I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

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

OP, my question is: what are your thoughts on the Nottingham Trust Inquiry into the failures in Valdo Calocane's psychiatric care and the subsequent corporate manslaughter investigation into the trust to determine whether it's criminally liable?

Can I ask if you have noticed if this is more prevalent in either sex or is it about equal?

I've been thinking for a long time that so many women have very low ferritin/iron levels and nothing is done about it or advice given, sometimes it's not even mentioned to the patient. Surely this has the potential to lead to more problems that could well have been prevented, as you have said above.

Your words "We even have a large group of local EUPD women trying to get admitted at the same time in the same hospitals so they can be on the ward together".

Yes I do find this offensive. Not the 'women' part, although you've shown yourself to be slightly sexist, a worry in the job you do. it's the describing people AS THEIR CONDITION. So yes, describing a group of people with cancer is acceptable. A group of cancer people is not so acceptable. A group of diarrhea people, a group of flu people, a group of demented people? Not acceptable and slightly offensive.

It's also worrying you can't see the difference in the job you do.

Seeing people as their conditions first before seeing them as people means you'll have preconceived ideas about them and will fail at providing good unbiased care. If you appear as judgemental towards your patients as you do in your replies I guess you're not as good in your job as you think you are. At least think about it before letting your ego dismiss what I've written again.

What do you mean by the risk involved?
Asking because DD is interested in this as a career.
Thank you, very interesting thread.

They use CMHT acronym where I live. Officially I’m an entitled at an annual lithium review and health check. If I feel I need their help in the meantime, I should contact duty team. However since my last consultant left, I have not been assigned one and any call I make doesn’t result in help.

The only two times in the last year I have received help is because I have managed to get someone else to intercede (first time my GP who got an urgent medical review. This result in a great appointment, their assessment was that I had a moderate depression and they recommended some medication - increase lithium and add melatonin.)

Plan was not followed up on and I couldn’t get them to enact it. Second time was my husband contacting them saying that ignoring me and not implementing plan was causing him great concern. They enacted it then. Contacting PALs changed nothing.

I already have (what they called in A&E) ptsd from an adverse childhood and seeing how my mother’s was treated in 1980s (she was diagnosed with schizophrenia in later life). They kindly kept me for 4 days on general ward to build my trust to move me to mental health ward. So I will comply with CMHT but I’m not relying on them anymore or volunteering what’s on the inside that isn’t visible to the outside. I appreciate it’s a funding and capacity issue but my father would sometimes not talk to me for days if I asked for help. I never knew what reaction I would get. So now trying to get help is making everything worse.

We can afford to go private but it will make things potentially complicated as still under CMHT officially. My GP practice is usually amazing but I know they won’t view a private consultant the same as NHS based on previous questions from reception.

Sorry long waffle there!

A psychiatrist I know insists there is no genetic component to ADHD. What do you think?

Thank you for such an interesting thread. How do you stay well? Given you are carrying so much responsibility every day? How do you manage if you lose a patient to suicide?

The mental health professionals do an outstanding job in this country. I work in an unrelated industry but we use psychiatric reports for our decisions sometimes, I’m always staggered by both their work load and professionalism and care.

What is your opinion on transcranial Direct Current Stimulation devices such as ‘Flow’? Can they be helpful for depression (I think they’re also being trialled for chronic fatigue, but may be wrong).

You can’t have been a psychiatrist for long if you’re young enough to have an A-star at A-level. What do you think qualifies you to make many of the sweeping statements you have made across all areas of psychiatry in this thread?

My ex husband has bipolar disorder. He has had several manias over the last few years.
We have a son who is 5. My ex had a big episode a while ago which was hugely distressing for all of us at home.
I have been doing quite a bit of reading around the genetics of bipolar and I'm absolutely terrified that this could be the future for my little boy. I have also read that there is evidence to support that a settled and secure childhood (which my ex husband never had), can mitigate some of the risk of it developing.
I think my son appears to be happy and settled, my parents help a lot and he has secure attachments to them and me, a good circle of friends at school, teachers who know about the history and have been hugely supportive, an older sister who loves him - although they do argue, and is quite bright and confident. His father is inconsistent and does not put our child first.
Is there anything else I can do to lower his chances of developing this? I dread to think of him getting as ill as his father has been.

How does this work? I believe a distant relative of dh's had this a couple of year ago and it helped.

A (also distant) friend had it done privately and it costs 1000s of pounds.

To a lay person who has seen adhd up close this theory is crazy. of course there is a strong genetic component it runs through generations of families.

Do you ever get frustrated by revolving door patients who would probably do well if there was actual decent commuting support?

