What might this mean? (Written in medical notes)

[BlackMess]

I’ve been struggling with my MH recently (low mood) and saw the MH nurse that works at the GP surgery. I’ve looked at my GP record online and can she what she wrote. Amongst other things she’s written that my mood appeared elated at times, my speech rapid and there was some indication of thought disorder. She also commented that I was unable to maintain eye contact. I don’t really understand why she has commented on these things and I’m concerned she thinks I’m mentally unwell.

I’m autistic but I don’t know if she is aware of that and I feel like maybe she’s misinterpreted my autism as being indicative of a mental illness. She wanted to get advice from secondary care so I’m waiting for that but I feel quite anxious about what might happen next. Do you think it would be okay if I just contact the GP surgery and say I’m better now and don’t need any further support?

I hate to state the obvious but you are seeing her because you’re feeling mentally unwell. Yes, do tell her that you’re autistic.

Mental health services are incrediably stretched. People who are a danger to others and themsleves are not always given inpatient treatment so that isn’t going to be the plan for someone with a bit of low mood.

I did tell her I was autistic, I’m just not sure she took it on board given the comments she wrote.

I wasn’t thinking about inpatient treatment, I really don’t need that and I know it’s not always available for those that do. In terms of next steps I was worried about more people getting involved and maybe wanting to talk to me. Or what medications they might suggest

I’m confused OP, you went to see a MH Nurse, due to poor mental health, but you don’t want them to think you have poor mental health?

Yeah, as my issue was low mood. But she’s written elated mood, rapid speech and indication of thought disorder. Those are not typical symptoms of depression, so I’m worried she thinks there’s something more serious going on when there isn’t

I’m a mental health nurse. This is quite complicated. First of all, is your autism on your medical record? If yes, she will be aware of it as it’s an active diagnosis and so will appear at the top of your notes. I’m trying to unpick the rest a little bit.

You sound very worried that she thinks you have ‘a mental illness’. Gently, low mood bad enough to seek medical help for is mental illness and this is nothing to be ashamed of. Mental illness is just something that sometimes happens to people, like any other illness, and doesn’t mean you’re a bad person, broken or insane. It can be treated, like any other health problem.

In any case, it sounds like she thinks that something else might be going on and wants to seek extra support from specialists, especially in the context of your autism. This is a good thing. Please don’t be scared. Nothing bad will happen and, hopefully, you’ll get the help you need.

Just to end, a quick question. Are you taking antidepressants? If so, they can send people a bit ‘high’ which can be dangerous. How do you feel your mood is currently? Do you feel you can keep yourself safe?

I am not at all an expert in mental health treatment but it sounds to me like the nurse wrote down factually things that were observed during the consultation. That could be useful if someone else sees you next time to help them notice any changes. I would focus on getting the care you need and try not to overthink why those comments have been written.

Thanks, that makes sense.

I was taking antidepressants when I saw her last week but I stopped them the next day as I didn’t feel right on them. My mood is significantly worse now but I’m okay, I’m safe enough. I don’t want to try anything else now though. I’ll just have to try thinking positive I guess.

'Getting advice from secondary care' doesn't mean that they are considering inpatient treatment. It just means that they are taking your concerns seriously and taking the steps necessary to work out what support you need.

You have said that ADs aren't helping. There isn't very much more that GP practices can offer without heading towards a more specialist service. I think you should probably just feel relieved that they are taking some action to help you.

She noted her observations at the time, some of which may be attributable to autism, but thinks you would benefit from further input from a specialist service. That may be different medication if you felt that the current one was not helping, therapy or additional support, for example.

She's noting the lack of eye contact because it may be relevant when considered with other symptoms. It would be remiss of her not to. Her making note of elated mood and fast speech is the same, and possibly more telling than eye contact

You’re overthinking this. Doctors’ notes are the doctor recording their observations on how the patient presents. That is how you presented, therefore she wrote it down. It’s not a judgement or an accusation or a diagnosis. You told her that you were autistic, but that doesn’t mean she can reasonably assume that everything she observed was connected to your autism - she has to consider all possibilities.

Getting ‘secondary care’ just means referring you to a specialist. It doesn’t mean keeping you in hospital. It just means you’d see a doctor who was an expert in mental health conditions rather than a GP.

Appearance, behaviour, cognition, thought process , it’s a template/ tool for assessing patients .

This is part of mental state examination, the psychiatric equivalent of blood pressure, heart rate etc. Those things she's written don't by themselves add up to any diagnosis, but they do indicate there may be a few things going on, or just be normal for you- elated mood could be edging into full blown mania or it could just be you came across bright and sparkly. Thought disorder - could be paranoid thoughts as is quite common with depression. Lack of eye contact - maybe that's typical for you with autism, however for some people it's a symptom of fairly serious depression ie so apathetic and tired of it all that the person hasn't got through enthusiasm to look up at all. It all suggests there genuinely are clinical features of something and worth getting that MH team involved. In primary care a huge number of people present with no objective signs of psychiatric illness and the clinician just has to take the person's word for it - usually a sign that their problem is mild.

I was very low and suicidal. I went to see crisis team and I got pretty anxious talking to her. She asked if I am manic because I was behaving like that because of anxiety

I didn’t feel anxious when I was talking to her but I guess I could’ve been, I do sometimes smile inappropriately as part of my autism. I’m definitely not manic but I do think the Vortioxetine was giving me racing thoughts