Psych rec. for 'Differential Diagnosis' - San Francisco / Peninsula
September 8, 2018 12:09 AM   Subscribe

I'm looking for a Psychologist recommendation, preferable located in either San Francisco or the northern Peninsula, who's able to perform the battery of assessments that would lead to a Differential Diagnosis.

My personal coach has recommended I seek the services of a Psychologist for the purpose of obtaining a "Differential Diagnosis". Someone who would, over the course of 3-4 sessions, use a battery of diagnostic tools that would result in a written report.

I believe his recommendation is warranted and I'd like to pursue it. He has started to wonder if I might be affected by something like Bipolar II . He knows me very well (we've worked together for almost 2 years, sessions every week) and I fully trust him and his credentials, but apparently the performing of Differential Diagnostics is not in his wheelhouse.

Context: I've struggled with depression and anxiety for ~25 years (now in my mid forties). I'm currently under the care of a Psychiatrist for medications (only) ; have seen him maybe a half dozen times over the past 7-8 months. I've been on Cymbalta for over 10 years and for most of the past 3-4 years (or more) I haven't felt that it's been helping very much. My psychiatrist put me on mirtazipine (Remeron) a few months ago, and after a few weeks' time I experienced significant (but not complete) relief of symptoms -- the depression certainly improved, the anxiety did as well though somewhat less so.

However, the effects were short lived. In the past several weeks I've experienced a significant increase in both sets of symptoms, had a couple 'breakdowns' which significantly strained some important relationships, and my ability to do my job is almost nil ; I'm currently on FMLA Leave from work. It's entirely possible there are multiple things happening at once - significant work stress from a relatively new role/position ; some chronic physical health problems that are making it almost impossible to gain benefit from even a minor amount of exercise; tension and 'degraded quality of life' for both my wife and child ; general exhaustion from these conditions having persisted for so long.

I'm looking for a Psychologist recommendation, preferable located in either San Francisco or the northern Peninsula, who's able to perform the battery of assessments that would lead to a Differential Diagnosis.

Thank you.
posted by anonymous to Health & Fitness (4 answers total) 1 user marked this as a favorite
So, you're looking for neuropsychological testing.

A teacher friend in the Bay Area says her students and families often use The Clinic, their testing is comprehensive and reports are solid. They have 6 locations, 2 are in SF.
posted by yes I said yes I will Yes at 3:17 AM on September 8, 2018

A "differential diagnosis" is just a diagnosis. That's what a diagnosis does — it differentiates among many possible diagnoses and arrives at what the clinician thinks is th most likely one. If you are seeing a psychiatrist, then he or she has already diagnosed you.

I'm not your psychologist but I am a psychologist, and from what you're describing I don't see what neuropsychological testing would do for you. You'll pay for extensive tests of functioning, and they'll find that you're not functioning well in a number of areas (because, as you already know, you're not functioning well), and then they'll come up with some "neuro"-sounding diagnoses like ADHD and then you'll reify those (i.e. think that they're actual "things") and think that they've "found" something that you didn't know before and that somehow get to the "root" of your problems.

But most likely nothing will really be gained by this. If your coach is concerned that you might have Bipolar Disorder, why don't you ask your psychiatrist about this? A competent psychiatrist can diagnose Bipolar Disorder via interview, including history and current symptoms.

I would also suggest that you consider asking your psychiatrist for a referral to a "talk therapist" — either a psychologist or social worker — because it sounds as if your current coaching is not adequate treatment for what you're going through.
posted by DMelanogaster at 10:40 AM on September 8, 2018 [13 favorites]

I am a physician but not a psychiatrist. Echoing DMelanogaster above, I suggest starting with the psychiatrist who is already treating you. Let him or her help you figure out next steps. Extensive neuropsych testing is probably not the best place to start here.
posted by killdevil at 1:00 PM on September 8, 2018

I agree with DM above - a differential diagnosis is just a shortlist of possible diagnoses. I can give you that now: you might have any or all of anxiety, depression, bipolar, ADHD, ASD. Done. Not hugely helpful, is it?

What you actually want is a review of your original diagnosis. You can ask your existing psychiatrist about this, or get a second opinion. The fact that you haven’t found an effective drug regimen doesn’t mean that the diagnosis is wrong, but it’s always worth reviewing things if your symptoms aren’t improving.

Your coach may be very good in lots of ways, but it doesn’t sound like they have much of a clue about psychiatry. No reason why they should, as they aren’t a psychiatrist, but it’s not hugely helpful of them to throw diagnoses around in that situation. I would agree that an actual psychologist as an adjunct to the psychiatrist might be helpful - your psychiatrist’s office may have recommendations.
posted by tinkletown at 1:01 PM on September 8, 2018 [2 favorites]

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