Comprehensive Diagnostic Psychiatry Services

Systematic 16-system investigation

75-90 minute initial evaluation investigating factors standard psychiatric visits miss. Comprehensive history, mental status examination, and systematic review of physiological factors affecting mental health.

Body systems investigated:

• Endocrine function (thyroid, cortisol, sex hormones)

• Nutritional status (B12, folate, iron, vitamin D, magnesium)

• Sleep architecture and disorders

• Cardiovascular factors and medication effects

• Metabolic function (insulin, glucose regulation)

• Medication interactions (all medications reviewed)

• Inflammatory markers and immune function
  

• Hormonal optimization (reproductive hormones, DHEA)
  

When current treatment isn't working

If you're on multiple psychiatric medications without improvement, comprehensive medical investigation often reveals why. Medical factors frequently contribute to or cause psychiatric symptoms.

Common underlying medical causes we identify:

• Thyroid dysfunction (affects 15-20% of depression cases)

• Severe B12 or iron deficiency (can mimic psychiatric illness)

• Undiagnosed sleep apnea (80% undiagnosed in psychiatric populations)

• Medication side effects (beta-blockers, statins, steroids)

• Hormonal imbalances (perimenopause, low testosterone)

• Chronic inflammation affecting brain function

When ADHD is accurate diagnosis, evidence-based treatment with medications and strategies. But we ensure medical factors aren't preventing focus—can't treat ADHD successfully if untreated sleep apnea is the primary problem.

Hormonal changes affecting mood and cognition

Women's hormonal changes—perimenopause, menopause, postpartum, hormonal contraception—profoundly affect mood, anxiety, sleep, and cognition. These are often misdiagnosed as primary psychiatric disorders.

What we investigate:

• Estrogen and progesterone levels and patterns

• Thyroid function (perimenopause commonly triggers thyroid dysfunction)

• FSH, LH (assess perimenopausal status accurately)

• DHEA and testosterone (often critically low)

• Iron and ferritin (heavy bleeding causes profound deficiency)

• Vitamin D, B12 (commonly deficient, worsen symptoms)

• Sleep quality (hormonal changes severely disrupt sleep)

As a male provider who learned from women ICU nurses: I pay extra attention to women's symptoms because I witnessed how often they're dismissed. Hormonal optimization—not just psychiatric medication—often resolves "depression" and "anxiety" that are actually hormonal. Most patients achieve significant improvement within 2-3 months, with quarterly maintenance thereafter.

Testosterone's impact on mood, energy, and focus

Low testosterone profoundly affects mood, motivation, energy, focus, and sleep— symptoms often misdiagnosed as depression or ADHD. Systematic investigation identifies hormonal factors before assuming primary psychiatric illness.

What we investigate:

• Total and free testosterone (time-of-day matters—morning testing critical)

• SHBG (sex hormone binding globulin—affects available testosterone)

• Estradiol (elevated estrogen affects mood in men)

• LH and FSH (determine if testicular vs pituitary cause)

• Thyroid function (commonly co-occurs with low testosterone)

• Vitamin D (affects testosterone production)

• Sleep quality and sleep apnea (testosterone drops 10-15% with poor sleep)

Testosterone optimization—when clinically indicated—often resolves symptoms attributed to "depression" or "ADHD." We coordinate with endocrinology or primary care when testosterone replacement is appropriate. Many men function at 70-80% for years before discovering low testosterone is the primary issue. Most achieve 95-100% functioning within 2-3 months of appropriate treatment, with quarterly maintenance thereafter.

Medical factors affecting trauma recovery

Trauma is real and requires appropriate treatment. But physical health significantly affects ability to recover from trauma. Poor sleep, chronic pain, hormonal dysfunction, and nutritional deficiencies impair trauma processing and nervous system regulation.

What we investigate:

• Sleep disorders (trauma disrupts sleep, but sleep disorders worsen trauma symptoms)

• Chronic pain and inflammation (affects nervous system regulation profoundly)

• Thyroid and hormonal factors (affect stress response and emotional regulation)

• Nutritional deficiencies (brain needs optimal nutrition to heal from trauma)

• Autonomic nervous system function (trauma affects, but medical issues worsen)

• Substance use patterns (often self-medication for trauma symptoms)

• Medication effects on emotional processing and memory consolidation

We provide medication management when appropriate and coordinate closely with trauma therapists. But we ensure physical health isn't preventing psychological healing— can't process trauma effectively with untreated sleep apnea, severe iron deficiency, or unmanaged chronic pain. Most patients achieve significant improvement within 2-3 months when medical barriers to recovery are addressed, with quarterly maintenance thereafter.

Root-cause investigation of sleep problems

Sleep problems are symptoms, not diagnoses. Before prescribing sleep medications, we investigate why sleep is disrupted. Undiagnosed sleep apnea, hormonal issues, medication effects, and circadian rhythm disorders commonly masquerade as "insomnia."

What we investigate:

• Sleep apnea screening (80% undiagnosed—profoundly affects psychiatric symptoms)

• Restless leg syndrome and periodic limb movement disorder

• Circadian rhythm disorders (delayed sleep phase, shift work disorder)

• Medication effects on sleep architecture (many medications disrupt REM sleep)

• Thyroid function (hypo- and hyperthyroidism both disrupt sleep)

• Iron and ferritin (deficiency causes restless legs, disrupts sleep)

• Hormonal factors (estrogen, progesterone, testosterone all affect sleep quality)

• Substance use (caffeine, alcohol, cannabis affecting sleep architecture)

When sleep disorders are identified and treated—CPAP for apnea, iron supplementation for restless legs, hormonal optimization—sleep often normalizes without sleep medications. When sleep medications are needed, we use evidence-based approaches with clear treatment goals. Most patients achieve significant sleep improvement within 2-3 months, with quarterly maintenance thereafter.

