sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Hey all, I got a letter in the mail today from social security office saying that "additional information is needed" to process my disability claim. They scheduled me an appt with a local psychiatrist for a mental status evaluation.
What does this mean? I'm not depressed or crazy. I want to work but have very real symptoms that are preventing me from being able to do even simple activities of daily living.
What should I expect at this appt?
Posts: 5237 | From here | Registered: Nov 2007
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Maybe some hints here on how you can prepare for the appointment, especially if the psychiatrist is not well versed in lyme disease.
Posts: 8430 | From Not available | Registered: Oct 2000
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- This may or may not be for a test - a neuropsych evaluation. Even if for the test, you may or may not also talk to the doctor. Find out what this is to entail.
Can you choose your own psychologist or psychiatrist to do this evaluation? Or, if they have a list, can you see that list and then choose one (after talking with your area lyme support group to see if they know of one who is LL)?
Once you know who will be doing the evaluation, find out how long it will be and the environment so that you can plan what you need regards healthful snacks, if you can rest in between segments, etc.
I would need to know: if they've just painted; gotten new furniture or carpet; had the carpets recently cleaned . . . I would need anyone with whom I'd be near to avoid scented products that day . . . and, even in the restrooms, I'd need to know if they use scented air fresheners (as they trigger seizures for me).
For many lyme patients, scents cause all sorts of problems. So, if you also have MCS (multiple chemical sensitivities), just ask all the same questions that you usually do before going anywhere.
As my bladder often comes close to failing with little notice, I'd need to know close the bathroom is to the office; if you can lie down or if the chair has a head rest AND a foot rest. I would need to be sure there were no overhead announcement system in the building . . . if the elevator beeps or buzzes along the way . . .
I would need them to have a freezer near by with a soft ice pack in case I were to fall or seize from sudden startles. I would also need all their phones turned way down, or even covered with a small towel to muffle any sharp rings.
If you are similarly affected by noise, you might also need to know if their air conditioning system is loud. If the unit itself is in either the waiting room or the office, that is likely going to be louder. If it's a vented system, it is usually quieter and easier to carry on with the test.
Likely, you won't need all that, still, whatever your needs, just ask in advance so that you can be the strongest you can be for the session. It's a very fine line in their perception of your taking care of yourself and having an obsession. Be mindful of that.
Some of these tests are just an hour or so, some last for two full days. If you need a break, to lie down, even in quiet - you must say so and listen to your body. Don't make it like you are catering to your body but listening so as to prevent worsening of symptoms.
It is best if someone else drives you - for many reason but mostly as these can be exhausting and your safety and that of others could be at risk if you had to drive home after a grueling day.
And, by the way, although you are not depressed or crazy, it's okay to be honest if you feel exhausted and are saddened by that. Often, though lyme patients are labed as crazy and lazy, so do be prepared for that. The doctor will not likely say such things right to your face - as the tests are, well, tests.
But, if you sense an attitude where you feel like an alien and they've never seen someone like you before - that is often just how it works with doctors who have no clue about how lyme affects someone. Just roll with it. Even if non LL, the doctor is likely a good person. But they are often paid to jump to conclusions. It's just in their contract.
These are not just to determine if you are depressed but if your brain can concentrate adequately. That the "neuro" part of a Neuropsych exam. The "neuro" part will not really get into the neurological system as we might think, about walking and coordination.
The best thing is to just be honest. Be real. Be yourself as you are now. Don't feel intimidated, shameful or like this is your fault. Just be honest with what is going on, the cause will not be an issue (they don't really want to know about lyme, anyway). It's about how your body and brain are able to function (or not).
All you are asking for is a little help in order to have some time to get better. Keep your self-respect about you as these sessions can really hammer away at that. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
Hi Sammy....A couple ppl I know had to go to 2 kinds of docs. Usually a regular type doc also.
But it's good you heard something already! I know all states differ, but when my gf, who has fibro went to see their docs, it wasn't long b/f she started getting paid! You're not just on the bottom of the pile!!!
