Talking to Your Psychiatrist – How To Guide

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I get really bad doctor anxiety and have trouble saying what I want to say at appointments. I find writing things down as I think of them days in advance helps. Here are some pointers on making appointments with your psychiatrist effective for both of you.

Be honest. This is important. Don’t lie to your psychiatrist. Don’t exaggerate. Don’t hide symptoms. Don’t be embarrassed. He’s probably heard it all before.

If you think a medication is or isn’t working, tell you psychiatrist this and why. It’s important to be informed on your medications. It’s important not to control your medications, because the psychiatrist is the one with the MD and training, but if something isn’t working, you have the right to say so.

Psychiatrists don’t often offer therapy much anymore*, but they do need to know about your life and general health. A psychiatrist is trained in diagnosing mental illness and treating it with psychotropic drugs, or a referral for therapy or other care, like a medical doctor would diagnose a physical illness and treat it with the appropriate care or medication.

Don’t focus so much on your diagnosis, focus on your symptoms(1). The diagnosis is generally used in communication with insurance companies and too many people get caught up in the diagnosis hype. Treating symptoms is most important. Right now, the DSM has just changed over to the DSM 5(2), and things are confusing. It can take a while to reach a diagnosis, so focus on eliminating the symptoms and getting better.

Be reasonable with your psychiatrist. There is no magic pill (I’ve been told this by so many doctors) and you have to work at it, too. Mood trackers, therapy, keep track of medications, go to all appointments. Don’t stop a medication unless you’re having a side effect that could kill you. Some medications require blood tests – get them done. Work with your psychiatrist.

A psychiatrist is a doctor and is going to have good and bad days. There are good and bad psychiatrists out there, trust me, I’ve had a couple of bad ones. Fortunately, right now, I like my psychiatrist. It’s not always easy to change doctors, especially if you’re in a country like Canada (where I am) and there’s a doctor shortage. A psychiatrist should always remain professional and never be rude to you.

*A psychiatrist is a doctor trained in psychiatry with an M.D. A psychologist is more often referred to as a therapist and you spend more time working on issues with them. Very few psychiatrists offer 50 minute appointments with a couch, a notepad and psychotherapy anymore, unfortunately.

 

Signs of a good psychiatrist:

  •  They listen to your concerns and don’t ask the same questions over and over.  They will ask relevant questions, about your mood, your current situation, and current meds.

I had a psychiatrist that asked me, every appointment, if I had quit smoking “dope” yet. I had never smoked “dope” in the entire time I saw him.

  •  They respect your concerns, needs and what you say.
  •  They stop medications if they don’t work, or if the side effects get bad.  I had a psychiatrist bitch at me when I had to stop lithium due to diabetes insipidus. He said I “complained too much”. Same one that accused me of smoking dope. I had two doctors telling me I couldn’t take lithium, and that psychiatrist was being a jackass, he had never heard of the condition. Fortunately, he retired. (Note: I only stayed with him because of how hard it is to find a doctor in this area)
  • A good psychiatrist respects your wishes with medications and doesn’t intimidate you about them. You should be able to be open about medications – you live with the side effects of them and you also pay for them one way or another.
  •  No psychiatrist should tell you you’re going to fail or never get better. If they feel that way, they should refer you.
  •  They should schedule appointments appropriately. Some people need to be seen every few months, some need to be seen more often.
  •  They should have open time to see a patient in crisis. Sometimes they can’t get you in that afternoon, but they should be able to get you in fast.
  • Keeping you waiting for hours in the waiting room is not good. They should also return phone calls in good time. It’s disrespectful and unprofessional not to.
  • You should feel comfortable and not threatened with the doctor.(3)

(1) Talking to a Psychiatrist
(2) DSM5 HomePage
(3) Makings of a Good Psychiatrist on Shrink Wrap

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Self Diag-nonsense

We’re all guilty of this. With the internet, it’s even easier to diagnose yourself. Everybody has taken the personality disorders test, probably multiple times. (How many times have you scored the exact same? I don’t keep track, so I don’t know)

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Wake up call. Those aren’t diagnostic tests. The same way as an online IQ test can’t tell you you have an IQ of 180: only a few people in the world ever have scored that high in real life, they don’t come around often, based on the Stanford-Binet test. A psychological test has to be carried out by a psychologist or psychiatrist in person (with the new teleconferencing stuff, maybe, I’m not sure) and can take a few weeks or months. I was assessed over 6 months after multiple hospitalizations and treatments. An IQ test is similar, it cannot be biased, and the person has to be assessed by the tester for their reatctions. A lot comes into play.

