The Importance Of A Correct Diagnosis of Mental Illness

Why A Good (Correct) Diagnosis Is So Important

Good Diagnosis

One of the most important things in treating mental illness successfully is a correct diagnosis. That can sometimes be a difficult task since there are some medical issues that can present as a mental illness or a psychiatric symptom. Diagnosis is also challenging because a psychiatric symptom can be present in more than one psychiatric disorder. Why is a correct diagnosis so important? Because a correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission. For example, one symptom like irritability can be a common presentation in depression, anxiety, Attention Deficit and Hyperactivity Disorder, mania, hypomania, impulsive disorders, Post Traumatic Stress Disorder and even in Obsessive Compulsive Disorder, to name a few. Sadness, another common psychiatric complaint can be a sign of a Major Depressive Disorder or Bipolar disorder, and be seen in Schizophrenia in some cases; all severe mental illnesses with completely different types of treatment.


Examples of Misdiagnosis

To illustrate some of the challenges in forming a diagnosis, I have a couple of examples from our Clinic.

Patient A.

A 29 y/o male was referred by his therapist for an evaluation after increased concern that he might have Bipolar Disorder. The patient described periods of time when he worked more than 60 hours per week, reporting that people close to him would notice that he was increasingly irritable and also had a decreased desire for sleep.  He did not have any concerns about his behavior but said his family was increasingly worried about his mood swings, and his proneness to get into fights.  He had sought Christian counseling at his father’s urging. During his examination, he was very polite, friendly, but somewhat reserved and slow in establishing rapport. He reported that he was previously diagnosed and treated by his Primary Care Doctor for ADHD for many years and was treated with a number of medications over the years, but said he preferred Adderall XR. After the interview process and a routine check of his prescription across Texas database, we discovered that he was prescribed 30 mg of Adderall XR twice a day, with no early refills. However, we also learned that he was using the entire 30-day supply during a 7-10 day period each month, amounting to an average of 180-270 mg of Adderall per day. When I spoke with him about it-he was truthful, saying that he was not addicted to the direct effects of Adderall but to how much work he was able to accomplish during that time. Given this additional information, the correct diagnosis was not Bipolar Disorder and as a result he did not need a mood stabilizer. The correct diagnosis was amphetamine drug use, and substance-induced bipolar disorder that needed an addiction treatment and reevaluation of his prior diagnosis and treatment for ADHD.


Patient B

A 48 y/o, divorced, mother of one child, employed professional, was treated for depression with fluoxetine. Her symptoms responded to an initial dose of 20 mg of fluoxetine and almost got to remission with an increased dose of 40 mg. She continued to complain of persistent tiredness and lack of energy in doing things that she was interested in. Her blood work report did not show anything significant except for a low T3 on the Thyroid function panel and a high C reactive protein. As a psychiatrist, I recommended supplementation with liothyronine, which improved her energy level dramatically. At the same time, she was referred to an endocrinologist for further testing that came back suggesting an autoimmune thyroiditis disease. A new treatment plan was created to target both her depression as well as her thyroid condition.


Patient C

A 32 y/o recently married woman was referred for worsening mood that was not responding to the lamotrigine and bupropion that were started a few months prior to her initial visit to a psychiatrist by her Primary Care Doctor. She was in couple’s therapy to address difficulties in her relationship that started a month prior to her wedding. The therapist suggested a mood stabilizer because the patient had increased irritability, insomnia, and crying spells as the wedding was approaching. The response to the medication was minimum, she continued to be depressed, still cried a lot, felt anxious, and the tension in the relationship was not helping her symptoms. A new medication, Wellbutrin, was added to lamotrigine and her mood was slightly better. After the wedding her mood continued to be unstable, initially with insomnia and then she started having panic attacks.  In my initial psychiatric interview, she appeared to be very anxious but there was no history of clinical symptoms of mania, nor any history of bipolar disorder in her family. Her pattern of insomnia was suggestive of an anxiety disorder that neither medication addressed. We discussed options and I recommended that she add Trintellix and start a slow tapering of her Lamotrigine first and then her Wellbutrin. Over the next two appointments, both her anxiety and depressive symptoms were in remission and she said that she finally felt like she got back to feeling like her normal self, despite the continued difficulties in her marriage on which she continued to work in therapy.  In this situation, it was clear that she was misdiagnosed with a mood disorder and the treatment that was chosen was not addressing her anxiety which was her main presenting problem.


