How important is a correct diagnosis?

[Miffed]

My husband was diagnosed with Major Depession and GAD about 5 years ago. Since this time, he has been on many, many different meds. and some therapy but the relief was only marginal at best. In fact, his bad cycles are now getting closer and closer together and more severe now than ever.

In July, he saw a Psychiatrist for a consultation on his meds. and the Psychiatrist thought that he may in fact be bipolar (mis-diagnosed) - so now he is slowly building up on Lamictal (in addition to his current Effexor, Zyprexa, and Clonazipam).

Here is my question - it would appear that a correct diagnosis could be very beneficial. Even though these drugs often seem to be used interchangably - I would think you could find the right mix much sooner if the right diagnosis was available. But what is the very best way to be diagnosed. I know Psychiatrists are probably the most knowledgable - but the guy my husband saw spoke to him for a whole 25 minutes. I can't imagine being able to properly collect his history in this amount of time - never mind being able to diagnose the disorder. A few other consultations in the past with other Psychiatrists also went this same way.

Would you say that an accurate diagnosis is possible through interviewing alone? Who in the medical community is best able to do this well given the time pressures? Would a Clinical Psychologist be a better bet? All-in-all is an accurate diagnosis as important as I think it might be (or am I focusing in the wrong place)? If it is, what advise would you have for finding a way to get this done (e.g. again, what type of professional? What type of process? Would any tests help - e.g. PET scan or MRI (I'd be willing to go to the US to get one quickly if this could help))?

Sorry, a lot of question... just feeling a little desparate as I don't know how long my husband will hold on...

Thanks!

 

[Miffed]

My husband was diagnosed with Major Depession and GAD about 5 years ago. Since this time, he has been on many, many different meds. and some therapy but the relief was only marginal at best. In fact, his bad cycles are now getting closer and closer together and more severe now than ever.

In July, he saw a Psychiatrist for a consultation on his meds. and the Psychiatrist thought that he may in fact be bipolar (mis-diagnosed) - so now he is slowly building up on Lamictal (in addition to his current Effexor, Zyprexa, and Clonazipam).

Here is my question - it would appear that a correct diagnosis could be very beneficial. Even though these drugs often seem to be used interchangably - I would think you could find the right mix much sooner if the right diagnosis was available. But what is the very best way to be diagnosed. I know Psychiatrists are probably the most knowledgable - but the guy my husband saw spoke to him for a whole 25 minutes. I can't imagine being able to properly collect his history in this amount of time - never mind being able to diagnose the disorder. A few other consultations in the past with other Psychiatrists also went this same way.

Would you say that an accurate diagnosis is possible through interviewing alone? Who in the medical community is best able to do this well given the time pressures? Would a Clinical Psychologist be a better bet? All-in-all is an accurate diagnosis as important as I think it might be (or am I focusing in the wrong place)? If it is, what advise would you have for finding a way to get this done (e.g. again, what type of professional? What type of process? Would any tests help - e.g. PET scan or MRI (I'd be willing to go to the US to get one quickly if this could help))?

Sorry, a lot of question... just feeling a little desparate as I don't know how long my husband will hold on...

Thanks!

 

[Clockwork]

I think your right about getting a proper diagnosis. If you went and got your car fixed you would expect them to fix the right parts, if not it would not work correctly. It's not as simple as that but I think you hit the nail on the head regarding diagnosis. I read somewhere that it could take up to 10 years to get the proper diagnosis. I could be misinformed but I do believe it takes a long time due to the nature of mental ilness and the comorbidity of mental health disorders. Presenting symptoms can change over time and Dr's only diagnosis what they see in the short time you see them. Sometimes people are dishonest, sometimes people lack insight into there ilness. Sometimes people get help because family or friends are bugging them to get help and they only tell the Drs what they think the Dr wants to hear. Sometimes the Dr is not very good and there is a lot that are good and a lot that are terrible. I think the best thing to do and I have done it in my life is to find the best Psychiatrist you can find. Someone that takes the time with you and explains the diagnosis. Drs are not all equal. My Psychiatrist was the head of Psychiatry in a hospital. I have seen the 10 miniute shrink and how can that be a good service to a client. they rush you in like your at the bank. The one I see now takes as much time as I need.

 

[Clockwork]

I think your right about getting a proper diagnosis. If you went and got your car fixed you would expect them to fix the right parts, if not it would not work correctly. It's not as simple as that but I think you hit the nail on the head regarding diagnosis. I read somewhere that it could take up to 10 years to get the proper diagnosis. I could be misinformed but I do believe it takes a long time due to the nature of mental ilness and the comorbidity of mental health disorders. Presenting symptoms can change over time and Dr's only diagnosis what they see in the short time you see them. Sometimes people are dishonest, sometimes people lack insight into there ilness. Sometimes people get help because family or friends are bugging them to get help and they only tell the Drs what they think the Dr wants to hear. Sometimes the Dr is not very good and there is a lot that are good and a lot that are terrible. I think the best thing to do and I have done it in my life is to find the best Psychiatrist you can find. Someone that takes the time with you and explains the diagnosis. Drs are not all equal. My Psychiatrist was the head of Psychiatry in a hospital. I have seen the 10 miniute shrink and how can that be a good service to a client. they rush you in like your at the bank. The one I see now takes as much time as I need.

 

[David Baxter PhD]

This varies from one individual or symptom cluster to another. There are times, such as distinguishing between bipolar disorder and unipolar depression, when the diagnosis is not only important but may be critical to determine appropriate treatment. In other cases, it may be less important -- for example, if I see a client with obviously high anxiety, whatever the diagnosis those anxiety symtpoms need to be treated and reduced as the first step. As time goes on, it may be important to refine the diagnosis as to type of anxiety disorder but initially the nature of the crisis may be all I need to know.

