Neuropsych or Psychiatrist?
 

I saw my primary physician yesterday regarding my headaches and PCS symptoms. She feels I am depressed and need to see a psychiatrist. She said that psychiatrists are certified in both neuro and regular medicine. I feel that I am having problems with my head because of the injury. Will a psychiatrist be able to distinguish whether my symptoms are coming from a head injury, antidepressants I am on, or my seizure medicine. This is all new to me, but I find that I don't have very much patience and want to make sure that I am going to the right person the first time.

Thanks for any advice.

I'd see your neurologist, if you have one.

My neurologist is the one that prescribed my antidepressants and a whole host of meds to control the symptoms that popped up after my first head injury.

I'm not a doctor, but the way I see it- depression is depression, regardless of the cause. I feel that way about all my symptoms... knowing the cause doesn't matter much in the end- it is what it is.

See neither. Find a specialist in Physical and Rehabilitation Medicine. Do a bit of research to find the Rehab Doctor who is good with mild traumatic brain injury.

The neurologist is only good if he understands MTBI. Most do not. If they cannot image it with CT, MRI, or EEG, they say it should go away without any intervention.

The Rehab doctor has a focus at getting you better if possible.

My neurologist prescribed anti-inflammatories, an anti-histamine (for insomnia), and other useless things. He even discounted the natural remedies (B vitamins) that I take.

If the Rehab specialist thinks you should see a psych, neuro-psych or neurologist, then go.

The neurologists who prescribe anti-depressants do it to get your anxiety level down so you do not keep calling and coming back. Plus, the anxiety can sometimes make your symptoms worse. But the chemical effects of the anti-depressants can also be bad for a healing brain. Anti-depressants have been the cure-all for our screwed up health care system since the early 1990's.

Anti-depressants should be reserved for Psychiatrists and Neuro-Psychiatrists to prescribe, not GP's, PCP's, Internists, gyno's, nor neuro's.

Yeah but....
 

I must have a really good neurologist. I actually asked for the antidepressants because I have a history of being on and off them my entire adult life.

My neuro schedules me for a follow-up every 90 days and is always willing to listen to what's going on and re-adjust my meds as necessary.

My first head injury showed on an MRI, so maybe that's why mine is more proactive than most?

I just wanted to let folks reading this thread know that there ARE good neurologists out there. I've built my entire doctor network around her. I got a recommendation for a PCP from her, my PCP recommended my *cardiologist and so on.

*finally figured out that the fainting which caused three major head injuries is cardio related.

RisibleGirl,

Your neurologist is one out of a thousand. As you say, "He listens to you." This is not the norm. I have been seen by many different neurologists and not found one like you have. The various brain injury support web sites also report this situation. RisibleGirl, you have been blessed with this neuro.

The Physical Medicine specialists have been better. Two out of three have this willingness to listen to me. But then, I did research to find the two that listen.

I had a PCP that was good at listening but she did not have the good referral lists to work with.

Monday, I start occupational and speech therapy for the first time since my injury 8 years ago. Hope I can afford all of the co-pays.

I think your question is, "between a psychiatrist or a neuropsychiatrist, which should I see? Do I have that right?
If so, definately see a neuropsychiatrist!
They specialize in tbi, and pcs.

I went to one of the best rehab hospitals in philly, (Magee), and the doctor who is the one who is the "Director" of the hospital saw me, for intake.
He directed me immediately to a neuropsych.
I got the full regimen of testing and evaluation, and was seen out patient for about a year. (Of course, I can get back into this any time I need).

I agree also with what Mark said, as that's what I did.

Neurologists, by and by, are a lot who "wanted to be doctors, but not get their hands dirty". (That's just my take).

Mine is great! He's also a Ph.d, so that tells you.
I would never waste my time with a plain neurologist again.

As I understand your question, a Neuropsych is the way to go, over and above any plain psychiatrist. But, you'll probably find the best at a Rehab hospital as Mark has said.....