Prevent Undue Suffering By Getting A Proper Diagnosis Quickly

Any delay in obtaining a correct diagnosis can prolong the period that the patient suffers, and, in some situations, the treatment that is chosen for a different condition can worsen the presenting problem, like in the last case where the medical provider was treating a depressive episode of a bipolar disorder with an antidepressant. Please note that even though people might have the same diagnosis each person’s experiences and health conditions are different- so what works for one person may not work for another.  Any diagnosis of mental illness should include a full history of your both your mental and physical health.

Research indicates that if you get the right diagnosis early in the treatment process you will get better faster and experience fewer treatment-induced side effects.

If we can help in any way- call us at 713.426.3100  to schedule an appointment.

Get Help For Bipolar Disorder

A Psychiatrist for Bipolar Disorder Discusses Symptoms and Treatment

psychiatrist for bipolar disorder

Do You Have Bipolar Disorder?

A number of people come to me suspecting they have bipolar disorder. These patients often report extreme emotional highs and lows, as well as some other common symptoms such as feeling sad or manic. However, not everyone who experiences these symptoms has bipolar disorder. I wanted to write this article to provide some information so that people can learn more about bipolar disorder, and can get the help they need.  Although this information will be helpful-nothing is more effective than an in-person session with a trained clinician so that you can be properly screened, and make sure that you can explore all possible treatment options.


Bipolar Disorder Defined

In laymen’s terms, Bipolar disorder (often called manic depression) is a mental health condition whereby people experience extreme highs (mania), as well as intense periods of sadness or depression. The phases of depression and mania are known as “episodes,” and they can shift quickly.

Bipolar Disorder and the Brain

Bipolar disorder is a brain disorder that causes unusual shifts in energy, mood, activity levels, and can affect the person’s ability to carry out daily tasks.


Types of Bipolar Disorder

There are four basic types of bipolar disorder. Each of these types involves distinct changes in energy, mood, and activity levels. These moods range from manic episodes (periods of extremely “up,” elated, and energized behavior), to depressive episodes where the client presents as “down,” very sad, or hopeless. Less severe manic periods are known as “hypomanic episodes.”


Commonalities in Bipolar Disorder

What is common in all types of bipolar disorder is that people with bipolar disorder experience periods of unusually intense emotion, changes in activity levels and sleep patterns, as well as unusual behaviors. These distinct periods are known as “mood episodes.” What is different with bipolar disorder, is that these mood episodes are drastically different from the behaviors and moods that are typical for that particular person. When people experience these mood episodes, we typically see extreme changes in the person’s activity, energy, and sleep patterns.

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.


Diagnostic Criteria for Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.  Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

For Bipolar I disorder, you have to have had at least one manic episode. The manic episode may be preceded, or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).

For Bipolar II disorder, you have to have had at least one major depressive episode lasting at least 2 weeks and at least one hypomanic episode lasting at least four days. People with Bipolar disorder II have never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.

For Cyclothymic disorder you must have had it at least two years, or one year for children and teenagers, where you have had numerous periods of hypomania symptoms (this is the less severe episode than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.

There are other types of Bipolar disorder, which include bipolar and related disorders caused by another medical condition, such as Cushing’s disease, stroke, or multiple sclerosis.  There is an additional type called substance and medication-induced bipolar and related disorder.

Note that Bipolar II disorder is not a milder form of Bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be dangerous and severe, individuals with Bipolar II disorder have been known to be depressed for longer periods of time, which can lead to significant impairment in their daily functioning.


Bipolar Disorder Treatment

With proper diagnosis and treatment, people who have bipolar disorder are able to lead healthy and productive lives. Speak with your doctor or a licensed mental health professional if you think you might have Bipolar disorder. We cannot stress enough that you should have a physical exam to rule out other conditions.  Some Bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make an accurate diagnosis.

If the problems are not caused by physical illnesses, a mental health evaluation should be done with a trained mental health professional, such as a psychiatrist, social worker, or psychologist who has experience in diagnosing and treating bipolar disorder.

Bipolar disorder can sometimes co-occur with another illnesses such as an anxiety disorder, eating disorder or with substance abuse. In addition, some people with Bipolar disorder are at higher risk for obesity, diabetes, thyroid disease, heart disease, migraine headaches, and other illnesses.


Want Help? Call Us

If you would like to set up an appointment for an evaluation call us at 713.426.3100.