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Psychiatric Diagnostic Evaluation

The Evaluation

The first step for every new patient involves a thorough psychiatric evaluation. This process begins with an online intake questionnaire that must be completed prior to your initial appointment. This helps gather the basic information such as your main concerns & stressors, medical history, psychiatric history, and social background.

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Following this, we will spend 60 to 120 minutes together, where I can hear directly from you about the experiences leading you to seek treatment. Since the intake questionnaire is comprehensive, we can use this time to elaborate on and clarify your responses. My aim is to gain a deeper understanding of not only your 'symptoms' but also your identity and connection to the world around you.

The Assessment

The assessment encompasses pertinent psychiatric and medical diagnoses, and may include conditions that still require further investigation. I utilize terminology from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s ICD-10/11 in my documentation for two main reasons: 1) these resources provide a shared language that facilitates our discussions about next steps, and 2) if you are submitting claims to your insurance, they require this specific coding.

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But I recognize that you are much more than a list of diagnostic codes. This method of assigning a diagnosis based on checking off a list of symptoms does not sufficiently account for the context of your life. It fails to distinguish between genuine internal disorders and psychological reactions to challenging situations. This initial interview marks the beginning of a collaborative exploration, and may generate more questions than answers.

The Plan

The information gathered will help in formulating an initial treatment plan. It is essential to ensure that your concerns and personality align well with a dynamic approach to therapy and medication. This plan may encompass various aspects, such as:

  • recommendations for psychotherapy and/or medications,

  • referrals for evaluations by medical specialists,

  • guidance on beneficial lifestyle changes, and

  • requests for further lab tests or imaging.

 

We will review this plan together before making a mutual decision on whether to proceed with working together.​​

Not a Good Match?

There may be several reasons for choosing not to proceed with treatment together, the most common being:

  • the patient-physician relationship does not feel like a good match,

  • a different level of treatment is more appropriate, or

  • an alternative therapeutic skill or approach is more suitable.

 

It’s essential to note that if either the physician or the patient decides not to move forward with treatment, the full evaluation fee remains applicable. Resources for finding a mental health professional can be accessed on the Contact Me page.

What about the DSM?

In 1952, the American Psychiatric Association (APA) introduced the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Researchers needed such a manual in order to group similar patients together for studies to advance treatment. Since then, the manual has undergone significant revisions, with the latest version released in March 2022. Each diagnosis contained withing is characterized by a set of clinical symptoms that have been agreed upon by APA committees.

The DSM was intended to provide a shared language for describing the constellation of symptoms exhibited by patients, facilitating the process of diagnoses. However, having a shared vocabulary does not ensure that everyone interprets these terms in the same way. For instance, when someone says they "feel depressed," they could be alluding to a variety of underlying experiences. It is the clinician's responsibility to delve into the patient's experiences and contextualize them within the clinical criteria provided.

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That said, it is important to acknowledge the valid criticisms directed at the DSM. For some conditions, research has indicated that clinicians often disagree on the diagnosis for the same patient. There are also concerns regarding overdiagnosis as criteria evolve over time. Some critics argue that a rigid adherence to the DSM may obscure the broader historical and social influences that shape individuals' lives. I find myself in agreement with this final perspective.

Source: American Psychiatric Association. (n.d.). DSM History. Psychiatry.org - DSM History. https://www.psychiatry.org/psychiatrists/practice/dsm/about-dsm/history-of-the-dsm

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