I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

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

It is extremely effective and a life-saving intervention. As i'm sure you know it's extremely unfairly stigmatised and misunderstood

Would you choose the same speciality again, if you could go back in time?

Are you a Consultant and if so how do you feel that has changed your ability to provide a range of care for patients

I am trained in EMDR and it works very well IF it's given for the right reasons (True PTSD or acute stress reactions) if given for reasons outside of that the evidence is patchy and anecdotally can be very hit-or-miss. Typically I think it's being given for personality disorder / EUPD like presentations where trauma is a component and doesn't work as well in those cases.

I am not OP obviously, but there are neuropsychiatrists. DD 1 used to be under one, because as one clinical specialist nurse said:

”She is at the interface between neurology and psychiatry. Any psychiatrist would say to the neurologist ‘Get the epilepsy under control’ and any neurologist would say ‘We can’t!’”

She suffers every adverse psychological effect, there is, with the drugs she is on!

We know now that she has a very rare genetic metabolic disorder, which mainly has neuropsychiatric symptoms. She’s under a multi disciplinary team, who work with the neurologist.

Why do you call people who suffer from BPD / EUPD "local EUPD women" (your words). Would you call a group of people who suffer from cancer "local cancer women" or who suffer from a stomach condition "local diarrhea women". Seems odd and as if you have a prejudice against this diagnosis. Not a good look.

Is it true that psychiatry is the area medical people who are the lowest qualified and least talented go into as it's the easiest to get into? The people who aren't talented enough to be surgeons or other skilled professionals.

After all, a quick conversation and you can make a diagnosis that's difficult to remove from records and can harm vulnerable people for a lifetime. Often later found out to be wrong but the damage to vulnerable people is immense.

Absolutely

Is there a link between GAD, depression and Autism?

My 30 year old brother has been taking Sertraline for depression pretty much consistently for past 10 years. He was living in Arctic Circle for some of that + 24 hour darkness didn't help. Dose has been as low as 50 mgs but up to 150 mgs for quite a while.I'm wondering if he has always had undiagnosed Autism.He doesn't want to be tested. I'm wondering if testing would be beneficial in any way? Maybe if he understood himself better he'd stop being so hard on himself? Hope this makes sense

It's a behaviour I have only observed in women with EUPD. What do you want me to say? The men don't tend to do that. Lots of things men do with EUPD that women don't as well. Yes I would say local women with cancer or local men with cancer. Shall we be pedantic? In which case why do you say "people who suffer with EUPD" ? A lot of patients take issue with saying things like that.

Feel like your next question about psych being the lowest qualified / least talented as slightly loaded given you were offended by my answer. Yes it has been seen as the 'easy option' but is now one of the most competitive specialities. It's also the easiest speciality to be bad at. Lots of bad psychiatrists out there and I admit that.

If you're talented enough to do medicine you're talented enough to do whatever speciality you want. The issue is not talent it's competitiveness from sheer numbers applying vs available posts.

Yep, very strong one

Why do you think the stigmatisation is unfair? I asked a question upthread about the crossover between neurology and psychiatry and the reason that popped into my mind is because my friend was treated by ECT when we were at university. She has an absolute aversion to it and found the experience horrific.

Recently (the last 5 ish years) she has been attending the clinic of a medically qualified Harvard educated neurologist who is operating in the psychiatric field which is deeply unpopular with other psychiatrists who consider the treatment controversial. Her results with this doctor have been absolutely revolutionary. I have known her for 30 years and I have never seen her this well.

It just seems to me that the damaging schism between neurology and psychiatry is so damaging for both the profession and for patients.

Husband has just been moved from a section 2 to a section 3 after being hospitalised with psychosis (triggered by drink and cannabis).

This is his 4th section, over 35 years, and for each admission he has been diagnosed as bipolar, based on how he presented on admission, stabilised on meds and discharged by the end of S2 if not before.

His current consultant mentioned that the bipolar could be a misdiagnosis and that he is considering histrionic personality disorder with narcissistic traits (talking to Dr Google and Dr chat gpt they could have his photo as an example)

How common is it, with enough time under observation, for a diagnosis to change or are some cases so clear cut there is no possible alternative?

Btw thanks to you and all the inpatient facility staff in NHS x

Name changed for this as very personal and possibly outing.

How common is my mental health story. As i recently shared witha psychologist ( Though work ) it and she was shocked/impressed?!

