I am an NHS Psychiatrist AMA

[ipredictariot5]

There has been so much in the news this week about the mental healthcare of the man who killed the three people in Nottingham. If anyone wants to
ask any questions about this or psychiatry in general fire away

Thank you so very much for posting this. I'm am 46 and all my life have had to apologise for how I am. No matter how hard I try I always end up being me. Lol. My son came in the other day and said he thinks that I may have ADHD. I've researched the topic on NHS website and I feel like I've came home. I recognise so much of myself on paper. What do I do about this, if there is anything I can do?🤗🤗🤗

I am on the waiting list for a psychiatrist appointment, I have private diagnosis ADHD autism and ptsd. I'm interested what will happen initially and how we get to a point of being able to unpack certain trauma and be able to 'fix' it. So I go with a list? They will do an initial assessment but what if the stuff doesn't come up

This is the screening tool we use to determine if someone needs further assessment https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf
go to your GP and ask for referral. There is a scheme called ‘right to choose’ where if you cannot get an NHS assessment ( many areas do not have an ADHD service or r long waits)you can ask for a private assessment. Personally I think ADHD is under diagnosed and undertreated and can make a massive difference
to a persons quality of life

@ipredictariot5 wow, thank you so so much again. I'm going to make an appointment with doctor.xx

I would want to see the reports of your private assessments and start from there. I wouldn’t question the diagnosis of an appropriately qualified person but would
take a detailed history myself to
come up with a plan. I
would also be wanting to see
someone more than once to get an understanding of the problems.
I also find it helpful if there are a lot of issues if people bring some written notes and leave them with me to think about
it is also useful to Know what has
the biggest impact day to day so
can make a plan on how to tackle it.

Do you believe in personality disorders?
I say this as I know a psychiatrist who kind of doesn't .

Are you good at spotting people in ordinary life who have strong cluster B traits?

Why are antidepressants that need to be taken daily, have serious side effects and cause dependency so are difficult and unpleasant to stop taking, viewed preferentially to judicious and sparing use of benzodiazepines in specific circumstances that cause anxiety?

As an example, a relative of mine suffers from anxiety, particularly social anxiety, but generally manages well apart from the odd situation, eg family wedding, important work presentation etc. She was previously prescribed Valium to take when needed and has taken it very occasionally - average less than once per month.

At her recent appointment the GP (private, fwiw) tried to cajole her into taking antidepressants instead. My relative doesn’t want to take a medication daily for the odd day she needs extra support and the Valium with propranolol has worked very well for her. As far as she’s concerned, switching to an antidepressants would not be a positive move and I can see her point.

The GP did make out a new prescription but intimated it might be the last, even though she couldn’t provide any explanation as to why antidepressants would be the superior option. This has panicked my relative, who is now much more anxious! Just having the Valium and knowing she can take it if needed really helps and actually means she rarely takes it.

Somebody taking Valium once per month has no chance of getting addicted, so what’s the issue? Why is dependency on a prescription antidepressant with side effects such as metabolic issues preferable to occasional non-dependent use of benzodiazepines? How can it be? And why is the private GP suddenly cutting up rough about prescribing now?

It’s all been very unhelpful and unsettling, so any light you can shed would be gratefully received.

Is a dementia diagnosis based on medical evidence or just an educated guess based on symptoms? How can you be totally sure without a post mortem?

How can younger people (20's 30's) reduce their chances of Alzheimer's or is it fate?

Do you ever get frustrated with patients?

I'd like to know this too please. I was also in the same position where my gp kept trying to put me on antidepressants (I'd already been there and done that and they didnt work, despite me trying 5 different types) when very occasional use of Valium was working brilliantly for the times my anxiety led to a full on panic attack where I sometimes ended up hyperventilating.

• I do also practice cbt, breathing exercises and pay for my own psychotherapy to get to the root cause.

@ATerrorofLeftovers ""Why are antidepressants that need to be taken daily, have serious side effects and cause dependency so are difficult and unpleasant to stop taking, viewed preferentially to judicious and sparing use of benzodiazepines in specific circumstances that cause anxiety?"

This! I have opted to come off SSRIs after decades use and my doctor is very worried but the side effects are too problematic. Using occasional benzos would be much better. I know so many people who had this problem!

Also, why is it so hard to get sleeping pills - even faced with a patient who was drastically ill after 72 hours of no sleep, I got 7 pills. I had one colleague given two diazepam!

I know the usual answer is the addiction potential but I had a relative in her 90s who took a sleeping pill every night for decades, only to have them withdrawn under those rules. It wasn't great for a 90 year old to be awake all night, yes she was not working, obvs, but depriving her of sleep ruined the last years of her life.

I've had a doctor tell me that if I only need occasional benzos, I don't need them at all. So I can't win, I'm asking for too few or too many. They want everyone on long term medication.

