Diagnose BP w/ Single Interview?
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Q:  Im a 23 year old woman who has recently been diagnosed with BD. My question is, can a psyquiatrist make that diagnosis with a single  interview?! Hope to hear from you soon 

Dear Ms. G' -- 
That's a good question, in that lots of people probably wonder that.  Truth is, we do that all the time.  We're expected to.  People come to us with symptoms, which they hope we can help resolve.  They often have symptoms that are severe enough, sometimes dangerous enough, that if there's a treatment that might help, they want us to get going with that right away.  And to select a treatment to offer, we always try first to "make a diagnosis". 

When this process is done right, the "diagnosis" would be only the most likely of several potential diagnoses that would be considered.  We would call it our "working diagnosis" -- our current best way to explain things, and our current way of leading the patient to a treatment option based on their symptoms.  

The most important thing for us psychiatrists in this process is to maintain an open mind to the possibility that our initial diagnosis is not correct.  This includes the possibility that the person who came to us, for one reason or another, does not have a "diagnosis" at all; that they somehow ended up in front of us, but do not really have a condition that warrants treatment of any kind (which is usually the threshold for making a "diagnosis" in the first place).  

In medical school they teach "if the patient does not respond to treatment, reconsider the diagnosis".  So if after the first try at a remedy for a person's symptoms there is not clear improvement, before launching off on a similar treatment (e.g. another mood stabilizer for "bipolar disorder"), there should be a reconsideration of the diagnosis.  Maybe it's something else and that's why the person didn't respond.  However, unless we have new information at that point, the diagnosis is likely to stay the same -- presuming we went through the process right in the first place; until new information emerges that points to a different diagnosis.  

Granted it does sound presumptuous to "make a diagnosis" after a first interview, which sometimes can be brief (like if the doc' has hundreds of patients she's supposed to be taking care of for a mental health agency, and has little control over how much time she can spend on that first interview).  But I hope this answer, which may be more than you wanted, will help people understand how we approach this stage of our work. 

Dr. Phelps

Published September, 2002


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