Expert: Ivan Goldberg, M.D. - 1/26/2010

Question
My 41 year old son has gone to a psychiatrist, one session due to personality problems that started about 10 years ago. He is taking Zoloft, Concerta, Wellbutrin with no results. Now this dr is adding Abilify after one session and diagnosing Bipolar disorder. My concern is that none of these doctors have attempted to rule out any physical issues first. His medical history is: Diabetes (not controlled properly), Thyroid function destroyed due to Graves Disease (not sure if he takes thyroid medicine correctly), Major car accident at the age of 16 with head injury and broken back that was fused T3 to T5, and shingles. He had a slight change in personality after wreck that I attributed to his age and stress from the wreck at the time. I have been concerned about possible Frontal Lobe  damage for years now as the possible reason for his change in personality.  My main concern is the doctor only conferred with my son with no interviews of his family.
How can he make a proper diagnose of Bipolar Disorder without ruling out physical issues or at least talking to his wife and family?  How should we handle this?  I'm truly concerned for his life.  

Answer
Hi Diane . . .

Psychiatrists often, as part of the initial evaluation of their patients, invite family members to one of the early sessions to provide history that the patient may be unaware of or unwilling to share. To try to make a diagnosis without this information will in some instances will lead to major disgnostic errors. IN anycase, a psychiatrist starting to work with a new patient with a mood disorder should order laboratory tests including thyroid tests.

If your son wants the doctor to have you included in the diagnostic process he should tell the doctor that he would like you and/or his wife to be included. The situation becomes difficult if your son does not want you to attend one of his sessions. In that case there are a couple of things you can do. One would be to send the doctor a detailed letter in which you ask the doctor to consider the possible relevance or the history you provide. As a cortesy a copy of that letter should be given/sent to your son also. The other thing you can do is ask your son to get a second opinion from another physician.

Best regards . . .

Ivan
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