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

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)

Image

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.

Image

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

Be Nice To Yourself and Don’t Buy Supplements Online

Buying supplements online seems like a good idea, a cheap way to get supplements we want or can’t get in our country. I’m Canadian and some stuff just isn’t available here. I admit, I used to be a bit of a diet pill junky, or collector. I’d buy the stupid things and take a couple, get sick, and throw them all out when I got busted by my mom. I did that for 8 years. I wasted a lot of money. I admit, I still scour the Internet for diet pills. Bad habit. I don’t use them anymore, but I find them interesting.

simpsons

I am a very pro-treatment and pro-medication kind of gal. I’ve never found that naturopaths or homeopaths have worked for me, but I know those they’ve worked very well for. I’ve tried over the counter stuff for my bipolar disorder and it hasn’t worked. If it’s worked for you, great. Feel free to share experiences. I won’t deny that over the counter stuff works, it has helped me with other problems (pain, PMS, cramps. I hate painkillers, for example). I also won’t deny that it isn’t as tightly regulated as it should be, and that it can be dangerous. People need to see their doctors before taking it and follow precautions, especially if they mix it with meds. These are medications, too, just not as tightly regulated.

People are wary of prescription drugs. In the US, in one year, they spent $26.7 billion(1) on non-prescription supplements. I’m making a guess at this, but there is less guilt in taking something over the counter, less embarrassment than asking your doctor? It seems the world is split, some avoid prescription meds, and some overuse them. The happy medium isn’t big enough!

The FDA and a subsection (Dietary Supplement Health and Education Act DSHEA) have found:
– Some supplements found in stores and online can cause heart, kidney and liver problems with no warnings.
– There is little to no quality control and toxic substances such as pesticides, heavy metals or (for some strange reason) even prescription drugs are being sold with no knowledge to the customer.
– China is a major supplier of raw ingredients, which are often contaminated, have never had their factories inspected by the FDA.
Many products also exaggerate their claims, meaning, they say the supplement can prevent, treat or cure a disease. This is harmful advice, and this is illegal.
Consumers of the products often have no idea
A lot of the users of the supplements don’t know what they’re getting. It’s like a surprise, but it can hurt or kill you! A lot of vitamins and supplements purchased online contain very little nutritional value and can kill you, your kids or your pet. Seriously, if they get into them. There are a few reasons why buying online is a bad idea(2).

counterfeit

1. A medication can be “counterfeit” and dangerous. (I’m picturing a pill in fake Adidas with an Ak-47)
2. The product has probably expired, if it is real, and the seller has repackaged it for resale.
And for the best one 3. It’s stolen. No quality control.

If you can’t get it at home, don’t order it online. This includes even Amazon.

Counterfeit?
Counterfeit basically means “fake”, or “ripped off”. This is different from medications where there is a brand name and a generic, because the generic actually has real ingredients in it. A counterfeit mediction just looks real. It doesn’t act real. It’s never going to have as much active ingredient as it claims, and if you check out the link to where I’m getting this info, you’re literally paying a lot for a little bit of sawdust, according to the FDA.

roundup

Note: The criminals rarely get charged because it’s too hard to figure out who to charge, where it began and so on. Sad. This is costing a lot of money, $600 billion, to be, well, estimated, which is almost as much as terrorism costs. Cheap is so tempting, but it’s not legit.

Expired
All medications expire and can do weird things after they do. They can become more potent, less potent, or make you change colours and see things (or make you see yourself change colour?) It’s a bad idea to take that expired cough syrup. You’ll probably cough it back up into the toilet, for example, if you’re lucky. Generally a medication or supplement is good for 6-12 months after being filled at the pharmacy. Sometimes longer. Selling an expired product is illegal, its dangerous, because the product may or may not work, it could make you sick, and all the criminal has to do is slap a new date on the package.

expired

They can get any amount of $ they want. The pills aren’t counterfeit. If someone complains it doesn’t work, the “seller” and throw them a few good pills, or ignore it. Nobody knows exactly how effective this stuff is anyways. It’s a dangerous game when you buy online. Here’s a link on expired medications: http://www.rxlist.com/script/main/art.asp?articlekey=87599

As for stolen, well, that’s self explanatory. You could get a good product once, a bad product another time. Hit or miss.

