.
He is Board Certified in Psychiatry and Pain Medicine, is a licensed acupuncturist and a
Qualified Medical Evaluator. Many years of clinical experience in integrative medicine are
the foundation of Dr. Bokarius’ approach - to evaluate and treat patients as a whole,
rather than address only a partial set of symptoms. Prior to becoming a QME, Dr.
Bokarius has worked in a number of clinical settings, including emergency, inpatient and
outpatient psychiatry, geriatric and correctional psychiatry and pain management. He
has a strong background in conducting medical research and teaching and has made
multiple professional publications and presentations worldwide. His rich background has
contributed to a deeper understanding of cultural, social, economic and legal aspects of
his patients’ lives and allowed him to excel in comprehensive medicolegal evaluations.
In the course of his move to the Bay Area 5 years ago, Dr. Bokarius has identified a
serious gap in psychiatric services offered to injured workers and built Center for
Occupational Health to fill it. His field of expertise is assessment and treatment of mental illness, addiction,
insomnia and chronic pain. He is also the medical director of Medical Legal Evaluators, Inc, which is a multispecialty medical group, focused on providing all types of medical legal evaluations and expert testimony.
Download Dr. Heredia's CV
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5/9/16, 7:50 AM
CURRICULUM VITAE
VLADIMIR BOKARIUS
100 S Ellsworth Avenue, Suite 511
San Mateo, CA 94401
phone (415) 787-4667
fax (415) 787-4667
email [email protected]
QUALIFICATIONS
Licensed Physician and Acupuncturist (California), Diplomate of the
American Board of Psychiatry and Neurology and American Board of Pain
Medicine, Qualified Medical Evaluator, Ph.D. in Neurophysiology.
Specializing in integrative medicine: pain medicine, psychiatric disorders,
addiction and insomnia in adult and geriatric population as well as
evaluation and management of injured workers, particularly treatment
resistant cases; studying neurophysiologic mechanisms of the interactions
between the systems of the organism; developing and evaluating new
traditional and alternative methods of diagnosis and treatment.
CURRENT
Comprehensive Care Consultants, Medical and Research Director
Center for Occupational Health, Medical Director
Medical Legal Evaluators, President and Medical Director
EDUCATION
2012
Qualified Medical Evaluator Certification
2012
American Board of Pain Medicine Certification
2010
American Board of Psychiatry and Neurology Certification
2005-2006
Psychiatry Research Fellowship, Cedars-Sinai Medical
Center, 8730 Alden Dr., Los Angeles, CA 90048
2001-2005
Psychiatry and Mental Health Residency Program, Cedars-Sinai Medical
Center, 8730 Alden Dr., Los Angeles, CA 90048
1998-1999
Samra University of Oriental Medicine, Los Angeles, CA.
M.S. in Oriental Medicine
1995
Saint-Petersburg State University (Russia), Department of Physiology.
Ph.D. in Neurophysiology
CV Bokarius Page 1 of 12
1987-1991
Kuban State Medical Institute, Krasnodar, USSR. Doctor of Medicine
1985-1988
Postgraduate School (Ph.D. Program) of the Institute of Experimental
Medicine, Academy of Medical Sciences of the USSR, Leningrad, USSR.
Candidate for the Ph.D. in neurophysiology.
1978-1983
Leningrad State University, Biological Faculty, Leningrad, USSR.
M. S. in Physiology.
PROFESSIONAL TRAINING
2009-2010
Neuroscience Educational Institute. Master of Psychopharmacology
Program. 1930 Palomar Point Way, Suite 101, Carlsbad, CA 92008
2004-2005
University of Southern California, Pain Center. Elective rotation in
multidisciplinary pain management. 1520 San Pablo Street, Suite 3450, Los
Angeles, CA 90033
1999-2001
Cedars-Sinai Medical Center, Department of Psychiatry, L.A. CA
Certified Rater: SCID, MINI, BPRS, PANSS, SANS, ESRS, MADRS,
HAM-D, HAM-A, etc.
1995
Higher course in Manual Therapy, Academy of Postgraduate
Medical Education, St. Petersburg, Russia.
1994
Training course in Manual Therapy, Medical Foundation “Anima”, St.
Petersburg, Russia, Certified Manual Therapist.
1993
Higher course in Acupuncture, Soviet-Chinese Medical Center “LorniiSante”, St. Petersburg, Certified Acupuncturist.
1993
Training course in Massage Therapy, Medical Foundation “Anima”, St.
Petersburg, Russia, Certified Massage Therapist.
1991-1992
Internship in Neuro-Psychiatry, Institute of the Human Brain, St. Petersburg.
1983
Training course in Acupuncture, Academy of Postgraduate
Medical Education, Leningrad, Restricted License
EMPLOYMENT
2015–present
President and Medical Director. Medical Legal Evaluators, Inc.
Medical group with a focus on multi-specialty med-legal evaluations in
conjunction with SIBTF and California Workers Compensation claims,
long term disability, decisional capacity and competency evaluations.
CV Bokarius Page 2 of 12
2011-present
Medical Director. Center for Occupational Health, Inc.
Private practice in occupational psychiatry. Psychiatric evaluation,
Consultation (QME, AME, IME) and treatment of patients with work
related injuries.
2970 Hilltop Mall Road Suite 101, Richmond, CA 94806
2011-2013
Contract physician. EK Health Services. Utilization/peer review services.
