Attachment C(4)237881-D PhysicansPanTool4

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UPDATED MENTAL DISORDERS AND SUBSTANCE
ABUSE/DEPENDENCE GUIDELINES FOR APPLICANTS

In June 2010, CDC released new Technical Instructions on mental disorders and substance abuse/dependence. A key change is that the diagnosis
of mental disorders and substance-related disorders should be made according to the current Diagnostic and Statistical Manual (DSM). Other
changes are listed below. Please note that panel physicians should refer to a specialist if they cannot make a diagnosis or classification.

ITEMS TO REMEMBER WHEN EVALUATING MENTAL STATUS:
A mental disorder represents a serious departure from mental function that is considered abnormal according to developmental,
behavioral, cultural, or emotional norms. To evaluate an applicant, the DSM criteria for a mental disorder must be met and harmful
behavior must be evaluated.

1

CLASS A

Current evidence of mental disorder AND current associated harmful behavior OR history of associated behavior judged likely to recur.

CLASS b

Current evidence of mental disorder AND NO current associated harmful behavior AND NO history of harmful associated behavior
judged likely to recur.

For the Mental Health Examination, There are 4 Questions to Consider Asking Every Applicant:
1. Do you or have you ever had thoughts about harming yourself and have you ever taken any actions based on these thoughts?
2. Do you or have you ever had thoughts about harming others and have you ever taken any actions based on these thoughts?
3. Do you currently or have you ever used alcohol or any other substances?
4. Are you currently on any medications or have you ever been on any medications, including herbal supplements, vitamins,
or any other substances?

ITEMS TO REMEMBER WHEN EVALUATING ALCOHOL ABUSE AND/OR DEPENDENCE:
Alcohol abuse and/or dependence is not listed in the Controlled Substances Act (CSA), thus it falls under the criteria of mental disorder.
The DSM and harmful behavior must, therefore, be evaluated to classify applicants.

2

CLASS A

Current evidence of mental disorder AND current associated harmful behavior OR history of behavior judged likely to recur.

CLASS b

Current evidence of mental disorder AND NO current associated harmful behavior AND NO history of harmful behavior judged likely to recur.

REMEMBER:
• Evaluation for alcohol abuse/dependence is required for those with:
»» 1 alcohol related arrest or conviction within the last 5 yrs OR
»» 2 or more arrests or convictions within the last 10 years

• CDC does not require that panel physicians perform a liver function test or other blood test on applicants.

ITEMS TO REMEMBER WHEN EVALUATING SUBSTANCE ABUSE AND/OR DEPENDENCE:
Substance abuse and/or dependence and remission for drugs listed in the Controlled Substances Act (CSA) are evaluated according
to the criteria listed in the current DSM.

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CLASS A

Current evidence of use of substance on the Controlled Substances Act (CSA) list AND meets DSM criteria for substance abuse OR
Current evidence of use of substance not on CSA list AND meets DSM criteria AND current associated harmful behavior OR history of
associated harmful behavior judged likely to recur.

CLASS b

Meets DSM criteria for full, sustained remission from substance abuse or dependence
Note: Panel physician or specialist must use clinical judgment to determine if 12 months without substance use is sufficient
to determine remission.

REMEMBER:
• “Experimentation” is no longer included in the Technical Instructions.
• If panel physician does not have enough information to classify applicant, panel can hold
applicant file to gather more information or refer applicant to consulting specialist.

National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine

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SAMPLE Questions for the Mental Health Examination
The Technical Instructions on mental disorders and substance abuse requires panel physicians to determine the mental status of each
applicant and use the criteria (defined on the opposite side of this tool) to classify each applicant. Below, we have listed some sample
questions that panel physicians can use to assess mental status and substance use. These are only guidelines to use in your practice; other
questions or evaluation techniques may also be used to assess an applicant’s mental health.

Orientation:

Ask the applicant

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Name
What city they are in
The date and day of week
Why they are there

Appearance:

The panel physician should observe for:

• Inappropriate dress or grooming
• Unusual body markings
• Inappropriate body posturing

Mood and affect:

Observe for a depressed or irritable affect
Ask the applicant if they experience(d):
• Lack of interest in activities
• Feelings of hopelessness
• Feelings of guilt

Anxiety:

The panel physician should observe for: Excessive or
reduced activity level and/or Compulsive (repeated) behaviors
Ask applicant about:
• Increased appetite
• Decreased appetite
• Sleeping problems
• Difficulty concentrating
• Repeated disregard for rights of others
• Excessive energy level
• Reduced energy level

Harmful Behavior by Applicant in the Past:

Ask applicant about:
• Suicide attempts
• Other recurring self injury
Ask applicant about:
• Substantial injury by him or her to others
(including driving while intoxicated)
Ask applicant about:
• Substantial damage to property by him or her

Observe for nervousness, twitching or
other unusual body movements

Pertinent Past or Present Medical History:

Ask applicant about:
• Worry
• Fear
• Remembering bad events

Substance Abuse:

Speech and Language:

Observe for: fast or slow speech flow, slurred speech,
culturally or age inappropriate language

Anxiety:

Observe for nervousness, twitching or
other unusual body movements
Ask applicant about:
• Worry
• Fear
• Remembering bad events

Thought Processes and Content:

Observe for: Loose connections between thoughts,
racing thoughts or many thoughts at the same time

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Behavior:

Ask applicant about:
• Thoughts of hurting oneself or others
• See things or hearing voices that are not real

Ask applicant about:
• Family
• Social relationships

Ask applicant about:
• Alcohol Abuse/Dependence (include treatment)
• Other Substance Abuse (include treatment)

Medications:

Ask applicant about:
• Past or current medications
If you are unable to make a proper diagnosis, please
refer the applicant to your consulting specialist. If your
consulting specialist has a question about classifying
an applicant after their evaluation, panel physicians
should contact the U.S. Consulate to request an
opinion from the CDC consulting psychiatrist.
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