[north-polar-coaster]

Hi everyone,

As you may or may not know, I am currently undiagnosed and I am almost convinced that I have bipolar disorder (current symptoms, family history, etc.) I have my first pdoc appointment, in nearly 6 months, coming up in 2 days in an attempt to get a diagnosis and to begin treatment.

I was wondering if I could get input from you guys regarding my upcoming appointment. My previous pdoc sessions all revolved around treatment for ADHD and depression, however, I am currently in some new territory here with getting treatment for bipolar disorder.

Some questions for you all, if you don't mind answering:

1. Is it possible to obtain a diagnosis and to start treatment only after 1 visit?
2. Should I show up prepared with a manifest, so to speak, of my life history and recurring episodes? If so, how specific should I get?
3. Do you recommend I bring my wife to my appointment with me?
4. ShouId I bother with taking a mood journal for the next couple of days?
5. Does treatment usually begin with some first line meds? Or should I expect a recommendation to go inpatient or to do an intensive outpatient program?
6. If I can't get a diagnosis after the first visit, how many visits should I "hold out" for before I can expect an answer from my pdoc?
7. Can I expect to get a thorough appointment at first? Or is it more likely that this will be a short, in-and-out, 15-30 initial assessment?

I guess that's it for now. Thank you all in advance for any replies and thoughts. Cheers!

[RedDawn]

Bipolar is a serious diagnosis that will be in your medical history forever, so most clinicians won't officially diagnose after one meeting unless you're so manic you need to be in the hospital.

Bringing a personal history is a good idea. The pdoc will want to talk to you, but you can give him something in writing for him to review later.

I would go to the first appointment alone. It's easier to be completely honest with the pdoc that way. (Pdoc might ask about risky sexual behavior in your past...)

A two day mood journal isn't really worth the effort.

Unless you're in a REALLY bad state you won't go inpatient. Just the fact that you wrote out a long coherent question shows you're probably not there. Intensive outpatient... Maybe, depends on what your state is. If you're functioning at home and functioning at work, then probably no.

Meds... Yes, you'll probably get meds.

Don't put the pdoc on the clock for the diagnosis. The diagnosis doesn't matter. TREATMENT and felling better matter.

Whenever I've seen a new pdoc it's usually a 50 minute assessment. That's actually a lot of time to be thorough. .

[Sunflower123]

I love your user name! Best wishes for your new pdoc appointment. Here are my experiences. YMMV.

1. I did get diagnosed my first time with the right pdoc.

2. Having your symptoms, family history and occurrences can be very helpful.

3. Bring your wife if her input and observations would be helpful.

4. A mood jornal for only a couple of days may not be helpful unless you are rapid cycling.

5. Treatment usually begins with bipolar meds older or newer generation. You won’t have to go IP or IOP unless you are a danger to yourself or others.

6. You should be diagnosed within the first few visits in my experience.

7. On the first visit the pdoc will spend longer with you to make an accurate assessment.

Good luck!!!

I agree with the advice given above, but as for if and/or when you get some new diagnosis, that really depends on the doctor. Know that if the doctor thinks you've diagnosed yourself, they may want to really be sure you're not exaggerating anything. Not that you would. Heck, I don't know you. But I know some people have. Honestly, bipolar disorder is not exactly a winning diagnosis. The medications can be a real pain in the butt. In the end, you just want to resolve your psychiatric issues. If it is bipolar, then I certainly hope you get the right dx and medications that really help you.

I've only ever gone into an IOP if my psychiatrist thinks I need very Intensive therapy and doctor supervision (3 days per week). Hospitalizations are very serious. If you're not in crisis, then you probably won't go unless you need to major detox from drugs or alcohol before starting new medications.

[north-polar-coaster]

Originally Posted by RedDawn

Bipolar is a serious diagnosis that will be in your medical history forever, so most clinicians won't officially diagnose after one meeting unless you're so manic you need to be in the hospital.

Bringing a personal history is a good idea. The pdoc will want to talk to you, but you can give him something in writing for him to review later.

I would go to the first appointment alone. It's easier to be completely honest with the pdoc that way. (Pdoc might ask about risky sexual behavior in your past...)

A two day mood journal isn't really worth the effort.

Unless you're in a REALLY bad state you won't go inpatient. Just the fact that you wrote out a long coherent question shows you're probably not there. Intensive outpatient... Maybe, depends on what your state is. If you're functioning at home and functioning at work, then probably no.

