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I have been diagnosed for a long while with OCD and some form of an anxiety disorder which is still not fully determined and in the past (4 or 5 years ago) they had toyed with depression, than maybe bipolar, than I stopped going to the doctor due to some crazy medication stuff. So, I dealt with my shit for those 4 or 5 years and only recently (last 3 or 4 months) got crazy enough (I was still crazy before but I could function... mostly...) to get myself back into the system after having a few huge breakdowns.

I ended up at a hospital that deals only with mental health and had an evaluation. Then I was passed to a crisis psychiatrist who was to basically finish the evaluation. So, after only 1 appointment he dx's me with Bipolar II, rapid cycling, and panic disorder as well as the already know OCD. Sure. Whatever. I'm open to anything. He puts me on some meds (Tegretol, risperdal, and ativan as needed) and sends me on my merry way. So I go back in a few weeks and the tegretol has me toxic and with a rash that could be "the rash" so off I go from that. Now I'm only on the risperdal and ativan. I get hooked up with a place that is going to be with me long term and go see this guy about two weeks ago. If you want to read about my experience, it's posted under "The heathcare system sucks!" thread called something like "I just can't believe it." Anyways, so shorten it up, it was a bad experience. He talked to me for less than 15 minutes (and I was told the eval with him would be at least 45), questions the dx (which is fine except he didnt care to try and re-eval or ask any questions leading to his own dx) and was basically just a huge asshole (in my opinion). He threw around ideas about depakote primarily and then mentioned something about lithium and when I brought up my concerns he literally laughed at them and shut me down.

So, here's my questions:

Is it correct for me to have been diagnosed bipolar after only 1 or two sessions with the other psychiatrist? This seems very quick to me. I don't even feel as though I have been asked enough questions to have anyone come to a dx. I don't feel as though my past or present has been explored enough to nail down a diagnosis.... especially if they're going to be messing around with some pretty serious drugs!

-and-

If I don't like this guy (I'm seeing him tonight again, he had some blood work ordered) what should I do? The clinic where he works is the best place for me because it is open late and I work funky hours and far away so I can't get time off during the day and they also have not only psychiatrists but psychologists and therapists, etc. which I am definitly going to need. Can I request a new psychiatrist from the same clinic because I don't like this guy? Or would that be wrong? Will they even give me a new one if I don't like him? I just don't think it's fair for me to be forced to see someone just because, especially if I am not comfortable with him. I can't put my faith in him to help me get better if I feel that I cannot trust him.

I'm so confused. I feel like I did 4 or 5 years ago which is the reason I swore not to see another psychiatrist or try meds again. But I NEED help now or I'm going to go completely bat shit and soon.

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Thanks for your reply caligatia. I will go to see this doc tonight and then if I don't like what goes on I will talk to them about being able to switch. What might you suggest the dialog be? Something along the lines of .... "I am not comfortable with this doctor"?

I would just ask if it's possible to change doctors.  If they ask why, tell them you're not comfortable with him.  Frequently clinics are too busy to even ask.

Oh, and I forgot to add in my other post. I also went off the risperdal myself this past week. I couldn't get in to pick up another prescription from the office as I had to go away for the weekend to I just had to go off it myself. I'm on a low dose, 1 mg.... how much of an issue do you think this will be for him? I'm worried that he's going to be really pissed. If I could have gone, I would have, but I couldn't. Things just got to busy. What do you think his reaction that that might be?

<{POST_SNAPBACK}>

Doctors are not big scary beasts.  They are people.  It's hard to remember that when you're being stared at by one, but don't let him get to you.  Tell him you couldn't make it in to get your prescription.  If he gets mad, that's his problem.  You had your reasons.  Stick to them.  He's not going to cut you off just because you missed a few days' worth of meds.  (Or, at least, most doctors don't do that.)  Also, pdocs are used to noncompliance in MI patients.  If you've been sticking with your other meds and tell him so, he's less likely to get upset.

Again, good luck.

