PTSD - Calling the bluffs

And documenting the self reported subjective traumatic events along with the self reported subjective symptoms is very accurate.

Just like self reported subjective pain levels of 10/10.

Not exactly... a self reported 10/10 would objectively be a lie, as they obviously aren't passed out.
That’s not what 10/10 on a pain score is defined as....
 

pooky

Old-Salt
Re PTSD / psychological trauma due to childbirth / surgery.....l could never understand why women whose babies had died while still in the womb, but at quite a late stage of pregnancy, had to deliver their baby vaginally rather than by caesarean. It seemed so cruel, but apparently going into an operating theatre pregnant and then waking up from the anaesthetic to be presented with a dead baby can screw them up psychologically. (Also a caesarean is still major surgery which is always best avoided when not necessary). Going through the labour and birth, even knowing that the baby was already dead, supposedly connects the mother to her baby emotionally. I have no experience of this, mine were all healthy, thankfully, but it’s an interesting theory.
 
Ive no Idea
He wasn't diagnosed - but then he didn't seek help either -
He did have a hard time readjusting - with various symptoms you could attribute to mental health issues so was that PTSD , depression or just plain old coming to terms and a normal grief process.


However as I posed the question as a hypothetical and asked if - What actually happened to him personally is somewhat irrelevant - the circumstances could arise for A N Other - and so the question as posed remains answered.
In a situation where the results of the surgery constitute a bigger shock than the accident itself - is it not logical to conclude the surgery could be the trigger
Sounds more like plain old coming to terms with it. If it’s to a pathological level it would be defined as an adjustment disorder, but a certain level is completely normal as is a grief reaction.

It’s possible I suppose but in 20 odd years I’ve never known of it or seen it, so it’ll be extremely rare.
 
Re PTSD / psychological trauma due to childbirth / surgery.....l could never understand why women whose babies had died while still in the womb, but at quite a late stage of pregnancy, had to deliver their baby vaginally rather than by caesarean. It seemed so cruel, but apparently going into an operating theatre pregnant and then waking up from the anaesthetic to be presented with a dead baby can screw them up psychologically. (Also a caesarean is still major surgery which is always best avoided when not necessary). Going through the labour and birth, even knowing that the baby was already dead, supposedly connects the mother to her baby emotionally. I have no experience of this, mine were all healthy, thankfully, but it’s an interesting theory.
It’s considered safer physically with less risk of future complications for the mum to deliver naturally if possible, even though it’s clearly a very difficult experience emotionally.
 
Which is precisely what I said to Dingerrr, thank you for confirming it. It’s still a psychiatric illness. GPs can’t and won’t diagnose PTSD without extra specialist training and a mental health specialist will almost always be a psychiatric nurse who will refer to a psychiatrist for diagnosis if required (we can’t diagnose either).

The psychiatrist will prescribe meds (psychologists can’t do this, a few psychiatric nurses can but not psychologists) and will refer to a therapist, who may be a psychologist or psychiatric nurse to carry out psychological therapies. Many RMNs are CBT and EMDR trained.
Aww now DSM-5 is waaaay easier for Doctors to understand with all that multiaxial diagnosis nonsense hidden away...
 
Aww now DSM-5 is waaaay easier for Doctors to understand with all that multiaxial diagnosis hidden...
They still won’t and don’t. They’re normally not qualified to. Most UK diagnoses are given via ICD 10 rather than DSM, very similar but some criteria are different for some illnesses.
 
Not exactly... a self reported 10/10 would objectively be a lie, as they obviously aren't passed out.
”Based on a scale of 1-10, what is the pain you are feeling now; 1 being virtually no pain, 10 being the worst pain you can imagine”.

I can’t ever remember giving a reaction above 6, beyond that (for me) it was obvious I was in too much pain to answer.

Although a scream of “MORPHINE” = 10.
 
”Based on a scale of 1-10, what is the pain you are feeling now; 1 being virtually no pain, 10 being the worst pain you can imagine”.

I can’t ever remember giving a reaction above 6, beyond that (for me) it was obvious I was in too much pain to answer.

Although a scream of “MORPHINE” = 10.
Good days I am around a 7, my bad days are a solid 8, to a tearful 9, worst ever was a screaming 9. Asking for morphine gets one on the list for "drug seeking behaviours."

That worst ever 9 was waking up from an operation that was much more involved than was planned, on a morphine drip, after over half a decade on enough dilaudid to kill about 3 people every 4 hours.
 
As I said, I’ve no issue that it may be the cause, just that compared to other causes it’s extremely rare.
You are completely missing the point. It's only rare that you can't pigeon-hole someone with some obvious event that you can hang your diagnosis on. You've even passed the buck to the patient to identify the cause for themselves, which has the added advantage that the patient obviously has full buy-in.

How many of those you have come across personally, who definitely had PTSD due to a self-diagnosed cause, had coincidentally had a general anaesthetic?
 
You are completely missing the point. It's only rare that you can't pigeon-hole someone with some obvious event that you can hang your diagnosis on. You've even passed the buck to the patient to identify the cause for themselves, which has the added advantage that the patient obviously has full buy-in.

How many of those you have come across personally, who definitely had PTSD due to a self-diagnosed cause, had coincidentally had a general anaesthetic?
This is a standard part of CBT, formulation, and even developing the therapeutic relationship....
 
