I'm a medical doctor and NHS psychiatrist. AMA

[DoctorDr]

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

Thanks it’s not me, it’s my son. He’s struggled for years with it and it’s particularly bad when he’s stressed (makes sense). He hates taking any meds and pretty much refuses SSRIs (tried once for about 3 months and declared they didn’t work!).

He’s had various courses of therapy too (CBT and person-centred) but to not much effect. I’ve heard of ERP but he’s never been able to access it (we tried in his uni city but there were no spaces even in private practice).

He’s a recent grad and has come back home, so it’s up to him if he wants to take further treatment now. Next time he mentions it I will suggest ERP.

Thankyou very much. So as usual, lack of funds is putting everyone at risk and also making your job 100% harder.
Thanks for all you do, can't be an easy job.

Please can you advise how to find good, private psychiatric assessment and treatment for my young adult child. They have been failed repeatedly by the NHS and we are out of our depth. Thank you.

CBT is a little bit more here-and-now for trauma and past baggage. You may benefit more from something more psychodynamic or trauma focused. Having said that trauma focused CBT does exist

In defence of @PixeyandDixey I was quite shocked to see the reference to ‘a local group of EUPD women’ which op has later referred to in a much kinder way as ‘a local group of young women with EUPD.
I’m not commenting on the presentation or otherwise of people with this diagnosis but it is quite dehumanising (not always, eg autistic people prefer identity first language). I think if op had just said oh yes good spot rather than doubling down it would have resolved it.

I have to caveat and say I really don't have much experience with childrens psychiatry (CAMHS) and I wouldn't want to gueess. I can only assume the usual avenues of searching for local CAMHS consultants and checking their feedback and reviews. Sorry

Groups of EUPD women exist just as groups of diabetic women and disabled women exist. Not sure what the issue is. Can we please avoid anymore EUPD discussion. Thanks

What are your thoughts on Pans/Pandas? I’m conscious many clinicians in Psychiatry and Neurology are not accepting of the diagnosis, and families are forced to pay privately for help. I’m keen to hear your opinion and experience (if any). I know onset is pre-adolescence but many adults continue suffer from it.

Thanks for your response. I wasn't trying to be evasive. Was using a family members experience of not getting the right treatment until something serious happened. I'll think about it and resubmit!

By disability I was meaning struggling to engage with normal daily activities, difficulty coping in school or in the workplace without significant support.

Until last year I worked for a service which supported young adult with these types of problems, they didn’t need a diagnosis. But referral rates have rocketed and the service now has long waiting lists and many of the clients are now diagnosed ASD. It made me wonder whether we need research into reason for increased severity of problems

How cruel, but not surprising.

I didn't think there was much controversy about PANDAS? As far as I know (never seen it in real life) it's an an autoimmune psychiatric illness caused by streptococcal infection. It can cause severe OCD and uncontrollable body movements. I think perhaps there may be families trying to attribute symptoms to unproven PANDAS but I wasn't aware of any controversy with this one. Thankfully it's very rare

Have any patients ever disclosed they're being abused by other staff members?

That’s great to hear. Thank you. My 10 year old daughter has it and I’ve been quite lucky with being offered help and treatment but so many families I speak to with it have felt gaslighted and told it’s controversial and not recognised.

ASD, ASD symptoms and ASD diagnoses have skyrocketed. The reasons why are another conversation. It only makes sense that as the rates increase, so do the referral rates and people needing support with ADL's and in the workplace. Very challenging and I don't think it's attributable to just 'better detection'. Yes more research is needed for sure.

Yes. We would always take allegations seriously and investigate them.

but we have to also be careful in psychiatry where a lot of patients are just manipulative or abusive, irrespective of their condition. Some patients have a very poor relationship with reality, some have dementia, some have delusions, some are hallucinating and experiencing tactile hallucinations. That's the reality of it and it's challenging. No doubt people will take issue with this answer.

