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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Racer on March 18, 2004, at 15:27:05
In reply to Re: Diagnoses and DSM IV Links?, posted by EmmyS on March 18, 2004, at 15:07:25
After posting that, I did find BehaveNet, but I'm glad you posted it. Maybe it'll save someone else a step, and it'll certainly be great for me to find it more easily next time.
I'm looking for the numeric codes for the other axes, though, which this doesn't seem to include. Does anyone know where to find them?
Thanks!
Posted by Penny on March 18, 2004, at 15:58:49
In reply to Diagnoses and DSM IV Links?, posted by Racer on March 18, 2004, at 14:59:30
Racer,
Posting this quickly, since I have to leave work now, but didn't know if you had seen this - I didn't get a chance to look over it much, so don't know if this is what you are looking for.
http://www.dr-bob.org/tips/dsm4.html
You can also check the bookstore/library for copies of the DSM. I know Barnes & Noble carries them.
P
Posted by jane d on March 18, 2004, at 16:39:16
In reply to Diagnoses and DSM IV Links?, posted by Racer on March 18, 2004, at 14:59:30
Racer,
I know I've seen this but I can't find any links to it so I suspect it was in printed form. I got curious tho and did find this.
http://endeavor.med.nyu.edu/research/pda/pilot/downloads/rmenu.htm
This has an axis II criteria download for palm pilots. I haven't looked at it and have no idea whether these things can be read without a palm.
I also found lots of other goodies that have nothing to do with your question - lots of course related sites on psychology for instance - and I've absolutely got to stop now or I'll never get any work done (I've compulsively bookmarked them all for later of course).
Lots of the web sites have details on a few codes so the quickest thing to do might be to type the codes themselves into a search engine. I've done this before and it works pretty well, at least for the codes I've tried. One thing that is harder to figure out is just what a code meant at a specific time. Both the official definitions and how they are used keeps changing. Borderline personality and bipolar today can mean something very different than they did 15 years ago for instance.
If you come across any great sites in your research please post them. Good luck.
Jane
Posted by EmmyS on March 18, 2004, at 17:21:13
In reply to Thank you! need other Axes, though..., posted by Racer on March 18, 2004, at 15:27:05
Well....those DSM codes go in Axis I and Axis II. Axis III is for medical issues and they use a whole nudder coding scheme, which I don't recall the name of..someone here will know it. Axis IV doesn't use numerics and is for social problems (homelessness, no social supports, etc.). Axis V is the GAF score, or Global Assessment of Functioning (1-100). Does that help?
Posted by Racer on March 18, 2004, at 18:22:53
In reply to Re: Thank you! need other Axes, though..., posted by EmmyS on March 18, 2004, at 17:21:13
Yes, that helps a great deal. I found the axes I & II on the behavenet site, but couldn't find any of others. Now that I know what they mean, what each axis refers to, it's less of an issue, so thank you for posting that. I did see the scale for Axis IV was alphabetic, rather than numeric, but I wonder what the letter assigned me means? Don't suppose you know?
And Just plain thank you. That's good info.
Posted by whisper55 on March 18, 2004, at 19:09:53
In reply to Re: Diagnoses and DSM IV Links? » Racer, posted by jane d on March 18, 2004, at 16:39:16
How dod you get your records to begin with? I'd like to know what mine have in them but how?
Posted by EmmyS on March 18, 2004, at 20:21:14
In reply to Yes! » EmmyS, posted by Racer on March 18, 2004, at 18:22:53
I've worked in a few agencies, and have not used a form, or software that used any consistant standard code for Axis IV. One surely could exist - I just haven't seen it.
Emmy
Posted by Racer on March 18, 2004, at 20:36:56
In reply to Re: Diagnoses and DSM IV Links? » Racer, posted by jane d on March 18, 2004, at 16:39:16
I downloaded the .zip files, and they contain both the .pdb files for the palm pilot, and .txt files. So, yes, it can be viewed from a regular computer.
It was also very, very helpful. I copied the text into a word document, and will write a letter to my new therapist with the diagnostic criteria and my responses to it. I'll be including which specific criteria for each disorder I recognize in myself, along with those that I can recognize her mistaking in me. I'm hoping that a nice, rational outline of which fit and which don't will help us at least get to the point I'm not dreading therapy. (When suicide seems like a better option than showing up for a therapy appointment, something is wrong somewhere, right?0
Thanks for finding this for me!
