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

Yes but it often takes both

Lots of medical schools have psychiatry societies to try to do this

Have you ever diagnosed someone with Inadequate Personality? If so, is it not just extreme shyness, or is there more to it than that? Thanks in advance.

Yes I have seen both full recovery and it to remit so it does not affect quality of life but might re-emerge at times of stress.hope your DS gets better soon

That’s not a diagnosis we use to my best knowledge

Everything you say is completely valid and reasonable. I can’t advise on specifics but if someone put these arguments to me I would listen and ask myself why not do what the patient wants and says works? That’s what patient centred care should look like

To be fair @ATerrorofLeftovers, it is something that can and does happen, though I don't know why it happens for some patients and not others.

I can't take propranolol and I refuse SSRIs or antipsychotics, and currently get benzos on a repeat prescription, to use whenever I want, for sleep/agitation/anxiety/whatever. Only 14 x 1mg lorazepam (at the moment — a while back it was 28, but I wasn't using anywhere close to that), so little to no chance of forming actual dependency, and most months I don't request any.

I've never had any trouble being given benzos if I request them, and never developed a habit. If offered z-drugs, I ask for benzos instead and there's never a problem. GP out-of-hours once happily gave me a full box of 5mg diazepam for anxiety/agitation, while someone I knew would be lucky to get 2 x 2mg. Going through a bad spell, an emergency GP told me to take 5mg diazepam 4 times a day for two weeks, and when that didn't work, I attended a drop-in clinic in another county who added 1mg lorazepam, same schedule, same duration, to take on top. Crisis team gave me clonazepam to take on a similar schedule, when I refused antipsychotics, which I reluctantly took. It's not a class of drugs I've ever experienced any reluctance to prescribe from doctors.

I guess either I've just happened to always come across less wary doctors, or there's some sort of individual or illness characteristics that affect whether doctors are happy to prescribe this way for you.

We have a close relative with depression and anxiety. They have been admitted to the local mental health hospital on multiple occasions. They see a psychiatrist, psychologist and the local mental health team but don’t seem to be improving. This has a significant impact on the wider family. We meet regularly but it is hard work and ultimately it has an impact on us too. What can we do to support our relative and how can we ensure this doesn’t impact our own wellbeing?

Hello, does the NHS still prescribe Prothiaden in some circumstances? I was on that in the 1990s and I’m wondering if I can convince a GP or psychiatrist to prescribe it for me now?

How much were you taught about psychotherapy when you were training? How much do you and your colleagues respect what it can do? Wondering if the doctors I work with are outliers or representative of the profession.

Not OP but this might help:

https://www.nhs.uk/medicines/dosulepin/about-dosulepin/

Thanks, I had seen that but it would be useful to get the OPs perspective on it.

What are your thoughts on a ketogenic diet for a range of neuro/psychiatric conditions, including ADHD? I watched the Harvard prof of psychiatry Dr Chris Palmer on Huberman/Mel Robbins youtube this week and his ideas that many neuro/mental health disorders are metabolic in origin & caused by faulty mitochrondria in the brain seems compelling. I managed to lose ~ 10kg a few years ago (& have kept it off) low carbing, so I’m very interested getting back into this way of eating. I ordered his book and am motivated to try to improve my ADHD & anxiety symptoms (undiagnosed) through diet/exercise. I know keto has long been used in treating epilepsy, but to what extent does keto / healthy eating generally have a meaningful role to play in supporting remission of psychiatric disorders?

Also related - is there much truck in the “psychobiome” / gut-brain axis theory, that the biodiversity of microorganisms in the gut (or lack of) contributes to mental health. I try to eat a wide variety of plants (52/30 on my “Zoe” list this week) plus kefir/kimchi etc.

Type two bipolar sufferer back with another question. I am already morbidly obese. I lose weight when not depressed but generally gain more than I have lost each time I am depressed. With this in mind is there a particular antidepressant that doesn’t have weight gain as a side effect?

Yeah, agree that sometimes the official line doesn't fully reflect the complexity of what happens in practice. I mostly posted because I know the underlying generic name changed from dothiepin to dosulepin at some point, so it was possible you hadn't been able to find the relevant info.

@DogandMog just be careful with it; I went on a low-carb diet, started exercising, lost weight, and dropped into the longest, most extreme manic episode I've ever had 😅

This is a really common problem - there can be burnout for family and carers. Sometimes all you can do is limit the time you spend with them and remember that there are professionals who are responsible for their well-being.
sometimes carers support groups can be useful too

Yes there are
discuss with your mental health team
its often the depression that drives increased appetite and lower levels of activity though not just the medication
mirtazapine is the worst one for weight gain in my experience

I haven’t initiated it but have continued it.

HI
My dd 17 is on quetiapine - is it a drug you can be on for a long while . She has been on it a year- she has ADHD. Thank you
Lastly do you believe that ADHD is often misdiagnosed as BPD
Thanks again

Hi, thank you for starting this thread. My 16 year old daughter has recently been diagnosed with OCD via a psychiatrist (contamination fear with excessive hand washing, clothes washing).

She is now seeing a child psychologist for therapy but only availability is via video link.

I suppose firstly, what are your professional thoughts for exposure response therapy successes?

Secondly, will video therapy be less effective. We are about 7 sessions in and I haven't observed any reduction in excessive washing.

It is soul destroying watching your child suffer. I am guilty of also losing patience with her and have been very frustrated in terms of 'god, you are not contaminated from touching a door handle otherwise you would have died from contamination years ago', completely unhelpful and unkind I know 😰

I was once prescribed mirtazapine and it was only years later when a vet prescribed it for my anorexic cat I realised how bad it was for weight gain. Worked almost instantly for the cat though so was useful for him.

@ipredictariot5 my DH had a mental breakdown a few years ago, he was in a psychiatric clinic for 6 weeks and off work for 4 months, had medication for over a year and 1:1 therapy and psychiatrist appointments. Post breakdown and recovery, he's different - he doesn't react or behave in the same way as he did before the breakdown. The psychiatrist told me this is because of his treatment and that he's now better. In your opinion is that the case? I've found it so odd and hard that his personality/who he is is different to everything I've ever known about him.
They also said that he's no more likely to have a breakdown again compared to anyone else, but I find that hard to believe. I see his vulnerabilities and his moods can change like the wind, I really think it could happen again. Do you find that it's common for people to have repeated breakdowns?

Thank-you so much for this. It sounds like you have a very humane and patient-centred approach and your patients are lucky to have you. I’m just sorry my relative can’t see you!

What would you say are the three most common causes of mental/emotional suffering? Could you rank them?

Oh, and do you think social media is fuelling a mental health crisis among the young, or is that over-hyped?