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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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What battery of tests should a psychiatrist OKMH527211

Resolved Question:

What battery of tests should a psychiatrist perform to rule out somatization disorder and psychosis, NOS on AXis I of the DSM? What psychiatric battery of tests are needed before the psychiatrist gives the patient a score on Axis 5. What does a score of 35 indicate?

Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

Hi! I'll be glad to be of help with this issue.

I can imagine how frustrating this situation must be for you. Psychiatric terms and descriptions can seem like they are very precise. And yet how the diagnoses were arrived at can be very mysterious. This is because there are no blood tests or MRIs or similar types of batteries of tests that are done either as outpatients or in the hospital psychiatric departments. Rather, psychiatric diagnoses are a matter of matching symptoms with diagnostic criteria.

And this is actually the key to my answer to you that you need to consider and think about. There were no batteries of tests conducted to arrive at the diagnosis you describe. Let's start with Somatization Disorder (SD). The diagnostic criteria (referred to as the DSM criteria, because the DSM is the reference work from the Am. Psychiatric Assn. that lists the symptoms that we use to diagnose all mental health disorders) for SD are not that long, but they require evaluating the patient's history in detail. Here is a copy of the DSM criteria for Somatization Disorder on a web page I found for you:

http://www.dmacc.edu/Instructors/tkwilson2/AbSomatoformDSM.pdf

Psychosis, NOS (Not Otherwise Specified) is a DSM diagnosis for a psychotic episode that the doctors did not see as related to a medical condition, drug use, or ongoing schizophrenia or other thought disorder. That would be diagnosed by an interview with the patient and evaluation of the patient's responses and behavior during the interview(s) along with reports of the patient's behavior outside of the interview. The psychiatrist might or might not use a formal Mental Status Exam. The DSM doesn't require this for that diagnosis. Here, though, is a page I found on the web that gave a good overview of what the Mental Status Exam is like. You can see it's also a framework for interviewing a patient but a little more formal:


http://www.testandcalc.com/richard/resources/Teaching_Resource_Mental_Status_Examination.pdf

Now, your final question really gets us to the subjective part of the psychiatric diagnosis process. The Axis 5 GAF Scale, which you are referring to when you say a score of 35, is the psychiatrist's judgment about the patient's overall functioning. Here is a copy from the DSM of what the page in the manual on the Scale looks like:

https://www.msu.edu/course/sw/840/stocks/pack/axisv.pdf

So, you can see that a score of 35 means that the patient has some significant impairment both in functioning and functionality. The ability to work is impaired, there might be some psychosis, and there might be other problems as well.

Okay, I wish you the very best!

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Expert:  Dr. Mark replied 1 year ago.
Hi,


I hope you're well. I want to add to my answer that psychiatric diagnoses are not usually based on tests the way medical diagnoses are made. There are sometimes assessments made as I wrote, but most often the diagnoses are made by interviews, the patient's self-report, and histories the doctor has.


Okay, I wish you the very best!


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Customer: replied 1 year ago.


I did know about the somatization disorder, and that symptoms must start before age 30. And, that's the kicker. As a professional I had already undergone psychiatric evaluation before my ordination, and while in the Army as officially not having any mental disorder or psychiatric disorder, which the psychiatrist wrote "no history of a mental disorder." To justify this misdiagnosis the doctor wrote I had been treated at a psychiatric center (that does not exist) and I was refractory to treatment. Your answer helps alot, confirms what I already knew about this; but later I was found to have a swallowing disorder diagnosed by esophageal mynometry, put on a soft food diet and gained weight again. The doctor, not psychiatrist-type wrote I was losing weight for five months due to depression, and I was refusing to anything for five months and drinking only water (report, as you mention from others). Of course this could be easily disproved by the fact that the nurse exclaimed I don't know what they're talking about you just ate two plates of food. I started losing weight in the hospital while being treated for a seizure. This hospital refused to review my record or even rule out any physical problems with medical testing, except a blood test where my glucose was 140, and vitamin D deficiency. My husband's friend died suddenly, he called EMS because he was depressed and afraid I would die and EMS called the police who basically detained me for suicidal ideation, I did not have. The psychiatrist said I didn't have any mental disorder, but wrote she wanted to rule out psychosis, then transferred me by my signature to the medical ward, they didn't give me the esophageal mynometry that showed the motility problems, wrote I was in denial. But did not review that I was medically retired for physical service connected disability. Also, did not tell me they were even evaluating me for a mental disorder. Anyway social security turned me down for disability because of the record, but when I submitted my records declared I was


physically disabled. My husband finally told them the truth I was not suicidal or anxious about my health or any of that and I won the disability case. But I consider the record slander and am asking for changes and deletions of falsified information. So my understanding from what you are saying that psychiatry is all subjective. But, my experience is that to tell if a person is in denial or what they are thinking you have to actually take the psychiatric exam or a psychiatrist or doctor can say they said things they did not say. I mean statements without quotes about what I said are written, really ridiculous statements I did not make. Should I then ask a lawyer? I want to sue for malpractice-physically held down shot with valium and made to take a fifth x-ray I did not need that was taken while I was in the hospital for the seizure, for example.

Customer: replied 1 year ago.


Ok, let me be more direct. I have other records even after that visit to show that I was neither psychotic nor did I have somatiform disorder. In fact, the psychiatrist wrote she should would rule these things out, but never did. I mean she never spoke to me again, and transferred me to the medical floor. What she did write is "preoccupation with the medical illnesses and somatic symptoms that are pervasive in her life at present." What are somatic symptoms? Those included in the website you sent? Does this mean psychiatric symptoms? My question is how can a doctor go by the report of a family member only? Shouldn't the psychiatrist ask the patient for names of family and friends that can testify to the real situation? e.g. what is happening in the behavior of the husband who is reporting? How can a psychiatrist write that I said things like I have parasites swimming in my bladder, when I said no such thing? There are no quotes around the statements. I graduated from Princeton, and would not say such senseless things. What right does a patient have to challenge the psychiatrist? Of course, I will not see her again but it concerns me that she had me sign into the psychiatric ward on the pretense that she was going to have the medical doctors treat me for a swallowing problem that was diagnosed later.


 

Expert:  Dr. Mark replied 1 year ago.
Wow! It really sounds as though you got caught in the unpleasant part of the mental health system: that we don't know so much more than we do know and that much of our diagnostic tools are indeed observational and based on personal reports from patients and family members as well as histories. These are not objective tools such as medicine has for diagnosing diabetes, for example. And it really sounds as though you were caught in this imprecision we have to live with as professionals.


Whether it is in your best interests to consult an attorney I can't state. I would assume it's a question of how much it would cost to have a consultation with a top notch tort attorney. Because you would certainly need to have someone who is very good, I would think.


I can explicate a little further, though, what this means: "preoccupation with the medical illnesses and somatic symptoms that are pervasive in her life at present."


This would refer to a sensitivity to physical pains and aches (for example) and an unrealized fear that they are part of some organic disease or illness. A common example would be someone who has some left shoulder pain and is very afraid that it is a heart attack. It would become preoccupation with the medical illnesses and somatic symptoms that are pervasive in her life at present if the person went to the emergency room, found out it was not heart related, then went to her doctor who confirmed, then tried to find a different doctor to give a second opinion, and then was back in the ER a week later with the same shoulder pain but in a slightly different location. This is a rather simplistic example but I hope it illustrates the point.


Again, I am so sorry you have gone through all of this. I wish you the very best.


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5111
Experience: Dr. Mark is a PhD in psychology in private practice
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