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What is the general run down on being able to diagnose a mental disorder? ex-bipolar

 

Should you be able to call into your regular doctor, have them ask you a few questions over the phone then send a prescription to the pharmacy?

 

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NOOOOOO. 

 

I would recommend seeing an actual psychiatrist. Our family doc tried to help my DH, but he just didn't have the expertise. 

 

Some medicines, like antidepressants, are generally contraindicated  for the treatment of bipolar. And sometimes, antipsychotics are prescribed. All of these meds can have serious side effects. You want the diagnosis to be accurate and the meds to be correct, and you should expect to adjust meds regularly. I would not be comfortable with anyone diagnosing over the phone.

Edited by NorthwestMom
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I wouldn't even suggest that approach for depression, certainly not for bi-polar. Even depression can be tricky to treat. If you suspect bi-polar, my opinion is that calls for a specialist - a board-certified psychiatrist. 

 

Best wishes.

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What is the general run down on being able to diagnose a mental disorder? ex-bipolar

 

Should you be able to call into your regular doctor, have them ask you a few questions over the phone then send a prescription to the pharmacy?

 

Absolutely not, and if they do that they are unfit to be your doctor.

 

Mental illness needs to be evaluated for by a mental health professional.It takes more than just a single visit as well.  A proper Dx especially for something as complex as bipolar needs a lot of evaluation.  If the person is in acute crisis then taking them to the hospital for admission and evaluation is the best bet.

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What is the general run down on being able to diagnose a mental disorder? ex-bipolar

 

Should you be able to call into your regular doctor, have them ask you a few questions over the phone then send a prescription to the pharmacy?

 

I have found that before diagnosing a mental health issue, a GP will want to rule out other physical issues.  They usually want to do some blood work first and then screen you for mental health problems.

 

ETA:  I have also found that most GPs admit they are not expert enough to prescribe medicines.  They usually want you to see a psychiatrist for that.  They will often tell you that you meet the checklist for say, depression or ADD, but they usually leave the medicating to a specialist.

Edited by Pink and Green Mom
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primary drs shouldn't be diagnosing any mental illness - I don't even trust them for asd or adhd.   everyone responds differently to rx, and someone who deals with those things on a regular basis will have a much better idea of where to start.  one of the reasons antidepressants and adhd rx are so over prescribed is primary care drs writing prescriptions.

 

those take specialists - after a battery of testing.   not one or two or even 20 questions.

 

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Diagnosis should be done by either a psychiatrist or a PhD./PsyD. psychologist. If the latter does the diagnosis, you will need a M.D. to manage the medication.

 

Refills of an existing prescription can often be handled by a primary care doctor. That's what Kaiser HMO did for my daughter- any prescription changes required a visit to the psychiatrist but the refills were done by the pediatrician. Now both prescription changes and refills are handled by the neurologist (ADHD falls within her scope of practice).

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I have severe although fairly run-of-the-mill (I guess) OCD. I've been very happy with the treatment I've received from my family doctor. The family doctor I used before him was also very familiar with the treatment of OCD.

 

Most doctors won't call in a prescription for anything without a visit.

Edited by MercyA
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So how freaked out should I be that a doctor just did this for my husband.

 

eta he has been seen regularly for depression and anxiety

Edited by jrn
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So how freaked out should I be that a doctor just did this for my husband.

 

eta he has been seen regularly for depression and anxiety

 

Was he prescribed an antidepressant? If so, I would not be freaked out. Make sure he reads the drug monograph from the pharmacist so he knows what side effects he might expect.

Edited by MercyA
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What is the general run down on being able to diagnose a mental disorder? ex-bipolar

 

Should you be able to call into your regular doctor, have them ask you a few questions over the phone then send a prescription to the pharmacy?

 

It would probably require someone being examined by a Board Certified Psychiatrist. That's an M.D. who is trained to treat Psychiatric disorders and to (more importantly) try to see if there are physical causes, medicine causes, of the behavior.  The Psychiatrist might send someone to a Psychologist, for testing and additional insight.  

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Was he prescribed an antidepressant? If so, I would not be freaked out. Make sure he reads the drug monograph from the pharmacist.

He is already on an antidepressant.  I don't know what the name of the new medication is yet.

