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Q: I´m a 23 year old woman who has recently been diagnosed with BD. My
question is, can a psyquiatrist make that diagnosis with a single interview?!
Hope to hear from you soon
Dear Ms. G' --
That's a good question, in that lots of people probably wonder that. Truth
is, we do that all the time. We're expected to. People come to us
with symptoms, which they hope we can help resolve. They often have
symptoms that are severe enough, sometimes dangerous enough, that if there's a
treatment that might help, they want us to get going with that right away.
And to select a treatment to offer, we always try first to "make a
diagnosis".
When this process is done right, the
"diagnosis" would be only the most likely of several potential
diagnoses that would be considered. We would call it our "working
diagnosis" -- our current best way to explain things, and our current way
of leading the patient to a treatment option based on their
symptoms. The most important thing
for us psychiatrists in this process is to maintain an open mind to the
possibility that our initial diagnosis is not correct. This includes the
possibility that the person who came to us, for one reason or another, does not
have a "diagnosis" at all; that they somehow ended up in front of us,
but do not really have a condition that warrants treatment of any kind (which is
usually the threshold for making a "diagnosis" in the first
place). In medical school they teach
"if the patient does not respond to treatment, reconsider the diagnosis".
So if after the first try at a remedy for a person's symptoms there is not clear
improvement, before launching off on a similar treatment (e.g. another mood
stabilizer for "bipolar disorder"), there should be a reconsideration
of the diagnosis. Maybe it's something else and that's why the person
didn't respond. However, unless we have new information at that point, the
diagnosis is likely to stay the same -- presuming we went through the process
right in the first place; until new information emerges that points to a
different diagnosis. Granted it does
sound presumptuous to "make a diagnosis" after a first interview,
which sometimes can be brief (like if the doc' has hundreds of patients she's
supposed to be taking care of for a mental health agency, and has little control
over how much time she can spend on that first interview). But I hope this
answer, which may be more than you wanted, will help people understand how we
approach this stage of our work. Dr. Phelps
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