What to expect at an initial private psychiatrist appointment

[Shattered04]

I've (finally, after years of procrastination due to fear) got an appointment with a private psychiatrist in a few weeks. I struggle with anxiety and depression (especially related to PMS) and I also very strongly suspect I have ASD/ADHD. This doctor specialises in all these things including female hormones.

I'm obviously very anxious about what will happen at the first appointment. It goes without saying every doctor is different, but what kind of thing can I expect? What would the format be? They've not (yet) asked me for any more details other than the brief ones I supplied in my cover email.

Also, I'm currently on Venlafaxine (75mg, instant release, prescribed by GP a few months ago) - is he likely to change or add to my prescription after a first appointment?

Thanks!

Hi shattered04,

I completely empathise with you, it can be a really daunting experience.
They will most likely ask what it is that has led you to come and see them, what you think is the "issue" and then delve into your current lifestyle and your background - childhood, siblings, if your parents are still together etc.
A lot of people resent being asked about the childhood aspect but it helps them gain a background of stability and factors which may have impacted your belief system and self worth growing up.

They say that by the age of 7, you have established your self worth which resonates to me as I was severely bullied as a youngster and so my self worth was really impacted and have myself, suffered with mental illness all my life, combined with Trauma when I was incredibly young from the age of 6 months - 11 years, constantly being in and out of hospital with Kidney operations and Thyroid issues.

The most important factor is that you are being seen and they will put together a plan of treatment and have access to great support services. I have had 1:1 therapy and group therapy which I think really helps.

Good luck - I hope it goes well!

p.s. they may change prescription if they feel there is a more suited one for you, it can take some time to make the change and it's very individual with what will work for one may not work with another. They'll ask you how you are finding it - if you don't like it, tell them and they can help.

Thank you!

I completely understand about the childhood aspect - as you say, so much comes from there. I always felt "different" to everyone else growing up which I now realise is most likely down to being autistic but it would never have been recognised as such in girls at the time. I mask very well as an adult, but it took a long time to learn how to do that, so there is plenty of evidence from my childhood. I was also bullied a lot as a child, mainly due to my poor presumably ASD-related social skills. I know that had a big impact on my self worth and therefore, as you suggest, there's the knock-on effect into adulthood with mental health issues.

My prescription isn't great, I do hope he'll be able to change it for something more suitable. Part of what made me finally feel brave enough to go for it was that I realised my GP couldn't prescribe the medication I probably really need, I needed a consultant. And somebody who was an expert in diagnosis too, to make sure it's the right stuff. I could play the anti-depressant merry-go-round for years with the GP but I wasn't prepared to do that.

Thank you for your kind words

Private psychiatrist will do a thorough assessment, hopefully give you a diagnosis within one session and can change your medication so your GP can prescribe as per their recommendations same as an NHS one.

It's a good idea to write down anything you want to make sure you don't forget to mention, and make sure you write down any questions you have and make a point of going through your list of questions before you leave.

Thank you! I am guessing he won't be able to diagnose ASD or ADHD from a single session, but hopefully he can suggest I come back for a more formal assessment. I'm hoping he can prescribe something in the meantime at least.

Great point about writing stuff down. This is not an appointment I should be winging it at..

When I saw a private psych I was asked to send in any clinical letters I already had (saves time), and I was given an initial diagnosis at the first appointment, medication review etc. Psych took the view that he might never see me again as it's so expensive, so wanted to make sure I was clear about what was what. He also let me keep in touch with him by email, obviously he won't prescribe by email but it's nice to be able to ask questions when I need to. I consider this to be going above and beyond though so wouldn't expect it as standard!

Thanks! I do have several pages of A4 which I tried to use with an NHS assessment I had which details how I match the DSM criteria for ASD and ADHD, so maybe I should send along those.

I don't think they even read them at my NHS "assessment" - I didn't even see a psychiatrist, just a mental health nurse and she said I was too high functioning to have anything and I should take up mindfulness. The official report was also full of errors and said things I never even said - the exact opposite in some cases. That "assessment" set me back so far it's taken me this long to be brave enough to try again.

I guess the more stuff he has, the less I have to go over stuff!

www.kcl.ac.uk/ioppn/news/records/2018/march/High-IQ-autistic-people-learn-social-skills-at-a-price.aspx

Hi Op.
could you ask for clarity over a few things at the appointment.

Maybe things like; Can you contact the psychiatrist by email or telephone if they change your meds and you are not happy with them?
When will he see you again? Presuming you can pay for follow up appointments?
Will they liaise with your GP for repeat prescriptions?
You can you expect from the first appointment?
The psychiatrist should say at the beginning of the appointment what you can expect from the session, How many appointments they feel you may need etc.

I hope it goes well for you.

Why not ask your gp to refer to an NHS psych they will do exactly the same ?