When In Doubt
If you’re going to use supplements:
1. Don’t buy them online. Go to a local health food store.
2. See your doctor and pharmacist. Check for interactions. Get that physical every year, or every other year. Some doctors are very open to supplements. I know many that have a few concoctions for PMS and cramps!
3. Don’t take anything for weight loss, sexual ehancement or building muscle.
4. If it’s from the US, or you’re living in the US, it has a “USP Verified”(3) mark on the bottle. Their website is linked below with everything they verify.
5. You CAN overdose. More is not better.
6. If something feels wrong, tell your doctor. If it’s really wrong, go to an emergency clinic, or the ER.

Safely Buying Supplements
1. Buy from the manufacturer or a reputable operation in your own country. Try not to cross borders. Do not import things illegal in your country. (For example, ephedra, easy to get OTC in Canada, is illegal in most USA States)
2. Reputable companies supply a lot more information, ingredients, quality control info, and websites with more info, and even have phone numbers.
3. Avoid really cheap stuff.
4. Avoid sites like ebay and amazon, this is your health!

1. http://www.consumerreports.org/cro/2012/05/dangerous-supplements/index.htm
2.http://www.garyshealthtips.com/why-you-should-never-buy-supplements-on-amazon-or-ebay-a-must-read-by-former-fda-special-agent-gary-collins/wn

3. http://www.usp.org/usp-verification-services/usp-verified-dietary-supplements

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.

Involuntary Patient

Sorry, I had some stuff I was going to post yesterday but I had great fun going through the ER trying to find a new psychiatrist (mine retired) and ending up involuntary committed to the psych ward. I got out this morning after a 30 second “chat” with the staff psychiatrist, who referred me to someone not taking patients, back to the start.

I don’t see why I have to do all this by myself, or why I was admitted at all. I asked to speak to a psychiatrist about my medications, the doctor (it was his first day) demanded blood work and an EKG, which I had last week. I said no, I just want to talk to a psychiatrist. He asked if I ever attempted suicide.

If he saw my arms, he’d know, but I wear long sleeves. I said, once, when I was 17.

Apparently that made me a DANGER TO MYSELF and refusing the testing made me PSYCHOTIC so he served me with a Form 42 and would not let me talk to a patient’s advocate, which is illegal. 

They denied me my regular doses of Xanax and I went into withdrawal quickly.They referred me to this psych and that one, none are taking patients. I left with no med changes and with all of my patient rights violated.

I was not psychotic (I was saner than he) nor have I hurt myself in years (May 12, 2011). My last suicide attempt was in 2001.

I give up.

Can EEG (Electroencephaolography) Be Used as a Diagnostic Tool?

Some say yes, some say no, many say maybe.

First, let’s examine what Electroencephaolography (I’m going to call it an EEG, its way easier to type that) is. Electrodes are painlessly stuck to your scalp (this sucks if you have long hair, washing the goop out later) to detect electrical activity in your brain(1). There are always active brain cells, even when you’re sleeping. This test is commonly used to rule out seizure disorders, or determine what part of the brain is causing the seizure.

However, an EEG is not for use to diagnose mental illness, but there are studies that show the electrical circuits in the brain that are different in the mentally interesting than the “normal population”.

The EEG was used to test schizophrenics, a condition similar to bipolar disorder that has a “hybrid” of schizoaffective disorder. The study of patients indicates a higher number of them with abnormal records decreased in alpha activity. There are left side abnormalities, and some coherence abnormalities. (2) Further testing needed.

This study(3) claims that schizophrenia can be diagnosed before major symptoms happen, using EEG technology.

 

Image

“What we found, in terms of disease, was quite striking – defects in the genes that encode these human synapse proteins are really a major cause of disease,” he said. “There are over 135 nervous system diseases, psychiatric and neurological, that arise because of defects in these synaptic proteins. These are common and rare diseases – schizophrenia, bipolar disorder, autism.”

Although there are those doubting the EEG being used a diagnostic tool, it could help in the future as research continues, to decide on the best medications to use, and also to create new medications.

(1) http://www.mayoclinic.com/health/eeg/MY00296
(2) http://www.eeginfo.com/research/bipolar_main.html
(3) http://www.guardian.co.uk/science/2010/jul/05/brain-scans-predict-schizophrenia