Edited by jrn
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Family physicians and internal medicine physicians have adequate training in common psychiatric disorders like depression, anxiety, bipolar, ADD, etc. I would always start with my primary care physician first. I doubt one would call in an RX over the phone, however.

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He is already on an antidepressant.  I don't know what the name of the new medication is yet.

 

Okay. Well, if this is the same doctor who has been treating him all along, it wouldn't bother me. I would google the drug when you find out the name and find out what type of drug it is.

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OP, did your DH's primary actually diagnose your DH bipolar over the phone?

 

I can't wrap my head around that.

 

And - some antidepressants are *not good* if one is bipolar.

 

Your DH needs a psychiatrist to manage his meds in the most optimal way, and regular therapy would be helpful, too.

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So how freaked out should I be that a doctor just did this for my husband.

 

eta he has been seen regularly for depression and anxiety

 

You should also probably read up on the side effects of the prescription and the symptoms for the diagnosis, so that you can monitor "from the outside". Also, even for depression, it may take trial runs of several different medications to find the one that works for a particular individual.

 

You might want to see how long it takes to see a psychiatrist; if it's several weeks, go ahead and make an apointment; you can cancel later if not needed.

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OP, did your DH's primary actually diagnose your DH bipolar over the phone?

 

I can't wrap my head around that.

 

And - some antidepressants are *not good* if one is bipolar.

 

Your DH needs a psychiatrist to manage his meds in the most optimal way, and regular therapy would be helpful, too.

He called his primary doctor today (same one that prescribed the antidepressants) they discussed over the phone symptoms and the doc asked questions then prescribed what my dh called "something that helps with bipolar/schizophrenia"

 

I've talked to dh again and he is irate that I am questioning the process. 

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He called his primary doctor today (same one that prescribed the antidepressants) they discussed over the phone symptoms and the doc asked questions then prescribed what my dh called "something that helps with bipolar/schizophrenia"

 

I've talked to dh again and he is irate that I am questioning the process. 

 

Bipolar / schizophrenia are very complex diseases. I would never ever let a non-psychiatrist diagnosis, treat, monitor etc. those diseases. I don't know if your husband was prescribed lithium, but the dosage has to be adjusted to the correct level for each patient. A standard dose will probably not be effective.

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He called his primary doctor today (same one that prescribed the antidepressants) they discussed over the phone symptoms and the doc asked questions then prescribed what my dh called "something that helps with bipolar/schizophrenia"

 

I've talked to dh again and he is irate that I am questioning the process.

Some classes of drugs that were initially developed or used for bipolar and schizophrenia work in different dosages for major depressive disorder, PTSD and severe anxiety. Some of these meds are approved to treat aggression in those with ASD or BPD.

 

It sounds to me like he is trialing a new medication for an existing dx and not like he's been dx as bipolar.

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Some classes of drugs that were initially developed or used for bipolar and schizophrenia work in different dosages for major depressive disorder, PTSD and severe anxiety. Some of these meds are approved to treat aggression in those with ASD or BPD.

 

It sounds to me like he is trialing a new medication for an existing dx and not like he's been dx as bipolar.

Yes, that's my thought too, with more info. I didn't realize that this doc had been treating him already. So this is more like a med adjustment.

 

I hope it helps.

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Thank you. I appreciate all the help. Sorry I wasn't totally clear.  I had told him to call his doctor to get the process started for a diagnosis. I didn't expect meds after a phone call, and did not respond well to him saying that.

 

Now he wants me to decide if he should take the meds.  

 

 

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I definitely think it's good to have an established HCP/patient relationship with someone who specializes in psychiatric medicine but would caution you from concluding the worst about the doctor based on what you have shared. It could be that this drug was previously discussed as a possibility if whatever he was put on initially didn't work. I have had doctors, including noted and respected psychiatrists call in a new med between visits when I was already in their care. Not because they were making a new dx over the phone but because they wanted me to trial something before my next appointment or wanted to offer something that might help before they could fit me in. Or once because I reacted badly to a medication and they wanted me off it right away.

 

I explored the possibility of one of these medications for myself and at no time was I dx with bipolar or schizophrenia. We ultimately opted against it but it has been on the table at different times for PTSD, severe PPD and major depression.