Meds... Yes, you'll probably get meds.

Don't put the pdoc on the clock for the diagnosis. The diagnosis doesn't matter. TREATMENT and felling better matter.

Whenever I've seen a new pdoc it's usually a 50 minute assessment. That's actually a lot of time to be thorough. .

Thank you very much for your reply! I'm not in crisis mode right now, just a bit depressed and maybe a little manic.

Why would the pdoc prescribe meds without a diagnosis tho?

[north-polar-coaster]

Originally Posted by Jennifer 1967

I love your user name! Best wishes for your new pdoc appointment. Here are my experiences. YMMV.

1. I did get diagnosed my first time with the right pdoc.

2. Having your symptoms, family history and occurrences can be very helpful.

3. Bring your wife if her input and observations would be helpful.

4. A mood jornal for only a couple of days may not be helpful unless you are rapid cycling.

5. Treatment usually begins with bipolar meds older or newer generation. You won’t have to go IP or IOP unless you are a danger to yourself or others.

6. You should be diagnosed within the first few visits in my experience.

7. On the first visit the pdoc will spend longer with you to make an accurate assessment.

Good luck!!!

Hehe thanks for the compliment! It's quite apropos as I actually do live in North Pole, Alaska

Thanks for the encouragement to bring a life history and my wife, I think it'll be important for her to be involved.

I'll keep you all posted!

[north-polar-coaster]

Originally Posted by BirdDancer

I agree with the advice given above, but as for if and/or when you get some new diagnosis, that really depends on the doctor. Know that if the doctor thinks you've diagnosed yourself, they may want to really be sure you're not exaggerating anything. Not that you would. Heck, I don't know you. But I know some people have. Honestly, bipolar disorder is not exactly a winning diagnosis. The medications can be a real pain in the butt. In the end, you just want to resolve your psychiatric issues. If it is bipolar, then I certainly hope you get the right dx and medications that really help you.

I've only ever gone into an IOP if my psychiatrist thinks I need very Intensive therapy and doctor supervision (3 days per week). Hospitalizations are very serious. If you're not in crisis, then you probably won't go unless you need to major detox from drugs or alcohol before starting new medications.

I agree that bipolar is no winning diagnosis, but I'm totally prepared for it. Since my first *major* mixed episode, I've been generally getting worse and a diagnosis at this point is someI need (whatever the diagnosis is...) so I can begin treatment. I am at a huge risk right now for losing my job and sanity, frankly, so anything I can do to start legitimate recovery will be a blessing.

I am not trying to diagnose myself, but short of borderline personality disorder (my therapist has explicitly stated that I do not have BPD), I don't know what else in mental health that explains my symptoms after having researched, and researched, ad nauseum.

I'll be honest, the side effects of the medications scare the crap out of me, but I generally respond well with different meds so I'm willing to at least give it a shot at this juncture.

Thank you for your kind response, I'll keep you all updated!

[Faltering]

It's very possible you will be diagnosed and prescribed medication on the first visit. The first visit is usually about an hour. The doctor will ask about your history of symptoms so definitely be prepared for that. I wouldn't tell the pdoc you think you're bipolar right away. Let him/her ask questions and connect the dots.

[RedDawn]

Originally Posted by north-polar-coaster

Thank you very much for your reply! I'm not in crisis mode right now, just a bit depressed and maybe a little manic.

Why would the pdoc prescribe meds without a diagnosis tho?

To treat symptoms.

Really, with any psychiatric disorder it comes down to treating symptoms and the meds used on two different people with the same diagnosis can differ wildly depending on their symptoms (and their reaction to meds).

[Victoria'smom]

Bring your wife or a close friend. You can write down your history but it'll be for you so you don't go blank. The appointment will last about an hour. It's pretty easy to dx me with bipolar. Usually the intake is with a therapist but it sounds like you did intake already. Medication maybe given and you'll probably be given a meds management appointment within the next month. Don't think things will be better as soon as you get meds. Most Dr's will only start you on one or two meds. Most of us are on 3-4 meds and didn't get to stable first shot.

[north-polar-coaster]

Originally Posted by Faltering

It's very possible you will be diagnosed and prescribed medication on the first visit. The first visit is usually about an hour. The doctor will ask about your history of symptoms so definitely be prepared for that. I wouldn't tell the pdoc you think you're bipolar right away. Let him/her ask questions and connect the dots.