Thanks for doing this ama.

is it known/ common etc for someone to have one episode of psychosis (sectioned for it, stayed in hospital for 3 weeks) at nearly 50 and fully recover? My family member experienced this a couple of years ago and I think we have all just been on edge since waiting for it to happen again. It was caused by stress.

also would there be an underlying mental illness? Their follow up care has been pretty light. Just meds.

My relatives hospital “got round” this by charging (obv patients weren’t allowed their own chargers) they would take them for charging and not charge them, or charge them maybe 10%. It meant access was minimised but could still be used for the reasons you state. I would say my family member did need it, however they were in hospital with a man who thought the matrix was in his phone so I guess he had even less access

Thank you so much for replying, I really, really appreciate it.
Thank you ❤

What’s your opinion on women with autism being misdiagnosed with EUPD?

I was diagnosed with autism (then Asperger’s) at 14, discharged from CAMHS at 16 as I was told I was too old and given no support as I got older. I then had a breakdown in university and received a diagnosis of EUPD.

I feel EUPD is the only label mental health professionals look at now and don’t consider my autism diagnosis at all. I was actually told by the person who diagnosed me with EUPD that they believe that I don’t have autism just EUPD.

I was then referred elsewhere and was told by the nurse she suspects I actually had ADD and not EUPD and I need an assessment but was never referred. I saw another psychiatrist after that who said I was textbook EUPD 🤷‍♀️

I’m not saying I don’t have EUPD as I definitely have a lot of the symptoms when I am in crisis (however not all of the time and when I am doing well I have none of the symptoms at all), I have heard of a lot of women with autism being misdiagnosed with it though so was wondering your opinion.

Also what’s your opinion on it being called EUPD now? I know they changed it to try to help remove stigma but telling people I have emotionally unstable personality disorder feels humiliating to me.

Thank you, so much, I do worry about the future for my wee one.💜

@PixeyandDixey
You’re very hostile to the OP - unpleasantly so.

@DoctorDr This is an interesting thread, thanks for starting it and sharing your experiences and thoughts.

Do you have any experience / knowledge RE Lithium Orotate OP? I fell down a rabbit hole that explained Lithium Orotate in a 5mg or 10mg microdose is amazing for depression / anxiety, it re-wires the brain apparently. I know its used in much larger (400mg/500mg) doses for personality disorders on prescription only, but the tiny doses are available over the counter and I have replaced my prescribed Venlofaxine with OTC Lithium Orotate and I've never felt better in my life, wanting to know if this is a real thing or placebo? There's not much scientific evidence for the sucess, i only hear it from patients personal experiences.

Thanks OP. This has been very interesting (I work in a research related admin post in psychiatry in the NHS- don’t want to get too specific as there aren’t many of us)

do you think there is a problem of over medicalisation in psychiatry? Whereby normal human distress and life challenges are turned in to medical or psychiatric illnesses?

Maybe so, but in the way the OP refers to patients she has shown arrogance and a lack of respect. That's unacceptable and something she needs to recognise in herself. Seeing them as PEOPLE first rather than a walking diagnosis. That's what she doesn't appear to understand.

Many psychiatrists believe themselves to be beyond criticism / akin to God and, as a result, I've seen them cause a lot of harm and even needless deaths in their behaviour towards patients. For the people that have died needlessly due to mental health staff mistakes I feel I have a duty to get out of my comfort zone and speak out. Most of those that died blamed the mental health 'professionals', particularly not being listened to, wrong treatment or no treatment etc before they took their lives. They. need. to listen. and. respect. patients.

I'm not suggesting the OP is a problem psychiatrist, I appreciate she's put herself up for answering questions, that can't be easy. However, there are serious problems with that profession, which to be fair, the OP has acknowledged herself. Listening to patients, appropriate treatment, correct timely diagnoses etc would be a start. I'm not a patient btw, just someone who cares. Do you?

If someone was very mentally unwell, had extreme iatrophobia and was unable to engage AT ALL (ie no calls, zooms, etc) placing them in a chicken/egg situation where they can’t access help for cptsd, what would you recommend they do to self help to the point they could engage with healthcare services?

I will refer to the EUPD cohort as such. They are women with EUPD and that is a fact. Many GP's refer to diebtic cohorts as diabetics. It's a common abbreviation that is useful when talking on a public health / national scale. Yes they are patients first but it's just being offended on imaginary people's behalf and the world needs less of that. Kindly don't police my language. Many thanks.

It is common and more frequently seen in good psychiatrists. The best psychiatrists often do a lot of undoing of diagnoses and de-prescribing. That's where the real value is found. If your husband is presenting as more of issue in personality than bipolar, then recognising this is really valuable and has avoided a potential lifetime of unneccessary medication. Having said that manic episodes are usually very clear cut. So yes, diagnosis change is valuable and often very helpful. The treatment hopefully therefore lies in psychological intervention for him.