Hi all, I am working as a psychiatrist. I am happy to answer any questions you may have about the field. Offcourse, I will not be providing any management / treatment of illness as I do not think it is appropriate unless I have assessed a person myself.
For a good online self help resource, people can use MoodGym website.
[AMA] I Am a Shrink (Psychiatrist), Ask Me Anything
DiLs on 13/11/2020 - 22:02
Last edited 15/11/2020 - 08:36
Last edited 15/11/2020 - 08:36
closed Comments
Your best bet is discussing your concerns with him. Other options could be talking to a financial adviser or if there is someone who is managing his mental illness.
You have to consult a lawyer (or fin. counsellor) not a psychologist. Your posts are very confusing.
First of how did he use your house as collateral? If he didn't own 100% of it, he more than likely did not (the lender would not allow - usually you need signatures and agreements from All owners).
Secondly if the Banks have a mortgage over the property (your house) then a POA will do nothing about that and no Lawyer will allow it to be backdated! especially without permission from your Brother! just on your say so!
If you organise the POA and your brother didn't sign it, how are you going to prove its valid?
Do a Title search on it. If you see a mortgage or some interest from a Bank, well then you have an answer.In terms of the mortgage - people with mental problems can get loans. The Banks main duty is to make sure the person is 'normal' at the point of applying (do they understand the contract at signing - if he is making repayments then he probably does) and can they afford it.
Banks do Not allow people to live in property for 10 years without paying a mortgage.
Saying that, if the house is worth $55k, then a mortgage is going to cost him $1,650 per year or $31 per week - if he leaves the property - where is he going to go and pay how much rent? $240 or so?!
More than likely if you want a court to sell it so he can rent (Very debatable they will IF he is paying the mortgage, especially without permission from the Brother) then the Bank will more than likely recover their funds.Here is more info: https://www.goodshep.org.au/media/1288/mental_illness_debt_i…
Three months ago (when we were in contact) He'd mentioned to me he eats ramin 'cause bills are tight…
55k isn't much. Yet, over 10 years. If he hasn't been paying it: It may-well be 1/4 Mill by now. Who knows?If your brother has not been paying it, which I highly doubt then it would be about $100k, or so which would cost him $57 per week.
How do you diagnose ASD (high functioning) in an adult if there is little memory (both patient and interviewees) of what happened as a child?
How does the ADOS test compensate for this to avoid misdiagnosing?
We rely on the diagnostic criteria from ICD or DSM.
It's all self-reported though. Your reply makes no sense when you really come down and look into the core principles. I would also ask this question myself as I am interested but I always get the same response that they follow the criteria. Is the criteria relevant though?
You do understand that the facts need to be correct before you apply the criteria………
There is nothing concrete like a DNA test yet. That's why there is controversy. I'm surprised you didn't mention anything about it, but most of your posts have very little substance because you just don't know. None of us know. Why isn't this declared to the patients though?
I've always thought there is a possibility of Autism in myself, but can it actually be defined the way you describe it; or inside the manual itself? It all relies on the accuracy on the data which is undoubtedly incorrect, or at times questioned for example by insurance companies, medical professionals, scientists, social services and more. I'm lucky I've not had to rely on a diagnosis yet, but clearly there are massive problems in your profession that just aren't addressed at all to the clients.
Yup I agree. The industry needs to overhaul autism diagnosis process, especially for adults. Sadly, also no Medicare rebate for adults.
More research needed to provide better assistance those that have social/relationship/work issues.
There is little to no awareness on ASD.
I've tried to discuss my concerns with him… He's (we're each) our only kin… Ofcource I'm concerned. & not just financially.
The nature of his illness typically manifests in denial (I've witnessed it)… Staring at blank walls in some-sorta mental block.
I'd only know the half of-it & what I do know frightens me: If there's much-more to it/him it's potentially terrifying. I love him.What are your thoughts on Magic Mushrooms and depression?;
https://www.psychologytoday.com/au/blog/your-brain-food/2019…
https://www.medicalnewstoday.com/articles/magic-mushroom-the…There is early evidence of psilocybin being useful in treating depression. More robust evidence is needed.
To clarify: When I recently found out He's an owner & not a tenant-leaser.
I paid for an Owner-Title search… I thus found where/when & how much.
I appreciate your kind efforts DiLs… Not helpful yet… Maybe some day?Do you read self-help books?
What self-help books do you recommend?
I dont really read those books
What are your thoughts on literature bias in regards to antidepressants? For example, in this study it was shown that 3% of studies that showed antidepressants in a positive light were not published compared to the 67% of studies that were not published that showed antidepressants in a negative light.
