Meeting with Psychiatrist for Dx - Big Letdown

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So, I finally got in to an initial meeting with a psychiatrist so I could get an official diagnosis for my daughter. My main motivation is to have the tools I need to effect changes at school. I know a psychiatrist is usually there to write prescriptions - at least in my limited experience, but I was told by my insurance and their office that if I want an official diagnosis, I need to start with a psychiatrist. So we are rushed in with a pile of paperwork that I'm half completing in the session, the Dr. is completing a pile himself and we are talking about everything in front of my daughter which I hoped wouldn't happen. But, i can sense I've only got a few minutes to get started so we just rush through, he asks about 30 or so questions, I fill out a few papers with about 30 or so rating type questions that I can easily see are to determine ADHD and depression. Then he says "Your daughter is majorly depressed with ADHD, probably has Aspergers, OCD and social phobia". Now, he has no history on her other than what we talked about in a 20 minute session. She said she didn't like her life and felt shy (so that equals major depression and social phobia). Since she looses everything and is disorganized, so she has ADHD. Since she likes to chew on things therefore she's OCD. Oh and probably Aspergers but he's not sure since she doesn't talk about things at length - to the point of boring everyone. We need to increase her medication since she's so depressed (keep in mind this has been diagnosed from a few questions.)

So, yeah, right, I'm not even sure what to do other than be stunned at this first meeting. I guess I should start over with someone who will actually talk to us. And, BTW - I think it's insane (excuse the pun) that our mental health system has divided itself into one Dr. that writes prescriptions based on very little evidence and another that actually spends time getting in depth information about a patient.

Unfortunately I'm with Kaiser and I can't make an appointment with anyone, I'll have to find someone else in their system.

Any advice is appreciated!

And herein epitomizes my issue with those who have issues with those who do not have an "official diagnosis".

My friend thinks he is a knight because he went to some horse joisting place and got knighted by a guy with a goatee who he paid $25 to.


Anyway, psychiatrists think everyone is depressed. That in itself should be a syndrome listed in the DSM...the false idea that everyone is depressed.

Not only that but they also tend to think that everyone who is depressed is clinically depressed and should be medicated. And in the event your depression is caused by environmental factors, they tend to think you should still be medicated, because that is, after all, the only thing they know how to do' write prescriptions.

It didn't used to be like this. The profession used to have validity and integrity. Doctors were interested in their patient's well being. They recognized that it was not always appropriate to medicate and that there were other means of treatment. It's rare that one will find a real psychiatrist today, who is not a walking pill dispenser.

I am not adverse to medication when needed but most of the time, it's not needed, not warranted, and ultimately degrades the patient's quality of life. Those who actually have neuropsychiatric illnesses and take medication regularly for it, only continue to do so if they have no say in it, or the medication helps to some degree, and even then, it with it's side effects is usually only the lesser of two evils.

And PS. Chewing on things is not a symptom of OCD. It never has been, it never will be, and if I ever met a psychiatrist who was under that impression I'd report them for being completely inept.

Yes, that is completely "insane." My bf dealt with the same kind of thing for years.

Search the Kaiser system (my sympathies to you for being in THAT situation, too) and make a list of names of mental-health practitioners. Then, look them up on doctor rating websites (search "rate doctors physicians" on Yahoo or Google) and see what their credentials are, what other patients have said about them, etc.

This one sounds like he has no clue what he's talking about.

It's stuff like this that makes me glad I stuck with a self-diagnosis.

Good luck. Hope you find someone who's actually competent.

I'm definitely in the minority here: if I ever went to see a psychiatrist, I'd actually prefer a "walking pill dispenser", also known as "pill pusher". I have no interest whatsoever in sitting for session after session, talking about my feelings. Being an aspie, I always have trouble answering the ever-so-popular, yet anxiety-inducing "how did that make you feel?" question. It doesn't help me at all, and doesn't help the therapist either, because all he/she is getting are answers I know he/she wants to hear, which I memorized from Wikipedia. So in the end, I pay $200+ per session to spew out scripted answers! I'd much rather pay $100 for a prescription (because I refuse to buy psych drugs online) and 20 minutes of small talk, so I can get medication that will help me feel better, without having to memorize "right" answers to questions about feelings.