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Now he wants me to decide if he should take the meds.

This is something he should discuss in person with his doctor or a psychiatric provider.

 

Also some (really most) of these meds are started at a titration dose and then increased to a higher clinical dose only if there are no deal breaking side effects.

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The thing that worries me is that I don't know how the conversation went. He said that I think he is bipolar (I didn't say that- I don't know what his issues are-I'm not a doctor) so he went into the phone call saying that he thought he was. I'll have to trust the doctor and encourage dh to see a psychiatrist. (he argues he doesn't have time for that and just wants meds)

 

thank you again

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The problem with saying "see a psychiatrist" is that in many areas the wait time for a psychiatrist can be very long. Long enough that bad things can happen while waiting. IMO if your DH has a well established relationship with his PCP then there's likely little/no issue in that provider starting him on a medication. And as LucyStoner said, these types of medications are typically started at a very low dosage and gradually increased. I believe "start low and go slow" is the mantra. I'd be more concerned about making sure that protocol is being followed than I would be in the medication being prescribed.

Edited by Pawz4me
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I would not be troubled by a prescription after a phone conversation with a doctor who already knows you and has already been prescribing other psych meds. Ideally one sees a psychiatrist for severe mental illness but these days, sadly, many psychiatrists are pure prescription writers who rely on GPs, therapists, or others to make the actual judgments, so I would not make contact with a psychiatrist the be-it and end-all of mental health treatment. I would look up the medication, its side effects, and how large the prescribed dose is relative to the typical range. I would start having doubts about the doctor if it turned out to be relatively high at first. But I would use my gut sense about the doctor's ability to handle issues like this as a GP. It is not an absolute yes or no. And by "I would..." I mean the person who's the actual patient. Unless they are incompetent - in which case a psychiatrist really does need to be involved. Ultimately this is all a judgment call.

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Thank you. I appreciate all the help. Sorry I wasn't totally clear.  I had told him to call his doctor to get the process started for a diagnosis. I didn't expect meds after a phone call, and did not respond well to him saying that.

 

Now he wants me to decide if he should take the meds.  

 

Given the history, I think it's ok he prescribed something to try, but I think he should still see someone who is more of an expert in that area.

 

Then again, it's your husband's choice to try something if he wants IMO.  There is no blood test for bipolar.  KWIM?  So if he responds to a bipolar medication then who knows, maybe he does.

 

Those meds don't come without their share of lousy side effects though.

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To the original question, I would ask my Family Doctor for initial meeting because he has known me for 28 years and knows my family and my situation re: other health issues.  AND (this is a big AND) he is incredibly humble.  He's not afraid to diagnose things but neither does he think he knows everything, and he gives out referrals like Halloween candy...and his referrals have always turned out to be terrific practitioners.  

 

That said, I would not be happy if he asked me a few questions over the phone and "called something in."  I'd like a little bit more of a face-to-face than that--there is a lot of information one picks up in a personal meeting that can't be expressed over a phone or email.

 

And the other thing about my doctor is this:  if he sends me somewhere else, he will READ the diagnosis and treatment summary offered by the other doctor and it will show up in my records and if he needs to understand it better, he will take a CLASS to learn about it.  He has done that twice based on working with me...learning more about my afflictions so he could be a better doctor to me.  One class was three days long.  

 

So that is what *I* would do, but it is also WHY I would do it.

 

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He called his primary doctor today (same one that prescribed the antidepressants) they discussed over the phone symptoms and the doc asked questions then prescribed what my dh called "something that helps with bipolar/schizophrenia"

 

I've talked to dh again and he is irate that I am questioning the process. 

 

NoNoNoNoNoNoNoNoNoNoNo

 

Those are serious mental health conditions and a PCP should not be diagnosing them, least of all over the phone.

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The problem with saying "see a psychiatrist" is that in many areas the wait time for a psychiatrist can be very long. Long enough that bad things can happen while waiting.

 

That is fine, but there are a bazillion psychologists who have completed graduate coursework and supervised clinical practica in mental health diagnosis. A PCP has not. The PCP may need to write a prescription since only MD's can do that, but should not be diagnosing.