Pete
Asb

Thanks for the replies. I was seeing a psychologist within a rehab medicine clinic every two weeks for biofeedback and relaxation techniques. She then referred me to a chronic pain group this summer. I don't feel like I need a chronic pain group. I went to a "fair" last week where there were lots of rides, lights, sounds. I couldn't go to work the next day because I had such a headache. I didn't sleep at all the night of the fair. I was wide awake and I think overstimulated. Why is this stuff happening? We have a family vacation planned this summer for Utah and the kids are really looking forward to the mountain slides and the zip lines down the ski slopes. I can't even imagine doing something like this, but having two active kids and having once been active is really hard for me. Do I try things and then suffer the rest of the week or do I wait until the last day and it doesn't affect me and I have wasted the whole week? My neurologist is seeing me because of a seizure disorder, not a head injury. When I call about questions, her nurse tells me to take ibuprofen and the headache will go away in the few days. I feel there is something "wrong" with the right side of my brain and I'm not being heard by anyone. I have just recently (within the last couple of weeks) noticed that I lose my balance to the left quite frequently and when I walk I tend to walk to the left. I feel like I'm at my wits end.

Which specialty
 

People with PCS need to understand the different specialties.

Psychologists are usually Ph.D. or Psych.D trained. They are not medical school trained. They usually try to put a psychological cause to every diagnosis. Their treatments are limited to psycho-therapy. They may refer to an MD who will prescribe drugs at their recommendation.

Neuro-psychologists are still just Ph.D or Psych.D trained with a residency in Neuro-Psychology. This allows them to administer full battery neuro-psych assessments and interpret the data. Remember that they are interpreting the data, not scoring it. There is a serious need to read between the lines when sinterpreting neuro-psych assessment scores. They also have a bias toward psychological causation and treatment. They cannot prescribe medication. Their treatments are limited to psycho-therapy. They may refer to an MD who will prescribe drugs at their recommendation.

The above are often members of the APA, the American Psychological Association which has much lower standards for specialization that medical boards.

Psychiatrists are MD trained with a residency in Psychiatry. They can order blood and other lab work, prescribe drugs and also provide psycho-therapy. Their training in the chemistry of pharmacology provides a much better opportunity for proper medication therapies. Some are more prone to drug therapies with minimal or no psycho-therapy. Some are more prone to psycho-therapies with drug adjuncts. Their neurology training does not necessarily go beyond the basics. The Board that certifies psychiatrists is the same Board that certifies neurologists. Each certification is different.

Neuro-psychiatrists are MD trained with a residency in Psychiatry with further study and residency in neuro-psychiatry. They can order blood and other lab work, prescribe drugs and also provide psycho-therapy. Their training in the chemistry of pharmacology provides a much better opportunity for proper medication therapies. They usually have a more scientific approach to how the brain functions. They may be dual certified by the Board of Psychiatry and Neurology.

GP or PCP M.D's do not usually have much training in psychiatry beyond basic med school. They get their drug information from the drug companies and the drug representatives who try to get them to prescribe drugs. Their experience with anti-depressants is usually limited to what the drug companies told them and a bit of anecdotal information from their patients. They do not see psychiatric drug patients on a regular basis with their focus being a medicine review. Their medication review will often be limited to a general "How are you feeling" without any specific questions into the various side effects or other issues that come with psychotropic drugs.

Even run of the mill Neurologists do not usually have a broad understanding of psychotropic drugs. They may be good with anti-epileptics and movement disorder drugs or drugs for stroke victims but their knowledge of psychotropics can be haphazard. Their in-depth expertise is usually limited to those disorders that can be imaged with CT, MRI, PET, EMG, EEG, etc. The invisible injuries such as concussion leave them taking shots in the dark.

The most important issue to consider is the Continuing Medical Education (CME) that keep the physician up to date with current research. Some pursue improving their skill and knowledge set with CME. Others are content to go to Hawaii to play golf and get their CME hours credited.

The doctors who have established good multi-disciplinary approaches by combining the other specialties through good and open communication with the other specialties are often the best. Beware of those who try to keep you in their care only. They usually are less helpful. Their egos are usually much bigger than their skill and knowledge sets.

So, when it comes to Doctors, whether M.D., Ph.D. or Psych.D., it is always caveat emptor, Let the buyer beware.

Just because there are lots of letters after a name does not mean they are any better. I have seen M.D.'s with Ph.D's that were in Public Administration or Public Health. These extra degrees are worthless to a patient.

