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

Are you concerned about the over reliance on medications that have a poor safety profile and severe side effects?

Is there a plan to tackle MH more holistically?

This is an area I am particularly shocked by as I worked in sexual assault services for many years. I cannot comment on allegations against staff but I see people being very careful on this and making sure they work in twos and try to maintain dignity for patients. But at the same time I have seen restraint for tranquillisation in very ill patients that must absolutely feel like an assault.
I have been really bothered for years that MH services seemed to have a casual attitude to safety of female patients. Mixed wards exist and even if technically patients have their own rooms in reality the extra privacy leads to more opportunity for sexual assaults. Women who are manic can often be sexually disinhibited are at particular risk. They do not have capacity at the time to make good decisions and should in my view always be kept safe on single sex wards. Also vulnerable women with EUPD for example or who have experienced abusive relationships can be vulnerable to male patients
I joined an initiative looking at this a few years ago and was dismayed just how little people knew, even if people have sex pregnancy tests and STI screening were never offered. I also felt the Police should be called by staff and it was either not thought about or patients were asked if they wanted the Police when they were not well enough to make choices
I did my best to point all this out and work on guidelines but my job took me away from inpatients to a different role
I also know a woman in my personal life who was admitted manic and had sex on the ward. She is a happily married professional woman with children and she wasn’t kept safe
short staffing exacerbates this. You might plan to have a patient on regular observations but if there is no one to do other important tasks inevitably this can suffer
I am as horrified as everyone else by this and am so glad it has finally reached national attention. Really really glad

Thank you taking the time to post.

Any tips on managing adhd in peri menopause?

I see an nhs psychiatrist privately. He seems to have the empathy and compassion as of a dead dog! It feels like "take the prescription and please leave".

My peri menopause is well managed by hrt. But I feel my adhd symptoms are off the chart in the last 12 months. I take medication but I think it's accepted that medication isn't a fix all. It just plugs a bit of a gap. (Let's not EVEN talk about medication shortages 🤣)

Hrt medic while lovely and compassionate doesn't have much concept of adhd. And psychiatrist...well, I don't know! He doesn't comment on much at all.

I mentioned that anxiety has been off the chart with perimenopause. I worked out that despite a life long love of caffeine I suddenly had a massive intolerance. Give up the caffeine and anxiety drops. (Life is cruel!)

I said that if/when I have low mood it is associated with the impact of my adhd. (Low mood because I can't do something I need to). Not depression in an "isolated" way. Then psychiatrist keeps talking about my "anxiety and depression". When I explain the above AGAIN he simply states that they are comorbid with ADHD.

Sorry. There's not much of a question in there. I'm just struggling to find any one specialist who seems to GET me as an entire person. Specifically struggling with adhd AND perimenopause 🤷‍♀️

@ipredictariot5 - thank you for your thoughtful and considered response.

Oh and the b1tch of ADHD that is "knowing what might make things better but can't ACTUALLY do them ". Ie eating regularly, high protein diet etc etc.

Today I've had a slice of toast, 2 running gels (I DID manage to run today) and a packet of salt and vinegar crisps 😩

(Sorry, turning in a a sad rant now 🤣)

Really well said @ipredictariot5 mixed sex wards are completely inappropriate for mental health patients but really for any vulnerable female patient.

What do you think of ECT? It’s being suggested to my friend but it seems so brutal and outdated - is it risky?

It is a common problem and all I can advise is you ask to go through the different ADHD meds as suggested in the NICE guidance and see if you can find one that suits you
if you work you can apply to Access to Work and get a grant for 12 sessions of ADHD coaching that might help
giving up caffeine sounds good idea, try to manage as healthy a lifestyle as possible and exercise may also be really benefical
there is an ADHD podcast on Spotify The ADHD adults podcast that talks about it and also an episode in Dr Louise Newson menopause podcast

It has got a good evidence base for it and is less brutal than you think, a short anaesthetic is given.
tends to be after various medications have not given improvement and would not be offered without careful consideration

Yes and I always try to think holistically and access psychotherapy if appropriate
I think we often keep adding meds and don’t always ask if we should stop them
but medication is absolutely essential for many - you couldn’t manage bipolar disorder severe depression or psychosis without medication.

Sorry - it’s another narcissism one!

you said in earlier post that it’s a very small minority who have narcissistic PD. But do you think that it is under diagnosed?

I know every other ex partner is called a narcissist on here, but I think a lot of people are recognising narcissistic traits.

and even if very few people actually meet the NPD criteria, is narcissistic behaviour a symptom of some kind of trauma?

