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Author Topic: Meeting with a psychiatrist...  (Read 3128 times)
Hrothmeir
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« on: January 26, 2015, 04:32:56 PM »

I'm working on a MS dealing with a MC who has undiagnosed Obsessive Compulsive Personality Disorder.  I've been researching the heck out of symptoms, diagnosis criteria, and personal accounts of people with OCPD.  But now I've run into a brick wall: the MC is ready to be diagnosed, but I've never been to a psychiatrist before, and thus have no idea how to write the scene. 
Does anyone know of any resources (fiction or non) that would accurately portray psychiatrist/patient interactions, especially a first-time meeting?  Also, if anyone has personal experiences, would they be willing to share them?  Any help would be appreciated.
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Pandean
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« Reply #1 on: January 26, 2015, 05:07:58 PM »

I've been going to a psychiatrist since I was very young. I could give you my experiences if you like? There is a big difference between seeing a psychiatrist and seeing a therapist.
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Hrothmeir
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« Reply #2 on: January 26, 2015, 05:10:30 PM »

That would help a lot, thanks.
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coaldog
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« Reply #3 on: January 26, 2015, 05:22:33 PM »

The book "People of the Lie" contains some examples of patient/therapist interviews. It's been so long since I read it that I can't recall if it specifically addresses the psychiatric interview or is the more general therapeutic one.
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KimE
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« Reply #4 on: January 26, 2015, 06:59:08 PM »

People,pf the lie is an awesome book. Also, I was at a panel discussion last year and Jonathan Mayberry suggested googling  an issue to find academic papers written on it and then emailing the authors. He said academics and scientists are usually very willing and excited to help an author doing research
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Pandean
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« Reply #5 on: January 26, 2015, 09:22:49 PM »

Okay:

So, psychiatrists are different than therapists because therapists give, well therapy while psychiatrists prescribe medicine and treatments. So, therapy can be prescribed by a psychiatrist along with other things--such as medication, hospital evaluations, even emotional support animals.

Therapy appointments are usually around an hour in length while psychiatry appointments are around 15-30 minutes. Both discuss very different things. Again, therapy is well, therapy. The mental and psychological side of it. What was your situation, what can we do to change it, etc. Psychiatry is the medical side of it. What can we prescribe to help the symptoms.

In both psychiatry and therapy, the first couple appointments are usually when you explain your symptoms and your history (which is basically your life story. Relationships with people, thought patterns, education, etc. pretty much everything to the point where you're at now.)

Then, after a few sessions or even just one (sometimes it's that easy) a psychiatric will probably diagnose you. A diagnosis isn't any flashy or special--I remember as a kid thinking you needed a certificate of diagnosis but that's a lie--basically a diagnosis a "This is what you have" and a code number or something to write down on your insurance sheet. Literally what most diagnoses are are a way to get insurance to pay for thing. It's that simple. So, a lot of times you can have a hodge-podge of symptoms and be treated for a number of different things but your official "diagnosis" might be just "anxiety".

For other things, like personality disorders, some psychiatrists won't technically "diagnose" you with it. Because if they do, since those disorders aren't considered things medicine can help you with, and therefore you won't get coverage, etc. So to ensure coverage they might write down a similar disorder and prescribe pills for your symptoms (such as aggression or impulsiveness in a personality disorder) but they will TREAT you for the disorder you actually have.

For example: My official diagnosis is "OCD, Anxiety, ADHD, Rapid Cycle Bipolar Disorder" but that's just to get me the meds I need for my Borderline Personality Disorder--which is the disorder I actually have and am treating with my therapist and psychiatrist.

I hope this is helpful. Since your MC has Obsessive Compulsive Personality Disorder it's likely they would be treated as having a personality disorder yet on paper it would be something like Obsessive Compulsive Disorder or Generalized Anxiety or something similar.

For diagnosis, there are usually certain questions asked depending on the disorder.

As well as, as a fellow personality disorder sufferer, it is really hard to be taken seriously while trying to get help for a personality disorder and many psychiatrists refuse to either diagnosis it or treat it and they are the most stigmatized type of mental disorder. Your MC might have to go to more than one psychiatrist to finally find a "helpful" one, he or she will probably have people try to dissuade them about having a personality disorder, and a lot of times you aren't taken seriously.

Hope this helps some.
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Falthor
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« Reply #6 on: January 27, 2015, 10:35:27 AM »

Thank you Goat with it's tongue stuck out...  that helped me as well.
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Pandean
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« Reply #7 on: January 27, 2015, 10:39:18 AM »

Thank you Goat with it's tongue stuck out...  that helped me as well.

No problem, dude holding the naked baby.
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SamIAm
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« Reply #8 on: January 27, 2015, 10:57:42 AM »

Thank you Goat with it's tongue stuck out...  that helped me as well.

No problem, dude holding the naked baby.

