“I am embarrassed to be here.” “I really didn’t want to come today.” “I’ve put this off for a long time.” These are three of the most common things patients tell me at the beginning of their first psychiatric visit with me, and — let’s face it — the idea of unpacking your struggles with mental health can seem intimidating.
I’d like to share with you what your first visit with a psychiatric provider will be like in case you are considering medication to treat your mental illness. (Note: Not all psychiatric providers will conduct their evaluations exactly the way I do, but the information gathering process will usually be similar to what I describe here.)
First, I will introduce myself and get a general sense of why you are here and what issues you are interested in treating with medication. I will assess any mood disorders by asking about depressive symptoms – How do you sleep? How is your appetite? Do you frequently feel irritable? If your answers provide clues to a mood disorder, I will ask more about any cyclical patterns of behavior. Do you have periods where your thoughts move so fast your mouth can’t keep up? Do people often tell you that you are speaking faster than usual, or acting more impulsive? Have you ever spent a large amount of money in a short period of time and regretted it? These questions are meant to identify an underlying bipolar disorder.
Next, I will assess anxiety by asking about ruminating thoughts, panic attacks, or fear of something “bad” happening. Then I then ask about psychotic symptoms, such as a history of hearing voices or seeing shadows or spirits. Sometimes these questions offend patients, who may assume I am addressing psychosis because I believe they are very ill. Not true! I ask all patients about these symptoms so that I may get a thorough history.
We will talk about your psychiatric history and I will ask if you have ever taken psychotropic medication or been hospitalized for a mental health reason. I will also ask a few questions about drug use and trauma history.
The information you give me helps me to identify a diagnosis and rule out others that may not apply to you. What do I think about diagnoses? They’re loose guidelines. Not everyone with depression wants to kill themselves, and not everyone with anxiety has panic attacks. I practice person-centered care, which means that I help patients find what works for them. Ultimately, you know yourself best and without your input my suggestions are meaningless. You shouldn’t be afraid to tell me about any uncomfortable side effects, and I shouldn’t make you feel bad about quitting a medication that made you feel worse.
The end of the session is where we discuss medication options, based on a variety of factors – ability to afford medications, insurance coverage, side effects, and previous reactions to similar medications. This is also where I provide education – dropping a diagnosis like “Bipolar” or “Schizoaffective” on someone who is new to mental health can uproot their reality in a major way; it can cause them to view themselves as broken, crazy, or defective. I have heard all of these words come out of recently diagnosed patients, and this is the time that I build my greatest therapeutic rapport with them. I create an individualized treatment plan, provide education, and answer any questions they may have.
Overall, the process isn’t that much different from getting a physical exam from your primary care physician – lots of questions and information you will need to provide.
Caring for your mental health is important to your overall quality of life and daily functioning. I hope this post has been informational for you, and helped you become more comfortable with scheduling an appointment with a psychiatric provider.