What qualifies for a “mental disorder”

[Throwaway13]

I’m filling out medexpress for the first time (3rd class), and I was looking at the drop down for “mental disorders,” and I’m curious if I’m legally required to check off this box b/c one time my pcp prescribed just a couple doses of Xanax for a short-term stresser, which required him to put anxiety down as a diagnosis. It’s nowhere else in my records, nor is there really a narrative surrounding the decision to prescribe the meds, but my heart sank when I saw this, given the reading I’ve done about anxiety and the FAA. I don’t have any sort of anxiety disorder, and I never even needed or took the meds, but I did fill the script. I’ve read about people kind of hiding things, but I’d be nervous if I ever had to submit these records. I didn’t visit the doc for anxiety, it was just something that came up during my exam. Just curious if this is what the FAA is looking for in terms of “anxiety”. Thanks.

 

[AggieMike88]

Pinging Doctors Lou, Bruce, and Brad for their input.
@lbfjrmd @bbchien @Brad Douglas MD MPH AME

 

[steingar]

Personally I think we all have a mental disorder. No other reason to explain the insane financial output vs utility of our aircraft.

 

[flyingron]

You have to report it. A transient anxiety situation is not likely to be too onerous.

 

[lbfjrmd]

 

[Throwaway13]

So this isn’t generally something that would require a HIMS visit/eval? @lbfjrmd

 

[Brad Douglas MD MPH AME]

Well - you have to be VERY careful in writing as an AME and what goes to the FAA - NOW - if you have a Psych doc diagnose you with Anxiety, Depression - etc - and you have been placed on Antidepressants - that is one thing - NOW if you are going through a DIVORCE - I see this a LOT - and I mean a LOT - this is NOT necessarily anxiety/ depression - and this is CALLED ADJUSTMENT disorder - which is ALLOWED to have a medical issued without a SI from the FAA - but the AME MUST document, DOCUMENT, and DOCUMENT - this is important. I had a pilot who was about to have his medical expired - so he could not see me and I KNEW he was going through a divorce and he was VERY stable, no issues - and I labeled him with adjustment - WELL - the NEWER AME he saw, put down he had anxiety about his divorce - which was not necessarily true - but he was labeled and he lost his medical for about 4 months to get this all clarified - I could not help him since he went somewhere else - so WORDS matter - and how you document MATTERS - and AMEs who KNOW the AME guide well, and who know MEDICINE well and have been practicing docs for may years - that helps a lot - an AME needs to know when to issue and when to differ and an AME must know the definition of any diagnosis - that sometimes is a problem that I see.

 

[Throwaway13]

Hey @Brad Douglas MD MPH AME - thank you for your response! That is good to know. What's confusing to me is that I never saw a psych doc. This was a "diagnosis" that was seemingly very off-hand based on one answer I gave on how I was doing with a current situation. I've never seen a psych of any sort. So, that's where I come from in wondering how "legit" it was, although I recognize that in the records, it shows as an official diagnosis from an MD, so that's probably all that matters...should I reach out to my PCP to see what the exact diagnosis was?

 

[lbfjrmd]

So this isn’t generally something that would require a HIMS visit/eval? @lbfjrmd

A senior AME could assist you in this early stage, though a HIMS AME could too.

 

[Throwaway13]

A senior AME could assist you in this early stage, though a HIMS AME could too.

Good thing I've found a Senior HIMS AME! I just didn't know if it might require the full HIMS workup. I've disclosed this information to him now, and he's said to get a full write-up from the diagnosing doctor and we'll go from there.

 

[bbchien]

What matters here is if you can show it to be a one-off. FAA divides the firmament of “disorders requiring medication” into recurrent and one-time.

it becomes important for your pcp to state that to his knowledge this was the only exposure in your life
That no reality testing was affected
No suicidality
Give start and end dates and that there was no dual drug Rx (2 @ once)
That you have been seen and evaluated>60 days after discontinuation and that you have nothing remaining to treat;
He has to Name the stimulus to the event and that the event has passed. The above are the “elements” of an adequate note.....

His authority over this pragmatically ends at a years’ duration, though I have one PCP note eloquently written that FAA agreed with in which the exposures was just under 2 years. More than that and you need a Psychiatrist to opine.