@DoctorDr thank you for this really interesting thread and for your generosity in responding to so many questions.
My young adult DD has just discovered she has iron malabsorption. Prior to this she has had two episodes of depression (once with an inpatient stay) and unfortunately was overmedicated post discharge (community team disbanded at the same time so no supervision of meds) which led to psychosis and a further in patient stay. Subsequently she has also been diagnosed with anorexia 7 months ago and is receiving excellent NHS care and is making good progress with this. The ED has been going on since she was 17 apparently (she’s now 23).
She’s long been frequently diagnosed with anaemia (since teens) and I am wondering if this could be a serious factor in the onset of the anxiety which led to the depressions?
Her NHS psychiatrist has diagnosed bipolar but for both depressive episodes there was a direct cause (stressful events) and the Drs have confirmed the psychosis arose from overprescription.
Coincidentally she has her discharge meeting with her psychiatrist tomorrow as she’s been under their care for 2 years now. Her ED psychiatrist and team will continue to support her with therapy for another 5 months or so.
She lives at home, has re-engaged with life amazingly, is working p/t, has great friendships and is working hard on the ED. I think she could benefit from separate therapy in the future to deal with some of the very traumatic incidents that happened in hospital that she witnessed or was the target of. She also has been a on-going support figure to some of the other patients she met who had no family support.
I suppose I’m also asking If you were her parent is there anything else you’d be doing to support her (in addition to my question about the iron malabsorption).
Thanks again for your thread.

I will preface my comments here by saying that I have every respect for doctors in general, particularly those working in the UK within the NHS with everything that brings, and particularly now that somehow they are being demonised at every turn in the media and by ignorant fools on social media. I'm also grateful for this thread, as it it interesting. And finally, I don't think that Googling stuff (or even a bit of direct knowledge) is a substitute for years of training and experience. Ive got close friends whose medical training I observed over a long period and my general view is that they all could've earned more money, far more easily and with a lot less personal risk (and inconvenience - years of being dumped in placements in random hospitals!) doing almost anything else.

So please bear all of that in mind when I say - for the love of God, this appears to be an ignorant response! Childhood trauma and neglect are not purely a matter of what the child consciously remembers! Neurologically speaking the effects are baked in for a lifetime, and this takes a massive toll which parents of adopted children almost all have to deal with (and I assume that's what the other poster is, given the way the question is worded).

I have no medical qualifications whatsoever but, like most adoptive parents, have done a lot of learning on this subject in the four years it took us to become adoptive parents and the two years since. I'm sure you'll be aware of the work of Bessel Van der Kolk (The Body Keeps the Score - Wikipedia) and others on this, so are you in the camp of contesting it?

I'm not pretending to understand either the psychiatry or neuroscience of it personally, but I will say that there are many, many adoptive families who have adopted their child at an age way too young for conscious memories whose children struggle extensively with the effects of the trauma and neglect inflicted upon them, even those for whom alcohol and drugs in utero can be excluded as an obvious cause/ contributing factor.

I'm immediately depressed whilst also still being very interested in you expanding your perspective on this (I recognise you have said elsewhere you don't work with children, but children with trauma become adults with trauma.. especially if they can't get the help they need as children, which most can't at the present moment in time, in the UK - and in most places.)

Absolutely. Thanks for bringing this to my attention. It sounds like you know far more about the subject than I do and it's why I don't proclaim to be a psychologist. It sounds like children are affected by trauma, even if it happened before they are able to form memories. I will incorporate this into my practice going forwards. Thanks for pointing this out and correcting me on this.

@OldForANewMum it's probably another thread but I find that fascinating because of my own anecdotal experience. I know two families where they adopted babies who later had severe mental health struggles leading to suicide. These were adoptions in the early 60s before abortion was available and babies were easily available for adoptive parents.

I am also interested in this. (I'm a doctor, but not a psychiatrist!)

There's also Nurosym, which seems to be similar to Flow. (ETA Flow is transcutaneous vagus nerve stimulation for inflammatory disorders and has a good evidence base in eg RA, Nurosym is transcranial direct current simulation which is intended to regulate mood.)

Sorry for another "what's your thoughts on"! But this time on hypnotherapy. I work without the need for the trance element, which seems to be at least as effective as traditional hypnotherapy.

Big fan! Transcranial magnetic stimulation and similair technologies have a lot of emerging evidence and appears to work quite well, again, when done under the correct indications.

Flow as I understand does work but the evidence so far is patchy. I know they had to retract a lot of claims about it's efficacy because they were misleading. I don't think it will be a miracle cure, BUT a useful tool or adjunct to use alongside established treatments like medication and therapy.

Anecdotally a psych colleague of mine used transcranial magnetic stimulatio (not direct current) and had modest improvements to mood but big improvements to his insomnia and sleep quality.

How do you work out who's who? I'd be terrified of misjudging and someone's abuse wasn't taken seriously.

No problem. As it's not used in the NHS my experience is limited. I understand there's a good evidence base (strangely) for it's use in IBS and chronic pain.

What condition are you asking about specifically? I assume depression? The evidence just doesn't support it's general use otherwise it would be NHS funded. If there is the time and motivation to attend hypnotherapy then that would likely be spetter spent attending CBT or therapy. It could be a useful add-on treatment to medication though. I don't know any anecdotal accounts either or people who have used it.