100 S Ellsworth Avenue, Suite 511, San Mateo, CA 94401
2010-present
Medical & Research Director. Comprehensive Care Consultants, Inc
Private practice in integrative medicine. Pain, Psychiatry, Addiction,
Insomnia. (Pharmacotherapy, Acupuncture, Manual Therapy, Herbs)
Psychiatric and Pain consultation services in geriatric psychiatry in
Skilled Nursing Facilities, Retirement Homes and Assisted Living
100 S Ellsworth Avenue, Suite 511, San Mateo, CA 94401
2009-2012
Contract Psychiatrist, Atascadero State Hospital, California
Department of Mental Health
2008-2009
Contract Psychiatrist. Valley State Prison for Women. California
Department of Correction and Rehabilitation.
2007-2009
Chair of the Pain Committee. Valley State Prison for Women.
California Department of Correction and Rehabilitation.
2007-2008
Contract Senior Supervising Psychiatrist (A). Valley State Prison for
Women. California Department of Correction and Rehabilitation.
2006–2012
Attending Psychiatrist. Cedars-Sinai Medical Center. 8730 Alden Dr.
Room E123, Los Angeles, CA 90048
2006-2010
Medical & Research Director. Comprehensive Care Consultants, Inc.
(Pharmacotherapy, Acupuncture, Manual Therapy, Herbs)
2670 Amalfi, Chowchilla, CA 93610
2006-2007
Contract Psychiatrist. Valley State Prison for Women. California
Department of Correction and Rehabilitation.
2004-2006
Private practice in integrative medicine. Pain & Psychiatry
(Pharmacotherapy, Acupuncture, Manual Therapy, Herbs)
9730 Wilshire Blvd, Suite 102 Beverly Hills, CA 90212
2003-2006
Psychiatrist. In association with Westwood Consultants Inc.
Psychiatric consultation services in geriatric psychiatry in Skilled
Nursing Facilities and Retirement Homes. 462 N. Linden Dr. Ste 230
CV Bokarius Page 3 of 12
Beverly Hills, CA 90212
2004-2006
Contract Psychiatrist. California Department of Correction and
Rehabilitation. Locum Tenens.
2000-2004
Licensed Acupuncturist (acupuncture, manual therapy, herbs).
Private practice in pain management, 820 S. Indiana St., Los Angeles,
CA 90023
1999-2001
Research Associate Cedars-Sinai Medical Center Department of
Psychiatry, 8730 Alden Dr. room E123, Los Angeles, CA 90048
1998-1999
Research Associate UCLA Center for East-West Medicine, 200 Medical
Plaza, Ste 420, Los Angeles, CA 90095
1998-1999
Massage Therapist, California Medical Arts Group,
1437 7th St., Ste 301, Santa Monica, CA 90401
1996-1997
Massage Therapist, Dr. Wexley Medical Clinic,
739 N. Fairfax Ave., Los Angeles, CA 90046
1992-1995
Associate Director of Research, Laboratory of Physiology of the
Organism and Brain States, Department of Neuro-Psychiatry,
Institute of Human Brain, Russian Academy of Science,
St.Petersburg, Russia.
1990-1992
Research Scientist, Laboratory of Physiology of the Organism
and Brain States, Department of Psycho-Neurology, Institute of the Human
Brain, Russian Academy of Science, St.Petersburg.
1985-1990
Junior Research Scientist, Laboratory of Physiology of the Organism and
Brain States, Department of Human Neurophysiology, Institute of
Experimental Medicine, Academy of Medical Science of the USSR,
Leningrad, USSR.
1984-1985
Research Associate, Department of Acupuncture, State Institute of
Postgraduate Medical Education, Leningrad, USSR
1983-1985
Supervisor, Department of Functional Diagnostics,
City Hospital #5, Leningrad, USSR.
TEACHING EXPERIENCE
2012-present
Center for Occupational Health. Supervising and teaching at postdoctoral
program for psychologists and psychology students’ practicum. FNP
program preceptorship.
CV Bokarius Page 4 of 12
3260 Blume Drive, Suite 450, Richmond, CA 94806
2011-present
Sunovion Pharmaceuticals, Inc. Certified speaker for education about
Latuda (Lurasidone)
2005-2006
Research Fellow. Psychiatry and Mental Health Residency
Program, Cedars-Sinai Medical Center, 8730 Alden Dr., Los Angeles,
CA 90048. Teaching and supervising students and residents.
2004-2005
Chief Resident (research). Psychiatry and Mental Health Residency
Program, Cedars-Sinai Medical Center, 8730 Alden Dr., Los Angeles,
CA 90048. Teaching and supervising student and residents. Course in
structured Interview for DSM IV-TR for clinical interns.
2000-present
Professor, Chair of Western Clinical Science Department,
American University Of Complementary Medicine, 11543 Olympic
Boulevard, Los Angeles, CA 90064
1998-2000
Professor, Samra University of Oriental Medicine, 3000 S.
Robertson Blvd, 4th Floor, Los Angeles, CA 90034 (Clinical
Aspects of Western Medicine, Pathophysiology, Anatomy,
Physiology)
1998-1999
Professor, Emperor’s College of Traditional Oriental Medicine,
1807B Wilshire Blvd., Santa Monica, CA 90403 (Acupuncture Anatomy,
Anatomy, Physiology, Pathology).