Can you diagnose bipolar disorder or certain other disorders by a clinical interview alone? Certainly. A trained clinician with experience in diagnosis and treatment of that disorder knows to look for certain pathognomic (identifying) signs and that provides the starting point for a provisional diagnosis. It's more a matter of skill and experience than time per se.

In Canada, only psychiatrists or other physicians and psychologists are authorized to diagnose a mental disorder.

 

[David Baxter PhD]

This varies from one individual or symptom cluster to another. There are times, such as distinguishing between bipolar disorder and unipolar depression, when the diagnosis is not only important but may be critical to determine appropriate treatment. In other cases, it may be less important -- for example, if I see a client with obviously high anxiety, whatever the diagnosis those anxiety symtpoms need to be treated and reduced as the first step. As time goes on, it may be important to refine the diagnosis as to type of anxiety disorder but initially the nature of the crisis may be all I need to know.

Can you diagnose bipolar disorder or certain other disorders by a clinical interview alone? Certainly. A trained clinician with experience in diagnosis and treatment of that disorder knows to look for certain pathognomic (identifying) signs and that provides the starting point for a provisional diagnosis. It's more a matter of skill and experience than time per se.

In Canada, only psychiatrists or other physicians and psychologists are authorized to diagnose a mental disorder.

 

[Clockwork]

What about the DSM, since it has so many disorders that are very simular? I have read it several times and can easily see why people get the wrong diagnosis. It seems to me that they made it too complicated, I have read that some Drs don't particularly like it. Is Bipolar one of the hardest mental health disorders to diagnois since it has so many different spectrums. Anxiety, depression, mania, hypo-mania, OCD, psychosis, peroids of stability etc. Thanks for making this site Dr Baxter. I am hoping one day to get my Phd in Psychology and focus on mental health and criminology. Unfourtunatly for me I rapid cycle. I do very well in school but could do better if I was stable most of the time.

 

[Clockwork]

What about the DSM, since it has so many disorders that are very simular? I have read it several times and can easily see why people get the wrong diagnosis. It seems to me that they made it too complicated, I have read that some Drs don't particularly like it. Is Bipolar one of the hardest mental health disorders to diagnois since it has so many different spectrums. Anxiety, depression, mania, hypo-mania, OCD, psychosis, peroids of stability etc. Thanks for making this site Dr Baxter. I am hoping one day to get my Phd in Psychology and focus on mental health and criminology. Unfourtunatly for me I rapid cycle. I do very well in school but could do better if I was stable most of the time.

 

[David Baxter PhD]

The thing is that practitioners who are trained in diagnosis are trained in differential diagnosis, which is the process of narrowing down from often overlapping symptoms. There are parts of DMS-IV-TR that I find awkward to work with, especially certain parts of the personality disorders section, but overall I think it's a workable system.

The other point I'd make is that regardless of the diagnosis there are differences among individuals and among the overall symptom cluster that make diagnosis quite easy in some cases and much more difficult in others. Even for a single disorder, e.g., schizophrenia, or obsessive-compulsive disorder, there are degrees of severity and variations in specific symptoms. That's one of the reasons only psychologists and physicians are authorized legally to provide a diagnosis in Canada.

 

[David Baxter PhD]

The thing is that practitioners who are trained in diagnosis are trained in differential diagnosis, which is the process of narrowing down from often overlapping symptoms. There are parts of DMS-IV-TR that I find awkward to work with, especially certain parts of the personality disorders section, but overall I think it's a workable system.

The other point I'd make is that regardless of the diagnosis there are differences among individuals and among the overall symptom cluster that make diagnosis quite easy in some cases and much more difficult in others. Even for a single disorder, e.g., schizophrenia, or obsessive-compulsive disorder, there are degrees of severity and variations in specific symptoms. That's one of the reasons only psychologists and physicians are authorized legally to provide a diagnosis in Canada.

 

[dor]

Dr. Baxter,

What is unipolar disorder??

 

[dor]

Dr. Baxter,

What is unipolar disorder??

 

[Miffed]

Thanks...

Thank you all so much for your insights and wisdom.

I will try to find someone (Psychiatrist or Psycholgist) who can spend the time to try to properly diagnose my husband - I just hope I can find someone good, and soon.

These disorders are so complicated and elusive - and just to make things a little more complicated it always is so difficult to find the right help.

This forum is a great help and great place to start when you are just not sure about anything anymore.

Thank you so much!!!

 

[Miffed]

Thanks...

Thank you all so much for your insights and wisdom.

I will try to find someone (Psychiatrist or Psycholgist) who can spend the time to try to properly diagnose my husband - I just hope I can find someone good, and soon.

These disorders are so complicated and elusive - and just to make things a little more complicated it always is so difficult to find the right help.

This forum is a great help and great place to start when you are just not sure about anything anymore.

Thank you so much!!!

 

[David Baxter PhD]

Dr. Baxter,

What is unipolar disorder??

Unipolar depression is just a way of referring to depression to distinguish it from bipolar disorder (manic-depression).

 

[David Baxter PhD]

Dr. Baxter,

What is unipolar disorder??

Unipolar depression is just a way of referring to depression to distinguish it from bipolar disorder (manic-depression).

 

[David Baxter PhD]

Thank you for the kind words, Miffed. Good luck in your quest for help for your husband.

 

[David Baxter PhD]

Thank you for the kind words, Miffed. Good luck in your quest for help for your husband.