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Hey there,

I hope you get this in time.  Get another doctor.  That one is obviously a jackass in a tuxedo.  However, on the off-chance that you are unable to get another doctor, simply do this.  Tell him what you want.  Walk into the clinic fully informed on what drugs you are considering, their side effects, what you are not willing to take and stop and look at him.  Do not give him a choice.  Sometimes, that's what you have to do when you get one of THOSE pdocs.  Say, "Hey, I am willing to try Seroquel because I feel that the side effects are tolerable for me and maybe Depakote or Lamictal.  I would like to add an antidepressant, perhaps Wellbutrin or Lexapro."  Period.  If he tries to divert to his condescending tone, you simply say, "I have decided what I feel comfortable with.  I would like to try this.  If it does  not work out, I will try something else."  Period.  Your body. 

I understand that they have the medical license and they have a vast body of knowledge that we don't.  But we know our bodies and our medical histories and they do not, especially the ones who don't bother to take the time to find out, so it is our responsibilities to ourselves to do it for them.

And, be careful on the Risperdal, ok?  1 mg is equal to 5 mg of Zyprexa and 200 mg of Seroquel.  It's a deceiving medication, the most potent out there.  Yikes! ;)

Good luck, hope I caught you in time.

JBella

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I totally agree about seeing about getting another Pdoc.  If at all possible.  Some of these docs have the "Holier Than Thou" attitude and for what it's worth, and don't seem to care about YOUR needs.  As JBella said, tell the Pdoc what you think you might be comfortable with.  This is YOUR body you're dealing with.  You're the one who's read up on these meds.  Docs don't like it when you read up on these meds.  This is known for a fact because my doctor doesn't like it when I actually know more about meds than he does.  Ha ha ha upon my part.  I spend hours doing research on meds and I usually tell my Pdoc what I think my body can handle just because of my kidney disease.  He seems to forget about my PKD and tries to put me on meds that can be extrememly harmful for me.  Plus, I usually call my nephrologist and ask him if certain meds are okay to go on.  Example: Topamax  There's that certain chance of kidney stones that Topamax can produce...my nephrologist just told me to keep pushing my fluids and I should be okay.  It took me three years to get back on Topamax again, but after begging and pleading, I finally got my way.

Hang in there, Echo.  That's all you really can do for the time being.

Elizabeth

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Thank you both JBella and Elizabeth for your thoughtful replies. I am actually JUST on my way out the door. If I do not like what goes on tonight I will try and switch. If they will not switch me than I do now know what I will do.... become hopeless yet again? The system seems to have failed me so many times. *sigh* But alas, I shall keep on pushing.

I love the "telling him what I'm comfortable with" idea but I don't have time before I go tonight to read up! I guess all I can do is go on what I know now and what I know I am NOT comfortable with.

If he is not going to take the time to even look at me in the eye for a moment than I am not going to let him fuck around with my body with very harsh drugs.

Oh, and thanks for the input about the risperdal JBella. I knew it was potent but every doctor kept stressing to me how TEENSY a dose I was on. Guess not. ;) I didn't even feel it doing anything at all after the first week. Oh well, I'm off it now. I'll see what Mr. Fathead wants to do tonight about maybe putting me back on.

I'll give you all an update when I get back.

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Back now and even more confused.  ;)

The doc was better this time. I don't like him by any means but I think he's tolerable.

So this is what he said:

He now basically disagrees with the BP II rapid cycling dx. He says that he doesnt understand why the other psychiatrist thought that in the first place. He says that if OCD is left untreated long enough it will cause depression.

He thinks the main problem is the OCD which is fine with me BUT I am still concerned about the bp because I DO experience hypomanias, although not very often and I believe I have experienced at LEAST 2 actual manias before. I did crazier and more wreckless things than I have ever done before in my life. I didnt sleep. I was not myself at all. I was a nut job.

He also kep trying to test me or something by asking me to constantly touch the doorknop of the door in his office. This makes me uncomfortable and would be a pain in the ass because then I would need to go wash my hands to feel comfotable so I wouldn't and he kept asking me to do it. I refused. What was he trying to accomplish by this? I mean, I could have touched the door knob but it would have been a big ordeal to do it and then need to wash my hands. Wtf.