1997-2000
Lecturer, UCLA Center for East-West Medicine, 200 Medical Plaza, Ste
420, Los Angeles, CA 90095, (Integrative Medicine, Traditional Chinese
Medicine).
1993-1995
Assistant Professor, Department of Neuro-Psychiatry, Institute of the
Human Brain, Russian Academy of Science, St. Petersburg. (Advanced
electrophysiology; Acupuncture and Manual Therapy in Neuro-Psyciatric
Clinic and Rehabilitation).
1991-1993
Lecturer, Health Department, Russian Adult School of Science.
(Alternative Medicine: Acupuncture, Manual Therapy, Phytotherapy).
MEMBERSHIPS
International Association for the Study of Pain
International Biotherapy Society
California Society of Industrial Medicine and Surgery
California Applicant Attorney Association
Neuroscience Educational Institute
American Botanical Council
CV Bokarius Page 5 of 12
HONORS/AWARDS
Chairman of the Board American University of Complementary Medicine
since 2009
Leading Physician of the World & Top psychiatrist in California 2013
America’s Top Psychiatrist 2007
American Psychiatric Association Awardee for Eleventh Annual Research
Colloquium for Junior Investigators 2006
American Association of Directors of Psychiatric Residency Training
International Medical Graduate Award 2003
PARTICIPATION IN CLINICAL TRIALS (USA only)
As a Principal Investigator
Active:
Objectivization of Traditional Chinese Pulse Diagnosis. Internal funding by Comprehensive Care
Consultants
Completed:
Effectiveness of Ischemic Pressure and Acupuncture for Treatment of Myofacial Pain Syndrome.
Internal funding by Cedars-Sinai Medical Center
Is Humor a Feasible Option in Treating Depression? Internal funding by Cedars-Sinai Medical Center
As a Co-Investigator (Completed)
Pharmacotherapy for Minor Depression: A Double-Blind, Placebo-Controlled Study of the Acute
Efficacy of Citalopram and St. John’s Wort in the Treatment of Minor Depression. NIMH / NCCAM
Medisorb Naltrexone in Combination with Psychosocial Treatment in Alcohol Dependent Adults.
Alkermes, Inc.
A Multi-Center, Open-Label, Flexible-Dose, Parallel-Group Evaluation of the Cataractogenic
Potential of Quetiapine Fumarate (Seroquel) and Risperidone (Risperdal) in the Long-Term
Treatment of Subjects with Schizophrenia or Schizo-Affective Disorder. Astra Zeneca
Ethnic Variations in Antidepressant Response. NIH
PUFA Augmentation of Unipolar Major Depression. NIH
Treatment of Depression with Massage. Internal funding
A 28-Day, Multi-Center, Randomized, Placebo-Controlled, Double-Blind, Efficacy and Safety Study of
Ocinaplon (DOV 273,547 Modified Release Tablets) in Patients with Generalized Anxiety. DOV
CV Bokarius Page 6 of 12
A Randomized, Double-Blind, Placebo-Controlled And Risperidone-Referenced, Parallel - Group
Efficacy And Safety Study Of Two Fixed Doses Of Bifeprunox In The Treatment Of Schizophrenia.
Solvay
Prospective, double-blind, randomized, placebo-controlled dose finding study of the efficacy and safety
of 2 target doses of Org 34517 used as adjunctive therapy in subjects with psychotic major depression
(major depressive episode, severe, with psychotic features). Organon.
Treatment of Depression with Massage in End-of-Life AIDS. NIH
A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Fixed Dose Study Evaluating the
Efficacy of Paroxetine CR in Elderly Outpatients Diagnosed with Major Depressive Disorder.
GlaxoSmith Kline
As a Coordinator (completed):
A Randomized, Double-Blind, Placebo-Controlled Trial To Evaluate The Efficacy Of Divalproex
Sodium Therapy For Agitation In Nursing Home Residents With Probable or Possible Aizheimer's
Disease. ADCS.
A Double-Blind Placebo-Controlled Study Of Depakote In The Treatment Of Behavioral Agitation In
Elderly Patients With Dementia. Abbott.
Risperidone Depot (Microspheres) Vs. Placebo In The Treatment Of Subjects With Schizophrenia.
Janssen.
Rapid Transcranial Magnetic Stimulation In The Treatment Of Resistant Depression. Neotonus.
As a Rater (completed):
A Randomized Double Blind Placebo-Controlled Trial To Evaluate The Efficacy And Safety Of
Galantamine In Subjects With Mild Cognitive Impairment (MCI) Clinically At Risk For Development
Of Clinically Probable Alzheimer's Disease. Janssen.
The Combination Of Olanzapine And Fluoxetine In Treatment Of Resistant Depression Without
Psychotic Features. Lilly.
Duloxetine Vs Placebo And Paroxetine In The Acute Treatment Of Major Depression. Eli-Lilly.
Safety And Efficacy Of Depakote® As Combination Therapy In The Treatment Of Psychosis
Associated With Schizophrenia. Abbott.
A Randomized Double-Blind Study To Evaluate The Anticholinergic Burden In Subjects With
Psychosis Of Dementia Treated With Risperidone And Olanzapine. Janssen.
A Multicenter, Randomized, Double-Blind, Placebo Controlled Study Of Two Fixed Doses Of
Aripiprazole In The Treatment Of Hospitalized Patients With Acute Mania. Bristol-Myers Squibb.
