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847433 tn?1243009652

Board Certified in Psychiatry and Neurology?

Hi,

I am going to see a neurologist referred by my ortho surgeon as he seems to believe that my symptoms of leg weakness, paresthesias(foot, leg, groin, and buttock)  may be related to something else besides my L5/S1 herniation. He states that the symptoms I have are grossly out of proportion for the size of the herniation revealed by the MRI.  I have 2 in my neck as well that are controlled for the moment with epidurals.

I find it would be extremely coincidental to have something else going on at the same time as these herniations all of a sudden but he believes there may be something else as well.  I also have increasing word finding difficulties that even others have noticed. anway, my question is:

Does the Neurologist I go to have to be board certified in psychiatry as well as neurology in order to get thorough testing?    I am also having another MRI (thorasic) and Brain.

thanks:)
missy
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Avatar universal
I was treated for clinical depression. Some of the "neurological tests" that the neuro gave me were the same that the psychiatrist gave me before he diagnosed clinical depression.. the one I remember from both was a memory test.

He appear to be just making conversation. Then suddenly he says to listen and repeat four words. Then he continues with the "conversation,  talking about something else besides those four words. Then suddenly he says repeat those 4 words I told you to say. I remembered 3 of them. I did get my records from the hospital after words and he charted that I had "remembered 3 of 4 words  under duress". I was pretty upset, going to a walk in clinic, being directed to an ER then being admitted to an NICU. He charted correctly, I was under duress. My family and I, both. That's probably why my little sister could not stop talking and I was so aggressive about him not being able to diagnose depression.

About 10-15 years before that. I kept getting lost. And I was not able to change a light bulb. I couldn't get the bulb in the socket. I was seeing a social worker because I kept getting lost all the time was very frustrating. I'm a fiercely independent person. I analyzed and determine this was a mental problem. So I self diagnosed myself. No one did it to me.

I got a self help book about depression I went to a social worker who was a counselor.. I found her in the Employee Assistance Program. I needed assistance to be an employee!l HELP!! She recommended I see a psychiatrist, after she had seen me a few times & continued to see me while I saw the psychiatrist.. I have to say they took me serious. But I do believe I was really clinically depressed. Not that MS lesions formed in the right area to cause depression. I think I couldn't seem to control me. I couldn't understand it & it really did cause depression. Depression is black & everything was black at that time. I think I might have been wetting my pants then too. There is no way in hell i would have told anyone about THAT!!!


I had lost a lost of weight very fast. It looked like depression, it acted like depression, they diagnosed clinical depression.

I was having so much difficulty getting lost one day after I left the psychiatrist office I got lost in the building. He had to find me & show me out of the building. I'm not certain how I functioned.. I lived alone, I couldn't change the light bulbs, but I lived close to the street lights. So I kept the curtains open to get light in my apartment.

I told the psychiatrist I wanted to get the problem I was having changing light bulbs  & getting lost fixed but I wanted to keep the weight loss because that was a good thing.

He said he couldn't just fix somethings he was gonna affect everything. It was likely when I stopped getting lost I was gonna gain the weight back. Did I want to stop getting lost if it meant I would gain weight? I told him I really wanted to stop getting lost and if it meant I was gonna gain weight back that was what was gonna have to be done.

He asked me if I wanted to go into the psychiatric hospital. I said NO!! I don't want that in my record and I felt so out of control of everything I certainly did not want to go somewhere where I might have what control I did have taken away from me.

He prescribe prozac. He said people taking prozac often stop taking it when they feel better, so he wanted me to promise I would take prozac for a year even after I started feeling better. I resented needing prozac, but I was getting lost all the time and finding myself where I didn't expect to be. What could I do? I promised to take the prozac for a full year if he would prescribe it.

In three -four months I could change a light bulb again, And i didn't get so lost. And I found out why I had lost so much weight. I would get tired eating a 99 cents TV dinner and put it unfinished in the refrigerator. There were stacks of half eaten 99 cent TV dinners.

I believe I would have been diagnosed with MS at that time if I had gone into the hospital where they could have observed me....You know how people chocking in a restaurant will often go to a bathroom to be polite, how you are suppose to follow someone chocking that is going to a bathroom alone. Same with me. I had all these strange things happening to me, that I didn't understand and I couldn't control so I was trying to get help and hide it at the same time.

At the end of the year I told him I wanted to stop prozac. We had an exit appointment. He started gradually bringing the prozac down. He told me I  should recognize the signs of being depressed now, and seek help if I saw those signs. He told me if I wanted to go back on Prozac that I should just make an appointment with him and he would prescribe it again.

Then he asked me if I had any questions. And I said yes I did. I asked him in that first appointment when he had asked me to repeat the words he said earlier in the appointment. Did I get the words right? He started flipping through my file with agitated hands and said " yes you did. you really are ok"

So both the neuro & the psychiatrist do some of the same test for memory especially. With the psychiatrist I was in my early 30's, with the neuro I was 41. I believe I did better on the memory test with the psychiatrist at an earlier age than with the neuro at a later age. But MS progress. A person is not legally entitled to psychiatric record. A person is legally entitled to all their medical records but not their  psychiatric records. So I won't ever know if I got that memory test correct in my thirties. I think I was under duress then too!
Helpful - 0
847433 tn?1243009652
Yes thanks so much.  I originally had an appt with one Neuro that was certified in both but i couldnt get the appt till 4/27.  Another neuro was able to see me on 4/17 but is only certified in neurology. I will have both my thorasic and brain MRI back by then and wanted to take the sooner appt.  

