Having your head examined?

by ih-mmd ih-mmd

By Dr. Raymond Zakhari, NP

So, you have been told maybe you should speak to someone?  Your doctors cannot seem to find anything wrong with you? Your friends and family say you are not acting like your normal self. Seeing a psychiatrist or mental health care provider can be quite a distressing experience.  A psychiatrist is often the last stop in a medical investigation of symptoms that has not revealed a diagnosis.  Perhaps this describes your situation.

            Many physicians refer to psychiatry as a last resort for their patients complaining of vague symptoms consistent with depression, anxiety, fatigue, and insomnia.  These physicians throw up their hands saying, “I can’t figure out what is going on, it must all be in your head.”

Psychiatry and mental health are legitimate areas of evidence-based medicine which have serious impacts to your physical well-being.  However, it is bad medicine to label something as a mental illness when there is an actual medical ailment affecting you. Often psychiatrists are relying on medical records passed from one doctor to another to formulate a diagnosis while assuming a proper work up has been done.  It is the psychiatrist’s job to discover if you are having a psychiatric manifestation of an underlying medical condition or if you are truly suffering from a primary psychiatric condition. 

Some patients are fortunate enough to receive care from a dually qualified physician who is trained both in internal medicine and psychiatry or a nurse practitioner dually certified in family practice and psychiatric mental health. Dual certified clinicians have completed both training programs to achieve board certification in both specialties.  The patient benefits because one clinician can get to know you very thoroughly from a mind and body perspective, and will be able to provide your care in a bio-psycho-social approach. 

 What can you expect in a psychiatric evaluation?

 Why did your doctor refer you to a psychiatrist? During you first few visits the following information will need to be gathered: 

  • A complete history and physical exam will be conducted based on your symptoms, and what has not been previously completed by your primary care physician.  
  • Lab work will be ordered to evaluate for underlying conditions that may be contributing to your presenting symptoms. Some lab tests may be repeated if it has been some time since your last test or if results are not available or if validation is needed of previously reported values. 
  • On rare occasion you may require some radiological studies to rule out suspicions of underlying conditions.  
  • Pharmacogenomic test cheek swab will be done if you have failed to get well on previous psychotropic medications or if you are taking multiple medications that may have interactions.  
  • You will need to allow the release of your past medical information, and allow me to contact key people in your life discretely to formulate a more nuanced perspective of you. 

All of psychiatric diagnoses are done by excluding other medical conditions. There are no lab test results that confirm a psychiatric diagnosis. 

 The consultative phase of a psychiatric evaluation can take up to 4 visits depending on test results; turn around time, and accessibility of information.   Treatment begins once a diagnosis is established. It may include medications, talk therapy, exercises, or a combination of these three.

            Patients may seek counseling services from another therapist or may choose to have counseling provided by their psychopharmacologist. Some patients may not need counseling beyond medication, or may require only short term therapy.  Your treatment should be individualized to your life circumstances.

Sometimes life happens and we need some assistance and wise counsel along the way.