REVIEWER
CV Bokarius Page 7 of 12
American Journal of Psychiatry (2005, 2006)
LANGUAGES
Russian, reading French, medical Spanish
CV Bokarius Page 8 of 12
LIST OF PUBLICATIONS
1. Bokarius VB Some Electrophysiological Characteristics Of Acupuncture Points. Thesis For
M.S. In Physiology. Leningrad State University, 1983. 92 P. (In Russian)
2. Iluchina VA, Kozhevnikov ND, Bokarius VB Development Of Optimal Electrode Systems
For The Investigation Of Infraslow Physiological Processes In The Brain, Visceral Organs
And On The Skin Surface. Report To The Academy Of Medical Sciences Of The USSR.
Leningrad, 1987. 153p. (In Russian)
3. Bokarius VB, Kozhevnikov ND, Seriakov MG Universal Electrode For Recording Infraslow
Physiological Processes In Visceral Organs Of Rabbit. Physiol. Journ. Of The USSR, 1989.
N2. P.275-279. (In Russian, Abstr. In English)
4. Bokarius VB, Kozhevnikov ND Recording Of Infraslow Physiological Processes Of The
Rabbit Brain And Lung In Chronic Experiment. Physiol. Journ. Of The USSR, 1989. N4.
P.582-585. (In Russian, Abstr. In English)
5. Bokarius VB Psychophysiological Status Of Patients Who Survived The Accident Of The
Chernobyl Atomic Energy Station In 1989-1991. Chapter In Report To The Russian Military
Medical Academy, 1993. P.123-138. (In Russian)
6. Iluchina VA, Zabolotskich IB, Bokarius VB, Iluchina AY Discrete Omegametry In
Registration "Vertex-Thenar" In Express-Diagnostic Of The Alert State Gradation And
Estimating Of The Compensatory Abilities And The Adaptive Resources Of The Organism.
Energy Deficient States Of Healthy And Sick Persons. St. Petersburg, 1993. P.98-103. (In
Russian)
7. Iluchina VA, Kozhushko NY, Bokarius VB Neurophysiological Study Of The State And
Physiological Activity Of Some Striopallidar And Thalamic Structures In Different Forms Of
Parkinsonian Disease. Physiol. Journ., 1994. N1. P.78-87. (In Russian, Abstr. In English)
8. Iluchina VA, Bokarius VB, Matveev YK, Rumyantzeva OM Psychophysiological Aspects
Of The Possibility Of Correcting Emotional Disorders Using The Dynamic Field Of Acoustic
Waves In Mode Of Infraslow Physiological Processes. Human Physiology, 1994. N4. P.2939 (In Russian, Abstr. In English)
9. Bokarius VB Infraslow Physiological Processes Of Brain, Lungs, Liver And Kidneys In
Chronic Experiment. Abstract Of The Dissertation For The Ph.D. In Neurophysiology. St.
Petersburg State University, 1995. 24p. (In Russian)
10. Bokarius VB Infraslow Physiological Processes Of Brain, Lungs, Liver And Kidneys In
Chronic Experiment. Dissertation For The Ph.D. In Neurophysiology. St. Petersburg State
University, 1995. 129p. (In Russian)
11. Iluchina VA, Kozhushko NY, Bokarius VB Neurophysiological Investigation Of The
Features Of The State And Physiological Activity Of Some Structures Of Striapallidum And
Thalamus In Various Forms Of Parkinsonism. Neuroscience & Behavioral Physiology, 1995,
25(2): 104-10.
12. Furberg CD,…Bokarius V,…Zuliani P. Major Cardiovascular Events in Hypertensive
Patients Randomized to Doxazosin vs Chlortalidone. The Antihypertensive and LipidLowering treatment to Prevent Heart Attack Trial (ALLHAT). JAMA, 2000, 283:1967-1975.
13. Kramer BA, Bokarius V The Use of the Microsoft Access Database Manager in ECT
Practice. The Journal of ECT, 2001, 17(1): 6-7.
CV Bokarius Page 9 of 12
14. Bokarius V, Richeimer S, Victor L, Nemat A, Matharu Y, Wolf MK. Multidisciplinary
Treatment Of Chronic Pain. Directions in Psychiatry, 2008, 28: 17-31
15. Bokarius AV, Bokarius V. Evidence-Based Review of Manual Therapy Efficacy in
Treatment of Chronic Musculoskeletal Pain. Pain Practice, 2010, 10: 451–458.
16. Bokarius A, Ha K, Poland R, Bokarius V, Rapaport MH, Ishak WW. Attitude Toward
Humor In Patients Experiencing Depressive Symptoms. Innovations in Clinical
Neuroscience, 2011, Sep;8(9):20-3.