Don't let the white lab coats and extra diplomas blind you to your true needs.

So, just a little update. I went to see a psychiatrist today on my family physician's suggestion. I really liked him, seemed knowledgeable, etc. Within the first 1/2 hour, he was pretty much convinced that I was not depressed. He said that the "even" feeling I am experiencing is because I have reached the "poop out" effect from my Prozac. He is going to gradually ween me off of it in hopes that I won't even need it anymore. He said sometimes family docs seem to think that increasing your meds will make everything all better when in fact, it contributes to the problem. He told me there is a razor thin line between being depressed (with a little d) and being majorly depressed. He said that typically general practitioners just don't ask the right questions. So starting today, I am dropping my level by 20 mgs. and will check in with him in 5 weeks. Also starting today, I am going to rethink my life and get used to the fact that I have daily headaches and all the other good stuff that comes with PCS. I am too young to let this take over my life. Time is short and I have a lot to live for. I think that I am finally moving on in the stages of grief and have gotten to the acceptance level.

Sheds,

Sounds like you found a good psychiatrist. He agrees with my perception about GP's over-prescribing anti-depressants. Wean of the Prozac very slowly.

A 20 mg drop might be a bit fast. If you notice problems, you might consider only a 5 mg reduction. Do this 5 mg reduction in steps once every 2 to 3 weeks. When you get to 5 mgs, reduce to 2.5mgs for three weeks.

The withdrawal symptoms can be worse than the supposed depression the SSRI is supposed to treat.

Paxil can be even worse at getting off. I am on 60 mg/day. It will take quite a while for me to get off.

Regarding the headaches, ibuprophen is not a good idea to take when you are taking an SSRI like Prozac. Acetaminophen is ok though. It works well for my headaches.

I think I upset the Psychiatrists, the psychologists and the neurologists. I studied Neurotoxicology and found that the reason I was suffering so much.
I was suffering from IATROGENESIS. I was being poisoned by the drugs they were prescribing for a non-existant illness.
My faith and trust in Doctors is at a very low ebb indeed

not sure if this may be helpful to this discussion
http://www.breggin.com/

He has written a book called "Your Drug May Be Your Problem",amongst others
http://breggin.com/index.php?option=...d=15&Itemid=42

The good Doctor is quite correct, my studies into neurotoxicology have confirmed to me that Doctors are Prescribing drugs on the basis of what the drug salesman tells them, rather than reading the facts themselves. It is such a pity that Doctors never listen to what their patients are telling them. Their actions are indeed criminal and fraudulent. They are almost as dishonest as polititians.

I would not say doctors are criminal and fraudulent. As their diplomas say, they are doctors of medicine. That is what they do, prescribe medicine. It is the FDA and drug companies that are to blame.

The biggest problem is that the doctors are just about the only game in town. How do you find a good one and avoid the bad ones?

The patient needs to be self informed. The internet has finally broken the veil of secrecy the doctors used to have. Do the research and ask questions. Be careful what questions you ask. Many doctors get very guarded if they think you have too much knowledge.

If your doctor does not answer your questions, try to find one that will.

Doctors boast about their 7 years training. During that 7 years they are supposed to learn to listen to their patients, and to observe any distress they may be experiencing from the treatment.
They (or some of them) take an oath which includes "first, do no harm". I am now permanently crippled because they DID do harm. All of them treated the records, and totally ignored the patient.

Does a policeman, after shooting a villain, blame the manufacturer of the bullet for causing the damage?.

One goes to a Doctor to seek a solution to a problem rather than spending time searching the internet without guidance. Does a surgeon just give an opinion or does he actually cut open the patient to cure the problem?. To give a patient a toxic compound to ingest then tell the patient that he/she is imagining any feelings of poisoning is not exactly my idea of professsionalism.

hi jackie
 

hi jackie sorry you have been disabled any kind of male practice and people run for cover

what drugs did they administer and for what condition , what do you feel has been damaged , a nuero psych will be able to map any damage to the brain, see if your lawyer can get you to see one for evaluation ,without knowing the cause this is how they should work with there testing as results are more accurate

A long story. but basically, My mother suffered from Munchausens Syndrome by Proxy. She convinced Doctors that i was taking fits-- (when I was 13 years old) Despite my pleas, I was given anti-epileptic drugs for 45 years. Mainly barbiturates (impossible to stop taking).
My cerebellum and brainstem have been damaged by the drugs. It was the neuro crowd that refused to listen to me and added even more drugs to control the depressive action of the barbiturates and also amphetamines to counter the efects of the barbiturates.

