Talking to Your Psychiatrist – How To Guide

psych
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

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

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

form1

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.

sparkle

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.

CAT & PET Scans for Diagnosis Bipolar Disorder

CAT (sometimes referred to as CT, computer axial tomography) scans are a diagnostic tool for problems in the brain. It’s a painless procedure, takes less time than an MRI, and doesn’t have the risks from the magnetic fields. It is used mainly to rule out other disorders before a diagnosis of bipolar disorder can be made.(1) Generally if there is something found abnormal on the CT scan, an MRI is ordered.

 “Information gathered from a CT scan isn’t useful in making a bipolar diagnosis”

 PET (Positron Emission Technology) Scans work differently. It uses radiation (eek!) or nuclear medicine imaging to produce a 3-D picture of the human body.(2) The machine detects pairs of gamma rays emitted indirectly by a positron(3) emitting radionuclide, which is in the body on an active molecule. The images are constructed on a computer, and many machines take a CT scan and X-ray during the procedure. Again, this is a painless procedure, just boring.

 PET scans are used to diagnose health conditions, or find out how an existing condition is developing, to see how the treatment is working.

 And now onto the mental illness part.

Pharma companies have been saying mental disorders are chemically based for years, but actually, there isn’t really any proof.(4) A PET scan is changing that, they are finding interesting results comparing PET scans from the mentally interesting to the normals.

 Research:

  • Depressed brains are more active

  • PTSD sufferer’s brains are less active

 The other side of the fence(5)

What Brain Scans Can Do

  • Show damage to brain tissue, the skull, or blood vessels in the brain

  • Be used with other medical tests to help doctors find the right diagnosis for mood and behavioral problems

  • Help researchers study healthy brain development, effects of mental illnesses or effects of mental health treatments on the brain.

Image

What Brain Scans Cannot Do

  • Diagnose mental illness when used by themselves

  • Predict risk of getting a mental illness.

 There is a lot of controversy surrounding brain scans and mental illness. Some say yes, some say no. Specific scans can show the damage done by drug use, however. They are mostly used to rule out neurological disorders. Perhaps in future years, technology will allow us to see into the brain more carefully.

 

 

 

 

 

  1. http://www.answerbag.com/q_view/1928160

  2. http://www.medicalnewstoday.com/articles/154877.php

  3. Positively charged particles

  4. http://gaia-health.com/gaia-blog/2011-11-27/pet-scans-proof-that-depression-is-a-chemical-imbalance-or-a-psychiatric-delusion/

  5. http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml

 

The Fisher Wallace Unit: Worth it?

ImageThe Fisher Wallace Unit.

 

I personally haven’t tried this thing out, because I can’t afford it, and I haven’t done the research. It almost seems too good to be true, so I’ve gone investigating on if this device helps or not. It is said to be used for anxiety, insomnia, and depression.

It is supposed to work relatively fast, they claim it will “relieve your symptoms within 60 days of receipt” or you get a refund(1).

 

How does it work?

It is portable and is considered “cranial electrotherapy stimulation” (CES). The name does sound kind of scary. It is delivers pulses to stimulate the brains production of serotonin and GABA(3) and beta-endorphins, three things that basically make you feel better. (2) It is FDA cleared and appears to have no side effects and has been in use for over 20 years. It is mainly used in depression, anxiety and insomnia but there are reports that it works well for alcohol withdrawal as well. No placebo effect was found(4).

 

It is used twice a day for 20 minutes. It delivers a mild current that is 1/1000th of the jolt given for ECT, so you’re sort of performing ECT on yourself. Let’s go on.. there is no memory loss. One in 500 people said they had a headache after using the CES. If the electrodes aren’t wet enough before being used, there can be irritation because of this. Some people say they feel nothing at all, others say they feel a slight tingling where the electrodes are placed.

 

Cranial Electrotherapy StatisticsImage(5)

 “It is concluded tht CES is a clinically significant addition to the treatment regimen for this patient population.”

 Is this too good to be true?

  1. The purchase price of the device will be refunded, minus a $69.95 processing fee to cover the costs of used disposables (sponges, headband, carry case) and device testing and processing. Shipping charges and the purchase of extra accessories (such as extra sponges) will not be reimbursed.” http://www.fisherwallace.com/cranial-stimulator-refund-policy

  2. http://www.fisherwallace.com/how-cranial-electrotherapy-stimulation-works

  3. GABA: A neurotransmitter that slows down the activity of nerve cells in the brain.

  4. http://www.ncbi.nlm.nih.gov/pubmed/3521373

  5. http://www.fisherwallace.com/uploads/Ray_Smith_CES_Monograph.pdf

Does being born premature mean you’re more likely to end up bipolar?

The answer is “it’s possible”

Premature birth is something I’m familiar with, as I was born almost three months prematurely. I stayed in the NICU for 31 days after my birth, and I was never breastfed. I was given a blood transfusion my parents didn’t know about until I was ten years old and needed to be tested for AIDS. Fortunately, it came up negative, or I’d probably be dead by now. But let’s get to the main topic:

 Very premature babies were more than seven times more like to have bipolar disorder and nearly three times as likely to have depression.