So.... what now? He says he wants to start me on Lithium and Seroquel which will help stabilize my mood. But if he doesn't think I am BP than why put me on a mood stabilizer? He said this will help the OCD. I have NEVER heard of either of these drugs being used for OCD. Have any of you?

I also told him I don't think the ativan is doing the trick quite right. He mumbled something about me not using it the right way, or it not being prescribed the right way, but didn't go into detail and jumped right into something else so now I am even MORE confused.

Oh, and he used this exact terminology with me. "I want you to stop taking everything for this week until you see me next time, I want to see you when you are crazy." What kind of thing is that for a pdoc to say? :) Geeze.

I think I am going to try and find another pdoc to find another opinion. Is it proper for me to seek out another pdoc on my own and get set for another evaluation? Am I even allowed to do that? To seek treatment from another pdoc when I already have one without telling the other one?

If I do I want this new person to start with a clean slate. No notes, no nothing because in my entire life every single doc pdoc, tdoc, whatever, has dx'd we with something different. So what does this mean?

Good god I am more confused than ever. I saw the other pdoc for all of two hours of my life and he dx'd with bp II rapid cycling and panic. I see this guy for all of 30 minutes of my life and he disagrees with dx. I feel as though no single doctor has ever looked deep enough to fully understand the extent of everything going on.

I'd appreciate if any of you would be so kind as to answer any of my questions. I really appreciate it.

Thanks

Echo

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"I want to see you when you're crazy?"  Oh, please.

I think his meds ideas are sensible, but yeah, I don't like him either.  Yes, second/third opinions are always okay, and no, you don't have to tell him.  If you go back to him, you might want to level with him about what you think of his dx and why.  Even when I've been way off (I had BP confused with ADD), I've always found this helpful.

And you know what?  I wanted mine to see me when I was crazy, so he would take me seriously.  But I didn't want him to see me crazy when I was in the morgue (would I still be crazy then?), or, God forbid, intensive care.  And it turns out that it's taken less than a year for him to see me in three flavors of crazy.  So there's time for that.

-- sg

wonders if she can embark on her divine mission before her noon appointment, so doc can see her hit for the cycle...

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He also kep trying to test me or something by asking me to constantly touch the doorknop of the door in his office. This makes me uncomfortable and would be a pain in the ass because then I would need to go wash my hands to feel comfotable so I wouldn't and he kept asking me to do it. I refused. What was he trying to accomplish by this? I mean, I could have touched the door knob but it would have been a big ordeal to do it and then need to wash my hands. Wtf.

<{POST_SNAPBACK}>

He was checking the extent (level) of your OCD.

In a mighty smart manner, I should say.

6

p.s.  If someone has a history of manias, a mood stabilizer is EXACTLY what one uses to treat OCD.

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He also kep trying to test me or something by asking me to constantly touch the doorknop of the door in his office. This makes me uncomfortable and would be a pain in the ass because then I would need to go wash my hands to feel comfotable so I wouldn't and he kept asking me to do it. I refused. What was he trying to accomplish by this? I mean, I could have touched the door knob but it would have been a big ordeal to do it and then need to wash my hands. Wtf.

<{POST_SNAPBACK}>

He was checking the extent (level) of your OCD.

In a mighty smart manner, I should say.

6

p.s.

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If the Pdoc kept asking you to touch a door, and you verbally refused, he was listening for changes in your voice, to see if your anxiety level was going up as he continued to ask you.  If it REALLY bothered you (the concept), he could gauge it in that manner.  In the absence of sitting in your house and staring at you washing your hands (or whatever your compulsion is), OCD pretty much has to be diagnosed by asking questions.

As to SSRIs vs Mood stabilizers, even "very few" manias is too many to put a person on an SSRI - there is too great a risk of throwing the person into an SSRI induced mania.  As such, a mood stabilizer would be a first line treatment.

As to wanting to see you "crazy", what he wants to see is you not you-medicated.  As everyone reacts differently to different medications, he cannot see your true BP (or not) symptoms while you are on your current medications.  Regardless, he obviously does not feel you are a danger to yourself or others, or he would not be suggesting such a thing.