All the tests these people carried out were negative but the still kept up the drug regime. Since the Neuros could not see the damage they were doing, how can a special witness see any better?.

Wow,

I was on phenobarbitol for years as a young adult. Also Dilantin (phenytoin). I did not know they have long term side effects.

I took Klonopin (Clonazepam) for a year about 8 years ago. It was not good. Now, I have been on Neurontin (gabapentin) for 8 years since switching from the Klonopin.

I agree with vini. A neuropsychological assessment (Ph.D.)will help you define the current dysfunctions. A neuropsychiatrist (M.D.)may be able to help you get your brain chemistry normalized.

I have read Dr. Bregggin's comments. I wish there was something beside the Paxil (paroxetine) that I take at maximum dose to keep my brain from looping on mundane meaningless repetitive thoughts. He says to stay of these meds but offers no alternative. A new psychiatrist has been recommended to try to find a new drug regimen.

But I already KNOW what is wrong.. I studied neurotoxicology. I made contact with the Epilepsy research foundation and was invited to their meetings at the Royal Society. Professor Alan Richens -co-author of the book " A Textbook of Epilepsy" has given me his personal copy --signed to me. The professor told me that in a probability I was a foremost authority on the subject. I have lesions on the flocculonodular lobe of my cerebellum --lesions in the flocculus usually affect the vermis resulting in truncal ataxia.

Anti epileptic drugs are cerebellar toxic, and when you never suffered from epilepsy in the first place they are more toxic -- The drugs were not phenobarbitone but phenyl methyl barbituric acid and Sulthaime both were taken off the market in 1974 as being too toxic --I had been taking them for 17 years at that point. Cerebellar/brainstem Dysfunction in fact

Wow,

I was put on the dilantin and phenobarb in Jan 1971. I missed a bullet when the doctor didn't prescribe those poisons they gave you.

My seizures were very mild, petit mal (absence) and cognitive seizures.

What functions do you lose from the poisons? Just motor ataxia or also sensory?

My father passed away from complications of Parkinson's and vascular dementia. I understand your struggles with a movement disorder. My brain condition sometimes manifests as tremors and limb jerking. Sometimes my Neurontin helps. Other times, nothing helps. I end up sleeping in the other room in a reclining chair because my body jerks prevent my wife from sleeping.

At my last doctor's visit, she warned me about the long term side effects from the Neurontin.

Before I started the Neurontin, I had ballistic movement problems. If I started to move my arm, it would fly to the end of that range of motion. I had hit my wife a few times when this happened in bed. I once kneed her as I tried to roll over in bed. The Neurontin has stopped the ballistic movements but not all of the tremors. I still have occasional postural rigidity problems where my shoulder and upper back muscles tense up. My fingers and toes occasionally spasm in strange positions.

My hands will grip objects in my sleep. My wife knows to keep her hands away from mine because I will squeeze her hand with a vise like grip in the dead of sleep. Sometimes she will find me locked in a major body spasm with a grimace or scowl on my face.

Sometimes an odd thought or stimulus will cause muscle jerks that I have to literally shake off by shaking my arm or shoulders.

I wish somebody could tell me why this stuff happens. Fortunately, it is usually just weird or funny. Other that the few times I hit or pinched my wife, it has not caused any serious problems.

One neurologist wanted me to try Gabatril and Seroquel. After checking the literature, I chose not to try them. I did not need to try a weak shot in the dark with such strong side effects with unknown long term outcome.

It would seem that you have many probems, and as such you might need to allow your Doctor to try different drugs. Bear in mind that different people get affected in different ways when taking drugs. They may find one that is compatable with your condition. Long term use of drugs is bound to cause problems. In my case the drugs were not what could be called high dose. Having said that, I now know that long term low dose drugs cause the most damage, since no-one can gauge the effects. All my paraspinal muscles are paralysed both motor and sensory.