Publication bias does exist
Just wanted to say that this is a great AMA. Thank-you!
Welcome
Mods.., Could you please consolidate my & DiLs posts (in reference to me) under my initial post.
Please forgive my ignorance with regards to keeping things in order… Also-then delete this post.
OP, Tough crowd eh? Or this is typical in your profession?
All good
My psychologist doesn't charge a gap (I believe her consults are $125 for the hour, which is the amount that seems to be totally covered by my mental health plan). She is the director (highest role) at her clinic and I think great at her job. Does this essentially mean she is a nice person who is basically earning lower than she could charge for her work?
Thanks :)
Yes, she may be earning lower than what she can.
I would assume so! Thats nice of her then! Thanks!
You may like to give her some chocolates for new year then
In the past I have had depression for which I was successfully treated. Years later, after contracting a virus, I came down with severe Chronic Fatigue Syndrome (ME) from which I have not yet recovered. I agree that from the outside, there can be some similarities and i can see why people would try and misdiagnose people with depression when they have CFS (a physical not mental illness, although its tough on patience and often of course they can suffer emotioally as a result). Are you aware of the differences? It's often a nasty insurance tactic for insurers to just render a person with CFS as mentally ill to try and deny their claim :(
- patients my bad.
Yes, they can be difficult to distinguish. Even then there are certain diagnostic criteria for Chronic Fatigue Syndrome. Generally this is a diagnosis of exclusion.
Why did medical professionals treat homosexuality as a mental disease until 1973 and what was the major factors that lead to that change of thinking?
As our knowledge has increased, certain things have been removed from mental illness. I guess it is all about new evidence. Similarly, there was also consumer movement which helped get homosexuality out of DSM.
Hi,
Thank you for taking part in this AMA, especially at this time. If you have no time for a reply, I quite understand
So
1. What changes has coping with COVID caused in your patients and the community ? What things can we do to recover?
2. The efficacy of ECT was been questioned in a Journal metastudy which was mentioned on a BBC radio article. ""https://www.bbc.com/news/uk-52900074 . What are your thoughts?
3. What can you do if a relative is behaving in very mentally ill ways, but refuses to get.treatment ?
4. Lastly my neighbour in the opposite unit is a schizophrenic who refuses.to take his injected meds. I call the police or his sister when I have to, but mostly he is ok but just delusional . His sister tells me she is frustrated that there is no way he can be made to have treatment , except in emergencies.
P- Some clients have increase in anxiety and depression due to factors like unemployment, financial stress, relationship issues, concerns about their health and that of family. Some can have increase in OCD e.g. Cleaning behaviour. Recovery is helped by having a good support network e.g. Friends, family, health professionals. Develop good coping strategies rather than drugs, alcohol. Link in regularly with a gp.
- There is overwhelming evidence that the benefits of ECT are much more than harms.
3 and 4. The issue is between the rights of the patient vs the harms involved if illness remains untreated. The main thing considered in deciding if treatment can be involuntary is the level of risk. The best you can do is to educate them about illness, link with a gp, get them into positive activities, avoid drug and alcohol abuse. In urgent situations, you can contact the police, ambulance, local mental health team.
Good response, but I've been thinking what are you opinions on the illness when there exists a "mental illness" but if it disappears when you remove the stress factors.
Some people exhibit schizophrenia-like behaviour because they are socially isolated, induced through bullying, unlearned behaviours, neglect from parents, lack of parent figure and more. In one case the symptoms disappeared once they won the lottery… Where it is managed and disappears over time through patience, does this mean that it doesn't exist or is just misdiagnosed? The problem is it is advantageous for the client to accept a schizophrenia diagnosis as they can use that to get the DSP pension. That raises questions of a skewed statistical distribution of patients to assign to parts of a spectrum which would not in ordinary circumstances be schizophrenia, just using that as an example.
This also addresses another issue that others have raised and is about the confirmation biases in your profession whereby the patient would recover by themselves without intervention.
I would appreciate some more indepth responses, or at least only picking a few. As most of your responses are very short and have little substance, sadly reflecting poorly on the profession.
There are certain illness which do disappear after removing the stressor e.g. a person becoming depressed after becoming financially broke. Then they slowly come to term with it and financial situation also improves and they get out of depression. Or people can have adjustment disorder to some stress but when the stressor is removed, their condition improves.
In some cases (just like in other fields of medicine), misdiagnosis occur.That just proves, we are all human.
I do not tend to believe that it is easy for people to accept a diagnosis of schizophrenia.
