Thursday, March 8, 2007

Confusing the Psychiatrists

Well, I just returned from my second psych evaluation. I never blogged about the first, I don't think? I can't remember. Well if I did (or did not) here's a brief review.

Of course with my "doctor anxiety" I was nervous as hell. Add to the fact that I hadn't had a full consult in about seven or eight years. I had no idea what to expect. It went alright, however. The psychiatrist at this "institution" had a gentle demeanor and a soft voice and we actually ran over the allotted time. I felt okay with it and he allowed me to ask as many questions as I needed.

Alright
, I thought, this whole evaluation thing isn't so bad. Granted, it was difficult to pack your entire life's woes and psychological/neurological history into such a brief time span. I didn't cover everything in perhaps as much depth as I wanted with this man. The reason being, this consult was a "one off" and I did not expect any further appointments or follow ups with him. And again, I was nervous, unprepared and it was difficult. However, we went through Medication History, Family History/Trauma, Bipolar Disorder, Self Injurious Behaviour, Hospitalizations, ADD and a little bit about Aspergers.

After it all, he said he would "try and put something cohesive together" for my GP. I had to laugh a bit at that one.

Today was a bit different, however. I was mistaken about a lot of things. First, my appointment duration. I was told an hour, I only received 30 minutes. Also, I was under the impression I would be seeing this psychiatrist on an ongoing basis. Nope. But more on that later. Also, this man was not as...well, he certainly had a different "demeanor" than the first psychiatrist I saw.

It was a good thing I was a bit more prepared for this appointment. 30 minutes! We very briefly touched on all of the above mentioned in the first appointment. He asked some fairly simple and straightforward questions and I answered them. I gave him my prepared "dossier" and he flipped through some of the pages. Basically some self-prepared notes about ADD and Aspergers and some highlighted notes from referenced materials etc...

He asked if he could keep all of it. I told him the copies were his.

He basically told me about a counselling group (i.e group therapy) for women who are trauma survivors and how I could take advantage of that. He also told me that I would not benefit from ongoing psychiatric treatment from a psychiatrist due to my problems with functioning and other issues. I have no idea what this means. I don't know if this is an allusion to the fact that I have Aspergers or not. He said that seeing a psychiatrist would only exacerbate my problems. He said that I already have a therapist, see a neurologist and have a GP so that is good enough. Well, then why offer me group therapy? During all of this I simply stated that people with Aspergers do not usually do well in therapy. He agreed.

I still remain confused.

I did manage to get out of him his med recommendations. He had five. Ooh, decisions, decisions! He also casually mentioned one of them, Risperdal, would be helpful with both Bipolar and Aspergers. I told him that yes, I knew this. I also had to remind him of another med that would probably be helpful. He agreed and wrote it down. I so often wonder what doctors think of me when I stroll into their offices and spout such things.

So at that point, time was pretty much up. I felt unfulfilled. I asked him what he thought of the ADD and Aspergers. He said it was hard to tell due to "other issues" and the trauma I had been through. Alright. I understand all about truama and it does not preclude neurological disorders. I also argued high comorbidity rates (and even had that reference material with me.) I asked him if he planned on reading what I had brought him. He said that yes, he would. As I was putting on my coat, I asked again, "So it wasn't all in vain, then?" He said that no, it wasn't.

Yes, I can be terribly blunt.

Now I understand that clinicians can not provide diagnoses on the spot and I did give him a fair amount of documentation to review but a little more feedback would have been helpful.

Shoot, I can't stream the song I wanted for my new MP3 so you'll just have to go with my second choice. "One In Ten Words" by The Spoons. Canadian Band and the poppy little song is from my youth...it makes me laugh about communication.

8 comments:

Sleepy said...

Took the medical 'profession' nearly 30 years to diagnose me as Aspergers.
They started with me aged 6 and told my Mother I was a sociopath!
Next I was hyperactive, then ADHD, then ADD etc... Whatever the new 'fashion' was, that's what I was diagnosed.
Sociopath is my favourite though!

Patient Anonymous said...

Hi sleepy, thanks for your comment. I'm still not ruling out the ADD either (that was diagnosed by my ex-GP a few years ago so "theoretically" I do already have ADD) but there are several Aspergian traits that also have me scratching my head. Who says that I can't have Bipolar, ADD and be an Aspie? Oh, and let's not forget the Seizure Disorder. Hey, I've seen it before.

Yes, I suppose I could get tagged with Antisocial Personality Disorder too. That thought has definitely crossed my mind. After today's appt. I wouldn't be surprised as I certainly wasn't Susie Sunshine, that's for sure.

I don't have a personality disorder though. Pretty sure on that one.

Thanks again for stopping by my blog.

Benedict 16th said...

Modafinil* (and omega-3 fatty acids - fish oil or flax seed - if vego)

Benedict

* If you can afford it

Patient Anonymous said...