 

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The thing that worries me is that I don't know how the conversation went. He said that I think he is bipolar (I didn't say that- I don't know what his issues are-I'm not a doctor) so he went into the phone call saying that he thought he was. I'll have to trust the doctor and encourage dh to see a psychiatrist. (he argues he doesn't have time for that and just wants meds)

 

thank you again

If it's that severe, he doesn't have time to not see someone. Meds only might work for some but it is rarely optimal.

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He called his primary doctor today (same one that prescribed the antidepressants) they discussed over the phone symptoms and the doc asked questions then prescribed what my dh called "something that helps with bipolar/schizophrenia"

 

I've talked to dh again and he is irate that I am questioning the process.

This would be OK since the PCP has already seen the patient and now is adding to it based on results, even if conveyed over the phone. Personally, I would stick with the primary care physician.

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He called his primary doctor today (same one that prescribed the antidepressants) they discussed over the phone symptoms and the doc asked questions then prescribed what my dh called "something that helps with bipolar/schizophrenia"

 

I've talked to dh again and he is irate that I am questioning the process. 

 

I'm sorry, that doesn't sound normal to me if his previous diagnosis was only for depression.  Bipolar/schizophrenia are not in the same ballpark as far as complexity.  Was he already diagnosed by this doctor before for bipolar?  Changing a diagnosis like that over the phone, by a GP, I would not be comfortable with.

 

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I'm sorry, that doesn't sound normal to me if his previous diagnosis was only for depression. Bipolar/schizophrenia are not in the same ballpark as far as complexity. Was he already diagnosed by this doctor before for bipolar? Changing a diagnosis like that over the phone, by a GP, I would not be comfortable with.

 

He can be prescribed certain drugs that are approved for bipolar/known for treating bipolar *without being bipolar*. As I stated, some of these meds are also prescribed for major depressive disorder, PTSD, severe anxiety and aggression as a symptom in ASD or BPD. It doesn't sound to me like this doctor dx him as bipolar.

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What is the general run down on being able to diagnose a mental disorder? ex-bipolar

 

Should you be able to call into your regular doctor, have them ask you a few questions over the phone then send a prescription to the pharmacy?

 

Holy smokes! Absolutely NOT!

 

Even with a previous dx of depression, there is a HUGE leap from that to Rxing Seroquel.  Quite bluntly, I would be seriously angry with a GP/Family doctor who did that so recklessly.  You really need to see a qualified psychiatrist for a proper diagnosis of anything that would warrant Seroquel.  That is not a light-weight anti-psychotic.  You don't just go casually tossing out a dx of schizoid disorders and/or bi-polar based on a phone call.  I'm appalled.  If that were my spouse, I would be mother-flippin' outraged!

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The problem with saying "see a psychiatrist" is that in many areas the wait time for a psychiatrist can be very long. Long enough that bad things can happen while waiting. IMO if your DH has a well established relationship with his PCP then there's likely little/no issue in that provider starting him on a medication. And as LucyStoner said, these types of medications are typically started at a very low dosage and gradually increased. I believe "start low and go slow" is the mantra. I'd be more concerned about making sure that protocol is being followed than I would be in the medication being prescribed.

 

 

Respectfully, I disagree with this.  If getting an appointment to a psych is a problem, and issues are becoming unmanageable or leaning dangerous, you can present at an emergency centre who has a psych on hand.

 

I really can't get behind going on the advice of an untrained medical practitioner for psych dx or rx.  The stakes are too high for that risk, IMO and IME.

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Respectfully, I disagree with this. If getting an appointment to a psych is a problem, and issues are becoming unmanageable or leaning dangerous, you can present at an emergency centre who has a psych on hand.

 

I really can't get behind going on the advice of an untrained medical practitioner for psych dx or rx. The stakes are too high for that risk, IMO and IME.

I tend to agree but I've seen a lot of variability in this area. And the reality of emergency psychiatric care may not meet anything approaching helpful. Depends on the hospital and who is on duty.

