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

Hopefully my answer to the first poster helps ?

Are you aware of protracted withdrawal syndrome from SSRIs where the brain is incapable of managing without them, however slowly a person tapers off them?
Also, I have developed myoclonic jerking several times a day over the last 15 to 20 years, due to ongoing SSRI use since 1992. If I ever manage to get off them, is this likely to go?

Don’t know about the opioids
there is evidence that zopiclone for sleep
does not have addictive qualities that were once thought.
However both with these and benzos the
more they are used the less effective
they are.
I don’t mind scripts of a limited number of tablets a month for as needed use on a
longer term basis but a lot of doctors wont.
but I would usually be prescribing like this in the context of a major mental illness
like bipolar disorder
yes drugs go in and out of fashion
SSRIs are currently being seen as something to use less of not more
a good place for info is the BNF which will tell you the rules for doctors when prescribing ( google the drug plus BNF)
also the NICE
guidelines for anxiety/ depression will show you the evidence base on treatment

Five years med school one year
as a house officer and six years
psych training
but I retrained in my
late 30s after kids and firmly believe the additional life experience really helped me

This may be out of your sphere somewhat, but do you think there is a connection between trauma and autoimmune diseases? Or trauma and neurological conditions? I know that ADHD, for example, often exists without any traumatic factors but does trauma make some people more like to experience certain conditions? How have you seen untreated trauma playing out in people's lives in ways in which the pain gets shoehorned into other aspects of a person's being? I know someone with huge, huge amounts of untreated trauma who also has a huge amount of autoimmune and other undiagnosed health issues. I don't mean hypochondria as the symptoms are very real but I've often wondered if it's related to their terrible upbringing and subsequent events in later life. I know that a recent spate of emotional stress totally destroyed my immune system and I was sick every 2 minutes.

Bipolar often diagnosed years after
onset of symptoms. and we should
think about it much earlier but if there is not an obvious manic episode it can be very subtle. Some people can just seem like a depression that is hard to treat and there can be other factors like alcohol or drugs which complicate the picture.
im a consultant late career.
don’t do private work but not for any particular reason
we tend to deal with more complex patients that GPs want specialist advice on also as you say acute cases.
most junior psychs see a
lot of both

Sorry don’t want to talk about specifics but can be both high risk of patients to themselves and others and severe
illness that is difficult to treat

Forensic will see people in the crimimal
justice system.
very few people with a mental illness commit crimes and if they do it’s not related to the illness
but sometimes it is like the case
in Nottingham
they look after people in secure services prisons and do court reports and
give evidence

You might not be able to for that generation.My own parents
in their 80s
dont really believe in mental illness!

I know lots of neurodiverse doctors who do well. We are much better at identifying it and supporting them now
certain specialities do suit better
i love psychiatry and would not put her off.
most people find their place in medicine where their skills are best used. Plus we all have to take care of our own well-being and mental health.
my main colleague has Asd
and Adhd

GP first then neurology / psychiatry -
does not matter hugely as we refer a
lot between specialities and psychs think about physical illness first off and can arrange investigations

What is your view on the latest research that SSRIs do not work by stabilising mood?

Are there any new theories about how they work?

And why do you prescribe them if you do?

In your experience after treating many patients do you find that anti-depressants are genuinely effective or do you think a large part of their efficacy is caused by a placebo effect?

An acquaintance of mine (sister of friend) is a psychiatric nurse. She is also abusive and manipulative. She's told me anecdotes that were supposed to give me the idea of what a hero she is working with these kinds of people and all it did was make me fear for those who were in her care (teens).
Nothing she told me was anything I could report her for though, it was all intangible. 😭
She moves jobs often, presumably to avoid getting known for what she actually is. She can always find work though, I suppose her quals are in demand. She has been promoted and now has authority over others (so much varied experience!).
So I wonder...
What mechanisms are in place in institutions to try to weed people like her out?
How common to think it is that the staff view their patients with contempt and enjoy turning the psychological screws?
😔😔😔

Thank you OP

Thank you so much. That's hugely reassuring. We are afraid she's being sent down a dead end and would suffer delays as a consequence. Thank you.

Thank you @ipredictariot5 - their comments make me doubt myself, but I keep reminding myself that psychiatrists, paediatrician, CAMHS all came to the same conclusion, so it's not me being too over protective. My DD did take 2 overdoses after her existential crisis (mask fell off and her 'mental bucket ' overflowed) so I am very caring, but honestly, DD particularly struggles and has had panic attacks in the supermarket, she collapses or just runs, but she is trying to push herself to get out and take time in the world in small controlled samples, she'll likely just be choosey about which environment she can handle, and for how long - I just wish her grandparents would respect and try to understand that

... sorry, one last thing, could you suggest any research papers / systematic reviews etc that I could forward to them?

I'm a Psychologist, used to be NHS but private for a decade now for flexibility reasons. How well do you think the interplay between psychiatrists and psychologists works in the NHS? How would you change the set up and provision of mental health services in the UK if you had the scope?

My Dad has psychosis, anxiety, depression and OCD. He is on 5 different drugs for his mental health, including lithium. He was discharged from the mental health services because he isn't actively suicidal at the moment. It means most of his care is left to me. My main question, which no mental health professional has ever been able to answer, is this: when my dad is saying things that are blatantly untrue as a result of his psychosis, how should I respond? Should I argue with him, agree with him or what? The things he says vary from 'there are tiny matadors walking across the dining table' and 'my cat is brown' (when it is actually black and white) and 'it is impossible to change a lightbulb unless you are a qualified electrician'. All fairly harmless stuff, but I'm hearing it on a daily basis and don't know how I should be reacting!

Just wanted to say thank you - I recently had my first appointment with an NHS psychiatrist and it's the first time I've ever felt truly 'heard'.

My son has prader willi syndrome and autism, he has psychotic episodes. He takes flouxitine to cope with anxiety. His coping mechanism to otherwise manage this anxiety is to pick his skin and create sores which eventually become infected. He has mild learning difficulty so will not be seen by disabled services (apparently too bright for them). He has just been assessed again and although the assessor recommended support and review by a psychiatrist he has been turn down again and offered 'talking therapies'- guess we just wait for the next episode, police intervention and hospitalisation.

What's your experience on EUPD? I was diagnosed a few years ago but i wasn't under how helpful it is as a diagnosis beating mind I now can't get access to any kind of therapy because thouse I've approached won't work with me!

Wasn't sure, not wasn't under

Do you actually believe in the medical model of mental distress?

Thanks for sharing your advice and experience with us.

My DS18 is convinced that he has ADHD, and I agree. I took him to the GP a couple of years ago, the GP did a referral but we have heard nothing. I should have chased it, but haven't.

He's doing well at college, however, he has just done exams, and due to time restraints and not being able to concentrate he has flunked one exam. (It's a T Level course.)

The part of the exam he completed he did well on, but he simply did not have the concentration to enable him to complete the necessary amount of written work in the allocated time.

We have realised it is now too late for him to have an NHS diagnosis in time for his exams.

What would you advise - is there any way that I can get him extra time? I have failed him badly by not chasing up the diagnosis. I am prepared to pay for a private referral, but I don't think the exam board will accept this.

TIA.