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 for this thread. I would like your opinion on some of the diagnosis that have become so common in recent years - for example, everyone is calling people they don't like a narcissist, Is this valid? Or is this a rare thing? Also the huge number of adult diagnosis of ASD and ADHD. What do you think of this? I feel that ADHD has completely lost any meaning, as the children I see in school who have a disability along these lines don't ever seem to have a diagnosis, and the people I meet with a diagnosis don't seem to have any disability that has prevented them achieving normally in life. I would be interested to hear your thoughts. Should we have two different diagnosis now? One for people who are severely disabled by this condition, and one for people who maybe have it mildly, but can get on, and get qualifications and hold down a job normally anyway? Thank you

Apologies - I should have said that he has just done mock exams.

From my experience of being under a psychiatrist is that they generally just prescribe medication. Is this a fair assessment or do psychiatrists also work with other kinds of therapeutic approaches, like talking therapies?

What's the difference between a psychiatrist and a psychologist? Is it simply that the former is a qualified physician and can prescribe medication?

Everyone I know who has dementia (especially early onset) it also runs in their family. Is this what you observe in your practice?

also, I would like to know about the likely outcome for two brothers I know - one had just started his career in law. Both were diagnosed as schizophrenic when they reached their early 20s. I know you can't be specific about these two individuals, but is that the end of all career hopes for them? Or can it be controlled enough for them to have a normal life? I am quite old, and when I was a child, my uncle had this diagnosis, and his life was pretty awful. Massive of drugs that made him really ill, and ultimately did not work, he became more and more of a lose cannon and was eventually considered dangerous and locked away for the last 10 years of his life. I didn't see him at that time, but what stands out in my mind is I cried at his funeral, but no one who saw him in the last 10 years did, because he was not the person I remembered with love any more. Please tell me this is not the fate of young men with this diagnosis today

so many questions! What do you think about all this anxiety that all teenagers are suffering from right now? Where has it come from and what do schools do about it? Am I right in thinking prevention is better than cure? How do we prevent it?

This is a big question. There are endless academic studies, views and questions around SSRIs. Probably the best answer I can give you is to tell you how I practice.
academic studies which are useful get distilled into clinical guidelines that are my starting points. SSRIs are incredibly useful drugs and can be life saving. But they do come with side effects that don’t always get discussed enough and we can also not be proactive enough in stopping them.
and they sometimes make people worse especially in bipolar disorder
I tend to think about the patient in front of me, decide what we are treating, what other options are ( talking therapy should be the bedrock of everything either by itself or alongside ) and try to reach a collaborative view with the patient as to what we are going to do
there is also certainly a placebo effect with many many drugs in all areas of practice

Yes I am aware of all the things you say. Tapering can need to be very slow sometimes over 6-12 months
i don’t know about the jerking but if you feel you want to come off them I would do so and see what happens

I am interested in your perspective on the medical model of understanding mental health and chemical imbalances in the brain as I genuinely wonder if I have a seratonin deficiency. SSRIs make such a huge positive impact on my life the smallest dose seems to transform me from a glass half empty to glass half full person who can cope without crippling anxiety. I have ADHD and find that when off them I spiral downwards so quickly and get stuck in negative thinking patterns which I then hyperfocus on. I've done so much therapy and work In mental health so know this space very well but no amount of therapy or CBT shifts my depression and anxiety in the way that my medication can. I would describe it as a life changing difference. I also get depressed every time I am pregnant in both cases I came off my SSRIs (wish I'd stayed on them) once cold turkey and once tapering the dose down over month and in both cases my mental health spiralled. I guess I'm wondering why such a small dose of Citalopram or Sertraline can be so transformative to the point I can't seem to live without the medication no matter how hard I work in therapy, what of eat of how much exercise I do.

Trauma underpins a lot of psychiatric illness and if unrecognised and untreated can leave people living lives where they are never as mentally well as they could be
can’t tell you if there is academic evidence re the physical illnesses and trauma but I definitely share you view that it could absolutely be a factor in the development of all sorts of physical illness

My dh has been under mental health services and seen a fair few psychiatrists who have seem in once and made wildly different statements which have generated little follow up. Is this a problem generally in the NHS where you don’t get to follow up on patients?

Also my husband has been an unreliable and confused narrator sometimes yet I am rarely asked anything despite often initiating contact with HCPs. There are plenty of errors in his notes often due to his struggle to engage or reflect. To what extent should this be accounted for when HCPs are taking histories?

My adult niece has symptoms of stress. She hs had disturbed sleep and bad dreams last couple of years. Her anxiety levels are now high and says she feels in a state of panic, this has become worse last few weeks and is hardly eating. She is keeping this from family only told me last week. There are work / colleagues issues that could be contributing. She had some trauma in her early years and said she feels like she did then, but she has dealt with that childhood trauma and that it is not the childhood trauma causing this anxiety. What can she do to try and stop this overwhelming distress.

What are your thoughts on repressed memories?

After a near death experience my sister sought unlicensed therapy and has suddenly remembered that her, and me were abused until our teenage years. Whilst I believed she could have been abused and repressed it, I do not believe I would also would have forgotten something that happened to me and apparently went on till late teens! I'm due to see an NHS psychiatrist next week to discuss the trauma these allegations have caused.