 

It really depends on the PCP. Some have additional training in and experience with mental health issues. Others are clueless. Without knowing the history, the severity of the existing dx, the dose, the med (I missed which specific one it was, I assumed it was a second gen anti-psychotic of some sort) and the plan for follow up, it's hard to say. I'd be pretty outraged if this were the first conversation about this class of meds, if there wasn't a follow up in the works and if the doctor is a-ok with meds only. I just didn't get the impression that the prescription necessarily meant any new dx, much less a dx of bipolar.

 

What I can say definitively is that this meds only desire/thinking/approach preferred by the patient/husband is unwise.

Edited by LucyStoner
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Lucy Stoner post 42 hit the nail on the head

Medication is the quick and inexpensive way to treat people with mental issues​. Psychotherapy is expensive. Probably both medicine and Psychotherapy are needed by most patients?

 

Sent from my SM-G355M using Tapatalk

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A seroquel rx doesn't necessarily mean his diagnosis was changed. Seroquel is used for lots of different diagnoses, including depression. However, he'll probably want to see a psychiatrist to discuss options for the future--personally, I wouldn't want to take seroquel long-term if there was another option.

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Try to get your hubby in to see a mental health professional. ASAP.

 

BSDs and SSDs are super complicated to diagnose and general medical consensus is that a complete and thorough history validated by an immediate family member or other close relative is the current standard to even write it in a person's chart.

 

The medications to treat them are loaded on the front end and back end. I wouldn't pop one single pill without someone close to me (partner, spouse, etc . . . ) knowing what I was taking, how much, how often, and the potential side effects. That's how we handle acute mental illness in my family. And make no mistake the diagnoses you are throwing around are acute and serious.

 

No one needs to be managing those alone if at all possible.

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Yes, it is very difficult to get a timely appointment with a psychiatrist.  Because of that, the pros and cons of primary doc prescriptions are extra complicated.  Faster medication that may or may not be the best option, or the best option with a longer unmedicated period?  ("Best option" being based on training and experience, with the obvious caveat that it takes some experimenting for even the most excellent professional to find what works for each patient.)

 

A decent middle ground is often to get in with a master's level therapist, who will often expedite a psych appointment for someone in crisis, typically with someone with whom they already have a working relationship to balance med management and active therapy (which, in our experience, psychiatrists generally don't directly provide.)

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My current GP doesn't even understand some of the medications my psychiatrist has me on for bipolar. It also took quite a while of trying out different meds to find the right combination that worked for me.

 

And to be honest, my former GP was a little at fault for my bad bipolar episode. She saw only depression. She didn't give me a proper evaluation and didn't consider my depression could be anything else, so she prescribed an antidepressant. That actually kicked in a super bad manic phase. That was when she referred me to the psychiatrist and I was tested properly for a true diagnosis.

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Was he prescribed an antidepressant? If so, I would not be freaked out. Make sure he reads the drug monograph from the pharmacist so he knows what side effects he might expect.

 

which may or may not be complete.  they may not include rare side-effects.   I had issues after one rx (for something else) . . . and I had to go searching online to see if it was connected.  one site - ONE - included the very rare side-effect I was having.

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I can only imagine how a phone call to the PCP went down.

 

"Good afternoon, Dr. Smith.You know how you've been treating me for depression? Well, I think I may be bipolar. You know I have a busy schedule and don't have time to wait for an appt. Can you help me out?"

"Well, are you still depressed"

"Yes"

"Are you experiencing any new symptoms? Like mania? Periods when you feel really good, excited, full of life? Like nothing can stop you or slow you down"

"Yes, exactly."

"Do you feel like your life is being negatively effected by these mood swings?"

"Yes"

"There's a new med I would like to try. I'll call in a script. Do you still use the Pharmacy on Main street?"

 

--

There are too many things wrong with this scenario. No PCP, no matter how long the doctor-patient relationship, should be diagnosing or prescribing psych meds over the phone. This wasn't a med adjustment; the Dr. didn't  increase the dose of Prozac from 20mg to 40 mg. This is a new med for a possibly new (previously undiagnosed) condition. There are obvious indicators that the current treatment wasn't working (there had to have been a precipitating event that caused him to contact the Dr) and that needs to be addressed in person. There are telltale behaviors/mannerisms, etc that clue doctors, psychologists, and psychiatrists as to what may be going on. These cannot be conveyed via a phone call.

 

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