17. Bokarius V, Ferber S. Treating Insomnia. Directions in Psychiatry 2015, 35: 163-182
18. Feinberg, S., Christian, J., Feinberg, R., Kalauokalani, D., Pohl, M., Manning, D., Bokarius,
V., Rizvi, S. American Chronic Pain Association Resource Guide to Chronic Pain Treatment
https://theacpa.org/uploads/documents/ACPA_Resource_Guide_2016.pdf
PUBLISHED ABSTRACTS AND PRESENTATIONS:
A1. Bokarius VB Distribution Of Bio-Activity In Acupuncture Points In Patients With
Enterocolitis. XII All-Union Student Congress In Physiology and Biochemistry. Jaroslavl,
1983. P.71-72. (In Russian)
A2. Bokarius VB Kozhevnikov ND Comparative Study Of Deep Brain Structures, Liver And
Kidney States Obtained By The Registration Of Omega-Potential In The Early
Postoperative Period. Principles And Function Mechanisms Of Human Brain. Leningrad,
1990. P.62-63. (In Russian)
A3. Amiri R., Bokarius V., Huang W., Wung J. Treatment of Resistant Depression. Case
Presentation. Thalians Grand Rounds, 2004, Los Angeles, USA
A4. Bokarius V. Effectiveness of Ischemic Pressure and Acupuncture for Treatment of Myofacial
Pain Syndrome. J. Musculoskeletal pain, 2004, 12 (Suppl): 2. International Myopain Society.
Sixth World Congress on myofascial pain and fibromyalgia, 2004, Munich, Germany
A5. Bokarius V. Acupuncture in Psychiatry: Traditional Approach and Evidence based review.
Thalians Grand Rounds, 2005, Los Angeles, USA
A6. Bokarius V, Huang W. Novel Methods for Smoking Cessation in Pregnant Women.
Society for Research on Nicotine and Tobacco. 11th Annual meeting, 2005, Prague,
Czech Republic
A7. Bokarius V, Huang W. Evidence based use of pharmacological and alternative methods
for the treatment of chronic pain. 11th International Congress on Pain, 2005, Sidney,
Australia
A8. Bokarius A, Bokarius V, Liflyandsky O, Kuo, J. East Meets West In the Treatment of
Myofascial Pain Syndrome. Combined Scientific Meeting in Anaesthesiology, 2005, Hong Kong
A9. Huang W, Bokarius V. East Meets West In the Treatment of Pelvic Pain Syndrome. Combined
Scientific Meeting in Anaesthesiology, 2005, Hong Kong
A10. Bokarius V, Richeimer S, Victor, L. Novel Approaches in treatment of Chronic Pain. American
Academy of Pain Medicine Annual Conference, 2006, San Diego, USA
A11. Bokarius V. Acupuncture as augmentation for treatment of resistant unipolar depression.
American Psychiatric Association, Annual Meeting, 2006, Toronto, Canada
A12. Bokarius V. Establishing and Utilizing research Volunteer Registries. Thalians Grand Rounds,
2006, Los Angeles, USA
A13. Bokarius A, Rapaport M, IsHak W, Poland R, Bokarius V. Humor and Depression American
Psychiatric Association, Annual Meeting, 2006, Toronto, Canada
CV Bokarius Page 10 of 12
A14. Bokarius V, Richeimer S, Nemat A, Victor L, Matharu, Y, Wolf MK. Multidisciplinary approach
to treatment of chronic pain. American Psychiatric Association, Annual Meeting, 2006, Toronto,
Canada
A15. Bokarius V, Richeimer S, Nemat A, Victor L, Matharu, Y, Wolf MK. Multidisciplinary approach
to treatment of chronic pain. American Psychiatric Association, Annual Meeting, 2007, San
Diego, USA
A16. Bokarius A, Bokarius V. Use of manual therapy in myofascial pain syndrome and fibromyalgia:
evidence based review. J. Musculoskeletal pain, 2007 International Myopain Society. Sixth
World Congress on myofascial pain and fibromyalgia, 2007, Washington DC, USA
A17. Bokarius V, Bokarius A. Evidence-Based Use Of Adjunct Pharmacological And
Nonpharmacological Methods In Treatment Of Chronic Pain. World Institute of Pain. 2007,
Budapest, Hungary
A18. Bokarius V, Richeimer S, Nemat A, Victor L, Matharu, Y, Wolf MK. Multidisciplinary approach
to treatment of chronic pain. World Psychiatric Association Congress, 2007, Melbourne,
Australia
A19. Neumann S, Bokarius V, Johnson P, Donaldson L. Multidisciplinary Approach to the Treatment
of Severe Axis-II Pathology in Women’s Correctional Facilities. World Psychiatric Association
Congress, 2007, Melbourne, Australia
A20. Bokarius V, Richeimer S, Nemat A, Victor L, Matharu, Y, Yang T . Multidisciplinary approach
to treatment of chronic pain. American Psychiatric Association, Annual Meeting, 2008,
Washington DC, USA
A21. Bokarius V, White K. Chinese Medicine in Psychiatry: Traditional Treatment and
Modern Concepts. California State Oriental Medical Association. Conference and Expo,
2008, San Francisco, USA
A22. Bokarius V, Huang W, Kuo J, Wilkins J. Addiction In Prisons: New Drugs, New Treatments.
International Association of Forensic Mental Health Services, 8th Annual Conference, 2008,
Vienna, Austria
A23. Bokarius V, Rosko T, Postolov A, Liflyansky O. Psychopharmacology Behind Bars.
