CHICAGO — The 13-member AMA Guides Editorial Panel has approved and issued the first content updates to the “AMA Guides® to the Evaluation of Permanent Impairment” since 2008 when the AMA Guides Sixth Edition was originally published. The Panel-approved updates to the mental and behavioral health content reflect current practices and standards.

Effective July 1, 2021, “AMA Guides to the Evaluation of Permanent Impairment, 6th Edition, 2021” (AMA Guides Sixth 2021) is the most current edition of the trusted and authoritative resource for impairment rating information and tools. AMA Guides Sixth 2021 reflects the foundational content of AMA Guides Sixth Edition with new Panel-approved content updates. Earlier editions that preceded AMA Guides Sixth Edition will not be updated with new content.

The AMA Guides Editorial Panel was convened in 2019 to ensure that the medical and scientific content of the AMA Guides Sixth Edition reflects the most current in medicine and provides a basis for fair and consistent evaluations and impairment ratings. The Panel holds monthly virtual meetings that are open to the public to discuss proposals to update the AMA Guides Sixth Edition. Future content updates to the AMA Guide Sixth Edition occur annually after careful consideration of proposals submitted to the Panel.

The new content was proposed by the American Psychiatric Association and the American Psychological Association to align AMA Guides Sixth 2021 with terminology and methodology changes to the “Diagnostic and Statistical Manual of Mental Disorders” (DSM)—the authoritative guide to the diagnosis of mental disorders for health care professionals around the world.

The AMA Guides Sixth Edition, published in 2008, utilizes terminology and methodology from DSM-IV-TR. After a reevaluation, DSM-IV-TR was replaced in 2013 by DSM-5—the most recent version of the DSM. AMA Guides Sixth 2021 reflects current practices and standards in mental and behavioral health by utilizing terminology and methodology from DSM-5.

“Evidence-based medicine and science related to the evaluation of permanent impairment associated with mental and behavioral disorders has advanced significantly since 2008,” said AMA Guides Editorial Panel Co-chair Mark Melhorn, M.D. “The content updates approved by the Guides Editorial Panel will help clinicians conduct mental health evaluations and better achieve accurate, equitable and consistent impairment ratings with updated terminology, methodology and assessment tools that mirror contemporary medical science and practice.”

At the recently completed Special Meeting of the AMA House of Delegates, physicians, residents and medical students approved policy supporting the use of the most current edition of “AMA Guides to the Evaluation of Permanent Impairment” by all jurisdictions to provide fair and consistent impairment evaluations for patients and claimants, including injured workers.

Key changes available in AMA Guides Sixth 2021 include:

Global Assessment of Functioning (GAF) scale excluded for impairment rating calculation
To rate mental and behavioral impairment the AMA Guides Sixth Edition released in 2008 uses three scales, Global Assessment of Functioning (GAF), Brief Psychiatric Rating Scale (BPRS) and Psychiatric Impairment Rating Scale (PIRS). The mental and behavioral health impairment rating is calculated by the median value of the GAF, BPRS and PIRS impairment scores. The GAF rating scale was removed in the update from DSM-IV-TR to DSM-5 due to questionable psychometrics and lack of conceptual clarity. For more accurate mental and behavioral health impairment ratings, the AMA Guides Sixth 2021 no longer calculates permanent impairment using the GAF rating scale. Impairment ratings are calculated by averaging scores from the BPRS and PIRS.

Newer editions of assessment tools and tests
New psychological tests and batteries have been published since the AMA Guides Sixth Edition was released in 2008. Updates available in AMA Guides Sixth 2021 keep pace with the changes that occurred over time to the standard practice of neuropsychological assessment and utilities newer batteries that have been developed and are more commonly employed in standard neuropsychological practice.

Updated descriptions of malingering and motivation
The literature on motivation and malingering is continuously updating, and editorial changes to AMA Guides Sixth 2021 were added to clarify language and include more recent literature references.

The updated content available in AMA Guides Sixth 2021 is offered on AMA Guides Digital—the first-time content has been released on the platform—to allow easy access to trusted content when users need it. AMA Guides Digital is also home to the 25 year archive for the AMA Guides^® Newsletter, the authoritative source for crucial updates, authoritative guidance, practical information for proper use of the “AMA Guides to the Evaluation of Permanent Impairment”.

To learn more about the most current edition of “AMA Guides to the Evaluation of Permanent Impairment” and how to apply the mental and behavioral health updates it contains, the AMA offers an educational module on the AMA Ed Hub™, an online leaning platform containing resources for continuing medical education.