I have a problem with this...

elkpark · Jun 22, 2004

I've been a psych nurse for close to 20 years (a child psych CS for 10), and I have never seen someone diagnosed with BIF on the basis of subjective observations by a clinician, MD or otherwise. The diagnosis would be based on psychological testing (including IQ testing). That testing would not be done by the MD, it would be done by a licensed psychologist, so it would not impact (or reflect) the amount of time the doc spent assessing the client.

"IQ" is notoriously unreliable, and can fluctuate depending on many factors and circumstances. It would be possible for your friend to test in the BIF range while severely depressed enough to require hospitalization, but test (and function) at a much higher level when not depressed.

It is also v. common that clients underestimate the amount of time that clinicians spend with them. Again, severe depression does rather dramatic things to your awareness of your surroundings, your awareness of time, and your memory. Not that I'm saying your friend is definitely wrong, but very depressed people often remember things very differently from the folks around them ...

**canoehead, BSN, RN** · Jun 22, 2004

While everything elkpark said is true I find it sad that the first response was that the depressed person was remembering things wrong. Very clearly the BIF diagnosis was incorrect, and thank goodness your friend made it out of that situation and is successful now. What does it matter what a doc who spent 2 minutes with him years ago had to say? Consider the source.

lsyorke, RN · Jun 22, 2004

My son was diagnosed with a "Mood disorder" when he had been admitted to an inpatient adolescent unit in Full Blown Paxil withdrawal.Now that he's off Paxil completely it's really strange the "mood disorder" is gone!! :uhoh3:

elkpark · Jun 22, 2004

Not that I'm saying your friend is definitely wrong, but very depressed people often remember things very differently from the folks around them ...

That was not my "first response," and I did not say that the friend was remembering things wrong. I said that that was one of the possibilities in that situation. :) I attempted to answer the question(s) that the OP asked -- would it have been more helpful to say that, yeah, the doctor was probably an ignorant quack? Problems with memory, concentration, and cognition are known symptoms of depression -- if I had a dime for every time over the years that I had a patient on an inpatient unit comment to me that the doctor didn't see them that day, or something didn't get done that was supposed to, when I knew personally that the doc had seen them and whatever is was had gotten done, I wouldn't have to work any more. I don't think that's being critical of the individual in any way or accusing or blaming them for anything; it's just recognizing the symptoms of the disease.

It is also not at all unusual for teens to recover from a severe depressive episode and go on with their lives successfully. I, too, am glad that is the friend's experience in this case :) .

FutureRNMichael · Jun 23, 2004

Thanks everyone. I too find it odd he diagnosed John with BIF. However in his recollection when I asked, he did perform a Psychological test and did pretty poorly. Thus probably where the diagnoses came from. But, how common is it for someone with depression to have a low level of mental functioning. The two seem to go hand in hand. This could be a single poor judgment case-I don't want to lump all Docs in with his or anything but it's seems like a quick finger to diagnose a child or adolescent with something like this. Concievably could really disrupt a kid's treatment.

finness · Jun 23, 2004

The adolescent mind can be so fragile. I, too, think it is dangerous for young people to receive such a diagnosis as it can be disabling to a person in his/her formative years and have serious repercussions. I would seek a second opinion if I did not feel that my physician was providing adequate care. By the way, congrats to your family member on all of his success!! He deserves it!!

lovinghands · Jun 23, 2004

But, how common is it for someone with depression to have a low level of mental functioning. The two seem to go hand in hand.

I've worked in psych for the last ten years and I don't believe lower mental functioning goes hand in hand with depression. Psychomotor retardation may include slowed thought proccesses, thought blocking and impaired concentration - it does not reflect intelligence.

I may be personalizing this as I suffered from major depression in my early 20's - I had difficulty getting up and going to class etc but still maintained a 4.0. The depression slowed me down and interfered with my concentration but never once had a direct effect on my intelligence.

blondebuddie · Aug 14, 2004

A friend of mine who we will call John was hospitalized in his late teens for severe depression. He was seen by an Child/Adolescent Psychiatrist upon his first few days at an acute care hospital. The Doctor was with him, from his recollection, under 3-5 minutes max. He later finds out that the Doctor diagnosed him with the depression but also with Borderline Intellectual Functioning. He is a very succesful person now,educated,with a good job and from what he tells me, which I believe 100%, his IQ range has been in the 150-160 range for quite sometime.
Now how can a Doctor diagnose someone in such a short period of time and come up with such a poor diagnoses? I wonder how common this really is(?). I'm sure some people are labeled things they are not, such as this case, and it can have a lasting effect on their own lives,self esteem and careers.
I understand diagnosing depression in such a short time but how does one dignose BIF in 2 minutes? Seems like more would have to be made and shown for this to happen. That's my non-professional opinon anyway. :uhoh21:

I don't believe anyone can properly diagnose someone as BIF without doing some intellegience testing usually done by psychologists.

CharlieRN · Aug 16, 2004

Mike

I work now in admissions. I collect the data, observe the patient, take the history, formulate my impression of a possible diagnosis and then call a psychiatrist to present the case and get admission orders. Often the admission diagnosis is not the same as the discharge diagnosis. Depression does depress intellectual functioning in many patients. My guess is that the MD "called it as he saw it". He saw a low functioning person and discribed that. I personally think that a "possible BIF or R/O BIF" is more appropriate to that sort of situation.

One danger in making a diagnosis is that others will read into it more certainty than you have. It is afterall a guess, an educated guess, but a guess.

Recently, I had to deal with an adolescent who was suddenly displaying psychotic symptoms. I interviewed him with his parents present because he assured me he did not mind and would be able to answer honestly. None the less, I felt there was a strong possibility that he minimized his substance abuse history. His parents wanted a definite diagnosis. The history he presented suggested a first schizaphrenic break. I thought he likely had either been doing a whole lot more drugs than he had admitted to, or had got some bad pot. After discussion with the Doc on Call we decided on "Psychotic episode, not otherwise specified". Because that was what I could see in front of me. "Possible Schizaphrenia" because that is what the history suggested. "Rule Out: substance induced psychosis." because I'm a suspicious bastard.

Sorry, can't tell you what was right. We don't know yet. We will have to wait and see. When we know, two of those diagnoses will be wrong.

wonderbee, BSN, RN · Aug 16, 2004

In this neighborhood, and this is a big neighborhood, there is one child psych. He's got it locked up and knows it. He'll spend five minutes with a patient and diagnose and treat, even hospitalize based on that five minute interview. Poor kids get labeled with schizophrenia without psychological testing. That sticks for a long long time. Pisses me off. He was my son's doctor and he put our family through hell and turned my son into a zombie. My son is now doing well and a functioning member of society without meds but I had to lose the doc and find a Ph.D. level psychologist who was willing to test and administer therapy for the pittance insurance would pay. It was worth the time spent.