It’s not my area sorry I have only met one patient with the diagnosis in 30 years!
however my experience of working with patients with addiction is many show narcissistic traits and behaviours but these tend to be addressed in therapy as part of recovery and I would not go looking to make a diagnosis as such
this is a service I know that has a good explanation
https://www.castlecraig.co.uk/addiction-resources/the-narcissist-and-addiction/

What do you think about the difficulty of getting melatonin prescribed? Very luckily my DS has it prescribed - he’s late teens now but it really really saved his and our sanity when he was younger. He just didn’t sleep - took 3 hours to get to sleep and woke up many times nightly. Once on Melatonin he was able to get to sleep and stay asleep - the ‘virtuous circle’ effect on daily life was/is massive.

why is it so difficult (GPs can’t prescribe it on their own) to get when the rest of Europe and the US/Canada can get it in health foods shops and pharmacies cheaply?

I have no idea and it would make my life a lot easier if there were not so many restrictions . I can prescribe it but GPs are often not allowed to and quite a lot of clinical time can be taken up writing scripts for people with autism who do not need to be open to MH services.
I can’t find a convincing reason from internet searches either

Thanks. He’s under the well-being team at uni and his tutors know his issues, so that’s really good, and he has a DSA mentor he gets on well with. He’s a bit rubbish at ‘reaching out’ though, as they say. I will look at the link!

@TrentCrimmIsHot and @ OP thank you very much.
My psychiatrist and care coordinator think I can get off 35 years of SSRIs and SNRIs in 3 weeks and refuse to listen to my concerns.🙄

@Flensburg I'm so sorry. Have you referred them to any of the recent studies?

I don't know if you're still answering messages. I just wanted to say as the parent of a 20 year old son with bipolar 1, who was sectioned for 3 months at 17 for hypomania and psychosis, thank you for what you do.

I wonder how you cope with all the suffering you see. I'm on a FB group for family members of people with schizophrenia and psychotic disorders. I'm humbled by the superhuman efforts of family to keep their severely mentally ill loved ones safe, at huge, huge personal cost and over long periods of time. My son is mentally ill, and was also diagnosed with chronic myeloid leukaemia in January last year, but when I go on this board and see what other parents are dealing with I feel lucky, because my son is kind, gentle, loving and despite his incredible problems is usually quite happy.

What keeps my son going is his love of classical music. A cancer charity pays for his piano lessons and I genuinely believe that this has been the most therapeutic intervention he's experienced in the years of his illness.
I'd like to know what your thoughts are on art and music therapy. Is it something you place much value on?

@TrentCrimmIsHot thanks.
Not specifically, as I don't know any. I dont think they would read them anyway.' I ve mentioned protracted withdrawal syndrome. They just smile and nod and tell me not to overthink things...

Sounds like you are doing a great
job supporting your son
families have it far harder than MH staff.
I think many of us lvle
our jobs but get distressed
by not being able to provide tbe care needed like so many sectors in the NHS.
we had a patient recently who we detained on a s3’who had to spend the next 5’days in A and E as no beds anywhere
in country. A government who thinks that is OK is shameful
YY to art and music therapy.
people with BPAD can be extraordinarily creative

My grandson has an extreme phobia for certain words all of which are connected to biology We have tried taking him to a special school they lasted 15 minutes before saying his trigger words. He went back the next day and the experience was repeated. He now refuses to go. He has seen psychologist and in fact a senior psychologist. The first lasted 10 minutes before saying a trigger word the second had no idea how to treat him. His reaction is very extreme sobbing vomiting. He was appointed a tutor who also used to trigger word almost immediately. All these people have had lists of his trigger words. Where do we go from here?

Thanks for this thread @ipredictariot5

Do you think the way we measure capacity could be better? I'm thinking for those with severe and enduring mental illness, who are not always compliant with treatment. Such a fine line where fluctuating capacity is concerned, but so many are "let go" in the community to make disastrous decisions when they lack insight into their illness, yet can pull it together for a single assessment, yet half an hour later can be completely deluded again.

Has he been assessed by CAMHS - that sounds like something a psychologist should be able to treat so don’t give up on this

Yes it is often something that CQC criticise that we do not assess it often enough or well enough. We do it well in formal and legal processes but not so much in everyday practice
however there is always the fact that people with capacity can make unwise decisions and also even those with fluctuating capacity if the MH Act or MC Act cannot be used you cannot effectively intervene
sometimes there are different opinions for MH services and families as to capacity and that’s often where the unwise decision comes in
in terms of being able to pull it together for a single assessment my view is that generally we will pick up fluctuating capacity but not always
it seems v unsatisfactory that people with SEMI go through cycles of non compliance with treatment and hospitalisation but that is also the case with many other medical conditions such as diabetes.

Is it possible to ever fully get over guilt? I still feel guilty for a termination for medical reasons, which I had a decade ago.