need help with understanding testing results

[jellibeans]

I have just received the test results of my dd15 at her RTC... .   I want to point out that the testing was done without our input. When we had dd tested two years ago there was a very long and detailed questionaire we had to fill out first but this test asked for none and we didn't even speak with the pschologist that was doing the testing... .   feedback please... .  


Axis I:  296:33: Major depressive disorder, recurrent, severe, without psychotic features.

           V61.20:  Parent-child relational problem

           history of: Attention deficit disorder, Anxiety disorder, substance use disorder

Axis II:  V71.09: no diagnosis

AxieIII: Status post: overdose

Axis IV: Primary support problems, social enivironmental problems, educational problems

Axis V:  Current GAF: 25

            Highest in the past year: 45

Can anyone tell me what this means?

This psychologist also feels the diagnosis of ODD be removed... .   that if she was able to regulate her mood she would be less defiant... .   she goes on to say that she rules-out Cluster B personality traits... .   does this mean they don't think she is BPD? Just looking for someone to help me understand this report. Her current T says she is classic ODD... .   her P says borderline... .   Just trying to make sense of this all... .  

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Vivgood]

The GAF is the Global Assessment of Functioning. Its meant to produce a score which measures the difficulties she has in basic daily functioning. Higher=worse.

Axis I is primary psychiatric dxs

Axis II is the PDs.

Axis II is medical dxs.

Axis IV is about involvement in expected spheres of functioning (environment).

Diagnosis is in part "clinical judgement" which is necessarily subjective. It is not unusual with complex cases for there to be conflicting, confusing and generally annoying multiple diagnoses.

vivgood

[Eclaire5]

Yes jellibeans, that means they think she does not have BPD traits. BPD cannot be diagnosed until the patient is 18, but often mental health providers will already say Cluster B traits if they think the patient is on her way to develop a personality disorder as an adult. Many psychologists and psychiatrists are careful with Axis II diagnoses because they are so stigmatizing, but in my opinion they should not do that because without an accurate diagnosis there can be no accurate treatment.  I am not a psychiatrist, but for what I know, patients with just severe depression for the most part do not have oppositional and defiant behavior (they are too depressed to do that, especially if their GAF is that low). You might want to get a second opinion…

[Vivgood]

BPD cannot be diagnosed until the patient is 18

Not unilaterally true. BPD can be dx'd prior to age 18 under some circumstances (I think there are a couple of people here who have kids dx'd before 18yo). There are concerns about the interplay between length of symptoms and developing personality, but a well-educated and experienced psychiatrist can juggle that. Many clinicians are NOT trained or experienced with BPD, and believe the 18-year is a rule rather than a guideline, plus may have misinformation about stigma (it may exist, but current evidence suggests that proper diagnosis and "telling the patient they have BPD" is a positive rather than a negative). In the US, due to insurance madness, BPDs may not get an official dx of BPD, but an Axis I diagnosis with a sort of under-the-table "treat the symptoms" quasi-dx of BPD or BPD traits.

We can only tell you what the Axis designations mean, we can't tell you what the results falling under each Axis mean since even if some of us were clinicians... .   none of us have evaluated your DD, nor can we.


vivgood

[jellibeans]

I talked to the P today that did the testing... .   he explained that my dd could not have the mood disorder along with ODD... .   something about the mood disorder coming first so they could not give her the ODD dx... .   I asked how he knew which came first... .   he told me by talking with my dd... .   this is the part I find really odd because no one asked us what her history was so they simply were only going on what dd said.

I have to say I really have some reservations about this RTC... .   they mailed the reports to me and by accident they also included a report about another patient at the RTC... .   I was more than a little shocked at this mistake.

My husband has been trying to get answers to our questions regarding our dd escape from the center two weekends ago. We still have not had all our questions answered and we keep having to email and call. I think they think we will just get tired and go away.

All these things might be little things but I really have some concern with their lack of organization and they seem not very structured. Her P that she has seen for the past two years is the one that told me about the BPD... .   Her T also agrees... .   but can it be she is not Borderline? IS this possible? Leaves me confused... .  