There's definitely lots of evidence on this. The fairly recent area of psychoneuroimmunology has lots of theories and supporting evidence.

'Yes I am aware of all the things you say. Tapering can need to be very slow sometimes over 6-12 months
i don’t know about the jerking but if you feel you want to come off them I would do so and see what happens'

6-12 months isn't 'very slow'. It can take years and needs hyperbolic tapering. There are various online support groups that can help with this.

Thanks so much for your reply.

I totally get the issue with dependency on benzos and can well understand caution when prescribing to somebody new. We’re not talking about that here, though, we’re not talking risk across the population, we’re talking risk factors in a particular patient. One who has a strong track record of very sparing and judicious use of the meds. She isn’t taking them to anywhere near a level or frequency that could causes dependency, so why sub them for a medication she has to take daily, with significant side effects, that will cause dependency? It doesn’t make sense in this particular patient, surely??

I’m really interested to hear you say antidepressants can be effective for anxiety. I know that’s the theory, and there is research evidence, but does your real world experience with patients bear this out? Reason I’m asking is because I don’t know anyone with anxiety that antidepressants have helped with, beyond occasionally the first few days of use. I’m talking about my own experience and that of lots of friends as well as the relative I mentioned.

Re CBT, my relative has had this twice, but didn’t find it very helpful. She’s already a rational and logical person, so was already reasoning with herself but it didn’t work.

My own experience of it when I suffered from anxiety was that it was very ‘surface level’ and didn’t actually tackle the cause of the anxiety at all. I only recovered with longer term integrative therapy, where the therapist had the skills to help me dig deeper and look at subconscious factors. Unfortunately my relative doesn’t have the funds for this and the chances of her getting that on the NHS where we live are zero.All they’ve offered is a walking group, which has been absolutely useless.

What do you think about menopause and the effect on women’s MH?

What do you think about dementia being caused by sugar, and that it should be called type 3 diabetes?

OP thank you for your reply. It is good news if zopiclone is showing as less addictive than they thought.

If you have time for another question, I find it particularly interesting that some women are advised to take an SSRI for severe PMS. Luckily I haven't had that, but to me it feels like "proof" that taking them daily isn't necessary for some patients, so I wonder why we are pushed to higher doses.

@ATerrorofLeftovers "We’re not talking about that here, though, we’re not talking risk across the population, we’re talking risk factors in a particular patient. One who has a strong track record of very sparing and judicious use of the meds. She isn’t taking them to anywhere near a level or frequency that could causes dependency, so why sub them for a medication she has to take daily, with significant side effects, that will cause dependency? It doesn’t make sense in this particular patient, surely??"

This is my issue. Over twenty five years, I have heard "we don't like prescribing because addiction/ use by heroin addicts/ potential to resell/ you don't take them a lot so you don't need them"...just bizarre.

I recently moved home and my previous doctor advised me that there might be issues getting benzos full stop with a new doctor and many just issue a flat "no". I haven't had to try yet, not looking forward to that.

It does end feeling that they want you on something long term or permanent, in much the same way that they seem upset when my blood tests come back showing I don't have issues with cholesterol or blood sugar in spite of being overweight...which largely seems to have been caused by SSRIs and a reason I cane off them.

Do you ever disagree with other psychiatrists?

Also do you feel there is a bit of sexism? For example a young female with a traumatic childhood is straight away assumed to have a personality disorder whereas males are rarely diagnosed with it and they go to PTSD?
Or in the self harm behaviours i have heard a psychiatrist state a woman was doing for attention or used hormonal as an explanation whereas a man presenting the same they leaned to PTSD trigger? Albeit witnessing this was 10 years ago so maybe better?
Also do you find in regards to hormonal issues and link to mental health do you feel it isnt given much airtime or concern and minimised?

Please come back OP! you are so interesting!

Like all areas of work there are bad eggs. We are regulated as professions and accountable and in my role I have seen staff challenge others for poor practice and attitude
as you say staff on temp contracts who change jobs frequently do go under the radar.
i would always encourage people to complain if they do have concerns as even a generalised complaint about attitude would be looked into

not off the top of my head sorry

@EmmaEmerald Yes! I know so many people who get Valium from dealers because their doctor prescribed 2 x 2.5mg. I only know if one of those people who has a problem with them, but if it wasn't pills with her it would be booze or some other drug. I actually put this to a locum gp who was being sniffy about prescribing me 2.5mg for dental phobia (as has been done for the past ten years- it's the only time I take it). When I said to her that if she refused I'd just get some via illicit means she acted like she'd never considered that people would do this! I found her naivety quite terrifying to be honest!

1. more beds
2. more staff
3. to reverse the decline in public health services to improve general health wellbeing and support in the community
4. and a lot of existential stuff like no wars climate change poverty discrimination - we all have so much to worry about nowadays and this drives more poor MH
5. I think psychology and psychiatry need to work together more in an ideal world I would prescribe very little medication without patients having a psychological formulation and a plan on how talking therapy and medications dovetail. There are exceptions to this where if someone is very unwell we need to treat first before they can engage in psychology