I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

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

can we leave off having a go at the woman who works for the betterment of people with severe psychological problems every day, please?

Not saying psychiatrists are immune from criticism but it's a weirdly bad-faith reading of her language

Very tricky and I think the starting point would have to be self-help in this instance. Textbooks / workbooks / apps etc until they can build enough courage to see their doctor. Even explaining the issue to AI (chatGPT / gemini etc) can result in a good, structured, tailored support programme that can be delivered for free. I do occasionally recommend AI for scenarios like this

Is it hard to keep on top of additional research that affects the brain and/or behaviour? E.g. the long term effect a covid infection can have on the brain. Just one example obviously, but picked that one due to the large and growing number of people already affected within a few years.

Thank you for your work and invaluable help.

I do not think things are over-medicalised. Psychosis, mania, shizophrenia, suicidality etc are rightfully made into medical issues and need agressive treatment for them to resolve quickly. Otherwise they are often fatal and highly destructive. This is clear medical disease.

Within the remit of low mood and anxiety, yes, normal fluctuations are generally over-pathologised and we even though we know medication is not effective in mild-moderate cases, it's still prescribed anyway, because it's cheap and easy. This is unfortunately mostly by GP's however within a very time and resource limited system. Psychiatrists (at least NHS trained) are psychodynamically trained and probably the last people to medicalise things that don't need medicalising. Obviously not always the case but I feel we're the least bad for that

You listen but you don't hear.

I listen to people with diagnoses of EUPD and what they say, over and over again. They endlessly complain about what you so glibly brush off, but it doesn't suit you to hear, empathy isn't in your makeup, respect for their point of view is non existent. They are not heard, your ego and self importance is blocking the path to your brain. To you their lives aren't important, to me they are.

I foresee problems in your career.

I'm not sure what I can add here unfortunately. I don't think it's sensible to keep testing until you get the result that you're hoping for. Perhaps ADHD is more likely?

Do you care for adults with anorexia as an inpatient? Do you find the same patients keep coming returning for inpatient care? Those that stay out why do you think they do and others don’t? Or do you think many just do ‘enough’ to stay out of inpatient?

You are being so rude, entirely unnecessary.

Appreciate your point of view but it's something I hear often from people with EUPD who are often much maligned by MH workers and the wider public. Many lead terrible lives due to the lack of respect and some take their own lives because there's no way back, not helped by MH staff who see the diagnosis and not the person (as shown in the OP's previous posts).

To have a chance at putting their point of view across was worth a try. Don't worry, the OP's point of view is she can say what she likes and she doesn't care what they think and they don't think that anyway (how does she know!!!).

It's a pity people on the receiving end of this lack of respect don't feel the same. They're not listened to, the imbalance of power remains and people die because of it.

Most EUPD diagnoses are wrong BTW, given to mostly young women who self harm without MH services even meeting them, It's a tragedy.

Are you saying that 1000s of high security psych patients have escaped, or is the 99.9% an exaggeration?

It really isn't unnecessary. The OP was offensive in her previous posts to people with a certain diagnosis. Someone has to speak up for them. To stay quiet when you know people are being harmed is evil in my mind and I would judge someone for that.

The OP says something along the lines of "EUPD women use their phones to get into hospital to be with other EUPD women" (paraphrasing). Sweeping generalisation, what if they were genuinely in crisis? If they then took their life was it because they failed to get treatment because the OP judged them as being an EUPD woman and denied them treatment, is that okay? Btw, people HAVE died in this exact situation because of the prejudices of staff around this diagnosis.

Looking at the previous posts of the OP do you entirely believe them to be who they say they are with all the misspellings and grammar fails?

I said we know that there are local groupchats of young women with EUPD who feign symptoms and suicidality to be admitted together at the same time. Do you have any experience of working with EUPD? Do you understand that manipulative behaviour is part of the diagnostic criteria? We have to stop putting patients with EUPD on a pedestal. Their behaviour is frequently highly destructive, very chaotic and extremely resource intensive. They are not immune from criticism and will almost always have capacity and insight into their actions. Exonerating them of accountability is part of the perpetuating issue and why recovery is difficult.

I think anyone who works in medicine or psychology can tell I absolutely am a psychiatrist, but unfortunately we'll never know for sure. That's the risk you take with anonymous AMA's.

I do not! It's a very specialised service. Generally the 80/20 rule applies (true across police / GP / prisons as well) in which the same 20% of patients utilise about 80% of the resources. I don't mean that in a demeaning way, i'm just highlighting that yes we do have the same patients returning for inpatient care. They are usually very complex with overlapping personality elements as well.

Yes definitely. Lots of new research and updated guidance which thankfully i'm very interested in. Reading the BJPsych / BMJ is usually the easiest way. Long covid so far has been more of a GP issue than hospital psychiatry so I actually don't have much experience with that

You snooped on ONE group of people with EUPD (EUPD women as you call them) and came to this conclusion about every woman with that diagnosis?

Okay

What about the people denied care because they were labelled (often wrongly) with an EUPD diagnosis who then went on to take their lives because of attitudes like yours? Being told their behaviour was manipulative, refused treatment and left alone to suffer and die. Can you understand the distress caused by MH workers like yourself? I've witnessed the abuse of patients over the years, some died and the pain and suffering is horrific to see.

Whilst we're not going to agree on this, I'd appreciate an answer around my earlier question on diagnosis. If you do have genuine experience around this area it would be helpful to know.

Ah you edited it while I was replying so I'll add, EUPD patients are definitely NOT put on a pedestal, which any MH worker should know. They're looked down on, avoided, refused care and treated appallingly. It should then come as no surprise that people with EUPD tend to have among the highest suicide rate of any mental illness. I'm surprised you don't know this.

Massive failures all around and although doctors pushed for sectioning, the assessing team pointed to new guidance regarding* *over-representation of young black men in compulsory psychiatric detention in the UK. This was a catastrophic failure and trying to section less ethnic minorities as a vague, blanket target cost people their lives.

I'm not sure if this is your area of expertise, but I'll ask anyway.

Do you think the 'normal' lab ranges used by the NHS for blood tests are used too rigidly and can lead to bigger problems and wasted funding?

For example, B12 was once 180 and my ferritin 7. I was diagnosed with GAD, and medicated even though I had no cause of anxiety, just because I would get palpitations, not feel like I was getting enough oxygen, and was exhausted.

The doctor said ' those symptoms can often be caused by Aneamia or B12 deficiency, but your haemoglobin is find and B12 is just in range'.

So instead prescribed SSRI's.

Yes of course. Don't forget a 24% increased risk is not a literal 24% increase. Doing the known things that reduce the risk carry far more weight. Actually the biggest risk factor is uncorrected deafness, so if you stay on top of that your risk is already slashed. Generally staying mentally active, social engagement, blood pressure management, glycemic control, stopping smoking, excercise and good diet will do far more than cutting down your gabapentin. I also wasn't aware of a strong link between gabapentin and dementia? are you sure the evidence is robust on that?

@PixeyandDixey I’d like to ask you politely to leave it be, and maybe start your own thread instead. I am interested in the broader answers and topics being covered in this AMA and your posts are taking it into a focus on one very specific area.

Even though my question remains unanswered lol I feel like I need to stick up for the op here. As a Women with a EUPD who has spent a while in hospital I have to say I agree with what she is saying. So much so that I found actively avoiding contact with other EUPD women to be highly beneficial on my path to recovery.

Seconded

Yup

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