Basically, an online IQ test is just a test with different scoring. Instead of 0-100% it assigns a number. An online psychological test is the same thing, but they have disclaimers: not a diagnostic tool. (Don’t ever pay for either one!)

I can say I hit a lot of DSM criteria, but it’s easy to say that about myself. Other people can say I hit different criteria. To get 3 psychologists and 5 psychiatrists to agree on my diagnoses was kind of amusing, but they did agree. (For the record, I was diagnosed with bipolar disorder type 1, rapid cycling with psychosis, schizotypal personality disorder, later on ADHD inattentive type and at that time, EDNOS, which is currently in remission). I did have to do that damn 500 question test. Apparently I exaggerated (that was what everyone who took the test got accused of: they exaggerated!) so the results weren’t clear. The psychologist had to use her head instead of the computer. Poor thing. Okay, enough about me.

Insight is good. Being a know-it-all and changing your treatment plan, double doctoring, doctor shopping and more are not good. In socialized health countries (pretty much everywhere but the US) most of that is harder to do. I work with my psychiatrist with medications, that is, if I really hate his medication decision, I’ll let him know, he’ll reconsider. When I was discharged from inpatient care, it was a mutual decision. If I’ve heard of a new medication, I’ll ask about it, and he’ll fill me in, about how he thinks it would work me me, and then it usually ends in, “and your insurance doesn’t cover it yet”. (It generally takes a year from the med coming out for my insurance to cover it!)

I have never told a doctor, “I think I have..”, partly because I think it’s rude and I’m shy, and partly because I’m not a doctor. Well, except for when I broke my jaw and ribs. “I think I have a broken jaw” fit. If you recognize symptoms earlier because you have heard of them and are able to seek help earlier, that’s even better.

Doctors are often guilty of self diagnosis, especially during medical school. They think they have every disease in the book. Medical studentitis is the name it’s given, as a joke.

“When you self-diagnose, you are essentially assuming that you know the subtleties that diagnosis constitutes.”

Not all mood swings mean bipolar disorder(1) for example. Self diagnosis can get in the way of proper diagnosis. Everybody has mood swings, but certain criteria has to be met. Bipolar disorder is actually not that common, despite hearing about it all the time. A GP should be seen before a psychiatrist so physical illness can be ruled out first. Sometimes physical illness feins psychiatric illness.

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Even if you do not want conventional treatment for depression, you may want conventional treatment for a brain tumor.
Self diagnosis is underminig the doctor, too, not good for the relationship, and the doctor could just end it. The diagnosis isn’t what is being treated. That is used for insurance information, symptoms are being treated.

Here are a few problems with self diagnosis:

  • – You can be missing something you can’t see, for example, focusing too much on one thing and forgetting the rest.
  • – Thinking too much is wrong, or thinking not enough is wrong.
  • – It can interfere with the doctor/patient relationship and agitate the doctor (they do get agitated)
  • – It can get in the way of proper treatment
  • – It can be hard to accept a correct diagnosis, and you could be disappointed that you’re wrong if the doctor disagrees.

Let your doctor do the work, that’s his or her job.

Even a doctor cannot diagnose or treat him or herself. For a lack of a better phrase, it’s a conflict of interest!

“Be honest and upfront with your doctor and make sure to let him know all of your symptoms, even if you do not feel that they are important. Also disclose any and all medications you are currently taking as well as supplements to make sure that your doctor has all the information necessary to treat your illness.”(2)

  1.  The Dangers of Self Diagnosis
  2. The Internet and Self Diagnosis

I suck. And I’ll start updating more, too.

August 1 2008 I had been discharged from my longest hospitalization.

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October 7th, 2013 I was hospitalized until October 24th because the stress of life, the universe and everything kicked in and I broke down. Of course, no beds on my Dr’s unit, so he loopholed me through PERT – Psychiatric Emergency Resource Team. They had an emergency room physician come in and put me on a Form 1. 72 hour involuntary hold. Dr N, my pdoc, was not impressed. He took me off it when I was transferred to Unit B, the ward he works on. I was a danger to myself. What crap.

I had a panic attack when they handed me the Form 42 (copy of the Form 1). PERT is just seclusion rooms. Luckily, I wasn’t locked in. They nurse gave me some Ativan and a heated blanket. I slept. BF showed up. He brought McDonalds. My friends took my car back to the apartment. The next day I was transferred to Unit B, where my pdoc works. I had a private room. It was BF’s birthday. He saw me anyways. I owed him big for that!  They tried to give me Ritalin at 10pm, night meds. I refused it. They charted I was “refusing meds”.  My pdoc laughed the next day, thankfully, saying it was good I knew to refuse Ritalin at 10pm! He then told them to NEVER give it to me after 4pm.