International Association of Forensic Mental Health Services, 8th Annual Conference, 2008,
Vienna, Austria
A24. Neumann S, Bokarius V, Johnson P, Donaldson L. Dangerous Women in Prison:
A Multidisciplinary Approach to the Treatment of Severe Axis-II Pathology in Women’s
Correctional Facilities. International Association of Forensic Mental Health Services, 8th
Annual Conference, 2008, Vienna, Austria
A25. Bokarius V, Wildman D, Corless D. Chronic Pain Management for Women Behind Bars:
A New Model for California Correctional Settings. 12th International Congress on Pain,
2008, Glasgow, United Kingdom
A26. Bokarius A, Bokarius V. Long-Term Efficacy Of Dynamic Neuromuscular Stabilization
In Treatment Of Chronic Musculoskeletal Pain. 12th International Congress on Pain,
2008, Glasgow, United Kingdom
A27. BokariusV., Wildman D., Corless D. Efficacy of Multidisciplinary Approach to
Management of Chronic Pain in Female Prison. World Institute of Pain. 2009, New
York, USA
A28. Bokarius V, Richeimer S, Nemat A, Victor L, Matharu, Y, McNalty, K .
Multidisciplinary approach to treatment of chronic pain. American Psychiatric
Association, Annual Meeting, 2009, San Francisco, USA
CV Bokarius Page 11 of 12
A29. Bokarius, V., Wildman, D., Williams, L., Snow, S. A Multidisciplinary Approach to
Crisis Evaluation and Management in Incarcerated Females. A Three-Year Analysis of
Outpatient Housing Unit Data. European Association for Psychology and Law. 2009,
Sorrento, Italy
A30. Snow, S., Williams, L., Bokarius, V., Wildman, D. Female Prisoners with Life Sentence:
Biopsychosocial Approach to Treatment. European Association for Psychology and Law.
2009, Sorrento, Italy
A31. Bokarius V, Richeimer S, Nemat A, Weinstein, F, Matharu, Y, Dieterle, C. Multidisciplinary
approach to treatment of chronic pain. American Psychiatric Association, Annual Meeting, 2010,
New Orleans, USA
A32. Bokarius V, Richeimer S, Nemat A, Egorov, A, Weinstein, F, Matharu, Y, Dieterle, C.
Multidisciplinary approach to treatment of chronic pain. American Psychiatric Association,
Annual Meeting, 2011, Honolulu, USA
A33. Musher G, Bokarius V, Bokarius A. Effectiveness of Transcranial Magnetic Stimulation in
Treatment of Depressed Patients with Chronic Pain. 20th European Congress on Psychiatry,
2012, Prague, Czech Republic
A34. Bokarius A, Bokarius V, Barats, M. Hirudotherapy in the Outpatient Pain Practice: a New Coil
in a Spiral of Medical Science Evolution. 14th World Congress on Pain, 2012, Milan, Italy
A35. Musher G, Bokarius V. Transcranial Magnetic Stimulation in Outpatient Private Practice. World
Psychiatric Association International Congress, 2012, Prague, Czech Republic
A36. Bokarius V. Effects of SB863 on Psychiatric/Psychological QME/AME Evaluations. Injured
Workers National Network Seminar, April 2013, San Francisco
A37. Bokarius V. SIBTF – MedLegal Aspects. California Applicant Attorney Association,
Sacramento Chapter Meeting, October 7, 2015, Sacramento
CV Bokarius Page 12 of 12
5/8/2016
PSYCHIATRIC ANALYSIS OF THE
FORENSIC EXAMINER’S REPORT
CROSS EXAMINING THE DOCTOR
Vladimir Bokarius, MD, PhD, LAc, QME
Components of a psychiatric report
History
Mental Status
Records
Psychological Testing
Diagnosis
Conclusions
Treatment Plan
History
History of injury
Current Symptoms
History of present illness
Past psychiatric history including substance use
Medical history and medications
Environmental History
Family History
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History of injury
Specific vs CT
Relevant history of the injury
If physical, relevant history of physical injury with ties to development of
psychiatric symptoms
Direct Result vs Sequela
If psychiatric, clear history of specific event or series of events leading to
injury
Current Symptoms
List of patient’s psychiatric complaints with regards to current
condition (within the past 2 weeks)
Clinician’s summary of patient presentation (as a foundation for the
diagnosis)
History of Present Illness (HPI)
Timeline of development of symptoms listed in Current Symptoms
Worsening and improvement
Treatment already obtained and its efficacy
Persistence of symptoms
Impairment in ADLs
Concurrent external stressors and their impact
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Past Psychiatric History
History of psychiatric symptoms and traumatic events
History of psychiatric treatment for any reason
Hospitalizations
Medications
Psychotherapy/Counseling
Substance use history
Type of substances
Timelines of use
Current status
Medical History
Current medical conditions
Untreated
Controlled
Poorly controlled
Past medical problems
Surgically corrected
Lifestyle corrected
Medication corrected
Pre or subsequent to injury
Current Medications and reason for use
Environmental History
Childhood
Developmental
Upbringing environment
School
Learning difficulties
Behavioral problems
Communication problems
Social
Social support system
Interactions with others
Marital
Current status
History of marriages and relationships
Children (including absence thereof)
Employment
Employment difficulties including
multiple short term jobs
Difficulties with colleagues or
supervisors
Current employment status
Current financial status and source of
financial support
Legal
Criminal history
History of workers comp cases
History of civil law suits
Military
Honorable vs dishonorable discharge
Access to VA service
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5/8/2016
Family History
Mental illness
Substance use
Relevant medical illnesses
(e.g. hypothyroidism)
Mental Status Examination
ID: The patient is a 47 year old Hispanic married
male.
Appearance: overweight, short statued,
adequately groomed, slightly disheveled, looking
stated age
Demeanor: partially cooperative, guarded,
mistrustful
Reliability: poor historian
Eye Contact: poor
Speech: Rate: normal. Volume: normal.
