Psychiatric evaluations

You do not need a referral or a diagnosis to book. People usually reach us at one of a few moments: low mood or worry has started to affect work, school or relationships; sleep, energy or concentration has changed and nobody has explained why; a therapist or primary-care doctor has suggested seeing a psychiatrist; or a family member is worried. Some patients come in with a clear question, such as “Do I have ADHD?” Others simply know that something is off and want a professional to look at the whole picture.

We evaluate adults and adolescents. For teenagers, a parent or guardian joins for part of the visit and the clinician also spends time with the young person alone, because many teens describe their symptoms more openly that way.

Plan on 45 to 60 minutes. The American Psychiatric Association describes a complete psychiatric evaluation as covering current symptoms, psychiatric and medical history, substances, family history, social circumstances and a safety assessment, and that is the shape your visit will take. Expect questions like:

• What brought you in now, and when did you first notice it?
• How are you sleeping, eating and getting through the workday?
• Have you had treatment before, and what helped or didn't?
• Does anyone in your family have a history of depression, bipolar disorder or ADHD?
• How much alcohol, cannabis or other substances do you use?
• Have you had thoughts of harming yourself? (We ask everyone; it is routine, not an accusation.)

You may also fill out short, validated rating scales before or during the visit, such as the PHQ-9 for depression, the GAD-7 for anxiety or an adult ADHD self-report scale. These questionnaires do not make the diagnosis on their own. They give a baseline we can measure progress against later. When a physical cause needs to be ruled out, such as a thyroid problem or a medication side effect, we may ask for recent lab work from your primary-care doctor.

Adults often come in after a child is diagnosed and the description sounds familiar, or after years of missed deadlines and unfinished projects. The National Institute of Mental Health notes that ADHD symptoms begin in childhood, so part of an adult evaluation is reconstructing what school and home life were like before age 12. Old report cards or a parent's recollection can help.

We also look carefully at conditions that mimic or travel with ADHD: anxiety, depression, sleep problems and substance use can all damage concentration. An adult ADHD evaluation may take more than one visit. More on diagnosis and treatment options is on our ADHD evaluation and treatment page.

An evaluation is not a commitment to medication. For some patients the right next step is psychotherapy, and we can refer you to one of our therapists, Nadine A. McKenzie, MFT-LP, or Samia Vieux, MA-MFT, or to a clinician near your home. For others, medication makes sense, and ongoing care continues under our medication management program. Many people do best with both.

If you have already tried two or more antidepressants without enough relief, the evaluation also checks whether you might be a candidate for TMS therapy, which is delivered at our New City office. You get our honest view and the reasoning behind it, and the decision is yours.

A second-opinion evaluation is useful when a diagnosis does not feel right, when treatment has stalled, or when you have been given conflicting advice. Examples include depression that might actually be bipolar disorder, intrusive thoughts that could be OCD, or anxiety that has not budged after several medications. Bring your records, and we will review them alongside our own assessment and write back to your current clinician if you would like us to.

By the end of the evaluation, or the follow-up if a second session is needed, you should have:

• A working diagnosis explained in plain language, including what it is not
• A written treatment plan with goals, next steps and when we will check in
• Any prescriptions, lab orders or referrals, with the reasons for each
• A summary sent to your primary-care doctor or therapist, with your written consent

Diagnosis can evolve. If new information comes up at later visits, we revisit it openly rather than sticking with a first impression.

• Photo ID and insurance card (we verify benefits before the visit; see insurance)
• Every medication and supplement you take, with doses
• Past psychiatric records, hospital discharge papers or prior testing, if you have them
• For ADHD: school reports or someone who knew you as a child, if possible
• A few notes on what you most want help with; it is easy to forget in the moment

Our New City office at 216 Congers Road serves Rockland County, and our Middletown office on Prospect Avenue serves Orange County. Monday and Tuesday appointments run until 7 PM and both offices open Saturday mornings. Evaluations can also be done by telepsychiatry when that suits your situation; your clinician may ask to see you in person when a physical check or a closer look is clinically important.