 This research comes from researches at the Institute of Psychiatry in King’s College London and the Karolinska Institute in Sweden. Let’s break it down to the basics and examine their research.

A full term pregnancy should last 40 weeks.
One in 13 babies are born prematurely (before 36 weeks).

The researchers in Sweden and London studied a group of 1.3 million born between 1973 and 1985.

 

They found 10,523 people were admitted to hospital with a psychiatric disorders, 580 of those had been born prematurely.”

That’s 5.5% of admissions being prematurely birthed. Full term adults had a 2/1000 change of being admitted, a 0.1% chance, while premature adults had a rate of 4/1000, a 0.2% chance if they were born before 36 weeks, and those born before 32 weeks were at 6/1000, or 0.6%. An early birth can distrupt the developing brain1.

Dr Nosarti2 says:

“‘We believe that the increased risk of mental disorders in those born very prematurely can be explained by subtle alterations of brain development. The immature nervous system in those born prematurely is particularly vulnerable to neonatal brain injury resulting from birth complications.”

 However, birth complications have gone down since the study was conducted.

  1. http://www.bbc.co.uk/news/health-18289197

  2. http://www.kcl.ac.uk/iop/news/records/2012/June/Premature-birth-linked-to-increased-risk-of-mental-health-problems.aspx

Psychosurgery Part 2 – Capsulotomy and Anterior Capsulotomy

*Note: This surgery is also used for cataracts and laser eye surgey, except in the eye, not the skull.

This involves drilling holes in the skull. That sounds pretty scary, but it’s actually pretty safe! This surgery was originally performed in Sweden. Small holes are drilled into the skull and electrodes are inserted into the brain, then heated up and small areas of tissue are destroyed. If there is no response, a second surgery is performed. 20% of the surgeries done are being performed again.

Since this surgery was introduced, some neurosurgeons use gamma knives to avoid drilling into the skull.

In the first 116 patients operated on by Leksell, 50% of patients with obsessional neurosis and 48% of depressed patients had a “satisfactory” response. Only 20% of patients with anxietyneurosis and 14% of patients with schizophrenia showed any improvement. In this classification system, only patients who were free of symptoms or markedly improved were judged as having a satisfactory response.

Of the patients who were rated as worse after capsulotomy, nine were schizohphrenic, four were depressives and three obsessives.

Percentages of Success and Failure with Capsulotomy Psychosurgery

Satisfactory Response to Capsultomy

  • Obsessional Neurosis – 48%

  • Anxiety Neurosis – 20%

  • Schizophrenia – 14%

Rated Worse After Capsultomy Psychosurgery – 14%”1

Side effects from this surgery include: emotional blunting, indifference, low initiative, fatigue and urinary incontinence. Studies2 have shown that the procedure is relatively safe.

However, at the 1-year follow-up, 7 patients reported fatigue, 4 reported poor memory, 2 felt more talkative, and 2 reported carelessness. In a recent study 13 of 15 patients had a permanent behavior disorder after postoperative brain edema, but the other 14 did not have any permanent adverse effects, and the study therefore indicates that the procedure is relatively safe.“2

Safety:

Brain surgery sounds dangerous, and it can be! There are risks to any surgery, though, especially when a general anesthetic is used. A case study2 shows that 9 patients attempted suicide before undergoing the procedure and one committed suicide after the surgery. One of the 9 patients developed radiation necrosis (infection), apathy, memory problems and executive dysfunction. This can be caused by using too strong a gamma ray.

It appears to be weight neutral, but can effect libido, a side effect of many medications.

I found an interesting case study on a woman killing herself through anorexia with obsessive-compulsive disorder, here it is:

Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report.

BACKGROUND AND IMPORTANCE:

State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD.

CLINICAL PRESENTATION:

A 38-year-old woman with life-threatening, chronic, treatment-refractory AN and OCD underwent anterior capsulotomy. Psychiatric and neuropsychological evaluations at baseline and at follow-up document the severity and progress of the case. Bilateral anterior capsulotomy resulted in normalization of eating pattern and weight and a significant decrease of food-related and overall obsessive-compulsive symptoms. Psychiatric evaluations and exposure to food cues confirmed the clinical improvement that was evident immediately after surgery and sustained at 3-month follow-up.

CONCLUSION:

This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.3”

 

Controversy

A 58 year old woman underwent the surgery and became mute and robotic (sort of like catatonic) Due to the location of the surgery the frontal lobes can get damaged badly, there can be damage to high mental functions, judging, insight, future planning, social awareness and creativity. It really is a modern day lobotomy, with a different name.

This is something I would never try, the fail rates are too high and the benefit outweighs the risk.

  1. http://www.winmentalhealth.com/psychosurgery_lobotomy_cingulotomy.php

  2. http://archpsyc.jamanetwork.com/article.aspx?articleid=210096

  3. http://www.ncbi.nlm.nih.gov/pubmed/21471837

  4. http://breggin.com/index.php?option=com_content&task=view&id=148