Expert: Ivan Goldberg, M.D. - 10/23/2008

Question
Dear Mr.Goldberg



 I would like to ask for your opinion on a medical procedure. Three professional opinions have  been made based on psychiatry exam. Two of them found that the patient (myself) has bipolar II affective mood disorder. The third one disagreed saying that the patient shows no signs of bipolar II affective mood disorder.

                           Due to the disagreements a fourth opinion has been made.

                           However the fourth opinion was based only on the previous three  opinions and not on an exam and it says that the patient does not have bipolar II affective mood disorder.

                           I am most concerned about the fourth opinion and it’s method.

Would you please be so kind and tell me what you think ?

How accurate can the fourth opinion like this one be ?

Can it be accepted as a professional opinion at all (  since there was no exam ) ?

According to The Best Psychiatrists in the U.S.A.(Include yourself)  what is the generally accepted principle for this type of cases?

Thank you for your time and I appreciate your help!

Peter

Answer
Hi Peter . . .

Psychiatric diagnoses are best made when a psychiatrist has a chance to interview a patient, a close friend or relative of the patient perform a mental status examination, and review the records of any past treatments. In some instances, knowing the results of various tests (medical, neuropsychological, etc) are also necessary.

It is not unusual for psychiatrists to differ, or for the final diagnosis to be something like "Undiagnosed psychiatric disorder with depressive, anxious, borderline and paranoid features."

Best regards . . .

Ivan Goldberg MD
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