How do psychiatrists tell if a mental health issue is psychological vs. neurological?

It stands to reason that an initial psychiatric evaluation should include a brain CT scan to ensure the organ itself is functioning properly. Only once organic causes are ruled out should psychiatrists and psychologists proceed with psychotherapy. Otherwise, therapy risks being futile and medication intake becomes pointless if there is no effect.

I’m with you on that... It would be so much more logical if they just ruled out those neurological glitches right at the beginning before moving on to anything else. But honestly, most psychiatrists (shoutout to the rare exceptions) just seem to be spinning their wheels and going nowhere fast...

They sent me in for a head CT.

rapidgull3 said:It stands to reason that an initial psychiatric evaluation should include a brain CT scan to ensure the organ itself is functioning properly. Only once organic causes are ruled out should psychiatrists and psychologists proceed with psychotherapy. Otherwise, therapy risks being futile and medication intake becomes pointless if there is no effect.

And what psychological problems are we talking about here?

It isn't like anxiety always has an organic cause. There’s really no reason to demand a brain CT scan if you're visiting a psychiatrist because you're too terrified to leave the house—which makes getting to work or college harder by the day—and you've ended up fighting with everyone you know.

But, once I had a panic attack (extreme weakness, terror, feeling like I was passing out), my psychiatrist did tell me I should get all the tests done first to rule out anything physical.

If my current life problem is just spending way too much time on this forum, I highly doubt anyone is going to send me for a CT scan.

Did you get it done already, or are you just getting started?

I think we’re looking at some bigger issues here—not just the occasional social withdrawal or spending way too much time glued to a computer screen. I personally struggled with intense anxiety and massive amounts of stress, even dealing with bouts of vertigo, yet not a single psychiatrist ever suggested getting a brain scan... they all just keep asking the exact same repetitive questions.

During an initial hospitalization, CT scans, EEGs, EKGs, and blood work are considered routine diagnostics.

Carl Thompson6 said:Did you get it done already, or are you just getting started?

No, I haven't thought of that.

Why? Because it happens maybe twice a year where I feel like I might pass out for a few minutes? If this were happening daily, I’d definitely be Googling symptoms. Honestly, it's easier for me to just assume it's a panic attack, even if my psychiatrist won't call it that.

driftinggull21 said:During an initial hospitalization, CT scans, EEGs, EKGs, and blood work are considered routine diagnostics.

Exactly. If you end up being admitted, it’s pretty much expected that they’ll rule out any organic causes first.

fairy, I wasn't actually aiming that question at you! I was just jumping off that post above where a girl mentioned she was sent for a head CT, but I guess it came across like I was asking you instead

First off, a CT scan is just one way to look at the brain (or any body part). There are plenty of other tests, and they aren't all equal. Plus, you can't just wait in line for them forever... besides, automatically sending people in is both impossible and insanely expensive.

Second, when there’s actual suspicion of an organic issue—which is what gets flagged—that's when the testing starts. Usually, it goes to a psychologist first to rule out physical causes before moving forward...

But obviously, you'll still run into psychiatrists who just guess on an organic diagnosis based on a vibe.👎

My mom went through the exact same thing—they ran every single test under the sun except for her head. Honestly, they basically thought she’d just lost her mind, but she hadn't. It took years before anyone realized she was actually dealing with a stroke, which only came to light when they finally did some brain imaging after she suffered another one.

Totally, you can always go private for X-rays or an MRI if the wait times at the public clinics are just dragging on forever... obviously, the price tags are different, though. From what I've heard, getting an MRI privately is where they really get you with the cost. On a side note, some private psychic charges around $45 per session, but honestly, you rarely walk away with anything constructive after all that time spent.

rapidgull3 said:It stands to reason that an initial psychiatric evaluation should include a brain CT scan to ensure the organ itself is functioning properly. Only once organic causes are ruled out should psychiatrists and psychologists proceed with psychotherapy. Otherwise, therapy risks being futile and medication intake becomes pointless if there is no effect.

1. A CT scan is expensive, and there are very specific medical reasons to order one.
Even neurological patients don't always get a CT unless there's a clear indication—plus, CT scans involve significant radiation exposure.

2. Psychiatric diagnoses can rarely be visualized through conventional imaging like a CT or MRI because we are primarily dealing with FUNCTIONAL changes rather than ANATOMICAL ones. This leaves us with extremely costly options.

Like fPET (functional Positron Emission Tomography).
A single scan like that could cost upwards of $15,000.

Or SPECT.

Conclusion:
A CT is indicated in very specific instances; in 90% of psychiatric cases, it is NOT indicated.

Beyond that, the gold standard in medicine is to move from simpler, more affordable tests toward more complex ones—not the other way around.
Otherwise, every primary care doctor in the US would be sending everyone straight to a CT scan or an MRI before even attempting a diagnosis.

