so what now? (sorry, long)

[crimsonwitch]

I was referred to the cmht a few months back with suspected BPD plus Bipolar, and I have had my assessment with the consultant today. After a full consultation he told me, that in his opinion, I have BPD with features of depression and anxiety. He told me he would be referring me to secondary care for psychological assessment. He decided that he would prescribe me sertraline at a low dose to help with the depressive symptoms (despite me telling him that I do not tolerate SSRI's) I am still breastfeeding Ds2, so he told me that because of this I couldn't have any other medication, but should I choose to stop breastfeeding he recommended a medication to help the anxiety, which is to be taken as and when needed and was in syrup form, but I cant remember what it was. He then told me that he was discharging me back to my GP and to wait to here from the psychologist, as BPD is not a psychiatric disorder and there is no "cure" for a personality.
My questions (if anyone can answer) are:

1. Am I going to be discriminated against because of this diagnosis? I have heard that this is common with BPD.
   
   
2. What is secondary psychological care, I have been under primary care in the past and had CBT which didn't work, the consultant said secondary care is different.
   
   
3. Is anyone breastfeeding while taking sertraline, and was there any effect on your baby?
   
   
4. Has anybody any idea what this syrup is that he recommended for acute anxiety? I honestly cant remember what he said.
   
   
5. Is it ok that he discharged me with no further follow-up and told me if I felt i was in a crisis to ring the samaritans or go to A and E?
   
   I feel more lost now than I did before.

[fluffydressinggown]

Secondary MH care is usually the community mental health team. The guidelines for BPD state that you should be offered long term therapy (longer than 3 months I think) so hopefully this referral will be for something longer term.

BPD can be a diagnosis of exclusion but it is seen as a curable and manageable condition these days, so the psychiatrist was totally out of order to suggest that it is not treatable. He is right in the sense that there is no medication that will 'fix' it, but there is medication for some of the symptoms of it, so depression, anxiety etc.

That said, I have a BPD diagnosis and rarely see a psychiatrist, I see a nurse and I used to see a psychologist. I think psychiatrists do tend to work more with people who are more medication managed, like bipolar and schizophrenia so maybe he meant he would not be seeing you regularly?

It is usual to be told to go to A&E or ring the crisis team in difficult times, I see someone once a week and I am still advised to get support from crisis if I am struggling.

[HoopHopes]

Secondary care as above said is more long term care than the talking therapies that you may have had. You may get a care plan, a chance to do therapy like DBT which is recommended for bpd sufferers or to work with a psychologist ( not necessarily straight away as there may be lists and waits). Some areas have specialist personality disorder teams as well, my next city does where I live but not where I am for eg.

Psychiatrists do not tend to be involved apart from diagnosis as they deal with diagnosis and medications and lower dose anti depressants they do not tend to review people for. But if under other mental health professionals then yes they can always re refer or talk to a psychiatrist anyway.

Every health team worlds differently so find out how yours works is good. For eg here no patient access to crisis team, only other professional can refer a patient to it. So get a plan and work out what you need.

You may need to declare your diagnosis, it can affect insurance policies, occupational health at work may need to know if you struggling at work etc.

No idea what the syrup is! I have tablets for anxiety but you may have to wait until you stop bf.

And bpd is not necessarily for life, many people when reassessed no longer have symptoms of it. I would be wary of a diagnosis made on one meeting as well so feel free to challenge it. There are official diagnostic tests and a long set of written questions that should be asked before diagnosis made!!!!!

Sertraline is one if the ad's prescribed for breastfeeding so yes it is the one peri natal mental health teams also prescribe.

If you have a baby under one yrs old you could ask your health visitor or gp to refer you to the peri natal mental health team for assessment if you want a second opinion a both diagnosis and medication.

[crimsonwitch]

Thank you for your replies. The consultant did talk to me for a very long time plus went through my medical file. I did answer lots of questions and he was referring to the official diagnostic criteria. He definitely said I was being discharged from his care. The medicine he said would be to take at points of extreme anxiety to calm me down, but I still can't remember what it was. I forgot to add, he told me about accessing the crisis team if I was in any danger, but didn't tell me how to contact them. I think your right about the secondary care psychotherapy, he said it would be a long process. I just feel in limbo tbh, without any support till the therapy starts.

[HoopHopes]

One session does not necessarily do the SCID -D test which has 119 questions that need answers writing down and then taking away to be scored in order for an official diagnosis of BPD if that helps.

Most patients cannot directly access a crisis team. If you feel you are suicidal and at crisis point you need to see your gp, contact out of hours if not in gp time ( or no appointments left at gp's that day as you can go to out of hours at 6pm onwards or thereabouts) and they can make a direct referral for you. As can a and e but expect a long wait, an assessment by a mental health social worker usually before getting through as they have to wait for people to come to a and e to do that role, as few dept's have psych staff there. The dr's can refer you to crisis no matter what care you are or are not getting. Crisis team is an assessment of your mental health, can you be cared for in the community, do you need vol/involuntary hospital and then seeing or phoning you every day to support you. Usually different mental health nurse each day will do this.

Yes, it took me years to get some short term therapy on the nhs. but they often do group therapy for people with bpd diagnosis as the skills of interpersonal effectiveness are taught that way which is one of the 4 modules of DBT therapy that is highly regarded for bpd sufferers. It often depends on when a new group is starting and when a slot comes free.

[crimsonwitch]

Thank you for your reply hoop. I feel that I want to challenge my diagnosis now, after reading your post. I've also been doing a bit of internet research, and while I agree I meet the criteria for this diagnosis, I have read of a number of other conditions that have a similar presentation. I think my consultant may have just wanted to stick a label on me. Seeing the gp in the morning to talk through what happened with the consultant.

[crimsonwitch]

I have been to my gp who agrees that the consultant was just going through the motions. He also believes that the diagnosis is probably right, but I should have had further consultations before it was confirmed. I am starting sertraline tonight and when I stop breastfeeding I am going to be prescribed promazine (the medicine I couldn't remember) now its just a waiting game for my therapy.

[HoopHopes]

Hi, hope medication helps. Yes it was the lack of seeing you before diagnosis that would concern me, not whether the diagnosis is right. But you got a diagnosis, medication and referral for therapy which is actually really good and not a, see me in 6 months then we will see about diagnosis and treatment options.

[HoopHopes]

The diagnosis may or may not be right and in a few months time with medication and better times perhaps it may be different... Medication is not used for personality disorders but for underlying depression etc that may go with it so in itself is not always a cure.

It depends whether you are happy with the label and the treatment that goes with it really. If you are then you got a good outcome. If you think a one off appointment and no diagnostic tools used is not right then perhaps think again.

Most people who get personality disorders are known to mental health teams, in and out of crisis or even hospital/ a and e etc and have a history that helps lead to the diagnosis. Not mean that others do not have it though, but as you say there are several disorders that may lead to it.

Different treatments are offered depending on a diagnosis - so DBT for bpd for instance. It may not be a useful treatment for someone with a different diagnosis etc. so wor finding out which talking treatment you been referred to. Not everyone with bpd will get access to DBT as it depends on their severity and ability to access the programme.

[crimsonwitch]

Thanks hoop, I am not happy with the label and the massive stigma associated, but I am glad that it has given me a gateway into hopefully affective treatment. I am known to services and have been treated in hospital A and E on a number of occasions, but this is the first time I have had a full psychiatric assessment with a consultant, and been given a diagnosis. I have only seen a mental health nurse in the past and been patched up and sent home. Mental health services are very poor in this area, but I do feel more positive now so thanks again