[lbjnltx]

I talked to the P today that did the testing... .   he explained that my dd could not have the mood disorder along with ODD... .   something about the mood disorder coming first so they could not give her the ODD dx... .   I asked how he knew which came first... .   he told me by talking with my dd... .   this is the part I find really odd because no one asked us what her history was so they simply were only going on what dd said.

Say what?  My d was dx w/ odd first (by a t and later confirmed during inpatient psych testing), emerging BPD (by a t), mdd (during inpatient psych testing) and BPD traits confirmed (through the same psych testing).  At no time have any of her diagnoses been removed... .   during RTC her pdoc (who I had 0 faith in) questioned the Axis II dx of BPD (emerging/traits of) and in the same breathe said her treatment would be best focused on her Axis II diagnoses. Her first outpatient visit w/a psychiatrist was a fiasco!  We already had the "emerging BPD" diagnoses from her t... .   we went to this pdoc to get a med evaluation to see if she could benefit from any meds.  First he tt my d and I together, then he spoke w/my d alone, then he called me back in.  He told me 1) No, meds won't help 2) Here's a book to help you understand your d and he showed me a copy of "Stop Walking on Eggshells" ... .   which I had already read 3) Told me her "T can't do that!" When I said "what if I told you she has already been dx w/emerging BPD?"

So you see... .   it all depends on the individual "professional".  By the way, this is the same adolescent psychiatrist on staff at the psych hospital my d was admitted to and had the inpatient testing done. When I saw his name on the admissions forms as the treating psychiatrist I (in writing) requested he not evaluate, treat, or test my daughter.  Because of this my d was evaluated by the head of the hospital and he continues to be her pdoc to this day.  We have a very good working relationship and he has helped us in many many ways.

The outpatient t my d had for a few years before rtc as well as after RTC coded her treatment as "depression" so that our insurance would pay.  At the same time he treated her based on what my d needed by addressing her Axis II diagnoses.  The best of both worlds in a way     

I have to say I really have some reservations about this RTC... .   they mailed the reports to me and by accident they also included a report about another patient at the RTC... .   I was more than a little shocked at this mistake.

Another 

My husband has been trying to get answers to our questions regarding our dd escape from the center two weekends ago. We still have not had all our questions answered and we keep having to email and call. I think they think we will just get tired and go away.

Another 

All these things might be little things but I really have some concern with their lack of organization and they seem not very structured. Her P that she has seen for the past two years is the one that told me about the BPD... .   Her T also agrees... .   but can it be she is not Borderline? IS this possible? Leaves me confused... .  

I try to look at these events and situations as stepping stones towards solutions and recovery.  As we have talked about before jellibeans... .   is this a long term option for care or just a stop along the way to garner what you can from it while you make other plans?

As your d's advocate the choices you and your dh make are the most important ones.

I know this is all very confusing, frustrating, and scary.  Knowledge is power.  Don't be afraid to challenge what you are told when the facts tell you different.

[Vivgood]

they mailed the reports to me and by accident they also included a report about another patient at the RTC

This is outrageous. In the age of HIPAA, this should cause heads to roll left and right.

"lack of structure"? in an RTC that works with Axis II patients? I'm worried for your DD!

The conflicting/confusing diagnostic codes... .   I wouldn't worry so much about that; its a confusing business all around, exacerbated by inadequate training, laughable funding, and the entire health care debacle. You need to advocate forcefully, but thats do-able... .   lousy facilities with ethics violations ongoing; I'd seriously start looking elsewhere.

vivgood

[mamachelle]

jellibeans,

When my SS15 was hospitalized last year for Bipolar and suicidal ideations, he also had some eeg testing done... . he is on the autism spectrum but more close to asperger's . At one point the psychiatrist called me happy to say-- his MDD could be due to his abnormal EEG. ? I insisted he be tested for psychosis. Sure enough he was psychotic ... .   and the testing psychologist told me he might be actually pre-schizophrenic--- SS15 has a laundry list of dx as it is. He does not have axis2 dx but his axis1 have varied between dysthymia, MDD, Bipolar, Bipolar r/o psychotic... .   within weeks of eachother depending on the clinician  

At any rate, you need to be your own DD advocate  and  would suggest that if your gut says its not right-- then believe it and don't be afraid to hire an attorney or consultant to help you.

 

mamachelle