A comprehensive physician consultation for complex psychiatric presentations.
Clarity. Precision. Individualized Recommendations.
Some psychiatric conditions are straightforward. Others require a more comprehensive evaluation to establish an accurate diagnosis, understand previous treatment response, and develop a clear, evidence-informed treatment strategy.
Diagnostic Clarification & Expert Consultation is a specialized consultation service for adults with complex psychiatric presentations, diagnostic uncertainty, treatment-resistant illness, or those seeking an independent expert evaluation.
Unlike a routine psychiatric evaluation, this consultation incorporates an extensive review of prior records, standardized clinical assessment, careful diagnostic formulation, and individualized treatment recommendations.
Consultation Process
Each consultation includes:
- Review of outside psychiatric and relevant medical records before your appointment
- Comprehensive 90-minute physician consultation
- Detailed psychiatric and medical history
- Review of previous diagnoses and differential diagnosis
- Comprehensive review of prior medication trials, treatment response, side effects, and reasons for discontinuation
- Medication reconciliation and assessment of potential drug interactions
- Family psychiatric history
- Substance use history and assessment of its impact on diagnosis and treatment
- Functional assessment across occupational, academic, interpersonal, and daily functioning
- Trauma and developmental history when clinically indicated
- Review of previous psychotherapy and other interventions
- Measurement-based assessment using validated psychiatric rating scales when clinically appropriate
- Comprehensive diagnostic formulation
- Individualized evidence-based treatment recommendations
Record Review
Previous psychiatric records are required whenever available.
Patients should provide relevant records before the consultation, including previous psychiatric evaluations, medication history, psychotherapy records, hospitalization records, laboratory studies, imaging, and prior psychological or neuropsychological evaluations.
Reviewing prior records before the appointment allows for a more complete understanding of your clinical history and reduces unnecessary duplication of previous evaluations.
Additional Diagnostic Recommendations
When clinically indicated, recommendations may include:
- Comprehensive laboratory evaluation
- Physical examination by your primary care physician
- Neuropsychological testing
- Comprehensive psychological testing
- Sleep evaluation
- Neurological consultation
- Substance use evaluation
- Additional specialty consultation
Recommendations are individualized based on the clinical presentation and are not routinely recommended for every patient.
Evidence-informed Treatment Strategy
Treatment recommendations integrate current clinical evidence, established practice guidelines, and individualized clinical judgment.
Recommendations may include:
- Diagnostic clarification
- Medication optimization
- Medication simplification when appropriate
- Evidence-based psychotherapy recommendations
- Lifestyle and behavioral interventions
- Measurement-based follow-up
- Consideration of interventional treatments, including TMS, when appropriate
- Coordination with treating clinicians upon written authorization
Who May Benefit
This consultation may be appropriate for individuals who:
- Have received multiple or changing psychiatric diagnoses
- Have experienced limited benefit from previous treatments
- Have complex mood, anxiety, ADHD, obsessive-compulsive, or trauma-related conditions
- Desire greater diagnostic clarity
- Are seeking an expert review of treatment options
Consultation Availability
Because this service requires extensive preparation and record review, appointments are offered on a limited basis and at the discretion of Dr. Santiago Almanzar. Acceptance is based on the complexity of the clinical question, anticipated benefit of consultation, and availability of sufficient clinical information for review.
Consultation Fee
Diagnostic Clarification & Expert Consultation
90-minute physician consultation — $750
The consultation fee includes:
- Review of records submitted before the appointment
- Comprehensive physician consultation
- Diagnostic formulation
- Individualized evidence-informed treatment recommendations
Follow-up consultations may be available upon request when clinically appropriate.
Superbills are available upon request.
Our Philosophy
Complex psychiatric presentations rarely benefit from simply adding another medication. Meaningful improvement often begins with a careful re-evaluation of the diagnosis, previous treatment history, contributing biological, psychological, and medical factors, and the evidence supporting future treatment options.
This consultation is designed to provide the time, expertise, and clinical depth necessary to develop a thoughtful diagnostic formulation and a personalized strategy for moving forward.