What to avoid mentioning at a psychiatrist appointment

[Dmitri]

Tomorrow I am scheduled to see a psychiatrist, the first time I would ever be seeing one. I have a number of symptoms that can be classified as "mental", including OCD, brainfog, strong mood swings, vivid nightmares, depersonalization and constant feeling of impending doom. Their severity tends to coincide with the severity of other symptoms such as pain, OI, digestive symptoms, etc, and they are especially aggravated by infections or reactions to drugs/chemicals.

Despite all of that, as well as several past referrals to psychiatry from unhelpful doctors, I avoided seeing a psychiatrist or even mentioning my mental symptoms because it would give the psychobabble camp more ammunition to abuse me with (I've had doctors accuse me of hypochondria, hysteria, etc. for a long time before I got more extensive evaluations). There was even a neurologist who cherrypicked my symptoms before, saying my pain was psychosomatic and completely unrelated to my verified autonomic dysfunction.

I want to firstly get my OCD diagnosed so I can be evaluated for PANDAS and other neuroimmune conditions. I know this can easily end up going the wrong way, with after-visit notes like "patient suffers from health-anxiety causing hypochondriasis and obsessive-compulsive thoughts." or "patient's false beliefs, depression and stress conjure up psychosomatic manifestations."

I've read threads from other patients recounting their compulsory psych visits just to rule out psych diagnoses, but my case will be trickier because I will have to return with a psychiatric diagnosis while avoiding having it written down as the causation of all my other symptoms.

 

[nanonug]

My advice: describe your psychiatric symptoms and avoid suggesting to him any particular condition you think you might have. Let the psychiatrist reach his own conclusions.

 

[Sushi]

@Dmitri What country you are in could be a factor in what you say as some countries seem to plug ME/CFS patients into an invasive and damaging program if you present yourself in a certain way or with a certain set of symptoms.

 

[Lala]

It depends on why you are going there. Do you need treatment for psychiatric symptoms or report for disability?

 

[Dmitri]

I had the appointment done, the impressions are better than I expected since the psychiatrist seemed understanding of my condition and didn't try to say my symptoms are psychogenic or push any quack theories on me. I was diagnosed with OCD and GAD.

@Dmitri What country you are in could be a factor in what you say as some countries seem to plug ME/CFS patients into an invasive and damaging program if you present yourself in a certain way or with a certain set of symptoms.

Is it a risk factor in the US? Psychiatric diagnoses are convenient skeletons for enemies to find in one's closet, but the ones I received hopefully shouldn't interfere too much in the future.

My advice: describe your psychiatric symptoms and avoid suggesting to him any particular condition you think you might have. Let the psychiatrist reach his own conclusions.

Yes, I avoid bringing up conditions I want to rule out unless it's a physician I trust or a specialist I'm seeing for something specific, otherwise I run a risk of being snarled at and having to listen to a rant about "doctor google" and "cyberchondria".

It depends on why you are going there. Do you need treatment for psychiatric symptoms or report for disability?

Just a diagnosis for now and possibly for disability for the future. The end-goal is having help connect the dots with my other symptoms, but that's probably asking for too much.

 

[nanonug]

I had the appointment done, the impressions are better than I expected since the psychiatrist seemed understanding of my condition and didn't try to say my symptoms are psychogenic or push any quack theories on me.

Awesome!

I was diagnosed with OCD and GAD.

In case you aren't taking NAC yet, here's something for you (although there is a lot more research pointing in the same direction):

Efficacy of N-Acetylcysteine Augmentation on Obsessive Compulsive Disorder: A Multicenter Randomized Double Blind Placebo Controlled Clinical Trial
https://www.ncbi.nlm.nih.gov/pubmed/28659986

Abstract
Objective: Glutamate is considered a target for treating obsessive-compulsive disorder (OCD). The efficacy and safety of the nutritional supplement of N-Acetylcysteine (NAC) as an adjuvant to serotonin reuptake inhibitor (SSRI) for treating children and adolescents with OCD has never been examined. Method: This was a 10-week randomized double-blind placebo-controlled clinical trial with 34 OCD outpatients. The patients received citalopram plus NAC or placebo. Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Pediatric Quality of Life Inventory (PedsQL™) were used. Adverse effects were monitored. Results: YBOCS score was not different between the two groups at baseline, but the score was different between the two groups at the end of this trial (P<0.02). The YBOCS score of NAC group significantly decreased from 21.0(8.2) to 11.3(5.7) during this study. However, no statistically significant decrease of YBOCS was found in the placebo group. The Cohen's d effect size was 0.83. The mean change of score of resistance/control to obsessions in the NAC and placebo groups was 1.8(2.3) and 0.8(2.1), respectively (P = 0.2). However, the mean score of change for resistance/control to compulsion in the NAC and placebo groups was 2.3(1.8) and 0.9(2.3), respectively. Cohen's d effect size was 0.42. The score of three domains of quality of life significantly decreased in N-Acetylcysteine group during this trial. However, no statistically significant decrease was detected in the placebo group. No serious adverse effect was found in the two groups. Conclusion: This trial suggests that NAC adds to the effect of citalopram in improving resistance/control to compulsions in OCD children and adolescents. In addition, it is well tolerated.

 

[Sushi]

Is it a risk factor in the US? Psychiatric diagnoses are convenient skeletons for enemies to find in one's closet, but the ones I received hopefully shouldn't interfere too much in the future.

Not so much in the US, one reason being that there are not centralized medical records.