I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

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

This isn't a helpful question. Please rephrase and be more specific. Thanks

Hannibal Lecter, dribbling patients, strapping patients to a chair and giving them ECT etc.

I’d be interested in your thoughts on a situation I find myself in with a private psychiatrist. I discovered via Amazon that they have written a book on their career, including some of their patients. I haven’t read it but suspect that I may be in it due to some specific circumstances around my treatment that were notable. Do you think it’s acceptable for a psychiatrist to write about patients without asking if they’re happy about it? I appreciate that there’s a market for medical memoirs but the relationship between a psychiatrist and a patient seems so intimate.

Thanks for doing this. No questions but it’s very interesting to read. My dad is a neurologist and said had he not specialised in that he would likely have become a psychiatrist.

Do you think more research is needed into the rise in level of disability due to ASD?
This is not a new condition so people have always presented with these issues with or without a diagnosis. But is this becoming more severe as the resulting issues seem to disable people a lot more?

I think unfortunately they can do so unless there is identifiable information. Either by disclosing your real name or very specific case details that could lead back to you. If they haven't done this i'm afraid there's not much you can do. The ethics of doing that are grey

Lots of overlap! Usually the line between neurology and psychiatry is what we can objectively test for. If there was a clear cut test for schizophrenia tomorrow it would probably fall under neurology. Maybe one day !

Could you elaborate? Disability due to ASD? Are you referring to physical disability?

Ok admittedly possibly some exaggeration there. Perhaps I should say the overwhelming majority of cases.

Thyrouid more common in women but low testosterone in men can also result in depression and fatigue etc. Low ferritin / iron is more of a GP issue in fairness but we will usually test it to ensure it's not a contributing factor. Yes there is the potential to lead to problems but it's rarely the sole cause, considering we are treating severe mental illness. Very overactive thyroid or syphilis can mimic mania to be fair.

Do you think paedophiles can be rehabilitated?
Do you think children can be psychopaths? (I know technically they can't but can you see it early on and do you think it can be 'cured')?

@PixeyandDixey not just hostile - aggressive, too. You’re making unnecessarily personal negative comments about the OP and adding nothing of interest to the thread. Please bore off.

What is your take on ‘pure’ OCD as I gather it’s quite a controversial diagnosis. And what treatment would you advise for a patient who is experiencing it.

You have to be comfortable with risk in any medical speciality but psychiatry is quite challenging in that respect.

The risk of releasing a patient who you have a gut instict may be deceiving you about their suicidality level. The risk of not sectioning someone you feel is borderline in terms of hurting themselves or others. The risk of using the wrong combination of drugs and killing someone from seretonin syndrome. The risk of missing an allergy and killing them with a simple penicllin prescription. Psychiatric drugs sometimes carry very dangerous side effects. Even life threatening constipation in some cases. Life threatening heart rhythm changes, life threatening destruction of white blood cells, life threatining conditions like NMS which is a rare side effect of some medications that you need to spot early. These are just examples off the top of my head and again, this is true in any medical speciality. That's just clinical risk, there's also risk of assault from patients (thankfully rarer than people think)

Im currently seeing an NHS psychiatrist for CBT. She is wonderful.
Thanks for the work you do @DoctorDr

In my experience, pedophiles detained under the mental health act are usually autistic and remorseless. No I do not think they can be rehabillitated unfortunately. I say that with a heavy heart.

I don't really believe in psychopathy, certainly i've never seen it in children. I suppose it's possible and there are cases but A LOT has usually gone wrong for it to reach that point.

You think there is a link between autism and pedophilia?

Not controversial at all ! At least not in my circle or understanding.

The ICD (our diagnostic bible) is very clear compulsions are not a neccesary component for a diagnosis of OCD.

My advice is that medication tends to work extremely well in OCD and it's typically very treatable unless severe. Combine it with good psychological input like OCD-focused CBT or exposure and response prevention therapy (ERP) and you will get there. Just stick with it 💐

I don't know. I'm just saying in my anecdotal experience the pedophiles who have been sectioned were usually highly autistic

There is clear evidence of a link between autism and people with autism being sexually assaulted. Women are 9 times more likely for example. I have never heard of people with autism being more likely to be pedophiles. Im really shocked by that.

I didn't say that

However

Greene et al. (2009) / Journal of Autism and Developmental Disorders

Evaluated 175 male suspected sex offenders alongside non-offending healthy controls and a clinical ASD sample. The researchers found that juvenile sexual offenders scored significantly higher on core autistic symptom scales than healthy controls. The authors concluded that elevated autistic traits were disproportionately present among young people involved in child sexual offenses.

So perhaps. Small study size though

The evidence is clear there are several genes implicated in ADHD. The heritability is estimated at 70-80%

You don’t need to stay on the thread if you are finding it difficult or you doubt the authenticity of the poster. Please allow others to continue to ask questions without derailing the thread.

Yes many people. More than one person is required to section someone in the community. They don't always agree unfortunately. Sometimes the risk is chronic and difficult to justify an acute NHS bed. There are also immense bed pressures and long waiting lists, so bed managers are not always keen to get patients into hospital.

What are your thoughts on the effectiveness of CBT for trauma and 'past baggage', so to speak?