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
medical (biological) approach to those who take a therapeutic approach
There are no biomarkers for mental ailments. Is psychiatry operating on a theoretical basis?
What do you think about psychiatrists prescribing an 8 year old child with methamphetamine (Ritalin)?
There is a difference between therapeutic and theoretical. Psychiatry is operating on the basis of theory and practice.
Well if the Ritalin is needed for ADHD, then why not? It is a medicine which improves ADHD.@DiLs: Do you think ADHD is a "western" phenomenon?
What are the long-term health implications for that child?
Just wondering if the current generation is facing more challenges than previous generations as more and more peope are seeking help from psychologists/psychiatrists . Both my daughters see psychologist and one them also sees a psychiatrist. The kids today just seem more fragile than from my generation as they are more prone to breakdowns and anxiety attacks when facing challeges (eg. exams, bullying etc…).
In comparison, I changed schools 12 times in my 12 years of primary/secondary education as my parents moved across 4 countries (Malaysia, PNG, Australia and Brunei) with massive education(including learning new languages), social(including bullying) and cultural changes & challenges. I survived, never had a breakdown and never saw a psychologists/psychiatrists - it was tough I will admit.
In your opinion, are we coddling our kids too much and does this generation need to toughen up?
I think there is more awareness now of these issues and the need to fix them early. To some extent, yes the resilience factor has also reduced but on the other hand stressors may also be increasing e.g. family system breaking down, bullying etc.
Thanks for your response. I am aware that things have changed and previous generations have had to make do with alot less in terms of support. In my days, bullying(even physical) in school was never directly actioned and I was just expected to cope. I am glad that society as whole is more aware and willing to actioning bullying in schools.
Why has no one asked the money question yet? What was your pre-tax income last year rounded to the nearest $100,000?
Mate, there's a gentlemanly way of asking that…
What Amex do you have?
already asked
As a long time sufferer of ptsd I found psychologists unhelpful, if talk could change me i wouldn't need a psychologist. Only through the efforts of a psychiatrist and they were big efforts did he ..
- End up convincing me ptsd was a real thing.
- Treat me with medications this took nearly 2 years of trial n error to find the correct treatment
- Taught me how to manage my condition
- And was honest enough to tell me there wasn't a cure.
My experience
Glad you felt better
Have you had a patient similar with Michael Scofields condition (Prison Break) who has a Low Latent Inhibition syndrome but turns out to be creative genius?
dont recall
How do you handle patients who are delusional/paranoid? Is it better to tell them what is happening in reality or allow them to continue with their thought process? Or does it depend on the patient
Generally, you do tell them that it is unreal and also ask for their evidence for the delusion. But you are not always successful in removing the delusion. In those circumstances, you try to give the utmost comfort to patient and reduce distress.
I have a relative with a mental health issue who believes in unusual delusional beliefs. Basically that someone from decades ago is influencing her and has told her what she must and must not do. But the catch is she doesn't recall any of these instructions until an event occurs. For example, a natural disaster occurs: "They told me that would happen". When I challenge her with the evidence that she didn't mention anything about the disaster before, she responds with "Well, I didn't remember them telling me about it until it happened".
I'm basically debating against phantom memories. Anything I do or say can be countered with "Well, I knew you would say that / do that / think that". Sometimes her beliefs take over her life and lead to job loss and severe distress. Everyone around her has been banging their heads against a wall trying to help her, including multiple doctors. She of course doesn't think anything is wrong with her, and that everyone else is wrong.
Dealing with such patients must sometimes be very frustrating.
Actually this brings up an interesting question for Mr shrink.
How do you help convince (for want of a better word) to get help?
Are there any strategies? (perhaps a web link - do this, then this, then this).
It just seems very hit and miss.
How do you convince your Psychiatrist that you can be released when you wake up with a short-term memory loss in a psychiatric facility?
Not sure if I understood the scenario properly. Generally people are discharged based on numerous factors including risk of serious harm to self and others, level of support, level of insight, medication compliance.
Have you ever failed any patients i.e lose them to suicide.
If so, what does it feel like? Do you have to seek counselling for yourself also?Yes I have lost. Depends upon how you cope, you may or may not wish to go for counseling.
If a patient suddenly stops seeing you without having made any progress towards resolving their issues, would you typically follow up with them to see how they are doing?