Posted by terrics on March 19, 2004, at 16:53:35
In reply to Diagnoses and DSM IV Links?, posted by Racer on March 18, 2004, at 14:59:30
Hi Racer, Sorry you are 'going backwards in therapy'. Are you sure that you want to know your dx? Maybe it is a good idea to know cause you can then choose a specific treatment. My pdoc says it doesn't matter, but I think it does. If you can't find it online look it up in a bookstore. good luck. terrics
Posted by lonelygirl on March 20, 2004, at 12:23:50
In reply to Diagnoses and DSM IV Links?, posted by Racer on March 18, 2004, at 14:59:30
My psychologist has not told me any diagnoses, nor has he offered to (though I did get a list of my "rights" at the beginning, which stated my right to view my records). Is this normal, or do most come right out and tell you? Do they ever have a problem with a request to view your records (regarless of whether they let you view them, do they oppose it or advise against it?). I am curious to see when my psychologist thinks about me.
Also, he took some notes during my initial consultation, but since then, he has not written anything down while I was there. Is THIS normal? I assume he writes things down after I leave (especially since he actually remembers a lot from week to week), but I know he sometimes has back-to-back appointments and can't write it down immediately afterwards.
Posted by Racer on March 20, 2004, at 19:25:42
In reply to Know your diagnoses?, posted by lonelygirl on March 20, 2004, at 12:23:50
The whole diagnosis thing came up for me because my therapist had to transfer me to another within the same agency, and this new one is hung up on Diagnosis. Not enough to need professional help, everything has to be pathologized. That's not very helpful to me, so I did ask to see my chart, and got my Official Diagnosis from it. (DSM IV uses a multiaxial diagnostic structure, with primary psychiatric diagnosis on Axis I, personality disorders or mental retardation on Axis II, Physical Health on Axis III, situational factors on Axis IV, and Global Assessment of Functioning on Axis V. My Axis I is Major Depression, Axis II is Not Found, Axis III is osteoarthritis, Axis IV I haven't found out the code list for, and Axis V is moderate functioning. Does that make sense? It does to me, and knowing that does help me. For some people, though, it might actually be detrimental to see those things. I think it's an individual thing.)
As for trouble getting the chart, that's another issue altogether. In California, we have the right to request the chart. In California, the doctor has the right to say that complying with that request would result in detrimental or adverse consequences for the patient, and refuse to comply. If you do ask to see it, be aware that it may not be positive for everyone, and that it might be best to discuss the issue with your therapist rather than simply saying, "show me!" (I know, I'm a "Show Me!" kind of gal myself, so it's probably stupid of me to say that.) Also, the doctor may choose to provide you with a summary, rather than the whole chart. That's also allowed.
Notes are a touchy subject, for a lot of good reasons ranging from the 'what if someone else sees them?' type, to the 'it interferes with patient rapport' type. If your therapist remembers things from week to week, and you're satisfied with your relationship, I wouldn't worry about it. My former therapist didn't take notes in session, and her notes in my chart were to the point, detailed enough without disclosing anything I wouldn't want to hear read aloud in public, and generally toeing the line of thoroughness versus exposing. I hope that makes sense.
Good luck, whatever you decide.
Posted by lonelygirl on March 20, 2004, at 20:43:50
In reply to Re: Know your diagnoses?, posted by Racer on March 20, 2004, at 19:25:42
Ah, yes, I do remember that there was something in the list of "rights" that said I have the right to review my records unless the clinician believes it would be detrimental to my treatment (or something like that). Under what cirumstances would they say it would be detrimental to the treatment, and why? It seems to me like it would interfere more with patient rapport for them to refuse to show the information.
As for discussing the issue, how do you go about bringing it up? Do they always go through the 5 axes and make a diagnosis on each one (or "not found" if there is none)? I wouldn't want to ask for that and then look stupid because he didn't do that (if that's a possibility).
Posted by Racer on March 20, 2004, at 22:45:24
In reply to Re: Know your diagnoses? » Racer, posted by lonelygirl on March 20, 2004, at 20:43:50
I think I'd tell him that you were curious about your records, ask him if he used the DSM IV multiaxial system, and if he'd go over your diagnoses with you.