Now I know it doesnt make a difference.  Thanks for your help:)

missy
Helpful - 0
572651 tn?1530999357
ahhhh... the real question! :-)

No, a psychiatric evaluation is not part of the workup for MS by the neurologist but I'm sure they are taking lots of mental notes.  One thing that is standard in the exam though is noting the mood of the patient.

Does that help?
Lulu
Helpful - 0
847433 tn?1243009652
Thanks for the input and insight.  However I really just wanted to know if in order to get a good neurological exam if the md had to also be certified in psychiatry as well.   I am a nurse and worked in psyche for a few years so I know what they do, like I said is it necessary for the neuro exam.

thanks
missy
Helpful - 0
572651 tn?1530999357
Hi JD,
Thanks for the correction - that makes all the sense in the world to be cross-trained in both fields.

always learning,
Lulu
Helpful - 0
790496 tn?1315615657
Funny story, I also have a younger sister who is now being very protective of me she has been e-mailing me a ton of info on everything MS. I try to tell everything will be okay but she just looks at my face and continues to research for me. It's funny that I protected her for so long and now I guess she is trying to return the favor !!

Lynn
Helpful - 0
Avatar universal
"A Neurologist specializes in the diagnosis and treatment of all types of disease or impaired function of the brain, spinal cord, peripheral nerves, muscles and autonomic nervous system, as well as the blood vessels that relate to these structures."....
Taken from  ABMS- American Board  of Medical Specialtiess

Board Certification IS in "Psychiatry & Neurology". Board certification is not just in Neurology or not just in Psychiatry. Both have to be competent at diagnosing the other type of problem. To obtain certification in one a person has to have advanced training in the other.

http://www.abms.org/Who_We_Help/Physicians/specialties.aspx

I have a funny story about this. I was diagnosed very quickly in the ER with suspected stroke or MS. With in 2&1/2 hours they told me it was MS admitted me and started IV steroid.

The next day a doc came to my room to take my history, do the neurological exam. He identified himself as a neuro. He took my physical history with my family present.
I think he though it would be more comfortable for me with my family present, but it rather constrained me because there were things I wanted kept private from my family.

I was having difficulty speaking. He tried to get me to speak as much as possible, he wanted to hear how I spoke. My younger now very protective sister answered every question that he asked to prevent me from having to talk while it was obviously so difficult for me to speak. She didn't realize he wanted to hear me speak. she was pretty upset at her older sister being "helpless" in the ICU at the hospital. It shook her up.

She was so protective of me trying to talk for me. SHE brought up the fact that I had been treated for depression in the past. It upset her very much, at the time. I'm her big sister & I wasn't suppose to get depressed so she didn't believe it at the time. When I was diagnosed with MS she right away thought of that depression & brought it up when the neuro was taking my history. I would not have brought it up. To her it explained why I had been diagnosed as depressed, because she just couldn't see me as depressed.

I would not have offered that information. I had real physical problems in the past and just been given anti depressants. It soured me on EVER telling a physician I had been given anti depressants in the past. They just start planning how they are going to spend their money on their vacation this year as soon as they know all they have to do is write a prescription for anti depressants And that's what they do as soon as they know a person has taken anti depressants in the past..

I did not bring it up!... My little sister,did. She was now in her 30's but still my little sister.  I was laying in an ICU bed with the need to contain damages she did. I'm her big sister, I'm familiar with that. I went right into action.I looked him straight in the eye and said..."You do not have enough training or eduction to diagnose depression. From now on, I AM THE ONLY ONE WHO CAN DIAGNOSE DEPRESSION IN ME!! And THIS is not DEPRESSION!!" His eyes opened wide when I said that & his head jerked back as if I really had slugged him.

About a year later, I was wasting time at the computer. I looked up Board Certification. I saw that to be Board Certified in Neurology meant Board Certification in Psychiatry and Neurology it meant he had to do additional training in both Neurology & Psychiatry...so he most certainly had put in enough training & education to diagnose depression....

I did pay for what I did. There were times in the first year that I would have liked to have used an anti depressant for a while. But there was no way he was gonna suggest such a thing. He was afraid I would blow his head off if he even suggested it.

I still think that was a funny situation. And yes to be board certified in neurology they are also board certified in psychiatry. When treating a psychiatric problem, the psychiatrist has to be able to recognize neurology issues. And a neurologist must be able to recognize psychiatric isues. They both have to prove competence at treating disorders of the brain. BUT MY FRST NEURO WAS CONCERNED HE WOULD BE SHOT IF HE TRIED TO TREAT A PSYCHAITRIC PROBLEM!! :-)

A patient has to keep control of the situation & remember who the customer is.



Helpful - 0
572651 tn?1530999357
No, the neurologist doesn't have to also be a psychiatrist, but I understand many do have extensive training and certification in that area as well.

A good explanation of the overlap of these two specialties is at
http://en.wikipedia.org/wiki/Neurology

we have several members here who have disc herniations and other spinal problems and MS or suspected MS.  It is very much possible to have more than one disease causing problems at a time.

I hope you will let us know how your testing goes.
Lulu
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