Psychiatric Evaluation
& Diagnosis

Psychiatric conditions overlap heavily in how they present. Depression, anxiety, ADHD, trauma, bipolar disorder and personality patterns share symptoms, and several medical conditions produce all of them. A fifteen-minute appointment can identify a symptom. It cannot reliably identify which condition is producing it.

The cost of getting it wrong is measurable. In a population-based cohort of 8,935 patients, the mean delay to a bipolar disorder diagnosis was 6.46 years, and prior diagnoses of unipolar depression or a personality disorder were associated with a longer delay still. Surveyed patients report initial misdiagnosis at around 69%, most commonly as unipolar depression. Those are years of treatment aimed at the wrong target.

This is not an abstract concern about labels. Treatment follows diagnosis directly. Antidepressant monotherapy is appropriate in unipolar depression and can destabilise mood across the bipolar spectrum. Stimulants treat ADHD and can worsen anxiety. Benzodiazepines relieve anxiety quickly and undercut the exposure-based therapy that produces lasting change in phobia and panic. Each of those is the right decision under one diagnosis and the wrong one under another.

A proper evaluation also asks what else could be causing this. Thyroid dysfunction, anemia, B12 and vitamin D deficiency, sleep apnea, and a long list of common medications all produce psychiatric symptoms, and none of them improves with a psychiatric prescription. Substance and alcohol use is asked about directly, because it changes both the diagnosis and the plan.

Validated instruments — the PHQ-9, GAD-7, and others appropriate to the presentation — are used as adjuncts. They quantify severity and give a baseline to measure against. They do not make diagnoses, and a questionnaire score is not an evaluation.

Dr. Farkas brings MD/PhD neuroscience training, NIH research center experience, and board-certified psychiatric practice to this work. The output is a diagnostic formulation explained in plain terms, not a code on a form.

The initial appointment runs 30–60 minutes and covers the full history above. Bring your current medications — the actual bottles are better than a list from memory — along with any prior records, test results, or previous diagnoses you have.

Dr. Farkas then discusses what she's found: the diagnostic formulation, what it rests on, what was considered and excluded, and what remains uncertain if anything does. Treatment recommendations follow from that, with the rationale and the alternatives explained, and a follow-up scheduled before you finish.