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

Thanks for the answer. Reading your replies I think your patients get a good deal.

I am going to give general advice here as I do not know you so please discuss with
your usual MH care team
Ask for a second
opinion. If you have neurodiverse kids it runs in families and we know BPAD and ADHD often go together.
lots of psychiatrists are nervous about stimulant medication in BPAD worrying it will trigger mania. The current advice it is safe with a mood stabiliser and careful oversight
for autism it is a pretty lengthy diagnostic interview usually
I am sorry to hear of your experiences. In your age group we are certainly reviewing old diagnoses and trauma and neurodiversity often flag up as perhaps the reason for a presentation that seems severe and poorly responsive to medication
we are also seeing more women presenting with obvious ADHD symptoms at menopause - some may be menopause but in some the lack of oestrogen makes the low grade ADHD symptoms seem worse. Don’t miss out on HRT in your 50s
if your GP assesses you as appropriate we know lots of women with MH problems do not get offered it

I am mid fourties’ and have type 2 bipolar with a 2-3 year loop with roughly 9 months deep depression in each loop. Is your experience is this likely to remain the same as I age?

@ipredictariot5
Thank you for the thread!
My daughter 16 has been struggling with depression and extreme mood swings.
Fluoxetine 20mg did nothing for her and we are 10 weeks in.
Camhs have prescribed aripiprazole as she is seen to have emerging eupd.
She also scores high on adhd pre assessment.
Having read recent bbc, mrha and mind websites about the dangers of aripiprazole (gambling, impulsive spend, binge eating) I am very concerned.
Dd is also overweight with bmi of 29 which has mainly caused her depression in the first instance.
I am terrified of starting thr aripiprazole but equally she is rotting away not attending school and staying in bed all day.
What do I do?
Xx

Are you aware of the links between eye problems and SSRIs? I have had unexplained swelling on my retinas and am really cautious of taking SSRIs as there is a (small) risk of further eye problems. Both the eye consultant and two GPs that I've seen have denied that there's any link between SSRIs and retina issues but just a quick Google brings up lots of research papers establishing a link.

Just wondering if this is someone widely known about? And whether there is anything else I could take for anxiety that doesn't have possible effects on the eye/retina?

It is true people often show similar patterns/ loops in their illness but have all treatment options been explored including third line options? There are tertiary centre mood disorder services if your secondary care service has tried everything
9 months every 2-3 years sounds tough to deal with

No I do not know but if you have done your research and there appears to be a link I would be cautious. Eyes are important
however please do make changes to your medical care without discussing with
your doctors first

Sorry to hear this
general observations about aripiprazole - often chosen as associated with less / no weight gain
we have recently had advice to watch out for the behaviours you describe but It did not try stop using it just ask patients and consider change if emerge

Not sure what third line options are? I was put on lots of antidepressants before bipolar was diagnosed as they thought I had a depressive disorder. I have also tried most mood stablisers without success. I am currently only on 200mg quetiapine.

Have you ever seen a middle aged adult suddenly develop a severe tic disorder with hands and face? No signs in childhood. Aggravated by anxiety, caffeine/alcohol and hunger.

Is it a psychological or neurological issue?

I'd also love to know the answer to this. I am eternally grateful to my GP whom without her support and willingness to allow me to continue to have Diazepam and Zopiclone prescribed to take when needed,meant that my children still have a mum when insomnia nearly drove me to suicide. I have absolutely no problems with addiction and that's after 20 years. I've tried several SSRI's/SNRI's and some are horrendous to bother get on, and come off.

Ask your psychiatrist - new treatment options for depression emerging all the
time

I answered this up thread I hope
?

this person needs to see a neurologist

@ipredictariot5 I agree re IMHA. You would be amazed how often I visit a unit and I really feel that the staff see me as a hindrance.
If we can work together then it ensure patients voices are heard and they can understand their rights better and therefore feel empowered.

I have not seen a psychiatrist for years and I probably need to. It's so bad I've fallen down the stairs and out of bed but I'm so reluctant and anxious about changing something that works well.

Thank you for your answer ipredictariot5, very interesting, and I like your approach.

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!

Sorry to pick up on someone else’s question but I would like to ask a follow up to it.

I remembered always both myself and my sister being abused as young children/teens. She did not ever remember the abuse until I gave her a very specific description of my actual experience of the abuse as a young child and it triggered a memory for her, then over time she remembered more and more. According to her she then realised she had subsequently abused right into late adulthood by the abuser.

What mechanisms stop a person from remembering abuse they experienced within the last decade. Is there a type of dissociation that can happen? Just the other poster was asking how she might not remember and I presume there is coping mechanism that can cause that.

Memory is really complicated - it's not so much a fixed storage process like a computer memory but something that is reconstructed (and potentially changed) each time a memory is visited. Trauma does interfere with memory formation and recollection.

There is research showing that memories can be quite easily changed and manipulated, although the research base is still evolving. I'd be wary of anyone who claimed to have all the answers.

Name change for this one

My DH has just been sectioned, under the MHA, following a suicide attempt. He's there for 28 days which I understand to be the maximum. It's been a traumatic experience for us - my DD and I saved his life. We're now very worried about him coming home after that and possibly doing the same thing again.

What happens after the 28 days of being sectioned?

Firstly, thank you for posting and taking time to answer.

How do you change a teenagers sleep pattern, when they are clincally depressed and are taking anti depressants which have effected their sleep pattern. When exercise and going outside isn't within the reach at present due their depression.

I really appreciate you taking the time to answer. However, I don’t feel it answers my question because it addressed risk factors across a population, rather than those in individual patients. When a patient presents for help, they want patient-centred care, with their own individual needs and risks to be considered.

So if a patient has managed well on very occasional use of benzos for several years and has demonstrably been able to not escalate intake and keep it way, way lower than would risk addiction, why the eagerness to transfer them to a daily SSRI?

The SSRI will likely bring with it a slew of side effects, including insomnia, low libido, a risk of movement disorders, brain fog, dependency and discontinuation disorder and metabolic effects, to name just a small sample of possible side effects.

If we home in on just the metabolic effects, then the patient can put on a lot of weight, causing low self esteem and quite possibly a consequent worsening of their MH, and, more seriously, metabolic disorder. You will be as aware as I am how serious this can be. Developing type 2 diabetes can result in hugely increased risk of cardiovascular problems for one, there is added cancer risk at higher weights etc.

How can this possibly be better for the patient than one benzo a month?

I cannot see how it can be, but I’d love to hear if you think it is and, if so, why?

My son age 16 has suffered with OCD since around age 9. He is on Sertraline 100mg and had 6 months of ERP last year. It can be truly debilitating and it breaks my heart.
Do you think there's a chance he can eventually lead a normal life?
Have you seen people with OCD recover well?

What can medical schools do to attract better students into psychiatry? For so many new drs it isn’t their first choice, they end up in psychiatry simply because they couldn’t get a job anywhere else. Do you have any ideas about how else to raise the standard of care?

@ipredictariot5 Do you think OCD can be managed without medication and tailored therapy? We are talking rumination ocd (pure), not contamination ocd.

I’m so sorry to hear this. I assume you are his nearest relative?
I am going to suggest you look at Mind website. It’s all set out there better than I explain
i hope your DH gets better very soon x