Articulation: normal. Quality: normal
Motor Activity: mild psychomotor retardation, no
abnormal involuntary movements/posture/gait
Mood: depressed
Affect: Range: constricted. Motility: fluid. Quality:
blunted, appropriate to content and situation
Thought Process: tangential and circumstantial,
patient had difficulty staying on track with the
interview and the questions asked.
Thought Content: no overt delusions, no paranoid
ideation
Dangerousness: chronic suicidal ideation without a
plan or intent, no homicidal ideation, no self
injurious thoughts
Perceptual Disturbance: denies, does not appear
to respond to internal stimuli, yet his wife states
she often sees him talking to self
Alertness: alert
Orientation: oriented to self, place, time and
situation
Attention/Concentration: impaired, loses the line
of the interview frequently, requires repetition of
the questions and redirection
Memory: forgetful
Fund of General Knowledge: average, appropriate
to the sociocultural and educational background
Abstraction: fair
Judgment: impaired, not fully compliant with the
treatment plan
Insight: fair, understands some of the symptoms of
mental illness and the need for treatment
Record Review
If inconsistencies exist between treater and evaluator psych reports, it
needs to be addressed
Psych doctors have to review ALL records to find patterns of
complaints and behaviors which may be relevant
Consistency of information provided by claimant during deposition
4
5/8/2016
Psychological Testing
Purpose of psychological testing
Diagnosis?
Personality Structure?
Severity of Symptoms?
Malingering?
How meaningful are psychological testing results?
Psychological testing results vs their interpretation
Diagnosis
DSM IV TR
DSM 5
Axis I: 296.22 Major Depressive Disorder,
Single Episode, Moderate
296.22 Major Depressive Disorder, Single
Episode, Moderate
Axis II: Narcissistic Personality Disorder
301.81 Narcissistic Personality Disorder
Axis III: Chronic Pain, Obesity
V61.10 Relationship Distress with spouse or
intimate partner
V60.2 Low Income
Axis IV: Financial stress, marital discord
Chronic Pain, Obesity
Axis V: GAF: 51
WHODAS: 75% Functional Impairment
Symptoms should support diagnosis according to DSM criteria
Ask evaluator to make a tie between severity of symptoms and
impairment in ADLs, resulting in assigned GAF or alternate rating
Conclusions
Case summary
Summary of findings
Biopsychosocial formulation
Work Status and MMI
Causation
Rating
Apportionment
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Case Summary and Summary of Findings
Case summary should clearly state mechanism of injury to psyche
Congruence of complaints, presentation, psychological testing data,
records and clinician observations
Incongruence does not mean malingering but may and should be
properly addressed by evaluator
Biopsychosocial formulation
Psycho
Bio
Meds side effects and interactions
Denial of treatment
Genetic loading
Substance abuse
Medical conditions
Social
Denial of treatment
Financial hardship
Concurrent, subsequent and pre existing
psychological stressors e.g.
Deaths of close ones
Divorce
Bankruptcy
Traumas/Stress exposure
Loss of life long career
Loss of status
Financial hardship
Work Status & MMI
Psychiatric (not physical) work status and restrictions
TTD
RTW guidelines vs reality of situation
TPD – psychiatric impairment in functioning and restrictions required
PTD
GAF below 51
GAF above 51 requires explanation of disability factors rather than impairment
WHODAS
8 work functions
PPD
Psychiatric restrictions specified
Usual and customary occupation
General ability to work
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Causation
Direct result of injury
Consequence of physical injury (with or without compensable PD)
Psychological injury only (including good faith personnel action)
Rating
GAF
Almaraz Guzman (encouraged by applicant attorneys)
Cognitive Impairment
Sexual Dysfunction
Pain
Sleep
8 work functions
WHODAS
Apportionment
Causes of injury vs causes of impairment
Apportionment to asymptomatic preexisting conditions
Apportionment to single instance of a preexisting symptomatic
condition
The science behind apportionment %
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5/8/2016
Treatment Plan
Even if it is a sequela of physical injury patients have right for psych
treatment (even if causation is not predominant but needed as a modality
to cure and relieve the effects of industrial injury, impedes recovery) and
future medical
Psychopharmacological
Psychotherapeutic
Individual
group
Other (rTMS, Vagal stimulation, ECT)
Relative to dx
Relative to MTUS & ODG
Final Remarks
Psychiatric reports are useful, even for post 1/1/13 injuries
Useful information exists in all parts of a psychiatric report
Challenging the evaluator may generate different benefits for your
clients, resulting in better treatment, higher PD or additional
compensation venues (SIBTF)
Contact
I am happy to go in depth into every section of the report which may
be of interest
Medical Legal Evaluators, Inc (855) 779 2763 phone/fax
Specializing in SIBTF, California QME/AME evaluations and expert
witness testimony
Center for Occupational Health (510) 323 2524 phone/fax
Providing full spectrum of mental health services to injured workers
8
5/8/2016
8 Work Functions
Rate impairment of the following functions 0 5 (none to severe)
1. Ability to comprehend and follow instructions
2. Ability to perform simple and repetitive tasks
3. Ability to maintain a work pace appropriate to a given workload
4. Ability to perform complex or varied tasks
5. Ability to relate to other people beyond giving and receiving instructions
6. Ability to influence people
7. Ability to make generalizations, evaluations or decision without immediate
supervision
8. Ability to accept and carry out responsibility for direction, control, and
planning
Global Assessment of Functioning (GAF)
91 100 No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or
her many positive qualities.