Pdoc was good to me. Saw me daily. I had a pass for Canadian Thanksgiving. It sucked, my dad was drunk and being an ass. It was a short pass, thankfully, I had BF with me. “Oh, back so soon.” Oh, yes. BF went for his MRI results: No change in the tumor since his diagnosis a year ago!! MRI’s are yearly, now. At the best cancer centre in Canada, only 45 min away from us. He had a seizure last night. His neurologist is still working on the meds. Less bad, shorter seizures, but still minor seizures. No unconsciousness, no disorientation, but still.

So, we had a lot of groups. I met a couple cool people. I had a day pass, I went to the barn, went riding.

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That’s me on Sparkle. She’s a five year old, gigantic Thoroughbred filly. Her registered name is “Sparkle Tangerine”. I did some walk, trot, canter and a small jump. She was very good. Look how tiny I am on her!  I was exhausted when I got back.

I did all the groups. I got so sick of the religious crap from a lot of patients. There wasn’t a lot of super craziness like I’ve seen. No restraints used, no chemical restraints used. A few “code whites” (unmanageable or violent patient) called. I was going to go long term, but the beds weren’t available. Dr N saw staying on the ward was getting hard on me, and we agreed on discharge for the 24th. I start outpatient therapy next Tuesday for anxiety, stress. CBT, that sort of thing. One on one. The only cost is parking.

I now take Geodon (aka Zedox), Lexapro (Cipralex), Ritalin, Topamax, Clonazepam, mostly at lower doses, managing. and my normal meds for my health. I was diagnosed with endometriosis yesterday. BLAH. I start birth control (I’ve had a tubal ligation!!) after my period to try to ease the pain. If not, we do more drastic things. It’s not the worst thing in the world. The ultrasound could have shown a million WORSE things. (Endo is not detected on most ultrasounds) I’ve decided on rotator cuff surgery. Dr N was great to me in the hospital. I thanked him before I left, for his patients. The rec therapists were great. One I’ve known since 2002. We even had a ball pit!

That’s my life for now.

Lithium Orotate – Consult a Doctor First

Consult a doctor

Consult a doctor

Just a quick response to my lithium orotate article.
Lithium orotate is lithium. Simple as that, it is just a different chemical formation. I have been called all sorts of names, a liar, an advocate for “Big Pharma” and so on. Lithium carbonate is probably the same price – it’s an inexpensive drug and it’s monitored by pharmacies, labs and you can’t buy it easily online and you know what you’re getting (in an ideal world, at least, you should know). Levels should be checked.

Lithium is dangerous to the kidneys in any formula, yes. However, lithium orotate is more dangerous. It is an over the counter supplement. This does not mean “safe”. Tylenol is deadly to the liver, for example, and is sold anywhere. Take enough, and you’ll need a new liver. What a crap example, I know.

Lithium has to be at a certain level in the blood to be therapeutic for the patient. I’m in a country (Canada) with socialized healthcare. I get blood tests for free, I get my meds cheap, yes, I have that advantage. (I can’t take lithium, but it did help for many years, I did end up with mild kidney disease called “diabetes insipidous”) It’s not the safest drug, I know that from experience. It has shitty side effects. It hasn’t changed much over the years. But it works.

Lithium orotate is dangerous simply because anyone can get it. Online supplements are more dangerous because you don’t know what you’re getting. People tend to abuse something advertised as “natural”, because “natural” sounds safe. Look at things like diet pills from GNC, a year later, they get banned because people end up with heart problems. The “healthy living store”.

I’m not saying all natural supplements are bad. But they all say to take with the advice of a doctor. Self prescribing anything is a bad idea. Especially for a psychiatric illness as serious as bipolar disorder. Especially with something like lithium. Blood levels are generally reduced to every 6 months, sometimes less once a dose is established.

A few things to remember.
Natural is NOT always safe.
Always consult a doctor, whether it be a GP or psychiatrist, before taking any over the counter medication or supplement. It could interact with something you already take, or even eat.

Be cautious if you order something online. The dose might not be accurate. It could contain something you don’t know of. It could contain something you’re allergic to. It could contain something that could come up on a physical or blood test as a false negative or positive.

A health food store doesn’t exactly have the most qualified people to give medical advice. This is medicine we’re talking about. Your mind and body. Again, see a doctor.

If you experience any weird side effects STOP.

Be cautious. Nothing works the same way for two people.

This is all my opinion. I do not have any links for you.