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

@WhatHaveIDoneNow
My DD16 had an emerging bpd "conversation" with the camhs psychiatrist and got given the leaflets explaining eupd.
We were so confused.
We were fortunate to be able to go private for adhd diagnosis after a 6 month wait list and got a diagnosis recently.
The private psychiatrist also told us to not worry about the eupd as DD clearly has ADD.

Thanks @DarkChocHolic. It's really good that you were able to access private assessment. I think it is extremely damaging to young people to suggest an emerging personality disorder.

I don’t do CAMHS but share your concerns re developing brains and neurodiversity and trauma
a PD label can be a real disadvantage for patients in terms of accessing care and experiencing stigma
however from prev experience of CAMHS colleagues I know they are v circumspect in making this diagnosis but the clinical picture can certainly suggest it
do not think politics or financials come into it at all

Use the ASRS and ASQ 50 screening tools as a starter ( google them and you will find them easily) both are tools that suggest if further assessment needed. ADHD can be hyperactive or inattentive in which the ‘Mind Excessively Wandering’ questionnaire can help
neurodiversity also runs in families so that is often a clue
i personally think ASD can be easier to suspect than ADHD but if you look for one you should look for the other
hope that helps

@NeverGuessWho I have just stumbled across this thread quite late. Your q caught my eye as we are dealing with something similar.

Alongside pursuing the diagnosis which may take some time, is it possible for your son to be assessed by an Occupational Therapist - private or otherwise? They can do tests which assess handwriting speed, visual processing and visual and motor integration and possibly other things, which may build up some evidence for your son for the summer exams to be allowed extra time, if a diagnosis is not forthcoming in time? It might be worth exploring at least?

I just wanted to thank you for this thread. I’m another one with suspected ADHD and score highly on online tests. I have discussed with my GP and debating whether to pursue but will now go ahead having read some of your replies. Interestingly, I’ve had a lot of therapy over the past 30 years, both CBT and psychodynamic. I found the former helpful but the latter worse than useless, mostly frustrating in it not helping in any way at all. However, realising I might have ADHD was like switching a light on in terms of why I responded to things and how I am. Thank you so much for your time.

This is a fantastic and informative thread thank you. I have finished reading through it.

It’s been a pleasure I have really enjoyed the thread too !

I just caught up with this excellent (long!) thread so it may be finished but if you see this OP and want to respond, do you know if there's been progress on treatment-resistant depression (or that's what it was called when I was diagnosed in the 90s)?

After 15yrs of suffering and many years of therapy I had some relief for about 18mos with fluoxetine and then it seemed to stop working. I tried over a dozen different meds (SSRIs, tricyclics and MAOIs) and a long intensive course of CBT. ECT was suggested but I was worried about my memory so didn't pursue it.

At the time I had a wonderful, compassionate psychiatrist who told me that while pursuing a solution I should also keep in mind that some people eventually just feel better and so it was for me. In time my mood lifted a little, I was able to become more active, met friends and a boyfriend (now DH) and eventually things were a lot better. The CBT penny finally dropped (it had never made much of a dent when I was unwell) and I was able to use it to improve my coping skills.

Things were better for about 20yrs and now, in menopause and on HRT, I'm really suffering again. I'm reluctant to ask my GP as they barely know me and there seems little point in starting from scratch with a GP after such disappointing results with a specialist. Not sure what to do next.

greeneggs… I am so sorry you have had that experience… depression saps your joy!
Encourage you to talk with your GP…I am a GP who suffers with awful depression… fortunately citalopram has completely changed my life.
In 20 years treatment has changed hugely and there are many more effective meds.
I would be interested to know what the OP thinks about ketamine treatment?
Thanks OP… I am sure that you area really wonderful psychiatrist!

@ipredictariot5

Thank you for such a wonderful thread! I haven't read it all yet so apologise if this has been asked.

I had a complete breakdown in 2022, was admitted to a psych hospital and treated with Sertraline.
I ended up on 200mg which helped but have been slowly trying to taper off.

When I spoke to my GP he said it was ok to taper off over the course of 2months.
I was a bit concerned about this so have been doing it slowly going down 25mg at a time.
Im now on 100mg but was wondering if it's too much of a jump to go to 50mg?

Thank you so much for the work you do x

Some good advice here
https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants

Definitely speak to your GP. Although it will seem like a hard job starting with someone else the GP will be able to read the previous records. Ask for a double appointment
it’s really common at menopause if you have had a previous episode of mental ill health for jt to happen again
it may be a further course of CBT would be a great place to start if you have not had it for years. The context of your life will have changed in those years so another course could really shift things again

Also rule of thumb that every reduction should only be by 10% each time particularly as you get to the final taper.

@Ugliest I am tapering off venlafaxine and magnesium is helping with some of the withdrawals. Just thought I'd share.

I don't understand the AMA topic. Are people approached by MNHQ to speak as a representative of their profession? Or do posters just randomly decide to post in this way. To me, it seems inappropriate, on a chat forum, for a member of a regulated profession to be speaking in their professional capacity .
Perhaps I am jaundiced. My long experience of mental health care for my son, who eventually killed himself following an inappropriate discharge, didn't really inspire much confidence in psychiatry on my part. They seem to have a senior place in the hierarchy on the basis of their prescribing expertise, but other professionals often had more insight and direct clinical knowledge of my son.

@GoodOldEmmaNess if you read the thread you will see the OP has been very careful not to give actual medical diagnosis/opinion. Most of her advice has been signposting where to go, what questions to ask etc. It has been a very helpful and informative thread.

Many thanks OP.

Hello there. I am really sorry about your son OP - it must really shake your confidence in services
AMA is a range of subjects. I started the thread after the conviction of the man who killed the two students in Nottingham as it was evident MH services had really let him down and it should never have happened
I was so sad and upset and a mother of university students myself
started the thread for anyone who wanted to know more about psychiatry and have really enjoyed it myself,
I would never ever advise on clinical care for a specific person but general advice/ information sharing and signposting seems to have been helpful . It’s also been enlightening too for me and I have learnt things through posters I have taken into my clinical practice too.