Good idea. Thanks!

[north-polar-coaster]

Originally Posted by RedDawn

To treat symptoms.

Really, with any psychiatric disorder it comes down to treating symptoms and the meds used on two different people with the same diagnosis can differ wildly depending on their symptoms (and their reaction to meds).

Ah, ok. Gotcha.

[north-polar-coaster]

Originally Posted by Miguel'smom

Bring your wife or a close friend. You can write down your history but it'll be for you so you don't go blank. The appointment will last about an hour. It's pretty easy to dx me with bipolar. Usually the intake is with a therapist but it sounds like you did intake already. Medication maybe given and you'll probably be given a meds management appointment within the next month. Don't think things will be better as soon as you get meds. Most Dr's will only start you on one or two meds. Most of us are on 3-4 meds and didn't get to stable first shot.

Thanks for the advice I'll keep all that in mind.

[LacunaCoiler]

My wife is very involved in my treatment (I want it that way) but with all the docs I've seen they ask to see me alone first and do about 30-40 min interview before calling in the wife to get her side of things. So I guess expect the possibility that you may go in alone at first then they'll call the wife in.

[Wonderfalls]

I wouldn't bring in my wife on a first visit.(at least until later in the visit.) No matter how close and loving you are, you are likely to have at least slightly different memories and opinions of events, which confuses things. Especially on an appointment designed to diagnose you. If I were a doctor I wouldn't prescribe serious medicines on a first visit--I would want time to consider things you've said and his thoughts and the self-diagnosis you've made (not questioning it necessarily)--but I would schedule a second appointment very soon.

[BipolaRNurse]

My very first pdoc appointment was 90 minutes, and yes, I was given a bipolar diagnosis and a mood stabilizer. I'd gone in with a laundry list of symptoms and said I thought I was BP, which was a mistake---doctors hate it when a patient diagnoses him/herself. He proceeded to use the first hour to give me reasons why I might NOT be bipolar, but concluded that I probably was and said I had BP not otherwise specified. It took two years to get the BP 1 label, and even then I didn't get it from him, I got it from the hospital pdoc when I was inpatient for suicidal ideation/intent.

In retrospect, I wish I hadn't been so quick to diagnose myself. Treatment is the most important thing no matter what a person has. Once you get a diagnosis, it stays on your medical record permanently and sometimes that's quite a load to carry.

[bioChE]

So NPC, how did it go?

[Guiness187055]

I have my wife go to most of my pdoc appointments it gives my doctor a different perspective

[north-polar-coaster]

Originally Posted by Faltering

It's very possible you will be diagnosed and prescribed medication on the first visit. The first visit is usually about an hour. The doctor will ask about your history of symptoms so definitely be prepared for that. I wouldn't tell the pdoc you think you're bipolar right away. Let him/her ask questions and connect the dots.

Thank you for your comment (which I did read before my appointment yesterday). I took your advice and didn't mention bipolar right away, but you were right in the end. My pdoc did pretty much exactly what you described, including a diagnosis (Bipolar II) and meds (Risperidone and Lamotrigine). I went into the visit extremely nervous, but I walked out with a smile on my face and a weight lifted off my shoulders. It was decent.

Thanks again for your support!

[north-polar-coaster]

Originally Posted by north-polar-coaster

Good idea. Thanks!

Oops, forgot I replied to you before today... My bad!

[emgreen]

After a lengthy interview, the doctor will most likely plunge knitting needles into your eyeballs. Not to worry you, or anything. In fact, I can hardly see well enough to type this post...

[north-polar-coaster]

Originally Posted by LacunaCoiler

My wife is very involved in my treatment (I want it that way) but with all the docs I've seen they ask to see me alone first and do about 30-40 min interview before calling in the wife to get her side of things. So I guess expect the possibility that you may go in alone at first then they'll call the wife in.

Sorry this is late getting back to you, I meant to respond before my appointment yesterday.

I took your advice into consideration and I didn't bring my wife in with me yesterday -- I decided to go at it alone the first time and if my pdoc wanted to see my wife too, I figured she would ask (which she didn't).

Thanks again for your support!