Heck, when I was 13, I had a psychologist send me into a two-week depression, so I have little trust for long talk therapy and prefer pill pushers instead. Then again, it serves me right for being naive enough to answer her questions truthfully instead of feeding her lines she'd want to hear. With all that said, at least a one-hour conversation is needed to properly diagnose a patient, but grilling an aspie about his/her feelings should be classified as unethical.

The only right answer to these questions is the honest answer. If a psychologist or counselor asks the "and how did that make you feel" questions it's to either give them insight about your or you insight about yourself. If a psychiatrist asks this question...a real psychiatrist, it's to give them insight about you to decide the best course of action or help them decide a diagnosis, and generally NOT to help you arrive at self insight.

Perhaps I should clarify a point from my original post though.

Unless a history can be presented and the psychiatrist has had time to review it, I believe that it will generally take a few "talk" sessions with a patient, along with applicable medical testing, before a proper diagnosis can be arrived at.

How many people who have seen a psychiatrist in this day and age have had them do a physical + bloodwork as part of the diagnostic process?

Wrong Diagnosis lists as causes...
For depression: 629 conditions, as a side effect of 846 drugs, and a result of 527 drug interactions.

For psychosis: 92 conditions, as a side effect of 59 drugs, and a result of 75 drug interactions.

For anxiety: 892 conditions, as a side effect of 428 drugs, and a result of 201 drug interactions.

For agitation: 238 conditions, as a side effect of 235 drugs, and a result of 251 drug interactions.

For hyperactivity: 272 conditions, as a side effect of 34 drugs.

I can go on. Too many psychiatrists forget today that they are medical doctors who have as much of an obligation to properly diagnose as to treat, or seem to be under the impression that the seemingly intangibility of the brain relieves them from the thoroughness and appropriate diagnostic procedures undertaken in other fields of medicine.

The actions of too many psychiatrists today are analogous to the actions of a nephrologist who both prescribes anti-biotics off the bat to every patient who walks in and says "Doc, I have to pee a lot" and simultaneously implies they drink too much caffeine because they saw them have a cup of it in the waiting room.

Last edited by Chronos on 08 Jul 2010, 3:22 am, edited 1 time in total.

Between my first autism diagnosis as a young child and my most recent one as an adult (by a neurologist), I have been diagnosed with everything under the sun. These diagnosis include multiple personality disorder, borderline personality disorder, adjustment disorder, mental retardation, and the one I like the most, possible schizophrenia. The "mental health profession" has hardly a clue about autism. I have talked to only two mental health professionals that I have met informally who figured it out. One was a psychiatric nurse who was my friend's mother, and the other one was a behavioral evaluation specialist who I encountered at a meeting (her grandson is Aspie). The ones that can see right through my act are speech and occupational therapists.

I was told by the psychologist that my son saw, age 3, that he couldn't be AS as he had rages, and that Asperger's children don't rage, that they are very unemotional (like Spock in Star Trek). Well I now know the saying, 'if you've met one person with autism you've met one person with autism', which to me sums it up, and explains why professionals can so often get it wrong. I would suggest you try and find a local autism/AS support group, and find out from them which clinicians in your area are trusted to give accurate diagnoses. Other parents and other AS adults are a great source of information, in my experience. Plus, you can have a rant and get some proper understanding, as they know what you're going through, which can make you feel a lot better.

All 3 year olds have tantrums!

i hate psychiatrist. sorry had to get it off my chest.

i think this is part of the biggest misconception out there about autistics, that they are unemotional. that is so very far from the truth. meltdowns are very common for autistic kids, how can you consider someone writhing on the floor screaming at the top of their lungs to be unemotional? its not lack of emotion but rather a difference in how they express it. to me a rage is just a meltdown. its uncontrollable emotional release above and beyond what the situation would typically warrant.