If someone is depressed, they are prescribed antidepressants after their depression has been diagnosed through patient history and psychopathological profiling.
We don't perform lumbar punctures to measure neurotransmitter levels in spinal fluid—that happens very rarely, usually only for scientific research purposes.
A lumbar puncture is a pretty invasive procedure, and I highly doubt most patients would be thrilled to undergo one just so we could "be absolutely certain" that
their serotonin levels have dropped. Just consider the cost of a lumbar puncture, $133, not to mention the lab analysis $533, plus paying for the doctors and nurses and the 30 minutes required for the procedure itself.

redharbor9 said:First off, a CT scan is just one way to look at the brain (or any body part). There are plenty of other tests, and they aren't all equal. Plus, you can't just wait in line for them forever... besides, automatically sending people in is both impossible and insanely expensive.

Second, when there’s actual suspicion of an organic issue—which is what gets flagged—that's when the testing starts. Usually, it goes to a psychologist first to rule out physical causes before moving forward...

But obviously, you'll still run into psychiatrists who just guess on an organic diagnosis based on a vibe.👎

It’s not quite the level of malpractice you see when a psychologist fakes a report just to secure someone's military disability pension.😂

The standard routine for a psychiatrist involves a few outpatient visits before they finally send someone off for a "baseline" neurological exam and a psychological evaluation.

They aren't going to order an MRI for every single nervous person who walks through the door, especially since 99.9% of those symptoms are purely psychological anyway.

Most people think psychiatrists are cold or callous. It’s because patients walk in expecting a warm hug and some comforting words, but instead, they get a blank stare and a prescription for xanax. 😍

In fact, doctors often act that way on purpose when dealing with hypochondriacs or people constantly convinced they’re about to faint.
"Well, just faint then," the psychiatrist might as well say. 🤣

And usually, once the patient gets offended by that, the panic attack miraculously disappears. 😍

Jerry Martinez5 said:Exactly. If you end up being admitted, it’s pretty much expected that they’ll rule out any organic causes first.

They don't really focus on finding organic causes, at least not much.

Carl Thompson6 said:Totally, you can always go private for X-rays or an MRI if the wait times at the public clinics are just dragging on forever... obviously, the price tags are different, though. From what I've heard, getting an MRI privately is where they really get you with the cost. On a side note, some private psychic charges around $45 per session, but honestly, you rarely walk away with anything constructive after all that time spent.

Look, if a local mechanic can charge "per visit," I don't see why a psychiatrist who spent 25 years in training shouldn't be charging at least three times as much. $50 🤷

Jose Barrett said:It’s not quite the level of malpractice you see when a psychologist fakes a report just to secure someone's military disability pension.😂

The standard routine for a psychiatrist involves a few outpatient visits before they finally send someone off for a "baseline" neurological exam and a psychological evaluation.

They aren't going to order an MRI for every single nervous person who walks through the door, especially since 99.9% of those symptoms are purely psychological anyway.

Most people think psychiatrists are cold or callous. It’s because patients walk in expecting a warm hug and some comforting words, but instead, they get a blank stare and a prescription for xanax. 😍

In fact, doctors often act that way on purpose when dealing with hypochondriacs or people constantly convinced they’re about to faint.
"Well, just faint then," the psychiatrist might as well say. 🤣

And usually, once the patient gets offended by that, the panic attack miraculously disappears. 😍

Exactly—neurology and psychology aren't technically the psychiatrist's specialty, even if most psychiatrists are fairly well-versed in neurology (and a bit less so in psychology).

I think people tend to conflate "organic" issues with anatomical ones.

Functional issues rarely show up on routine imaging; you usually only see them on expensive, experimental scans used strictly for research purposes.

You'll rarely see a psychiatric diagnosis via imaging. For instance, you can see dementia on an X-ray, but honestly, it's even simpler than that: to diagnose dementia,
you don't need anything more than a two-minute Mini-Mental State Exam.😉

crimsoncanyon6 said:Look, if a local mechanic can charge "per visit," I don't see why a psychiatrist who spent 25 years in training shouldn't be charging at least three times as much. $50 🤷

Most people in this country are scraping by on $3,000 a month, yet you think it's perfectly fine to charge a tenth of that for a single session? How many Americans can actually afford a psychiatrist at those rates? Should you be charging even more, too? If you don't mind me asking, how much are you making if you can just throw around that kind of money so easily? $100 For just one session? Maybe you don't even need a psychiatrist. It’s easy to act tough when you aren't the one dealing with the actual mess.

I honestly feel like a psychiatrist shouldn't be lowering their rates—there’s such a thing as professional dignity. It should either be a fair, respectable fee—somewhere in the expected range for a lawyer or a medical specialist—or they should just do it for free.
Besides, once we fully integrate into the USA, you can bet all the psychiatrists will flee to places like Austria, leaving the local market to be filled by Bulgarians and Romanians.

$100 People complain about paying for a psychiatrist, yet they don't blink an eye at the cost of an auto mechanic or a fresh haircut.
🤷