Psychiatrist - what to expect

[macduffy]

I have my very first appointment with a psychiatrist coming up next. I've been to plenty of councillors and psychologists but my doctor was quick to explain that this appointment would be very different. She said that they are not a "I talk they listen" kind of doctor so I'm not sure what to expect. What will happen at this first appointment?

[dave]

She/he will likely ask you an extensive amount of questions about your past, work, family, any history of trauma, and substance use/abuse, current difficulties, current/previous symptoms....the more accurate an complete your answers are will impact his/her ability to diagnose and treat your symptoms

[paul m]

Hello MacDuffy. Good question. Cannon makes very good points. I'll add that the doc may already have read what is in your file from another doctor and if he has he may spend more time asking you about your symptoms.

The first thing is to find out how long your appt is. Typically a 30 min appt is only 20 minutes long as the doctor uses the rest to write up his notes after you are gone. (an hr appt may last only 40-45 mins etc.)

By knowing approx how long you have, you can possibly sneak in few questions before your time is up. Take Some paper and a pen with you so you can jot down any questions that might come up while he is talking. Don't try and write a book, buta few questions never hurt

In any case spend some time writing down your symptoms. This can be harder than it sounds. If you say that you are depressed it doesn't mean much to the doc as depression covers a wide area. If you say that you don't sleep well at night , have trouble getting up in the morning, have no interest in ***, have no interest in going out for coffee with friends, have trouble in social situations due to anxieties, can't get the house work done, don't attend to personal hygene well or that you think about death all of the time than the doctor can tell a lot more about how bad your depression is.

Time frames may also be important. More than one doctor has asked me how many days a month did I feel depressed and I would realize after I got out of the office that my answer was way off.

The reason to make the notes in advance is just to stick them in your memory.

Also take what prior treatments that you have tried. For example, if you've taken an antidepressant, try and have the exact name of the antidepressant and how long that you took it for, plus what the results were. Good Luck and Take Care. paul m

He may also ask you about what stressors are in your life. Do you and your spouse get along, do you and the neighbors get along.

[astronaut]

Hi Macduffy,

I have been first time assessed by many, many pdocs in the past few years (7-8). In almost every single case my initial assessment was well over an hour, sometimes over two hours. There were a couple of instances where I was asked to go back to finish the assessment. Every pdoc is a bit different and they differ depending on if they are part of a clinic, a private practice or a university-hospital setting. I have sometimes had an assessment with a psychiatric nurse and then after that one with the pdoc. Or I have had an assessment with the pdoc and then an hour long questionnaire to fill out. Some pdocs will get you to do some bloodwork for them so that they can rule out any other non-brain related problems that might be causing some depression type symptoms. They can ask you loads of different things:
-sleep (duration, feeling rested or not? average hours slept per night?)
-nightmares?
-eating/weight changes
-anxiety
-panic attacks (frequency, triggers, duration)
-energy levels
-motivation to do things
-can you get pleasure in the things that used to give you pleasure?
-interest in things
-does weather affect you? Or season changes
-social life
-*** drive
-concentration or memory loss issues
-ability to make decisions
-headaches
-sore muscles not caused by any knowable thing that you have been doing
-family medical history
-history of trauma, stress, neglect or abuse (***ual, physical, emotional)
-recent triggers: I.e. moving, changing or losing a job, relationship difficulties, death, illness, etc.
-irritability
-suicidal thoughts/ideation
-suicidal plans
-thoughts of death but not necessarily suicide (frequency, duration)
-crying all the time or not being able to cry when you feel like you need to
-numbness or no feelings
-negative self thoughts (self hate, anger toward the self)
-self harm (cutting, burning, etc)
-hallucinations or delusions
-racing thoughts
-amount that your symptoms impair you from having what you would deem a "healthy" lifestyle in terms of your social life, ability to work or interact with people, do basic self care and household work, etc.
-females are often asked about their menstrual cycles and any mood disturbances that may cause.
-previous psychiatric diagnoses or hospitalizations
-past treatments

I've probably missed some stuff but all of the above are open game when it comes to pdocs asking questions. The questions get more specific if they think you might have something other than depression. For instance, when they start asking about mania, if you answer "yes" to a bunch of questions that relate to mania, they may go off on a tangent to asking mania-type questions non of which I have really included on the above list. So, you probably will be doing most of the talking but it will most likely be very specific to what the pdoc wants to hear in answer to exact questions. Paul's idea about bringing in a few questions of your own is a very good one. Don't be afraid to ask anything you want to the pdoc. You deserve to know what they think and what their honest assessment is of your symptoms.

good luck,
astronaut

Pdocs usually do not want an interpretation of your symptoms or illness (i.e. I feel like this because someone close to me died when I was 10). They just want to learn the "facts." They might ask you if you think that something specific has affected you but interpretation doesn't usually happen with the pdoc on the first visit (if at all).

[macduffy]

wow! you guys are great. I think I will make a point of writing stuff down before I go. I have a tendency to forget things and a really hard time communicating.
One other question. I am currently applying for LTD (I need sometime to figure out what's wrong with me and get used to my meds so I'm hoping I can go back to work eventually) and I have the dreaded forms I needed filled out. Can I ask for the forms to be filled out on my first visit or should I get the pdoc to just send a report to my GP and she can fill out the forms with the pdoc information?

[Kaight]

What a list Astro! It really got me thinking!

For one, I've been to 3 separate Drs regarding my depression and not one has ever done blood work.
What should I have been tested for?

[paul m]

Hello Kaight. Everyone should get a complete physical every year. However even a complete physical won't always catch depression causing problems.

I have included a link to a very long article at the end, but in regards to blood work I have just snatched a small portion:

TSH (thyroid test), CBC (complete blood count), SGOT (liver function test), Fasting glucose [or random glucose if fasting not possible] (screen for diabetes), serum albumin, serum calcium, vitamin B12, and urinalysis.

With all of those tests, you are not looking for depression, rather you are looking for an illness like diabetes which can cause depression. Even mild diabetes, with no obvious symptoms, can cause problems with depression. Take Care. paul m

http://www.alternativementalhealth.com/articles/diamond.htm

[astronaut]

Hi Kaight,

Paul's answer is the one you want. I would also add checking iron levels to the list. I think they check for iron levels with two different measurements but I can't remember what they are off hand-- your doctor would know though for sure. Women are far more likely to have low iron (anemia) than men. I have had anemia before and many of the symptoms are a lot like depression. I have also had anemia AND depression at the same time which is very difficult.

astronaut

[uni]

Hello macduffy. Without a doubt write up a list of your questions and symptoms ahead of time. You may not have time to cover everything, so hit the things you're most concerned about first.

It has been my experience that some pdocs make a diagnosis without going into a lot of the questions mentioned on this thread. An experienced pdoc may be able to pick up non-verbal cues and therefore ask fewer questions. In any case, I suggest giving any pdoc at least two appointments before deciding if you click - your gut feelings, trust level etc. The way I see it, you are entering into a "relationship" in a way, so it's important you understand each other.

[AJ]

Iron levels can be tested with the measurement of Hemaglobin and ferritin (iron stored in the body).

[astronaut]

Oh yes, "ferritin" was the word I was trying to remember. Thanks, AJ!

[AJ]

You're welcome.

[Kaight]

A very long article indeed, Paul! Very informative though.
I appreciate your specific summary very much!