Oooohhhh....memories of toast and milk and Netflix.
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Pandean
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« Reply #9 on: January 27, 2015, 11:21:34 AM »

Oooohhhh....memories of toast and milk and Netflix.

 clap clap

I thought of that only after I posted it. lol.
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Falthor
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« Reply #10 on: January 27, 2015, 02:44:27 PM »

dude she's got a diaper on... not nude... 
:-)
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Pandean
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« Reply #11 on: January 27, 2015, 04:09:51 PM »

dude she's got a diaper on... not nude... 
:-)

Oh. I thought that was your shirt! I can't tell!
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Hrothmeir
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« Reply #12 on: January 27, 2015, 04:28:47 PM »

Thanks for the feedback!  That's the most in-depth description of psychiatrist/therapist differences I've yet seen; most are limited to "A psychiatrist has a doctorate."

Then, after a few sessions or even just one (sometimes it's that easy) a psychiatric will probably diagnose you.

So if a diagnosis is reached fairly early on by a psychiatrist and drugs or hospitalization were prescribed, would one continue seeing the psychiatrist to "talk it out," or would that be handled by a referral to a therapist, with the psychologist generally checking up on your meds and symptoms?

And in terms of writing, should I split the psychologist into two characters (one a therapist), or do you thing a therapist might handle the narrative load better?  I've been trying to keep named characters to a minimum--five, so far--so I'd like to keep things as streamlined as possible.

And yeah, the diaper does look like a shirt with the sepia tone Smiley
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Pandean
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« Reply #13 on: January 27, 2015, 04:34:38 PM »

Thanks for the feedback!  That's the most in-depth description of psychiatrist/therapist differences I've yet seen; most are limited to "A psychiatrist has a doctorate."

Then, after a few sessions or even just one (sometimes it's that easy) a psychiatric will probably diagnose you.

So if a diagnosis is reached fairly early on by a psychiatrist and drugs or hospitalization were prescribed, would one continue seeing the psychiatrist to "talk it out," or would that be handled by a referral to a therapist, with the psychologist generally checking up on your meds and symptoms?

And in terms of writing, should I split the psychologist into two characters (one a therapist), or do you thing a therapist might handle the narrative load better?  I've been trying to keep named characters to a minimum--five, so far--so I'd like to keep things as streamlined as possible.

And yeah, the diaper does look like a shirt with the sepia tone Smiley


You would keep seeing the psychiatrist and a therapist if you see one. Psychiatrist you'd see every other month or so while therapist is more weekly basis. Psychiatrists you see every other month or so and talk about your medications, if they're working, if you're getting side effects, etc. if so, you discussion if you need to change meds, etc.

or hospitalization, you'd have an inpatient psychiatrist who works there and corresponds with your outpatient (normal) psychiatrist. Both usually are on the same terms. You gotta sign release papers so all your doctors can see each other's notes and share things because HIPPA, which says a doctor needs your permission to share your info even to other doctors.

__

It depends on splitting them. What's going on with your character. Are they getting therapy, prescribed medication, or both?
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Lupdiga
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« Reply #14 on: August 11, 2017, 01:38:54 AM »

I know this is a really really old thread, but I thought I'd comment on here in case it's useful to anyone else.
Here is the general template of what a psychiatrist would ask you, and why they would ask it. It's what we learn at medical school.

First, to get to know the patient, they'd ask social stuff:
Who do you live with? What is your job? Do you smoke/drink/take any drugs? (Often they ask this at the beginning, to help bond with the patient)

Then start with an open-ended question. Why have you come here today?
- Hopefully, the patient would then list some reasons.

Then, based on those reasons, the psychiatrist would ask about the specifics of symptoms. You can look these up in the DSM-V (because there's loads of them).
I'll give an example. If the patient says 'I've been feeling down and having trouble getting out of bed', then the doctor would suspect a depressive illness, and ask questions that are required for a depression diagnosis, as listed in the DSM. They would also want to distinguish between the different types of depression, eg major depressive disorder/bipolar

They would want to know how long the symptoms have been going on for, and how they've impacted the patient's life.

Then they would screen for other disorders using the following:

1) Have you found that you no longer enjoy the activities that you used to enjoy? (Depression)
2) Do you feel that you are more anxious than other people? (anxiety haha)
3) Do you ever see or hear things that other people can't? Do you ever feel like people are watching you? That you can control things? That other people/TV can control you? (Schizophrenia)
4) Are there ever times when you feel on top of the world? Or extreme agitated? When people tell you that you are talking much faster than usual? (Bipolar)

Then risk assessment (most important one!)
1) Do you ever think about causing harm to yourself or to others?
2) Have you ever felt so distressed by this that you've thought about taking your own life?
3) Are you still able to look after yourself/cook and clean/shower? (self-neglect)

Then:
1) Do you suffer from any medical illnesses?
2) Have you ever been diagnosed with a psychiatric illness?
3) Do you have a family history of mental illness?

And then usually they would say, "Okay, based on this, you meet the criteria for *this illness*". And then they would probably suggest:
1) Lifestyle changes
2) Therapy
3) Trialling a small dose of a particular medication

They would also want to do a physical examination and blood tests, because often psychiatric disorders can be due to medical problems or medications. For instance, anxiety can be caused by hyperthyroidism, adrenal problems, etc etc ...

To be honest, it's all very structured, and this is why I struggle to write about medical things - all the structure can make the scene run a bit slowly and clinical. But I hope that helps!
Cheers
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