[north-polar-coaster]

Originally Posted by Wonderfalls

I wouldn't bring in my wife on a first visit.(at least until later in the visit.) No matter how close and loving you are, you are likely to have at least slightly different memories and opinions of events, which confuses things. Especially on an appointment designed to diagnose you. If I were a doctor I wouldn't prescribe serious medicines on a first visit--I would want time to consider things you've said and his thoughts and the self-diagnosis you've made (not questioning it necessarily)--but I would schedule a second appointment very soon.

I ended up not bringing my wife after considering yours and LacunaCoiler's advice. I wouldn't have any issue bringing my wife anyway as we are really close, have literally no secrets between us, and we're pretty good communicators and allow each other to be right or wrong (we both have problems with interpreting what each other says, so there's a lot of grace). But you do bring up good points and it probably would have confused things if it got to that.

I did end up getting a diagnosis, and from what my pdoc says, she's starting me on pretty low doses (I think pediatric doses? I could be wrong, I'm not familiar with the dosing of Risperidone and Lamotrigine...) Also, my second appointment is in one month, so yesterday's visit will have a quick follow-up at least.

Thank you for your support!

[UpDownAround]

Originally Posted by north-polar-coaster

I ended up not bringing my wife after considering yours and LacunaCoiler's advice. I wouldn't have any issue bringing my wife anyway as we are really close, have literally no secrets between us, and we're pretty good communicators and allow each other to be right or wrong (we both have problems with interpreting what each other says, so there's a lot of grace). But you do bring up good points and it probably would have confused things if it got to that.

I did end up getting a diagnosis, and from what my pdoc says, she's starting me on pretty low doses (I think pediatric doses? I could be wrong, I'm not familiar with the dosing of Risperidone and Lamotrigine...) Also, my second appointment is in one month, so yesterday's visit will have a quick follow-up at least.

Thank you for your support!

They have a step up protocol for lamotrigine (lamictal) to keep you from getting the rash.

At my first diagnosis about 23 years ago, I went alone and the pdoc asked permission to phone interview my wife. I think that is helpful because we BP II people often don't recognize our hypomania as anything more than "better after being depressed".

[north-polar-coaster]

Originally Posted by BipolaRNurse

My very first pdoc appointment was 90 minutes, and yes, I was given a bipolar diagnosis and a mood stabilizer. I'd gone in with a laundry list of symptoms and said I thought I was BP, which was a mistake---doctors hate it when a patient diagnoses him/herself. He proceeded to use the first hour to give me reasons why I might NOT be bipolar, but concluded that I probably was and said I had BP not otherwise specified. It took two years to get the BP 1 label, and even then I didn't get it from him, I got it from the hospital pdoc when I was inpatient for suicidal ideation/intent.

In retrospect, I wish I hadn't been so quick to diagnose myself. Treatment is the most important thing no matter what a person has. Once you get a diagnosis, it stays on your medical record permanently and sometimes that's quite a load to carry.

Hello again BipolaRNurse

Incidentally you replied to my thread about two hours after I got out of the pdoc's office. Here's what went down.

I didn't bring my wife, but I did take about a 6 page "manifest", so to speak, of the events that I could remember leading up to yesterday, just as you did. We immediately launched into why I was there. On the advice of some of this thread's commenters, I didn't immediately mention bipolar as a self-diagnosis, but I did begin where I had my first major mental break from a year and a half ago. About half way through the visit, I concluded my story with the bombshell that my father has bipolar and that I thought I had it too, which is why I was ultimately there. She nodded in agreement and then we went straight away into the billion question questionnaire that she needed to ask.

At the end of the visit (about 2 hours) her diagnosis was Bipolar II, despite my intense manic driving incidents (see my previous threads for more info). I thought it would be Bipolar I, but after thinking about it, Bipolar II makes a good deal of sense and it gave me an idea where she drew the line. She prescribed me Risperidone to help me get back on a good sleeping pattern and Lamotrigine for the mania and depression, which I am currently in. Took my first pills last night and this morning. I gotta say, that Risperidone sure kicked in pretty good and I would out like a light within an hour and a half!

In conclusion, I agree with you that treatment is the most important reason why I was there. I was ready to accept almost anything so long as I could get a little something to help sort out the crazyness of my days. I was not at all surprised by her diagnosis and it made me feel better knowing I was at least on the right track. And to top it all off, my pdoc and I connected really well almost right away -- she's a really neat lady, I like her a lot.

Thanks again for your advice and support. I'll keep you all updated on how the meds affect me over the next few weeks/months. Cheers!