You will contact them and ask if there is anything you can do for them. Also to make sure they are safe. Also if they will like to be referred to someone else.
How can one organise speaking to a Psychiatrist, do you need to get a referral?
As a Dr, you should know that you can see a psychiatrist by getting a referral from GP. This is important to keep your GP in the loop and also to get medicare rebate.
Why do so many psychiatrists not bulk bill?
I am not sure if this is just for psychiatrists. I think even other specialists dont commonly bulk bill. There are a lot of factors involved which include the time and energy they vest in getting a patient better, administrative staff, office fee, indemnity insurance charges. They also have expenses just like everyone else.
Is there an epidemic of people who believe they're sick with ailments that aren't actually real, simply because of television and social media shoving ideas down their throat?
not 'epidemic'
mass hysteria
Have you read any of Irvin Yalom's books?
If so, what were your thoughts. If not, have you heard of Yalom?Most of his work is related to existential psychology and group therapy
Absolutely, and there is a lot of emphasis on content Vs process and the 'here and now.' I was interested if you had read his work, because he lived through the big transition from talking therapy to psychopharmacotherapy in the USA. He explains it quite well in that it was mostly driven by the insurance reducing their funding for talk therapy and increasing it for medications. The result being a large population of "pill vending machine-esque" psychiatrists.
What are your thoughts regarding this - what drives me to ask this as I saw that you said a good psychiatrist will engage in talk therapy and psychopharmacotherapy, but my experience as a psychologist is that it seems the talk therapy style of psychiatry is a dying breed. I see too many clients left with invalidating experiences with many psychiatrists (thankfully I have a few in my back pocket to refer to, but their books are terribly full!).
Yes, there is a general shift to medications but the reasons for these are complex and numerous. A major reason for that is trying to improve the condition quickly. Other reason include shortage of time and expertise.
Do you have an opinion on the current research into the use of botox for anxiety/depression?
Personal experience is that the injection into the glabella specifically has been super helpful in relieving chronic tension headaches, making it a heck of a lot easier in managing day to day stress levels. Haven't had any adverse side effects as yet.
There is very limited theoretical evidence for that. It needs much more evidence before it can be available routinely.
thanks for the response
This is a very specific question:
I know it would be unethical for you to recommend anyone take illicit drugs which always come with serious risks. But I was just wondering, would someone who recovered from meningoencephalitis over a decade ago be at any greater risk of adverse reactions to recreational MDMA use than your average healthy person?
Thanks!I am not sure if there had been research done specifically with this question. But it is possible that they are more prone given they had a brain insult in the past.
With the medications that are commonly prescribed for mental illness, are they safe to be consumed for a long period of time? How often do they need reviewing or how long do they usually take to work?
Anti depressants generally start working after three weeksweeks. Anti psychotic and mood stabilizer work a little earlier. All medications have side effects so it's best to get them reviewed at least once a year.
What car do you drive? :P
A black one
Sounds like a Beamer
Have you ever accidentally shrunk the kids?
One more question - how do you tell the difference between antidepressant discontinuation symptoms and the re-emergence of the original depression/anxiety?
From what you've seen would you agree that antidepressant withdrawal is similar to quitting smoking for example? In that some people can quit quite easily whereas for others it is a significant struggle?
Discontinuation symptoms generally occur early (within a week) than a depressive relapse. They also are mostly physical but can be emotional symptoms as well.
Yes, some patients have more discontinuation symptoms. Some antidepressants are also known to cause more discontinuation symptoms.
You're in a desert, walking along in the sand when all of a sudden you look down..
You see a tortoise lays on its back, its belly baking in the hot sun, beating its legs trying to turn itself over but it can't. Not without your help. But you're not helping………….You are too heavy to be turned
GP here. Thanks for the AMA
Kind of tongue in cheek…But…
Why is it so hard to get most psychiatrists to write update letters about patients we refer?
Also there never seems to be enough psychiatrists to refer to - where would you recommend that GPs try and find new psychiatrists that have just finished up their fellowship?
At times, it is indeed difficult to get a psychiatrist appointment given a single assessment take 40-60 minutes so a patient can not be just 'squeezed' into the clinic. You may like to try having a telepsychiatry appointment for your patient.