Psychiatry is a medical science and it’s medical practitioners are medically qualified doctors. Only they can formally diagnose a condition such as PTSD, psychologists can’t do this.

To vastly over simplify psychology looks at science of the mind, and how we’re shaped by experience etc.

Psychiatry is specifically concerned with disorders of the mind from a medical standpoint, including pharmacological interventions.

Just to confuse things most psychiatric conditions respond well to the correct psychological interventions, drugs tend to be less effective unless for maintenance and reducing behaviours that put others at risk.

PTSD is a diagnosable psychiatric illness that responds to both pharmalogical (to a lesser) and psychological (to a greater) extent.

Quick edit to add that there’s a fair amount of more or less good natured mistrust between psychologists and psychiatrists. Most of the time they work well together but there can be vocal disagreements about the best way forward for some patients.

The psychiatrist will win normally as they’re the ones with the legal powers, psychologists have no legal responsibility or powers of detention and treatment over patients.

Clinical psychologists can diagnose, but most prefer to work from formulation. https://www.bps.org.uk/sites/bps.org.uk/files/Policy/Policy - Files/Diagnosis - Policy and Guidance (Mental and Behavioural Classification Systems - 2013).pdf

They can also be the approved/responsible clinician for a patient - e.g. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy - Files/Approved Clinician FAQ - June 2017.pdf

Reference prescribing, there have been talks in the past, but generally my understanding is most do not want it and I think there would be resistance from the Royal College of Psychiatrists who hold much more leverage than the BPS. (whereas it works fine in some states in the US).

In my view, opposition from the RCPsychs would mainly be protectionism, because plenty of other professions allow non-medical independent prescribing, it would just be a case of creating the correct course.
 
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If the cancer is directly attributable to their service, the special treatment mandated in the covenant* should apply. The difficulty here is identifying the exact cause, obvs. The only reasonable way to categorise such cases, which also includes PTSD, is that unless it is clearly not due to something that has happened as a consequence of service, then it should be regarded as being a service-related condition. This is the way that CSRLD works.

* It's not that special.
I was diagnosed with skin cancer and I was invalided out of the Service last year. DPHC were not particularly helpful (losing reports and blood tests etc). Apart from an initial referral from Frimley Park MDHU, there has been no Service-influenced care or treatment. A no stage have I ever been asked about being a 'veteran'; equally I don't think that my treatment could have been any better or faster anyway.

The Hard Facts summary immediately prior to my end of service looked at my mental state, but I don't recall sitting in front of anyone qualified to asses it, either.

Wibble wobble, My old man's a dustbin,...
 
Hasnt CBT been found to be shite?
Generally the evidence base for CBT is good and shows that it works, and it also generally works on the basis that only a prescribed number of sessions are required, so the NHS likes it...

However there are a bunch of problems with being actually testing this stuff due to difficulties in provide a believable placebo etc (plus the CBT industry is just as money driven as the pharma industry), and there's also a debate around how much of the changes are actually to do with the therapeutic relationship (how much you and the therapist get on), rather than the treatment per se.
 
Hasnt CBT been found to be shite?
Like any such therapy, it is not only difficult to demonstrate it's effectiveness in the way that chemical-based treatments are, but also its effectiveness is very much dependent on both the skill of the practitioner and the receptiveness of the client.
 
the therapeutic relationship (how much you and the therapist get on),
Valid point, my experience thus far of those on the MH side are useless bone Idle fückers who did me more harm than good.

I just keep a lid on things now.
 
Like any such therapy, it is not only difficult to demonstrate it's effectiveness in the way that chemical-based treatments are, but also its effectiveness is very much dependent on both the skill of the practitioner and the receptiveness of the client.
There seemed to be a lot of people going away and completing a CBT practitioners course over a couple of days then thinking they can save the world.
 
There seemed to be a lot of people going away and completing a CBT practitioners course over a couple of days then thinking they can save the world.
It's a bit like NEBOSH. Too many people think that having attended the course means that they are experts.
 

overopensights

ADC
Book Reviewer
Its anecdotal to be sure - but somebody I knew who lost fingers following an accident with an electric saw - always maintained that the worst part was waking up with 3 fingers missing - he had gone into surgery with them severed but attached* expecting them to be repaired. He was shocked and upset to discover he was fingerless.

Contrast to my own experience asked the question what can you fix the Dr gestured at each finger and said No No No - Pffft we will try, - So I went under knowing Id lost several digits and my hands were a mess.

It would therefore seem logical to me that had my friend suffered PTSD then the shock of the surgery rather than the accident could well have been the instigator . Of course he may be the exception to the rule courtesy of poor communication from the surgical team.


*I suspect attached amounted to skin at base not cut through and he thought it was better than It was
I had the same situation but with two fingers missing, the cause was not a chainsaw but a 'fan belt' on a large belt saw. My problem was flashbacks of seeing my fingers on the floor, I would see them frequently for days afterwards which caused me to 'shudder' quite violently, it was quite dangerous while driving. I later spoke with a person that said they knew the answer to the flashbacks. He told me. 'Go to the saw and stand there with your hand on the offending part.' It was very hard to do, I did it about ten times while having my tea break; It actually worked, but how I would love my fingers back!
Perhaps not completely relevant to this very interesting thread, however the mind is a very useful aid when used to advantage.
 
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