Also, do you see a link between reduced prescribing of benzos and sleeping pills in the US and increase the opioid use, because I sure do.

I asked two doctors what they think patients will do if not prescribed those. They didn't reply. But surely they know the answer - hence the silence. We're going to drink enough to knock us out, or create something from the medicine cabinet that will bring on sleep, or knock us out.

Do you feel drugs go through trends of being used and then demonised?

Sorry for so many questions.

How long did you have to take to train to be a psychiatrist and what routes can people take to get there?

I just wanted to let you know op that my ADHD diagnosis was life saving for me. My life felt so hopeless and I'm just so grateful that the psychiatrist I saw listened and was able to help.

I have so many questions, so please feel free to pick and choose.
If you don’t mind answering, what stage are you in your career? Would you ever consider working privately and if so, why or why not?

On average, it takes the NHS over 9 years to diagnose Bipolar. Is there a similar statistic for other mental illnesses? What do you think needs to be changed to allow clinicians to diagnose quicker?

How long do assessments take generally?

It’s always been my understanding that NHS psychiatrists tend to deal with more acute cases. Do you think this is true? What are the impacts of this on how junior psychiatrists, learn and practice?

Full disclosure, I had an absolutely awful NHS experience before being diagnosed privately with bipolar. This isn’t unique experience, and going private isn’t an option for everybody. What advice would you give disillusioned people to help them re-engage when they are well enough to?

Interesting thread, thanks OP. My daughter is currently under a psychiatrist.

What is the most extreme patient you have ever had to treat? As in behaviours etc

What's the difference between a normal and a forensic psychiatrist

How can I get my in laws to understand autism and ADHD in children? MILtrained as a psychiatrist and FIL was a GP, they're nearly 80 now, but can't comprehend my children. They both also have sensory processing issues, around noise is the worst, my DD15 can't cope and quickly escalates to being completely overwhelmed - in laws just say I'm being too over protective
To be fair my MIL is a complete narcissist anyway who always needs to be centre of attention, bit it's so disappointing that they can't realise things are different with children but here days and they don't seem to even come sided educating themselves

• realise things are different for children these days, and dont consider educating themselves about childhood related ASD/ADHD issues

My exceptionally clever 17 YO has ASD and ADHD, but is sailing through her exams and has wanted to be psychiatrist her whole life.

She is, if anything, over-empathetic, despite being autistic. Grasping people’s underlying struggles, and understanding them ‘holistically’ is a sixth sense for both of us, and is probably the most stand-out quirky gift that we both have. On the flip-side of course there are high levels of anxiety and also strong feelings of injustice when things are unfairly wrong or broken.

I would love to know your thoughts on her career choice, and whether you think being a psychiatrist in the NHS (or training to get there) might ‘break’ someone like her? And if she followed such a career, at what appx age would she be actually ‘doing’ the job for real, rather than training? (I appreciate the ongoing training will continue for many years alongside practicing itself).

If it matters, she has interests in pathology, obs/gyn and paediatrics as well, so is reasonably open to the potential of diverting into a different area, if psychiatry turns out to be unsuitable.

Many thanks.

All I will say about PD is I am very circumpsect in using the diagnosis as I do not always think it is very helpful and can lead to barriers in accessing services.
far better to think about the symptoms and try to understand the causes and how to treat them
I tend not to think in cluster A and B symptoms though learnt about them academically.
I also try really hard not to think about psychiatry in people in my life outside work so no

lots of different reasons. One might be the licensing in that benzodiazepines are
never meant to be long term. They can definitely be addictive and this can
spiral quickly even if only
used occasionally.
Antidepressants can be very effective.
i dont personally prescribe propranolol much - it is often started by
GPs and can be effective for
physical symptoms of anxiety.
I do prescribe benzos at times and yes
they are effective
but the first line treatment should be CBT not meds

Is your specialism the correct place for a first referral in a memory loss situation? My friend has had significant memory loss over the last 3 months, combined with cognitive decline. Her doctor says he's referring her to a psychiatrist for diagnosis. He believes she may have early dementia (she's 60).

We're so confused. Surely a neurologist would be more appropriate? Is her doctor sending her to the wrong place? I'm have her PofA, and so am helping her, and it makes no sense to send her to psychiatry. Does it?

Medical evidence.
dementia is progressive and that can make it clear what’s going on.
tons of things. The usual healthy lifestyle things - for example vascular dementia
is linked with smoking.
Some is just not preventable - a high
percentage of people would have some signs at post mortem at advanced age
it does look like treatments are progressing rapidly as well

No more than any other health care professional! Obviously you try never to show it.
also if you feel this you need to ask why and try to do something about it.

See below - sorry I did not quote you in my answer - hit the wrong button!