Breaking confidentiality ****
Hi there, I would be super interested in knowing what psychologists CAN break confidentiality to report. I think from law school I can remember lawyers can only report if there is a risk of imminent harm to that person or another… not say, for example if they had committed a crime.
If I murder someone - can my psychologist tell the police? (lol, no plans to do this - I have just been watching too much tv!)
Yes of course they can tell the police. They can even tell the police if they think it's possible you might do something to someone or otherwise, whether specific or unspecific.
There should be a place in society where you can say something in confidence and it stays just like that.
The last places on earth are in private forums or confession at a Catholic or Orthodox church.
well after this i just went and looked up the law itself, and only in NSW is there a legal requirement to report such a thing, which means that no, in my state they wouldn't have grounds to break confidentiality and report my hypothetical past murder. YAY!
It's the law all over Australia.
So I don't know what dark web law site you are reading from
You're asking a psychiatrist but used psychologist. As a psychologist working in NSW, it is at the threshold to break confidentiality for reported crimes that would attract approximately a 5+ year prison sentence. Bloody vague right. But for clearcut things like "yeah I killed someone" - I would have to report that. I would first see if the person would report it themselves though.
Breaking confidentiality is mainly focused on stopping harm to yourself or others. Then yes for pretty much for everybody.
After that it becomes tricker. We know the standard confidentialities (law, medical, religion, etc).
There is talk about mandatory reporting on certain serious crimes.
Also you forget - Crimes can be reported anonymously.
Police who gather evidence and charge people, would much rather get a confession direct from the suspect, hence the use of undercover agents.
Even your past crimes can be reported. That being said most health professionals would consider the gravity of crime committed. So they may not report a shoplifting offence but if you tell them you have killed someone, they are very likely to report.
Health professionals can break confidentiality when they believe there is an imminent risk of serious harm to the person themselves or others. You may also like to read the Tarasoff case ruling from USA.
I'm not in the USA, isn't ozbargain Australian? :) And yes, I'm aware thats the general vibe, which is why I asked about past crimes (aka no imminent threat).
Common law applies to most places around the world.
@DiLs: Well I'm not sure about that good doctor, but its certainly applies to most of the US, apart from Louisiana, which much like Quebec in Canada is governed by a variant of the Napoleonic code, given their historical connections to France. Whether you are calculating by land mass or population size, most of the world is governed by some version of post-Roman civil law system, rather than the common law.
Why aren't trans people mentally ill? And is there evidence of this? (SORRY but they used to be classified as such I think so I would like to know how the change occurred)
That's like asking why Pluto is now a dwarf planet and not a real planet…
With increasing evidence and understanding, it was found that it does not satisfy criteria for a mental illness.
Gender dysphoria(the diagnosis that replaced gender identity disorder) is not a requisite to be trans.
Being trans does not necessarily have to involve distress/impairment and thus does not qualify as a disorder iirc.
Since nobody here has asked I will.
How much do you make?
a gram or two. Already answered earlier :)
Numerous factors impact that. As a permanent staff specialist in public sector, we earn something 170,000+ in a year. It increases with every year of experience.
In private, psychiatrists generally ear 300,000+ in a year.
But this is a very simple answer and there are a lot of factors that impact these salaries.
As a locum (short term contracts) you can earn a fair bit.Thank you for answering!
I'll answer without generalisation … upwards of 300k & near the mil mark if you want to.
;)
Why is it in 2020 there is such a high demand for paediatric psychiatry? This is also for private patients. To have a wait time of multiple years is not unusual, after sending through a referral.
Do you have an idea of what is causing this? Surely there is not an unimaginable amount of children and adolescents with mental health and/or personality disorders?
There are different factors involved. People are getting more educated and knowledgable. Family system is becoming weaker. Kids are under increasing pressures due to school pressures, bullying etc. Self harm is becoming commoner in schools. Teachers are more aware of the possibility of mental health issues and they also can oerganize an assessment.
why are you called a "Shrink" ?
He likes to go for a swim in cold water…
Good luck with your pts today.
Personal q, do you feel you can "read" people after meeting them for a few minutes? If so does that give you some sense of hubris?
Eg. Wife's friend came over with her husband (nice guy)… After about 1hr of him and I shooting the breeze, get told he's a psychiatrist. :/ not happy Jan. Should you wear tags so we can either be on guard or wear tin hats? ;)
hahaha, I can tell a bit after spending some time with people. Yes, we should have to wear tags so you can be on the guard. Thanks
What response do you give people that say depression doesn't exist?
You try to explain to them by evidence and psychoeducation.