Jackie, I agree. And by the time the doctors get through with you, you CAN'T learn to search "the internet without guidence". Thanks! billie

I WILL say this about that . . .
 

Through the years, I have developed the notion that, if you must trust a physician, trust one who carries around the PDR and actually reads about the drug before prescribing it. Yes, I have known one or two that actually did that. That having been said, however, guess who writes the drug descriptions for the PDR? sigh. billie:(

Choose your poison
 

:Bang-Head:Since my injury my experience with doctors has been almost uniformly awful. Mark is dead right that they don’t listen.

I could write a book about what an arrogant SOB my neurologist is. On the physical side, a neurologist is probably a necessary evil, but I agree with Mark that a good Physical Medical Specialist is your best bet.

On the emotional side, my psychiatrist couldn’t get it through her head that I’m not in pain because I’m depressed; I’m depressed because I’m in pain. It’s hardly a subtle distinction. All she wanted to do was toss drugs at me. No thanks. Outside of studies done by the drug companies themselves, there is absolutely no proof that SSRIs alleviate depression. In the case of TBIs, a large study at Toronto’s Sunnybrook hospital found that they might even be harmful. The British Broadcasting Corporation (BBC) investigative journalism program Panorama did a six part series on SSRIs that would probably get them yanked off the market if the drug companies weren’t so powerful. In Britain it did end the practice of giving Prozac to children.:Soapbox:

My psychologist has proved much more useful. In addition to exploring how I feel about what happened, he’s been invaluable in helping me deal with the practical fallout of having a serious brain injury. Thanks to his advice I’m doing a better job at cooking without leaving out ingredients, not missing appointments and regaining an understanding of figurative speech. He’s also been excellent on the big existential questions like how do I find value in a life that is so diminished physically and intellectually; how do I reconnect with family members who are now practically strangers to me when I’m a stranger to myself, etc…


There are times when I think the accident was less traumatic than the doctor visits.

jackie and others,

The drugs I am on have been review by various other doctors since they were first prescribed. The latest suggested considering a change until I explained what I had already tried. She then thought my current meds were about as good as it gets.

I keep watching the drug news to see if something else comes on the market to replace Paxil or Neurontin. So far, they are still the best.

Zoloft might be worth considering instead of the Paxil. It will cost me a big co-pay to find out from a psychiatrist. I don't like to depend on non-psychiatrists for psycho-active medications.

Regarding the PDR. I would prefer that the prescribing physician has more experience with the drug than just what the PDR and drug reps say. If thew prescribing physician has to look in the PDR, he does not have enough experience with the drug.

They say that if you need a specific surgery, you want a doctor who has done hundreds if not thousands and a hospital where they have done thousands.

In my home remodeling specialty, I had done over five hundred jobs before I began to be truly competent at the task. I was still learning new skills after 2000 jobs.

The same goes for physicians, especially physicians who are diagnosing/treating MTBI. .

Hockey,

I agree. maybe those who think they have PTSD from their brain injury are mistaking the brain injury for the trauma caused by the physicians and others telling them that all of their troubles are 'in their head.'

Well duh....

The pros just think it is in the emotional thinking and not the physiological processes and anatomy. They are the ones who should have their heads examined. We PCS/MTBI have a good idea of what is happening in our heads. We just want someone to recognize the reality of our symptoms and offer some valid explanations and help.

No matter how firmly the pros try to tell us that we are nuts, they are still the ones with a screw loose.

Can't agree more with you Mark. Actually Dr. Amen, of the Amen Clinics, was one of the first psychiatrists to come out and say that a lot of the psychological problems Americans deal with are the result of a physical abnormality to the brain.

I used to work with MD's when I was a researcher and I learned that you really can't fault them for how they think. They are just a product of the American Medical School System. The medical schools grind into their brains this sort of rigid and methodical way of thinking, and never, ever go against the establishment. None of them are taught to think critically or "outside of the box," and a lot of them aren't exactly "smart", they just have extremely good memories and they have gotten by on that. Most that do think critically and abstractly do this because they took it upon themselves to do so, or they had really good undergrad majors like engineering for physics. But, that is just my opinion from my limited experience.

Health Psychologist for TBI headache
 

Look up a board certified health psychologist for your TBI headache