I agree some psychiatrists (just like other health professionals) are not good at writing letters.Do you work for one of the Telepsychiatry services? Are there any you would recommend over another?
I have had a lot more problems with Psychiatrists not writing letters than other specialties - thank goodness for the Safescript system in Vic…
I find when doing a 291 referral I always get feedback as well as telepsych.
Yes because they legally have to or get in deep trouble if Medicare audit (Having said that have also sometimes failed to receive 291 reports).
It's the long term patients who have medications changes and the psych doesn't write to you that really annoys me…
I mean if you're prescribing horse doses of Valium as a psych I think the GP needs to know… (At least I could confirm via Safescript but that only came in this year on a mandatory basis…)
What is your opinion on relationship of mental health and nutrition? Is it something you look into/study as part of your work?
I have recently watched following talk, hence the question:
Dr. Georgia Ede - 'Our Descent into Madness: Modern Diets and the Global Mental Health Crisis'There is increasing evidence of impact of nutrition on mental health. Mediterranean diet has shown special benefits. Prof. Felice Jacka has done a lot of work in this regard who last year wrote a book 'Brain Changer : How Diet Can Save Your Mental Health'.
I have always wondered as a GP why it's can be significantly difficult to get psychiatrists to accept my referrals of complex patients. I mainly see mental health so I tend to refer a lot but there are numerous occasions where even entire private hospitals with dozens of psychs reject the referral. My letters are quite detailed and I am starting to think this may counterproductive as I have seen colleagues with the classic one liner "referral for opinion and management for anxious patient" get through whereas mine do not. I have not seen this in any other specialty and it is quite frustrating not being able to get help, especially with my personality disordered patients.
Additionally, do you believe that there maybe an issue of poly-pharmacy in psychiatry?
I am not sure why you have difficulty in getting patients seen. May be the books are full for psychiatrists in your area. Yes, psychiatry does have issue of polypharmacy but it is not always bad. There are benefits to it as well.
Are more intelligent/creative people prone to mental health issues ? Or certain types of mental health issues ?
As a very amateur history buff it seems that some of the most famous and influential people in history have had mental health problems, many undiagnosed it seems. For example Winston Churchill, Napoleon, lots of artists etc
Very interested to hear your response..
Quite a few articles published on this although as a reader, care in interpretation is necessary as some of the studies have embedded limitations and assumptions, some are made explicit, and perhaps others not. Just two I came across (pretty sure there are many others):
This study using data from American Mensa Society postulates the following, which seems plausible:
The researchers point out that highly intelligent people have tendencies for “intellectual overexcitabilites" and a hyper-reactivity of the central nervous system. On the one hand, this gives people with high IQ heightened awareness that helps their creative and artistic work. In fact, the field of cognitive ability recognizes one aspect of highly intelligent people to be “a broader and deeper capacity to comprehend their surroundings."
This hyper-reactivity, however, can also lead to deeper depressions and poor mental health. This turns out to be particularly true for poets, novelists and people with high verbal intelligence. Their intense emotional response to the environment increases tendencies for rumination and worry, both of which predict depression and anxiety disorders.
This study is also interesting but focused on bipolar disorder. It delved into more nuanced facets like technical skills and verbal ability of those studied. But also has major drawbacks - since it is based on men only (can it be extrapolated to all), and only in regard to hospitalisations (more extreme cases) and so forth.
Good post there!
Thank you.
Also, among our contemporaries and the creative personalities, I find this Stephen Fry doco: The Secret Life Of The Manic Depressive to be quite a fascinating look into the manic depressive mind.
Thanks for the response. Very Interesting.
From what I have read there is a degree of "mania" (?) attached to these high achieving personalities/people. They seem to burn bright, have a rest and go again. They also seem to not sleep as much as what would be considered to be a normal amount eg 8hrs, thus having amazing productivity. Churchill wrote mountains of memos during WW2 and also I think won a Nobel prize for literature for example.
So then, this leads me to wonder if being an intellectual and somewhat more intelligent than the average person is worth the mental anguish that comes with it.
Perhaps it is better to be an average Joe !
Psychoanalysis is rarely if ever used now. The closest to it is psychodynamic psychotherapy which is also used rarely. Offcourse, there is a conflict among psychiatrists between those who take more a medical (biological) approach to those who take a therapeutic approach.