It sounds like this guy knows his stuff and is approaching your case in a wise manner, psychopharmacologically.

That said, it is always your option to seek out a second, or third, or fourth opinion.  Yet please don't make the mistake of equating time spent with a Pdoc with quality of diagnosis.  There are very good Pdocs out there who have seen and read damn near everything and can diagnose someone practically by the way they walk through the waiting room, and there are others who could talk to a person for four hours and still not have a clue, even though the person has a very simple Dx. 

There is an old joke in medical circles:  What do you call the guy who graduates first in his class from med school?  Doctor.  What do you call the guy who graduates last?  Doctor.

6

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If the Pdoc kept asking you to touch a door, and you verbally refused, he was listening for changes in your voice, to see if your anxiety level was going up as he continued to ask you.
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I guess I am so skeptical because every single pdoc I have ever seen has dx'd me with something different and they all disagree with each other. I am so fed up with how I feel and I wish someone would just figure it out.

Sometimes, what the Dx is becomes irrelevant (stay with me here...), if the symptoms are identified correctly and treated with the proper medications.

I am so scared of meds. I am terrified of what they might do to me. I am even more scared because I am beginning to think that I don't want to take them and I wonder if maybe since no one can figure it out that there might be nothing wrong with me at all. But then I know something is wrong. But is there really?

As a very wise CrazyMeds member told me last year when I was in crisis: this isn't you talking, this is the illness.  And sometimes it is very hard to tell the difference, because they both eminate from your brain. 

It is perfectly normal to be afraid of meds.  Being afraid of the unknown is human nature.  That's why we're all here, and why Jerod made CrazyMeds - so we could all learn about different meds in a non threatening environment.  I've found that even asshole doctors will take time to explain the effects of different drugs (or how one drug is better than another) if I just ASK.  But I have to come in with some info of my own.  I have to SAY (for example) "Why am I getting a mood stabilizer instead of an SSRI?"  Not in a combative manner, but in a curious one.

I am all confuzzled.

I am also good at hiding my true crazy self.

I am afraid the pdoc won't know the extent of things (or how deep they go) because I am too good at hiding things and appearing normal.

Which is why he wants to see you unmedicated.  He may also refer you to a Tdoc (therapist).  Some Pdocs work in concert with Tdocs if they don't do talk therapy themselves. 

I found that I was more open about my cycling here at Crazyboards than at my med checks.  I finally just had to print out one of my posts and bring it in to my Pdoc.  I never seemed to be cycling when I saw him, or we'd be talking about something else, blah blah blah.  And I LIKE him!

Sometimes, it's just easier to hand over a piece of paper you've written out with your concerns than it is to have to look at someone and spill your guts.

Just a thought.

6

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I gotta say my jaw actually dropped when I read that he wanted you to go off all your meds for a week.  Dropped. 

You said that you've experienced manias.  That equals "a history of mania."  You've also said you have a history of depression.  But I agree with number_6 that the diagnosis doesn't matter at all so long as the symptoms as being treated.  Hell, a lot of dx's overlap and are used differently by different docs.  All that matters is that the symptoms are treated.

And as for time for diagnosis, a few questions, answered honestly, is all it takes.  Honesty is the key.  Meeting with the pdoc is not the time for hiding your symptoms or making up rationalizations.

From what you've said, either this guy is very confusing, or you're so anxious that you're over-thinking what he's told you.  But he does seem to have some method.  So one way to approach this is to try his method and see how much it helps you.  You may have one hell of a week unmedicated, but it will allow him to start fresh with medication approaches.  He may feel that some of your past symptoms may have been medication side effects.  Just be careful; feel absolutely free to call him at any point if you start to get uncontrollable feelings.  He needs to know how you're doing, and there's no reason to be brave about things.

Good luck, and I do hope that this guy works out for you.  I didn't trust my pdoc at all at first, couldn't imagine he cared about me.  But he does, and has done a very good job for me.  I wouldn't give him up for the world.  So try to be a bit patient, and remember if things work out you can always switch docs.  They're used to it, don't worry.  After all, they work for us.

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