Why would it be detrimental to a patient to see his or her records? That's also something that you could bring up with your doctor. I have never done it before, and never felt the need to do it before. This was an unusual situation, or I wouldn't have done it in this case, either. I don't even recommend it, because I could see it being devastating to a lot of people, including myself. In this specific set of circumstances, though, it seemed like the right thing for me to do. Only in a situation this bad would I ever have done it. In any other situation, I would not have done it. Is that a strong enough disclaimer for you? ;-) What I'm trying to say is that it's not something I think should be done for curiousity's sake. The information contained in mental health records is sensitive, and it can be quite disturbing to read what someone else has written about you. That's not something to undertake lightly, nor to dismiss as irrelevant. This really is one of those things that, if you are working well with your therapist, you shouldn't ever feel the need to do. In my case, because I do not have a choice of therapist, and because I am getting so much worse with this therapist, I felt that knowing the worst was probably the best. Because my expectations were so low, and because the things she was saying to me about what the pdoc said to her about me were so devastating, I really felt as if I needed to get a reality check. I did, and it helped me. If the situation were less adversarial, or if I were experiencing it as less abusive, I would never have done this.
So, if you're curious about any of this, why not tell your therapist that you've heard of someone requesting access to her mental health records, and wondered what he thought about you looking at yours. He'll probably discourage you from doing so, and I think he will probably be right. If it ain't broke, it don't need fixing, right? He may tell you outright most of the information you're curious about, though, if you discuss it with him, and that really strikes me as the best solution in most situations.
Good luck.
Posted by terrics on March 21, 2004, at 11:16:12
In reply to Just random advice » lonelygirl, posted by Racer on March 20, 2004, at 22:45:24
Can a T not keep records even if she is being paid by insurance? She told me she doesn't. terrics
Posted by Racer on March 21, 2004, at 11:50:26
In reply to Re: Just random advice » Racer, posted by terrics on March 21, 2004, at 11:16:12
Well, that depends on what you consider records. My understanding of it is that some therapists keep very, very limited records, to protect their patients. Remember, all these records can be brought out in court, or requested by insurance companies, etc. So, for your protection, your therapist may limit her note taking to dates and times of appointments, and try to keep everything else in her head. If that works for her, and she's working for you, that's fine. It means that no one can ever pull your records and use them against you.
Other therapists keep detailed records. How would you feel about having those read out loud in court? {{shudder}} A lot of therapists at this time write up sessions with a sort of personal shorthand: 'pt discussed distress at maternal disapproval', for example, so that they an remember what you talked about, without betraying any really personal or intimate information. Since most of us have some distress when our mommies don't approve of us, that's not telling any outsider anything much, but it may jog the T's memory enough to keep you both on track.
Damn, I shouldn't have to learn all these things just to go through therapy, should I? LOL Maybe next time my therapist will have learned them instead...
Hope that helps. It could be that she won't encourage you to see the records, so says that they don't exist, or it could be that she takes protecting you so seriously that she really does limit her notes to dates and times of sessions. If you trust her, though, does it really matter?
(That's just an expression of envy for anyone who trusts his or her therapist...)
Posted by terrics on March 22, 2004, at 7:45:57
In reply to Re: Just random advice » terrics, posted by Racer on March 21, 2004, at 11:50:26
I have alot of ambivalent feelings for my T. I love her, but I know she lies to make a point and also to make a mistake go away. The longer I work with her the less sure I am of her. Also my insurance pays her, but I start DBT today so I will have to pay her out of pocket as my ins. will only pay one therapy at a time. She said to pay her whatever I feel comfortable with. That in itself is a dilemma. ps The DBT group therapist said I could kep my own therapist if she is not detrimental. Oh well that is more than I intended to say. terrics
Posted by Camille Dumont on March 22, 2004, at 11:23:13
In reply to Re: Know your diagnoses? » Racer, posted by lonelygirl on March 20, 2004, at 20:43:50
My pdoc has also told me the same thing. I think the whole detrimental / dangerous thing would be, for example, with someone trying to work through serious paranoid delusions ... knowing your diagnosis could I guess feed into the delusion and such.
My pdoc told me that its very rare for them to withold information like that and even if they do you can still ask for a second opinion from other doctors in order to be allowed to see you file.
Posted by Camille Dumont on March 22, 2004, at 11:32:44
In reply to Re: Know your diagnoses?, posted by Camille Dumont on March 22, 2004, at 11:23:13
It turns out that for me, getting access to my psychiatric evaluation was sort of necessary because my GP gave me a really bad medication and I wanted to know / needed to know if the psychiatrist had ordered it ... and I couldn't wait a week with seizures until I could see him.
I'm sort of lucky that the psychologist I see for therapy is very nice ... well I did shop around before choosing her ... its an expensive thing to do but in the end I guess its worth it.
Anyway, she didn't even blink when I asked her about it and agreed with my concerns over the meds so she made me sign a paper and that was it, I got my diagnosis.