81 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially
effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).
71 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more
than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).
61 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or
theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
51 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school
functioning (e.g., few friends, conflicts with peers or co workers).
41 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school
functioning (e.g., no friends, unable to keep a job).
31 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as
work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up
younger children, is defiant at home, and is failing at school).
21 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts
grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends)
11 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails
to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).
1 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal
act with clear expectation of death.
9
WHODAS 2.0
World Health Organization Disability Assessment Schedule 2.0
36-item version, self-administered
Patient Name: _______________________
Age: ______
Sex:
Male
Female
Date:_____________
This questionnaire asks about difficulties due to health/mental health conditions. Health conditions include diseases or illnesses,
other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or
drugs. Think back over the past 30 days and answer these questions thinking about how much difficulty you had doing the following
activities. For each question, please circle only one response.
1
2
3
4
5
In the last 30 days, how much difficulty did you have in:
Understanding and communicating
D1.1
Concentrating on doing something for ten
minutes?
None
Mild
Moderate
Severe
Extreme or
cannot do
D1.2
Remembering to do important things?
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
D1.3
D1.4
Analyzing and finding solutions to problems in
day-to-day life?
Learning a new task, for example, learning how
to get to a new place?
D1.5
Generally understanding what people say?
None
Mild
Moderate
Severe
D1.6
Starting and maintaining a conversation?
None
Mild
Moderate
Severe
Raw
Domain
Score
Average
Domain
Score
Numeric scores assigned to each of the items:
Raw Item
Score
Clinician Use Only
____
30
____
5
____
25
____
5
____
20
____
5
____
25
____
5
Extreme or
cannot do
Extreme or
cannot do
Getting around
D2.1
Standing for long periods, such as 30 minutes?
None
Mild
Moderate
Severe
D2.2
Standing up from sitting down?
None
Mild
Moderate
Severe
D2.3
Moving around inside your home?
None
Mild
Moderate
Severe
D2.4
Getting out of your home?
None
Mild
Moderate
Severe
None
Mild
Moderate
Severe
Walking a long distance, such as a kilometer (or
equivalent)?
Self-care
D2.5
D3.1
Washing your whole body?
None
Mild
Moderate
Severe
D3.2
Getting dressed?
None
Mild
Moderate
Severe
D3.3
Eating?
None
Mild
Moderate
Severe
D3.4
Staying by yourself for a few days?
None
Mild
Moderate
Severe
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Getting along with people
D4.1
Dealing with people you do not know?
None
Mild
Moderate
Severe
D4.2
Maintaining a friendship?
None
Mild
Moderate
Severe
D4.3
Getting along with people who are close to
you?
None
Mild
Moderate
Severe
D4.4
Making new friends?
None
Mild
Moderate
Severe
D4.5
Sexual activities?
None
Mild
Moderate
Severe
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
Extreme or
cannot do
1
2
3
4
5
In the last 30 days, how much difficulty did you have in:
Life activities—Household
D5.1
Taking care of your household responsibilities?
None
Mild
Moderate
Severe
D5.2
Doing most important household tasks well?
None
Mild
Moderate
Severe
Extreme or
cannot do
Extreme or
cannot do
____
20
____
5
____
20
____
5
____
40
____
5
____
General Disability Score (Total): 180
____
5
Getting all of the household work done that
Extreme or
None
Mild
Moderate Severe
cannot do
you needed to do?
Getting your household work done as quickly as
Extreme or
None
Mild
Moderate Severe
D5.4
cannot do
needed?
Life activities—School/Work
If you work (paid, non-paid, self-employed) or go to school, complete questions D5.5–D5.8, below.
Otherwise, skip to D6.1.
Because of your health condition, in the past 30 days, how much difficulty did you have in:
D5.3
D5.5
D5.6
D5.7
D5.8
Your day-to-day work/school?
Doing your most important work/school tasks
well?
Getting all of the work done that you need to
do?
Getting your work done as quickly as needed?
Participation in society
In the past 30 days:
How much of a problem did you have in joining
in community activities (for example, festivities,
D6.1
religious, or other activities) in the same way as
anyone else can?
D6.2
D6.3
D6.4
D6.5
D6.6
D6.7
D6.8
How much of a problem did you have because
of barriers or hindrances around you?
How much of a problem did you have living
with dignity because of the attitudes and
actions of others?
How much time did you spend on your health
condition or its consequences?
How much have you been emotionally affected
by your health condition?
How much has your health been a drain on the
financial resources of you or your family?
How much of a problem did your family have
because of your health problems?
How much of a problem did you have in doing
things by yourself for relaxation or pleasure?
Raw
Domain
Score
Average
Domain
Score
Numeric scores assigned to each of the items:
Raw Item
Score
Clinician Use Only
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
None
Mild
Moderate
Severe
Extreme or
cannot do
Extreme or
cannot do
None
Some
Moderate
A Lot
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
None
Mild
Moderate
Severe
Extreme or
cannot do
© World Health Organization, 2012. All rights reserved. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0), World Health
Organization, 2010, Geneva.
The World Health Organization has granted the Publisher permission for the reproduction of this instrument. This material can be reproduced without permission by
clinicians for use with their own patients. Any other use, including electronic use, requires written permission from WHO.