Just like any profession there are some who are better than others and some who are completely incompetent. With the system we have in the USA insurance companies are in the drivers seat. They dictate what Drs can do to diagnose different things, how often and for how long patients can be seen and so on. Even a great Dr can be hard pressed to do the right thing for a patient within the confines of what the patients insurance will allow.

That said, I don't see why this Dr had you filling out forms while you were talking to him. There is no reason he couldn't have had you fill those out ahead of time, or had you bring them back later. It sounds like he was trying to do the right process but cram it into too small a time.

My kids AS was diagnosed by a psychologist. We had to fill those forms out at home, and had a similar interview with her. She also had teachers fill out forms. She gave us the diagnoses some weeks later after she'd had time to correlate all the data from the forms. She also did IQ and other academic tests. She could have dx'd AS and ADHD without those but we needed those results to help us get appropriate accomodations from the school. After she did her dx she sent us to a psychiatrist for treatment. The psychiatrist has councelors in practice with him and the boys have seen one of them as needed for talk therapy. Later our psychiatrist has added additional diagnoses based on many brief sessions. I feel he knows us all pretty well at this point. The councelor also works closely with him, so there is a lot of helpful collaboration.

We have Tri-Care (military), and it pays pretty well for it, but the number of visits per year is limited based on diagnoses.

My advice is to try to get a team of professionals who can work together for your child. Once you've got those dx's on paper, even if they aren't completely accurate, you've probably got more leverage to get more out of the system. Maybe your daughter isn't that depressed, but that dx can get you in to see someone who can make a more in depth assessment. Your Dr may have overdiagnosed a bit on purpose for that reason. I'd hold off on pills until you feel you've got Drs who have a better handle on things.

Yes, I wish I'd known then what I know now. I just trusted the psychologist you see, because he was a (kindly) professional, and I was a first-time mum with a small child who would go utterly ballistic several times a day. I just assumed that he knew what he was talking about. And yet there were so many clues that my son was on the spectrum. So many. Ach <waves hands in air>. What can you do, eh? Only your best. It was a heck of a relief for my son to finally get a diagnosis after all those years.

So now I am a bit wary of experts. They are not all as expert as they might appear. As others have said!

Wow, where to start with this one. I must admit that I am a bit jaded. Why? A failing in myself, I'm afraid. I chose to take the advice of "professionals". Not to say that all of the mental health professionals are bad, but I've not had good experiences with some. We have been working towards a diagnosis for my 8 year old daugher for over 4 years now. It started out well - my medical benefits covered evaluation/therapy/psychologists at one of the best university medical systems in the state (Univ. of MI). Things were moving along a little slowly, but at the time, my daughter was 4 and I was comfortable with that - I do agree that with younger children it is difficult sometimes to specifically diagnose a particular disorder. Then our insurance changed - and I can only say that it has been downhill since then. I too dislike the pill pushing P Doc's who after 15 minutes of asking questions starts pushing even more meds. It really irritates me to no end. I am SO incredibly frustrated with the mental health system and insurance companies in general at this point. In fact, I told my daughter's therapist that I thought their on-staff child psychologist was "flakey" last week. Because she is - she mumbles, doesn't make any sense, could not provide me with any sort of a hand out of information on the drug she decided to prescribe and told me that I could find info on the internet.

My advice: start researching for centers/non-profits that specialize in ASD/Asperger's - thus far, they have been the best source of information and referrals that I have found. Even if they don't take your insurance, a lot of them are helpful in finding lower cost alternatives and recommending a GOOD P-Doc or therapist who can actually help. If your insurance company is anything like mine (Value Options - the name says it all), most of their therapist/psych's are sub-par (just my opinion, I'm sure there has to be a good one in there somewhere, just not in the 10 that I personally talked to).
The path we have taken is to spend the money ourselves to have a neuropsych evaluation done (U of M had started the process, but once our insurance was no longer accepted, we couldn't go there due to costs as they would not agree to a sliding scale for payment as we had insurance, it was just our tough luck that they were out of network. At $210/hour, it adds up fast!) - this is currently in process. My hope is that it will get to some of the core issues that my daughter is dealing with - be it ASD, Anxiety, whatever. At least we will know what it is. I'm very frustrated with therapist and Dr's who evaluate and diagnose using only "symptoms" and "behaviors". These are important, but there are also tests that can help to nail down a diagnosis. Maybe it's the scientist in me, but I prefer to have a little more data behind a diagnosis and the presribing of a med than 20 minutes of question time. Unfortunately, that doesn't come cheap - the estimated costs to us for this is between $2500 & $3000. And yes, we could get it cheaper by using an "in network" provider - I did call the ones that were suggested by our insurance - and wasn't impressed with any of them.
Sorry to jack your post and turn it into my own personal rant I wish you luck, it's been a very frustrating for us so far.