How is seemingly schizophrenic behaviour such as constant talking out loud to oneself and regularly suddenly leaving to go somewhere considered to be symptoms of asd? I understand that asd is a broad diagnosis but i thought asd related more to obsessive behaviours and inappropriate social behaviours
ASD as you said is a very broad diagnosis and can present in many different ways.
How do I get someone with BPD to therapy? (if they think they do not have BPD - yes I have read DSM3, but happy to be proven wrong).
is Dialectical behavior therapy (DBT) the best treatment option for someone with BPD? Can it be a 'cure'?(i.e. no more substance abuse, self harming, etc).
Can doing telehealth with someone who has BPD help (can you do DBT via zoom)?
What drugs are usually used to treat someone with BPD?
Can psychologists do DBT if cannot find a Psychiatrist? (assume private practice).You can try to educate them and encourage them to therapy but it is very difficult almost impossible to get them to therapy without their agreement. DBT is the best treatment modality currently available. If dont properly and the consumer practices it regularly, the results can be very good possibly minimum symptoms. Yes, DBT can be done online although in person is preferrable. Different medications including antidepressants, antipsychotics and mood stabilizers are used although there is limited evidence of their efficacy in BPD. Yes, psychologists can do DBT.
Do you think fetishes (eg hucow) are signs of a mental disorder?
I think it's not important what I think, it's more important about what evidence and data tells. Some paraphilias are indeed in the main classification systems of mental illness e.g.DSM.
damn shouldn't of googled what hucow is lol
who-cow
How can you tell if your patient is faking a mental illness/delusions vs actually suffering from the ailment? This is in the context if you were asked by a judge to determine if the suspect can be tried based on their mental competence?
History, mental state examination, information from family / friends, observation
How much do you charge per hour? And is it claimable by private/medicare?
I work in public system so the facilities are bulk billed. In private system, psychiatrists charge somewhere around 200-500/hr and 100 or 200 of this could be claimable.
Can people go real crazy if let say Covid restrictions go on for years? And how come Covid related depression/anxiety can affect even people who are introverted, not so social, or people who generally love to stay home?
Not sure what you mean by 'crazy'. Yes, people can get quite anxious and depressed if the restrictions go on.
One is staying at home by choice while other is by force. Also, being introvert does not mean you stay at home all the time. It is more of you just like your own company, even outside. Also COVID has brought many challenges e.g. financial, unemployment, relationship conflict.
Thanks for doing this. I have a few questions.
- What is still considered a mental illness, but it shouldn't be anymore? (based on your personal opinion and recent research)
- What treatment is still being used today, but it shouldn't be anymore? (based on your personal opinion and recent research)
- What's your personal opinion on nootropics and their effect on mental health?
- What's the next big thing that will transform psychiatry in the upcoming years?
Yes why do I keep buying stuff here that I don't need.
You are an ozbargainer
You need a psychologist, not (OP) a psychiatrist ;)
Really keen to understand whether african migrants or migrants in general have prevalent mental conditions they are prone to because they have uprooted from their home country and have to "make it" in another?
Migrants do have high proportion of mental health issues when compared to general population especially anxiety, PTSD, depression etc. These are also more common in asylum seekers.
I'm currently in therapy for narcissistic abuse.
Someone close to me had "complex developmental PTSD" (according to a letter from their psychiatrist) and is very 'Cluster B' (their schema results are also consistent with this), and in my view is a covert narcissist complete with memory problems, and probable ADHD (medication is currently being trialled) etc.I helped them find a psychologist, psychiatrist, and neuropsychologist, and then during the 'discard phase' they tell me this:
• that their psychiatrist has said that I am a "toxic influence" and that they should get rid of me.
• they apparently tried to defend me to the psychiatrist, and then the psychiatrist recommended relationship counselling.1) I find it very unlikely that a psychiatrist would use the words "toxic influence" and counsel a patient to get rid of one of their closest friends and former partner. Does this sound plausible? Don't the ethics guidelines prevent psychiatrists from counselling their patients to sever relationships?
2) I feel like most mental health professionals don't have a proper handle on narcissism, which runs through most of the "Cluster B" disorders. I think part of the problem is the DSM criteria is outdated, so most coverts only just meet the DSM criteria or are on the cusp, and so in the case of covert narcissism, the practitioner can't give a diagnosis beyond "Cluster B". Narcissists thus avoid treatment, because they usually don't think they have a problem. What are your thoughts on this phenomenon?
Yes, narcissists do commonly avoid treatment. There is always room for improvement in the diagnostic criteria.