I can't help, the Lord was truely with me. Didn't have to see any of their docs. But I think it's good news. There should be ppl who could help you prepare for this.
Good luck! Posts: 847 | From upstateNY | Registered: Dec 2007
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Thank you Lou, Keebler, and Keltyl.
It doesn't look like I get to chose who I see for the mental status evaluation. They have already scheduled my appt with this particular doctor. Time is early in the morning about 4wks from now.
I'm supposed to return a form to accept the appt or explain why I cannot keep the appt.
It would be nice if I could see an LL physician for this exam but there are no LL physicians anywhere near me. My LLMD is in NY.
Would it be bad if I called the office and asked what to expect during the appt and "mental status evaluation"?
I would really like to hear if anyone else has been through this. What are they going to ask me?
I hate to think that they would base their decision on a brief appt with a doctor who is unfamiliar with my case and history.
Posts: 5237 | From here | Registered: Nov 2007
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posted
Sammy...At least in NY, it's one of their docs. You don't have choice. Hopefully someone can be of help to you as to what to expect.
Posts: 847 | From upstateNY | Registered: Dec 2007
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posted
The second url I listed is specifically about your situation, written by a psychiatrist about lyme, so it might help you prepare what you would say to the non-Lyme literate psychiatrist that you will be going to. Here is the first few paragraphs from his paper, the rest can be gotten by clicking on the url.
-----------------------------------------------
The Neuropsychiatric Assessment of Lyme Disease Robert Bransfield, M.D.
Objective: A structured clinical interview is proposed to assist in the overall clinical assessment when late state Lyme disease is suspected.
Method: From a combination of clinical experience, journal review, and discussion with colleagues, a structured interview was developed. Information from patients with late stage neuropsychiatric Lyme disease (NPLD) was entered into a database to serve as a reference point for diagnosis and tracking the patient's status after diagnosis.
Results: An analysis of symptoms acquired from a thorough history and mental status exam can be quite helpful towards the total clinical assessment when suspecting late stage Lyme disease. Details are provided in the text of this article.
Conclusion: When NPLD is a diagnostic possibility, a detailed, well-focused interview and mental status exam is proposed, and a database of symptoms seen in NPLD is established. It is recommended to continue perfecting the assessment as well as expanding the database. If diagnostic accuracy is improved, there would be better consensus regarding treatment strategies.
Objective
There are many unanswered questions regarding chronic Lyme disease. They remain unanswered as a result of our inability to accurately diagnose the presence or absence of the causative agent B. burgdorferi. The usual laboratory tests alone are not totally reliable to confirm or refute the diagnosis of Lyme disease (1). When we combine the current laboratory tests with a very thorough history, physical, and mental status exam, the accuracy of diagnosis is greatly increased. If we can improve the accuracy of diagnosing the presence of Lyme disease, there would then be more agreement regarding treatment guidelines. In an effort to improve diagnostic accuracy, I have developed a psychiatric diagnostic and tracking system.
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Thank you Keltyl and Lou.
I did also take the time to reread the links today. I struggle with cognitive difficulties so I would not be surprised if I missed something with the first read through.
From what I can understand, it looks like Doctor Bransfield's Neuropsychatric Asssessment of Lyme Disease was written specifically for physicians to use in the diagnosis and treatment of Lyme.
The physician that I am scheduled to see for the mental status evaluation will have no education or experience diagnosing and treating Lyme.
Do you think that the doctor would be offended if I mailed him a copy of this article and assessment form to be reviewed before my appt? Would it help him to know and understand how and why Lyme might effect my mental status? Would it help him to better provide a snapshot of my current capabilities and functioning?
I'm also wondering if I should try to reschedule the appt to late morning or afternoon? My symptoms are more severe and debilitating later in the day when I am tired.
Thanks so much for your opinions and advice.
Posts: 5237 | From here | Registered: Nov 2007
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posted
Only with experience as a New Yorker, I would honestly have to say no to both. Hope someone else can give their opinion too!
Posts: 847 | From upstateNY | Registered: Dec 2007
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