A careful psychiatric evaluation is the foundation of effective treatment. Before deciding what might help, we must first understand the nature of the problem.
Psychiatric symptoms rarely occur in isolation. Difficulties with attention, anxiety, mood, sleep, or behavior can arise for many different reasons, and similar symptoms do not necessarily indicate the same underlying condition. Arriving at an accurate diagnosis requires more than identifying a collection of symptoms.
Understanding the Whole Person
My evaluations begin with a detailed clinical history and a careful discussion of the difficulties that have brought someone to seek help.
I consider not only current symptoms, but also their development over time, previous treatment experiences, medical and family history, relationships, and the circumstances in which problems arise.
For children and adolescents, this may also involve information from parents, schools, and other clinicians, when appropriate.
The aim is to understand the individual in the context of their life, rather than approaching diagnosis as a checklist.
The Importance of Diagnostic Accuracy
A symptom is not necessarily a diagnosis.
Difficulty concentrating, for example, may reflect attention-deficit/hyperactivity disorder, but it may also occur in the setting of anxiety, depression, sleep disturbance, or other difficulties.
Distinguishing among these possibilities matters because different problems may require very different approaches to treatment.
A diagnosis is sometimes apparent early in an evaluation. At other times, the clinical picture is more complicated, and a degree of uncertainty is unavoidable. I believe it is important to acknowledge that uncertainty rather than arrive prematurely at a conclusion.
From Evaluation to Treatment
The purpose of a psychiatric evaluation is not simply to assign a diagnosis. It is to develop a useful understanding of the problem and consider what, if anything, should be done about it.
Recommendations may include psychotherapy, medication, a combination of approaches, further assessment, or consultation with other professionals.
Not every evaluation leads to a recommendation for medication. Sometimes the most useful outcome is a clearer understanding of the difficulties themselves and a more informed sense of how to proceed.
My goal is to offer a careful, individualized assessment that provides a sound foundation for whatever treatment may follow.