What happens during a psychiatric evaluation?
This is a biological illness, just like diabetes or asthma. It is due to an imbalance of neurotransmitters, which requires medications to decrease the mood swings and return moods to normal. Regular antidepressants and some other medications can worsen Bipolar mood swings. The appropriate treatment includes either mood stabilizers, or new medications called “Atypicals.”
While therapy itself will not stabilize the mood problem, therapy can be used to understand the illness and how it affects the individual, as well as to help cope with having a significant illness at such a young age.
Basically the job of the psychiatrist is to make patient’ feel comfortable and safe, so they can tell their stories and describe their symptoms. The doctor also talks to the parents to get their perspective. The evaluation looks at Biologic, Psychologic, and Social factors.
Biology: Just like asthma and diabetes, mental-health problems like depression or anxiety disorders run in families. The doctor takes a family history, looking at what kinds of problems run in the family. Biology also comes into play if medical problems are complicating the picture. Some medical problems and some medications are more likely to affect mood, so a good medical history is important. Sometimes a physical exam, blood work, and other tests are ordered to evaluate medical problems.
Psychology: Each teenager has his/her own personality which is unique. Some teenagers are optimists, some pessimists, some are confident, while others have poor self esteem. Teenagers may be outgoing or shy. They may need lots of down time, or they may thrive on activities. It is vital to understand how a teenager views the world, and how he/she communicate with others. It is also important to understand his/her hopes and their dreams.
Social: While some teenagers enjoy a great social support system, others deal with a lot of stress in their lives. Stress can come from so many directions. Some teens have learning disabilities, others have to deal with family problems, such as divorce, or a parent who is struggling. One of the worst types of stress is emotional, physical, or sexual harassment or abuse. It is important to understand how specific problems are overwhelming the teenager, and what can be done to reduce his/her stress to a manageable level.
After evaluation, some problems appear to be primarily biologic, such as a teenager who has been functioning well for years, then falls into a serious depression for no reason, and has relatives who also suffer from depression. This teenager primarily needs a biologic approach, and medication will be the primary treatment. Other teenagers are doing well until they experience an unexpected stress, such as divorce. For these teens, therapy is the primary focus of treatment. In most cases, there is a mix of biologic, psychologic, and social factors. An example would be a teenager who has a family history of depression, yet functions fine until he/she experiences a death in the family. They start with grief, but unlike others, they do not recover, and instead become more depressed and even suicidal. This type of situation may require both grief work and antidepressants, and either treatment alone would be inadequate.
Mental-health professionals understand the need for a relationship in which the teenager feels safe sharing everything, and trusts the therapist to help him/her, and to maintain confidentiality. It is normal to feel scared about starting therapy, but over time it should become a positive experience.
National Suicide Prevention Lifeline: 1-800- 273 –TALK (8255)