Yikes!! !!

My advice is to not take any med this doc is prescribing! Find a competent specialist knowledgeable in AS. Even if you have to pay out of pocket. Do not stay with this phoney quack!

I guess my situation is more the norm than I realized! GardenGirl414, I'm glad you posted, seeing how other parents are handling the situation helps me collect "data" on what move to make next. Since Kaiser is so centrally managed, I may call and just see if I can ask if we can be diagnosed by a psychologist who specializes in Austism and ASP (not holding my breath they exist). The funny thing is that the little information I could find after lots of digging on this particular psychiatry group (they outsource for Kaiser) is that they specialize in ADHD so it almost seems like everyone who comes through the door is viewed through their "specialty" glasses. I wonder if an Autism specialist would do the same thing!

Sigh - I hate to think of paying out of pocket unless she was slipping downhill. She's doing much better this summer, happier, less frustrated. I'm always trying to find the right mix of activity and downtime to keep her happy while still teaching her how to function in the world - I mean she's much better off with those tools if I can give them to her. That's what keeping her in school and getting the IEP is all about.

Thanks!

It's not the norm. When my daughter was being seen at the Univ. of MI and we made the decision to start ADHD meds, they did do a physical as well as baseline EKG and a follow up EKG. The 2nd and 3rd P-Docs never even suggested it. I take our daughter to our GP and have her write the referral for the EKG, so that we can make sure that there aren't side effects - but I wouldn't have necessarily even thought to have done that, had it not been for the outstanding care that we had while we were at U of M.



I couldn't agree more with this. They all just seem to be very pill happy, in my opinion. My daughter has a tendancy to be very anxious when she goes into a new setting. This usually manifests itself in agitated/nervous behavior. She can't sit still, fidgets, blurts out answers, interrupts and acts much younger than her age and somewhat silly. She acted just this way when we met with her current P-Doc for the first time - 10 minutes into the meeting, the Dr. said - she needs more ADHD meds. No reason was given - I assumed that it was due to her "adhd" like behavior, which is really a manifestation of anxiety. I know, I've seen it many, many times with my daughter. I disagreed, stating that I wasn't comfortable with the change - to which the Dr. replied - "so you want me to take her off the med?". My response was "No - I didn't say that". I discussed this with my daughter's therapist the following day - my misgivings about the mumbling, the quick rush to prescribe meds., the poor communication and general "flakiness" that I perceived. The therapist urged "patience" and stated that she had a very good working relationship with the doc (I must admit that I like the therapist) and that she could communicate very well with the doc on my daughter's behalf.
Ten minutes and already we are already moving to more meds. Interestingly enough, the next time we went to see the P-Doc (my daughter was more calm as she knew what to expect), she stated that both the Risperdol (to control outbursts) and the Ritalin (for the impulsivity issues) that my daughter is taking are "the right doses" - nothing had changed since we were there 3 weeks ago, when she recommended an increase in the Ritalin that I disagreed with. She then decided to add Topamax (after discussing a couple of other medications that I had questions about that she couldn't answer based on some earlier research that I had done) to help with the outburst - and couldn't provide information on other than to watch for "tiredness and being thirsty".

This is what has lead to us moving towards going "out of network" and finding competent Dr.'s/therapists and paying for it on our own - financially, it hurts a lot, but given the current issues we've had with providers under our plan, it's necessary.