I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

NHS pyschiatry (inpatient) with several years experience. Please ask away :)

It is a standard NHS consultant salary which is about £110k starting salary. Obviously this is only achievable after 10+ years training etc (F1/F2/ST1-6+). Very poor salary for the workload and risk involved and significantly underpayed compared to equally qualified consultants around the world. USA is $500k+ starting salary for example. I suspect they came into money or do very large amounts of private work somewhere

SSRI's are life-saving medications, even in children. They should however be used only for that purpose at 14 and the risk/benefit needs to justify it which can be tricky. With the right time / place / context yes I would do it but not without acknowledging multiple other options should be trialled first and they should be reserved for very specific circumstances. I am not a CAMHS consultant for disclosure

I can't really give specific medical advice directed at individuals unfortunately. It's also unclear what the main issue is here - is it OCD, ematophobia, low mood or anxiety? I also don't know her age which changes how this should be tackled. Ultimately if her symptoms are not controlled I would encourage you to speak to her doctor, sorry I can't help more than that

Do you ever do blood tests and realise the patient has long term deficiencies or thyroid issues that are likely causing their hormones to change their behaviours?

I have to be honest I have never seen or heard of this being used. I agree it sounds like a horrible label and upon googling can see it was discontinued in 1980 as a diagnosis. It seems to mean exactly that - poor tolerance to stress and anxiety. I would encourage you to speak to GP about having this diagnosis removed or updated which would be justified. I've seen lesbianism diagnosed from 1960's which are still viewable on their record today

Yep. This should have happened long before they reach hospital but I will always check syphilis, HIV, full bloods, kidneys, electrolytes, inflammation, vit d, thyroid, iron, ferritin, b12, folate, prolactin, lipids and autoimmune encephalitis. Most people will be vit D deficient anyway. But yes hormonal issues or deficiencies can definitely mimic psychiatric symptoms and neuro-syphilis is famously known as the great pretender as it can mimic so many diseases from depression to psychosis to dementia etc.

@DoctorDr

Am interested in your expertise for the following;

Are individual differences in brain chemistry a strong indicator as to whether a person may require support/intervention?

If so, which chemical messengers are strongly implicated and how successful is medication alone?

Is a combined approach, which includes "talking therapy" generally, more/most effective?

Is it true that the role of a psychiatrist is primarily medical management, and one who does not offer "talking therapies" per se?

Many thanks 🌻

Yes I am and I do think that the diagnositic criteria is too broad and that severe dopamine dysfunction from excessive screentime in children / young adults mimics the symptoms of both conditions, often leading to misdiagnosis. ADHD has a lot of 'scope-creep' in which it's starting to include more and more vague symptoms that are normal for a lot of people. Both conditions deserve a diagnosis if valid though and not the same as over-diagnosis which doesn't exist imo

Hi.

good question

Yes individual differences in brain chemistry make a massive difference as to whether they need support. With genetic susceptibility, I can smoke weed a few times and potentially develop lifelong schizophrenia and psychosis. Someone like snoop-dog who's smoked weed every day of their life and is fine is obviously not genetically vulnerable in the same way. Tests do exist but they involve the risky procedure of analysing CSF fluid via spinal tap which we do not do in the uk but do in some parts of USA.

Chemical messengers include dopamine, seretonin, noradrenaline, GABA, glutamate, acetylcholine. There are also lots of receptors and enzymes like COMT, MAO and AchE. Get's a bit complicated but all indicated. Medication is effective but depends what condition you're talking about. I assume depression? if so - medication works, therapy works, but by far the people who do the best statistically are the ones who combine both.

Most psychiatrists will do the medical management, the legal framework, sectioning and physical health bits. We do train in therapies though and some psychiatrists continue delivering it but it's tricky with time management. Generally we are more 'prescribers of therapy' and prescribing the right type rather than delivering it ourselves, but many do.

What A-levels did you do and what grades did you get, if that's not too personal a question?

Lifesaving intervention, extremely safe, works much better than anti-depressants and with far less side effects. Gold standard treatment and we don't use it nearly enough. I am trained and do ECT on patients.

They are under anaesthetic and put to sleep. They also have muscle relaxants. The very gentle current is there to induce a controlled seizure only. It's not being zapped in an electric chair as people seem to think. Extremely misunderstood treatment and it's a big shame

Thank you, I live relatively near Rampton, and there’s a children’s theme park near by with little houses you can go into which are nursery rhyme or fairy tale houses, and we used to joke about how creepy it would be in the dark, especially if an inmate or two had escaped from Rampton lol 😂

A family member was incorrectly diagnosed with a mental health condition when it was eventually discovered that it was a physical cause. Do consultant psychiatrists not rule out physical causes when there is a complicated medical history, including lack of oxygen to the brain and frontal lobe strokes, which can effect behaviour.

Philosophy & Ethics, Biology, Chemistry

A*, A, B

Was very lucky to get in but one uni allowed my A* to offset the B. Almost every uni needs 3 A's minimum, some want A* now too.

If it makes you feel better, 99.9% of studied high security psych patients who have escaped all do the exact same thing

• They go home and continue their usual daily routine. They have a bath, go and do their weekly shop etc.

Not go on a murderous axe rampage as people tend to think 😂

I understand you can’t give specific advice but we have an appointment soon for my adult dd who wants to come off Venlofaxine and switch to a standard SSRi. Any advice? The GP is unable to prescribe as I understand she may need to be on 2 meds at once during the transition.
She is autistic and has OCD.
The appointment is with a nurse practitioner but we were expecting to see a psychiatrist.
Thanks.

Yes please see my answer above. That is part of the reason we are also medical doctors. We should be extensively investigating patients with CT / MRI / FDG PET / DAT scans etc alongside blood tests and physical investigations. That is part of our job.

when during your medical journey did you decide on psychiatry?

Thank you - good to know as someone who had thyroid issues and B12 deficiency and was really worrying that I had bipolar disorder at the time. Now I am treated for both I am completely regulated again, but it scared me to think how many people get to the point of hospitalisation with mental issues without having it checked as mine had gone on for a number of years.

Do you think a child who suffered neglect as a baby/toddler and has early childhood truama would benefit from therapy? They are a happy 7yr old now but I think going forward they will have "issues". SW have a wait and see attitude!!

Cross titration is definitely doable but I understand why GP's get nervous. It's basically as you mentioned - the venlafaxine drops in dose over two weeks and the SSRI gets introduced in the same time period. I know many GP's who would be confident to do it but they probably had a psych placement in their GP training. Either way, expect some minor side effects in those two weeks and some ups-and-downs but it's generally safe and well tolerated 💪

Anyone with trauma would benefit from therapy as a general rule, but as you mentioned they were a baby it could be the case they don't remember and are largely oblivious? In that case it likely wouldn't be sensible to start bringing things up they didn't even know happened to them. Agree with watch and wait approach unless there's more to it

I can't help feeling surprised that ECT is still used, I trained as a psychiatric nurse in the mid-1980s and I remember it being used then. Then again, if it works, it works!

I knew from beginning of medical school I wanted to do psych. I did however enjoy palliative medicine and GP but always felt at home here.

What's your view on EMDR please?