When I was 16 I became psychotic which led to being detained on a emergency 72hr where I was admitted to a ipcu ( note my age at the time cahms was found unsuitable). I ended up being detained on a 28 day then a CTO. I spent 6 month's in the ipcu where I was eventually sent down to England to a medium secure unit ( St andrews heathcare) I spent one year there before being sent back to my own hospital where I then spent a further 18 months in a open ward. Apart from the last 3 months I was detained for the entire time. There was some debate between hospitals regarding what was wrong with me but eventually they settled on EUPD and CPTSD.
Im not 34 and haven't had any contact with any mental heath services for 13 yrs now. Most people I believe would be shocked at my history.

Is going private the only option for me? Diagnosed with bipolar later in life. After an initial section 2 and support, I can’t get help, I’m on lithium so GP won’t touch my mental health care and CMHT don’t feel I’m ill enough to need them. So I’m too ill to get back to living my life (currently depressed) but too well to get medical assistance. I have a great life I built but I can’t enjoy it right now. The thought that one day I won’t have to keep going is increasingly present - but I’m no risk to myself or others so again not ill enough for help.

You are wondering if he is autistic and he doesn't want to be tested by the sounds of it ? If there is a suspicion of autism then everyone is entitled to a diagnosis but equally a lot of patients actually don't care or don't want to know if they're autistic. Having said that it does help patients make sense of a lot of their own experiences and he might benefit from environmental adaptations that a diagnosis can help make happen. Don't know anyone who's lived in the artic circle before, really interesting

Really interesting thread, thank you. Do you find people have more of an idea of what’s going on with them from Dr Google or AI and if so is that helpful or a hindrance?

You should be under the local ATS service with a diagnosis of bipolar + lithium, no?

Taking a break, need to get back to work, will catch up on all questions in due course

My adult niece, is very, very intelligent but has clear ND behaviour. She is high functioning but chaotic, poor at decision making, lacks social skills, avoidant of taking responsibility for her actions (it is everyone else’s fault). She works in tech a high level. She can only work from home. Every job she has had that involves attending the workplace she has left very quickly.

She has taken 2 independent tests and they have both come back negative. I personally think this is because she is able to pass the tests if that makes sense.

I have an increased risk of dementia (around 24% increased risk) due to previous concussion (4 or 5) over a 30 year timescale, one of which they originally thought was a brain bleed as I was combative and repetitive in speech and this necessitated a short stay in ICU. I also have an elevated risk of dementia as there is a link to cognitive decline and gabapentin (around 22% increase), although I've cut down from 900mg to 300mg over 12 months. Is there anything I can do to try and stop or less this probable risk of decline please?

Who is entitled to make a diagnosis of any mental health condition? Does it have to be a registered mental health professional, eg a psychiatrist, psychologist or mental health nurse (ie someone on a register and accountable if they get things wrong)?

Or can it be any Tom, Dick or Harry that changes a young person's much thought through diagnosis and treatment from CPTSD to EUPD at 18, without even meeting the person? The people who signed the diagnosis sheets weren't on any register so unaccountable and unable to be reported to their regulatory bodies so their jobs and life weren't affected. So far.

The change of treatment to a condition the young person didn't and has never had adversely affected their life for going on 5 years since then and doesn't look like it'll ever change.

How do you explain this and should there be more oversight of mental health services (and sacking then easier legal action of mental health professionals who are negligent or harm people)?

I’m in Scotland
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Scotland faces a significant drug crisis, with the highest drug misuse death rate in Europe, which has been exacerbated by factors such as socio-economic deprivation and the rise of synthetic opioids. Despite a recent decrease in drug deaths, the situation remains critical, prompting ongoing calls for improved treatment and harm reduction strategies.

Yet getting an adhd diagnosis is difficult for adults - figures for 2025 say 2 and a half years wait And getting prescription funded by NHS also seems restricted.
It’s hard to get a clear picture.
When people with adhd are more likely to be attracted to drugs, alcohol surely this is a missed opportunity to attack the drug problem

Do you come across people who really shouldn't be out in the community? I can remember the government closing hospitals and institutions saying care in the community for very poorly people was better. Not sure if that was a good idea or if it just failed through lack of funding and care. I presume it was to save costs all around under Thatcher rather than to help anyone?

My mum's best friend's son committed suicide with his g/f, both were bipolar and it happened not too long after the mental hospitals started closing fast. It felt like he had little support after.

You may want to look up Dr Carine Minne who has written about how mental structures can become severely impaired by in-utero and early life trauma.