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Evaluation? What does that mean? - October 9th 2010, 09:13 AM

My counselor said I need to see a real psychiatrist and be "evaluated" when I told her that my depression is controlled by a separate presence in my mind. I told her I'm not sure if it's real or not. Then she started being all cryptic and acting like she wasn't sure what to say. She told me that I need to see a real psychiatrist because she can't be "accurate" enough. I'm kind of scared now. It'd be like if you went to your family doctor for a routine examination and they frowned and said, "Oh... I don't think I can properly diagnose this. I'm afraid you'll have to go to the hospital for more tests." It's like she's suggesting that something serious is wrong, and that scares me. I want to know WHAT they're evaluating and why.

So, to get to the gist, has anyone ever been evaluated? What's it like? What does it mean, and what do the results determine? I'm scared and I want to know what's going on. I was going to ask my counselor, but our session ended and she had another person waiting.
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Re: Evaluation? What does that mean? - October 9th 2010, 09:28 AM

Don't be afraid. It just means that she believes you need someone who is more experienced with your type of depression. A psychiatrist is better equipped to issue treatments for depression since it's a disorder of the mind. The doctor you were seeing (I'm assuming was a psychologist) is only able to give limited counseling. Where as if necessary a psychiatrist can administer medication to help you get control over your depression. Think of it as a step forward in conquering your depression. =]

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Re: Evaluation? What does that mean? - October 9th 2010, 10:21 AM

There are various "red flags" when talking to someone, things you don't need to be trained to notice. By saying there's a separate presence, the assumption is that there may be a psychotic disorder, delusion disorder or depression disorder with psychotic features, which requires proper psychiatric medication. It's a flag that there's something much more serious than what was previously expected. It's like if you were the counselor and your client tells you that they enjoy tearing living animals apart and building and testing torture devices for humans their father helped them build. That's going to be sending red flags all over the place and as someone who deals with the basic depression, anxiety, eating disorder and a few personality disorders, this is way out of your league. So, you would refer them to someone who knows more.

The psychiatrist is going to want to talk with you, try to understand how you've been feeling and coping, asking about your life, family and building a rapport. The first session allows them to get a good amount of information and may go for more sessions to get an accurate diagnosis. They may prescribe medications on the first session just to see if it helps. Sometimes they will ask for additional tests, such as brain-image scans (CAT, MRI or EEG, doubtful to use PET and other ones) or written or verbal tests.

The way it works is the psychiatrist uses a diagnostic tree. These are a set of yes-no questions and depending on the answer, it either leads to a diagnosis or you go further down the tree. At the bottom of every tree, the diagnosis is NOS or possibly none.

They may want to talk to your parents because your parents act as observers to your behaviour and can help the psychiatrist verify and gain further information. You can choose to have your parents in the room with you as the psychiatrist talks with you, there is no law (at least in Canada as far as I'm aware) for someone your age to have the parents present. They may be interviewed in a different room by another person, either a social worker, therapist or psychiatrist. Since you're a minor, the psychiatrist has to tell the parents their findings. They don't have to mention specific things you said unless something stands out a lot.

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