Evidence-based psychiatric prescribing with medical oversight

Psychiatric medication management requires understanding how ALL medications interact— not just psychiatric drugs. 19 years ICU experience managing complex medication regimens informs systematic approach to safe, effective prescribing.

Our approach:

• Review ALL medications (not just psychiatric—many drugs cause psychiatric symptoms)

• Investigate medical causes before adding psychiatric medications

• Evidence-based medication selection (not trial-and-error guessing)

• Systematic monitoring for side effects and drug interactions

• Clear treatment goals with objective outcome measures

• Medication reduction and discontinuation when clinically appropriate

• Coordination with other prescribers (cardiologists, endocrinologists, PCPs)

Many patients come on 4-5 psychiatric medications without clear benefit. Systematic review often reveals medication side effects causing symptoms, or medical causes that were missed. We optimize medication regimens—sometimes adding needed medications, often reducing or discontinuing unnecessary ones. Most patients achieve significant improvement within 2-3 months of appropriate medication management, transitioning to quarterly maintenance thereafter.

When you're "doing okay" but not "feeling great"

Many patients reach a plateau—medically improved with better lab values and successful procedures, but still not feeling well. You're "doing okay" on paper, but something still feels off. This frustrating gap between "medical improvement" and "actually feeling better" is exactly what medical optimization addresses.

What we investigate:

• Thyroid optimization (TSH 3.5 is "normal" but optimizing to 1.5 transforms energy and mood)

• Iron status (ferritin 22 is "low normal" but severely inadequate for optimal function)

• Vitamin D levels (deficiency extremely common, affects physical and mental health)

• Sleep quality (80% of patients have undiagnosed disorders affecting recovery)

• Medication interactions (common culprit for persistent symptoms despite treatment)

• Nutritional optimization (B12, magnesium, folate often overlooked in medical care)

• Hormonal factors (testosterone, estrogen, progesterone affecting mood and energy)

Common scenarios:

• Post-cardiac intervention: Heart function improved, but fatigue and low motivation persist

• Chronic pain treatment: Pain better controlled, but mood and energy still significantly low

• Diabetes management: A1C improved to target, but depression and fatigue continue

• Hormonal treatment: Levels "normalized" on labs, but symptoms remain unchanged

• Any medical success story where you're grateful for improvement but still not thriving

Comprehensive medical-psychiatric assessment identifies factors preventing you from feeling as good as your medical results suggest you should. We investigate systematically—not to replace your current treatment, but to optimize factors that close the gap between "medically better" and "actually feeling better." This is complementary care that works alongside your current providers. Most patients achieve 95-100% functioning within 2-3 months when medical optimization addresses the missing pieces. Once optimized, quarterly check-ins maintain wellness.

From 70-80% to 95-100% functioning

Many high-performing professionals function at 70-80% but know something's still off. Systematic medical investigation frequently identifies treatable factors preventing peak performance.

Common optimization targets:

• Thyroid optimization (TSH from 3.5→1.5 transforms energy)

• Iron optimization (ferritin from 22→70 resolves fatigue)

• Sleep quality improvement (even without diagnosed disorder)

• Testosterone optimization (affects energy, motivation, focus)

• Nutritional optimization (B12, vitamin D, magnesium)

• Inflammatory marker reduction

• Medication adjustments (beta-blockers, statins affecting energy)

Most optimization patients achieve 95-100% functioning within 2-3 months through medical optimization. Once optimized, quarterly check-ins maintain performance. This approach serves professionals seeking peak performance, not ongoing intensive therapy.

Medical investigation of performance decline

High-performing professionals often present with "burnout," but underlying medical factors frequently contribute. Systematic investigation ensures you're not treating "stress" when actual medical issues require treatment.

What we investigate:

• Sleep quality and disorders (even executives get sleep apnea)

• Thyroid dysfunction (common in high-stress professionals)

• Nutritional deficiencies (B12, iron, vitamin D)

• Testosterone levels (affects energy and motivation significantly)

• Chronic inflammation markers

• Inflammatory Substance use patterns (caffeine, alcohol affecting sleep/mood)marker reduction

• Metabolic function (insulin resistance, glucose dysregulation)

Many executives come thinking they need better stress management, when they actually need medical treatment for sleep apnea, thyroid disorder, or nutritional deficiency. Address those medical factors, and performance often returns naturally.

Fresh perspective on unclear diagnoses

If you've been diagnosed with multiple different conditions, or treatments aren't working despite compliance, comprehensive second opinion often provides clarity.

We provide second opinions for:

• Unclear or frequently changing diagnoses

• Symptoms not improving despite treatment compliance

• Medication regimens that aren't effective

• Concerns about overmedication or polypharmacy

• Questions about diagnostic accuracy

• Medical factors that may have been overlooked

Comprehensive medical-psychiatric evaluation often reveals missed medical causes or clarifies confusing diagnoses. You receive detailed written assessment with findings and recommendations, which you can share with current providers or use to guide new treatment.

Expert evaluations for surgical candidates

Many surgeries require psychiatric clearance. We provide comprehensive, timely evaluations with detailed reports for surgical teams—usually completed within 3-5 days.

Common clearance referrals:

• Bariatric surgery psychiatric clearance

• Transplant psychiatric evaluation

• Orthopedic surgery (especially spine procedures)

• Pain management interventions

• Chronic pain device implants

• Any surgery requiring psychiatric assessment

Evaluations are thorough but efficient. Surgical teams receive detailed report addressing psychiatric fitness for surgery, medication recommendations, and any concerns. If psychiatric symptoms are present, we investigate medical causes (as always) and provide ongoing treatment if needed.