Hi benedcit 16th, I had forgotten about Modanfil (and had to check if it was available here--yes it is under the name Alertec.) It looks like stims (not not self-stimulatory behaviour ha!) have been nixed by the two shrinks for any ADD so I'm not sure about it. Actually, I don't really stim anyway. Not much anymore and not in the more traditional ASD ways. I seem to have broken myself of a lot of repetitious behaviours but sometimes I still think about them.

But...seeing as I may not have a psychiatrist to monitor me anyway at this point(?) and I may be just sorting things out with my GP and making my own med choices (again...) I may bring this up.

Although yes, it looks like it operates differently than traditional ADD meds and yes, even though it is used "on label" for Narcolepsy, it could work for ADD. And if I go with the Risperdal and I get all fucked up and whacked out, it could counter some side effects and wake me up. But I suspect the Risperdal dose might be low, at least to start as I'm not completely batshit crazy? (yes, technical term.)

Modanfil/Alertec does have some cautions for mood swings and seizure disorder, however, so hmmm...lower doses needed?

I have a complicated brain. And my neurologist practically hits the roof everytime I mention Atypicals as he thinks they're going to lower my seizure threshold too. Well shit, just up my anticonvulsants then if I start seizing!

I was supplementing with large doses of Omega 3s some time ago but I couldn't tell if they made much of a difference. I know you have to do it for a really long time and you have to be consistent. I lack in that department and so many pills! I switched over to the oil for a while to make it easier but then I just dropped the ball on it. As again, I couldn't notice any difference.

I am also leaning toward Lamictal as I really like that drug but I think it might only aid with any depression that I might be experiencing.

I need to go back and brush up on all of my research/reading and try to figure out the best approach.

This is going to be a challenge.

Anonymous said...

Hello,

I am soo glad I found this blog, it is excellent, thank you so much. I am "officially" diagnosed bipolar, nos, with depression and anxiety, (that's for insurance!), but in reality, I am borderline...I think "they" call it the "high functioning" type...or something...anyhow, I too, struggle with emotional and mental illness each day and sometimes use humor and a bit od sarcasm to deal with it all...! I am married (my various problems, as you can imagine, have really taken a toll on my marriage) and have a 15 year old son with Aspergers (Hi Sleepy!). I work part time. Thank you again, I look forward to visiting your blog, Tracy in Va

PS I self injure too...

Patient Anonymous said...

Hi Tracy, I'll use your first name since you were so generous to share it. Thank you so much for visiting and I am glad that you enjoy my blog. Half the time I don't know what to think of it so I just spew.

Honestly and openly. Maybe that has some appeal, maybe that drives others away. So be it.

Yes, I use a lot of humour and sarcasm and a lot of other things (rantiness and profanity) to try and deal with it all. It's the only way to survive.

Dealing with a lot of psych/neuro issues can be challenging. And it can take a toll on relationships. You can only do the best that you can but I've always maintained that you need to take care of yourself first, otherwise you won't be of any use to anyone else.

I've never heard of "high functioning" Borderline. I have no idea what that means. I made a post about my thoughts on the whole notion of the term "High Functioning" vs. "Low Functioning." I think i just refiled it under the Aspergers section for one category at least--don't know if you've read it--but the terms kind of bother me when it comes to disorders and how things can fluctuate. Please have a look if you are interested.

I hope your son is doing well. I'm just sort of starting out on this whole Aspergers quest from a diagnostic perspective and I really don't know what will come of it out of the psych evals I had. I would definitely be on the "High Functioning" end of the spectrum. No doubt about it. But it is a spectrum disorder and it is so varied and can present in so many different ways. And Aspergers in adults is very different than in a child.

That's another complicated thing with diagnosis. Both the criteria for the DSM and the ICD tend to look more at children. I did go back and try to demonstrate some things from childhood to prove what I hoped were salient points and then move on to how Aspergers displays itself in adulthood. Now I will just have to wait and see, I suppose.

Okay, I seem to have typing diarrhea today.

Thanks again for your kind comments and feel free to come by and let me know how you're doing or contact me if you want to know anything further or have any questions.

Best,
PA

Janine said...

Gosh - navigating our healthcare system sure is a pain in the ass, huh?!? All the best as your continue your journy.

Patient Anonymous said...

Hi janine, thanks for stopping by and leaving a comment. Yes, navigating our health care system can be a real challenge but I've been doing it for years. That is not to say that it gets any easier but I suppose, in my case it is a necessary evil? I can't really go without seeing any doctors for both physical and mental reasons.

I recently switched GPs/FPs--whatever we're calling them these days. It's funny, I when I interviewed my prospective candidates I was actually rather tersely corrected by one of them that they are called "Family Practitioners."

Oh. Well, I still call them GPs as that is what we always called them all my life. Excuse me for not keeping up with semantic medical title protocol *rolls eyes*

Obviously, I didn't choose her. Ha! There were other reasons I didn't choose her either, though.

Thank you again for your kind comments.