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

Her GP should be her first port of call. Ask for a double appointment

Why is that psychiatry still consider ME as a FND rather a proper physical illness (as described in the NICE guidelines)?

I have had MH issues since I was a young teenager. Initially diagnoses with borderline PD and depression and treated with chlorpromazine with 2 yr hospital stay. 30 years later with regular ‘breakdowns’ diagnoses by Private Psych (couldn’t get seen in NHS) with bipolar and CPTSD. Currently prescribed an SSRI and a mood stabiliser, just been taken off quetiapine. Plus benzos PRN.

Been looking at ADHD as meet the criteria of your checklist- both my children are ND. Met with psych to discuss, tbh I had hoped that eventually I may be able to try ADHD meds and change/stop psych meds. He asked me questions for an hour at the end of which he refuted ADHD but diagnosed me as autistic despite not going through the required questionnaires. I’m in a waiting list to see a post diagnosis nurse.

This all seems wrong but I don’t know how to take it forward. How would you suggest I proceed. I’m almost 50 and I just want to manage my life. Thank you.

That sounds really hard
if I was seeing you I would start from the basis that your sister cannot hold memories for you. I would only really take this into account if she remembered things from when you were very young ( sat under 5) but I would not involve her in your care

No I haven’t heard of that sorry !

Argh @Flensburg, you've made me go and check and the best one seems to have disappeared which is unbelievable and awful. It was antidepressantwithdrawal.org or .com and now it's just blank. I can't find anything else useful as a website but there are FB groups eg Antidepressant SSRIs withdrawal support

Hyperbolic tapering is about making the reduction in dose smaller and smaller as you proceed, so you might reduce the first time by 50%, next dose by 25%, then no more than 10% at a time and when you get really low sometimes you can only manage a really tiny reduction eg 1-5%. Maintain each dose for a month or more before reducing again.

Its resources. My ideal would be for patients to have regular professionals who look after them for long periods and really get to know them. And lots and lots of psychological therapies available ina. Timely fashion

• I’m not sure about where you are but my trust really struggles to recruit Psychiatrists. What more can be done to attract people to the profession?
• What attracted you to Psychiatry?
• What is the hardest part of your job?

I do not know about Scotland but in England we have ‘right to choose’ meaning if paitents cannot get timely NHS care they have the right for private sector care. To be honest if you cannot access this I would go privately if you can afford to

Hi there
I'm a IMHA and I also have Bipolar.
2 things- as an IMHA I often come across professionals who struggle to understand my role- I feel there needs to be more cohesion between IMHA and Professionals as often things raised are not acknowledged- what do you think?

I am on low dose Quetiapine 200mg. I'm stable but I have lost a significant amount of weight ten stone plus. However reducing it I'm nervous about- it sedates me a lot to point I have to be in bed when I take it (I take at night). Would a lesser dose be better due to weight now?
Thanks

Oh sorry @Flensburg It's www.survivingantidepressants.org

Anxiety is a big feature of ADHD. If you score highly on the ASRS I would suggest you pursue assessment as if diagnosed you may find treatment takes away your need for sertraline

It will be a balance but those side effects are common and horrible to have
I can’t advise individually but if the side effects are intolerable I would seek advice about a change in medication

first of all it’s not my area of practice but a a a parent I share the concerns
as a professional this is an area I would not want to work in. I think the fact so many professionals whistle blew on the Tavistock shows there were serious concerns and I hope the new centres will deliver evidence based compassionate care that helps children and parents navigate these complex issues

I absolutely refer people for both.
most of the questions I have been asked CBT would be the modality of choice. Some people also need both or an interpreted approach
i tend to use CBT to treat ‘here and now’ problems such as not being able to work because of depression or able to get out of house because of anxiety
there are specific CBT treatments for eating disorders psychosis and trauma
psychodynamic I tend to refer for childhood/ relationship issues and to understand why people have ongoing patterns of behaviours and thoughts /
poor self esteem that may originate in childhood/ abusive relationships ( these are examples there are many others)
plus the sad fact is in the NHS CBT is time limited and cost effective
some other therapy modalities take years and are not offered routinely
i also haven’t mentioned group therapy which can be enormously helpful in some conditions

I absolutely hear what you are saying and generally will not meddle with people on more old fashioned medication regimes
if they are well and it is the patients choice
i will also initiate older drugs myself at times ( for example haloperidol)
i have not personally used MAOIs
sometimes we are restricted by drug
licence changes/
manufacture/ clinical guidelines both local and National as to what and how we prescribe, but guidelines can be deviated from on an individual basis
I am sorry of hear of your negative experiences

I do not think I do but I am not in that area of practice
my impression is that all the evidence emerging around long covid is challenging old ways of thinking about ME so
I hope things improve

@ipredictariot5 Thank you for answering my questions

I do not think we use IMHAs or IMCAs any where enough and for me it is always helpful for someone in the room
to be asking the difficult questions and challenging us.
two things you have said about the high
levels of sedation and your weight loss means a reduction would be absolutely a
good thing to discuss with your psychiatrist/ GP. My only general advice would be to do it slowly and you must have medical supervision by people who know you and know your illness

Thank you for your reply!
On top of the recovered memories, she is also claiming to see and speak to angels and auras and receive messages and is placing a lot of value on angel numbers. I told her this sounds like pyschosis but she thinks it's a spiritual awakening. Is it possible the trauma from the near death experience has caused pyschosis?

The Royal College of Psychiatrists have worked hard on this and at junior levels of the profession we are now over subscribed for doctors wanting to train in psychiatry
the attraction for me was a extension of why I entered medicine in that I am a people person and I get time in consults
to get to know people. I also
experienced a bout of mental ill health myself and go wonderful compassionate care and hope in what seemed awful. I try to model my
own care on the care I received
short staffing and lack of finding across
health and social care is the biggest challenge plus the wider political choices made by this government where
public health has been defunded, there is a lack of decent housing and vulnerable people have been more
marginalised than ever

Thanks so much for your very helpful advice

I do not think I can comment further
here but I hope she is accessing mental
health care

Thank you for this resource - I will have a look out for it too

Thank you, I understand. No unfortunately she is not as she prefers alternative therapies.