I guess some parts of it were slightly hurtfull ... mostly parts about psychotic symptoms which made me feel as though the psychiatrist thought I was making things up.
But on the other hand, I found it very insightfull to have a neutral evaluation of how you are ... it made me notice my tendency to minimize things, the defense mechanism I use ... and such.
All and all, I guess I agreed with most of it and actually, knowing that I'm an avoidant type has made me want to work through this and try to become more assertive ans such.
I guess however that I would have liked for a pdoc to go through it with me ... might have saved me many searches through the DSM-IV. But in the end, I found it a positive experience.
Posted by fallsfall on March 22, 2004, at 13:52:20
In reply to Re: Just random advice » Racer, posted by terrics on March 22, 2004, at 7:45:57
Maybe after you are established with your DBT group therapist you could talk to her about your ambivalence about your current therapist. At that point she'll know you a little better.
Posted by Fallen4myT on March 22, 2004, at 17:51:12
In reply to Know your diagnoses?, posted by lonelygirl on March 20, 2004, at 12:23:50
I know my DX I asked and I have the code on my bill :) I see NOTHING wrong with knowing your DX once its established cause you are allowed to know if you have diabetes why not PTSD as I was...Its the law they have to show you YOUR records UNLESS it would be harmful to you. I have read my records and am cool on it.
Posted by terrics on March 22, 2004, at 17:52:09
In reply to Re: Just random advice » terrics, posted by fallsfall on March 22, 2004, at 13:52:20
Thank you for the suggestion. I had a 2 hr. intake with a csw involved in the DBT. I told him T. is psychoanalytical. I also told him that she told me that SHE is borderline. He thinks I should have a DBT therapist and that is what I plan to do. terrics
Posted by Dinah on March 22, 2004, at 18:50:44
In reply to Re: Just random advice » fallsfall, posted by terrics on March 22, 2004, at 17:52:09
I know you've had trouble with this one for a while. Sadly, they aren't all the equally competent.
Posted by fallsfall on March 23, 2004, at 18:08:30
In reply to Re: Just random advice » fallsfall, posted by terrics on March 22, 2004, at 17:52:09
Terrics,
I'm glad that you have made a decision. Try to talk to a couple of choices before making the final decision, so you can find someone who you can feel really comfortable with.
Posted by terrics on March 23, 2004, at 19:29:42
In reply to Re: Just random advice » terrics, posted by fallsfall on March 23, 2004, at 18:08:30
Thanks all. I am excited about DBT. Sure hope it helps. They were all nice yesterday. You guys are wonderful. I do not feel so lonely when I come here. terrics
Posted by lonelygirl on March 25, 2004, at 18:36:40
In reply to Just random advice » lonelygirl, posted by Racer on March 20, 2004, at 22:45:24
Alright, I did some checking on the health center's web site, and I answered some of my own questions! The really ridiculous part is that I am positive that I have looked at that exact information before (though I was only focused on finding info about my psychologist, so I didn't remember the other stuff).
They do use the DSM multi-axial system... They also listed some of the "typical" client issues, which include "depression, anxiety, suicidality, personality disorders, eating disorders, substance abuse, and relationship issues. A small percentage of students present with psychotic symptoms."
Finally, it says, "Most therapy cases are time limited (approximately 12 sessions). The resident may carry several longer term clients for training purposes." (This was from the brochure for the post-doctoral residency program, which he completed last year, so I'm not sure what that means for those with permanent positions, which he now has, but I would assume that if they have residents take long-term clients, the full-time staff do, too.) It also says that most students go once a week, but some go every other week and some once a month. But I don't think more than once a week is a possibility.
I will probably ask him about my diagnosis at some point, though I don't know about tomorrow... There is always just SO much to talk about and it just feels like the time is SO scarce! I have realized that there are major, important things about my life that he has no idea about because they haven't come up. I feel like he knows me so well (probably better than just about anyone else on the whole campus, and I have talked to him for a total of 9 hours), yet he doesn't know some of the most basic stuff. It's not even that I have "issues" with some of that stuff, but it is still stuff that has been important to my life. I guess it wouldn't be that good of a use of time to talk about it, but it's kind of strange telling him my innermost thoughts and secrets when he doesn't even know about the last job I had. I keep thinking of things to talk about, but there is just so little time :-( I am ever conscious of the fact that there are only 6 weeks left in the semester, and after that, I will never see him again.
I am starting to get the pre-session butterflies again... I get to see him in less than 17 hours!
This is the end of the thread.
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