Part of the issue also comes down to a balance between rights of the individual and harm from them. If they are not posing any major risks, it is difficult almost impossible to involuntarily treat them.
What are your thoughts on moclobemide as an antidepressant with nearly no side effects?
Do you feel it should be prescribed more since it is a reversible maoi with no food contraindications?
MDMA is being used in the US to successfully treat PTSD - are you a proponent of this or have any knowledge of it?
Do you feel drug prohibition is more damaging to the mental health of the population than would be legalisation with an effort put towards drug education?
What is the most effective anti anxiety medication you have found helps patients?
Do you encourage the psychological assessment of underlying causes of various mental health issues or do you focus more on dealing with the acute repercussions of said traumas?
Is anxiety a significant portion of your business?
Thank you.
Moclobemide is not without side effects. It is a good antidepressant but the concerns regarding interactions and fatality in overdose.
There is early evidence about the usefulness of MDMA in psychotherapy in PTSD, there needs to be more evidence before we embark on this journey. We should not make the same mistake as the use of 'truth serum' in therapy before.
Drug prohibition is a complex topic and yes there needs to be more education. There is certainly a case for the restrictions causing more harm than good but this need to be further discussed.
Benzodiazepenes are probably the most effective anti anxiety medications but they have bad side effects and causes dependence, thus not good for long term use. SSRI antidepressants are good alternative with less side effects and avoids dependence.
You try the explore underlying causes of trauma only when the patient is ready. It is a very complex process and patients can quickly deteriorate if this is done prematurely. During that time you just deal with acute stress.
Anxiety is the most common mental illness and thus it is indeed seen a lot.
When should someone prescribed anti depressants from a GP consider getting a referral to a Psychiatrist?
If Gp finds they are unable to manage or the patient thinks they are not getting enough support, or in case of suicidal ideas which are not responsive to treatment. Or patient having side effects that are unmanageable, also to learn some therapy.
How is your first week out of uni?
Was a long long time ago, can't recall
Have you ever dealt with a conspiracy theorist? (5G causes corona, flat earth etc.). How do you speak with someone like that to bring that back to reality, especially when they just deny any facts presented to them? Is it possible?
More often see them on internet rather than in real clinical situation. You try to challenge their beliefs and ask them for the evidence for their theories. At the end of the day it is not always possible to reverse that, and thats fine as long as you could give them some comfort.
If you had to choose one of the various "community services" to be a job as apposed to your current role, which one would you prefer? If absolutely none appeal that's fine too, just whichever springs to mind first.
Social worker, youth worker, case worker etc and outreach or not etc etc. Thanks for the AMA!
Clinical psychologist probably
Have you ever treat a fellow psychologist? Was it harder or easier then a "normal" person?
I have not.
Thanks for doing this OP! Quick question with Psychiatry and Psychoanalysis… given that psychoanalysis was influential in psychiatry not too long ago, do you see a conflict amongst psychiatrists between those who seek an empirical basis of diagnosis vs those who use the traditional psychoanalytical methods?
Also forgive the somewhat broad assumption… how can you accept assume a community mindset in the diagnosis and therapeutic process while also challenging (if any) the patient to express their own “individuality” or quirks
Psychology department belongs in Science department in most unis from what I know. And psychiatrists are medical doctors so.. I am guessing that they'd be more focussed on biological side.
Even in undergrad psychology courses, I think I never was taught Freud as is. Some of the ideas that he put forward were touched upon, definitely, partly to see the development of schools of thoughts etc. I never read any of Freud's work, outside of those that I read for fun. Compare that to say, amount of reports I had to read for my assignments… ugh.
Well this was from a student who's trying to get back into uni, but eh. :P
How do/can I show/prove to-the Bank that my Brother was insane when he bought His Flat?. And should never have gained approval.
ie. Try to show/prove that due to my Brother; been in-an Mental Asylum twice; isn't capable of rational thinking re. finances-mortgages.
He didn't pay his previous mortgage; the Bank repossessed it; which left him with-little. I've just-now found he bought a flat 10yo for 55K.
There's no way a Bank would/should have approved that; unless he's somehow put our inherited family home (where I live) as equity-garantee.
Since I've now-recently discovered this supposid-predicament… He's black-listed me & won't answer my phone calls.
His Mental IIlness is "officially" defined as being "Depression Schycosic Schizo Affective". It may-well have morphed.
The/my concern is: He's likely used this house as collateral (although he denies it). How can I tell/know if this/our house is encumbered?
Also; if I gained Power of Attorney over him & subsequently put this house in my name: Would that be back-dated so Banks can't take it?