Dr. Bhavin Gajera’s

A more thorough examination allows me to discover more of a person’s subtleties and nuances that are easily overlooked in a single-session evaluation.  The additional time is also needed to address other potential causes or contributors to the presenting problem, including consideration of medical issues and comorbid psychiatric conditions.  Many patients appreciate the extra time to address any concerns or reservations they may have as well as to better work together in forming educated treatment decisions.

Any past evaluation or testing would be helpful, but not essential. Recent labwork and prescriptions.  For children and adolescents, copies of the Individualized Education Plan (IEP), recent report cards, and any school notes are also useful.

For adult evaluations, consultations are typically done in two sessions or one double-length session.  Rarely, very complex histories may require a third session.  During that time a comprehensive psychiatric exam includes discussing the current concerns as well as reviewing history, medical history, medications and screening for other potential difficulties or hidden causes and complications.  At the end of the consultation, findings are discussed and I work with patients to find an individualized plan for treatment.  This may include starting therapy (either with myself or recommending appropriate therapists).  Adolescent and child evaluations consultations typically span three sessions.  The first is with the parents, the second is with the adolescent or child alone, and the third is conducted as a family where the diagnostic impression and a personalized treatment plan are discussed.

That is a very important question.  Obviously, treatment varies considerably with each individual.  I do recognize that issues such as limited time, money, and desire for progress are part of an effective treatment plan and encourage discussion of treatment timelines.

Sessions typically last 45 minutes.  Psychotherapy is conducted, at a minimum, on a weekly basis.  Medication only treatment is typically monthly. Starting and adjusting medication may require more frequent initial visits, but once on a stable dosage of a non-controlled substance for several months, medication visits can occur once every two months.  This model of service differs from other medication-focused psychiatric practices where your visit may be from 10-15 minutes..

Absolutely.  A good treatment relationship with the right therapist is invaluable.  I prefer to be able to freely communicate with your therapist in this type of collaborative treatment.

I do see a limited number of patients in psychotherapy or in combined psychotherapy – psychopharmacology treatment.

No.  After a consultation I often will advise on therapeutic approaches that may be more effective.  However, I am often referred patients that would benefit from combining medications with therapy.

There is some addiction potential with certain classes of medications.  Other medications may require gradual taper when discontinuing to prevent withdrawl-like side effects (i.e. Serotonin Discontinuation Syndrome), but are not habit forming per se.

Yes, with the patient’s or parent’s clear understanding.  The Food & Drug Administration has a process where pharmaceutical companies can get approval for specific uses of a medication.  Many times, most often due to cost considerations, these companies may not pursue certain indications.  This is an issue particularly of concern with the pediatric population where most medication needs to be prescribed “off-label”.

I tend to be conservative and parsimonious with medication and allow adequate time to see if a medication is effective before adding additional ones.  There are, however, some treatment refractory cases which do need several complementary and synergistic medications. Ideally this would be a rare occurance.

Anywhere from infancy to adulthood.  With infants, the work is centered around the parent-child bond and often focuses on new parent adjustment. Younger children are usually seen when there is a behavioral concern such as with sleep, eating, anxiety or socialization (as in the Autistic Spectrum Disorders).

In a limited fashion. Autistic patients benefit most from school-based or team approaches addressing several different needs including academic, behavioral, and social adjustment. The psychiatrist’s role is usually limited and would consist of medication to help in more difficult cases of behavioral distrubance, impulsivity or irritability.