Psychiatry

HeadPig

Any psychiatrists here? How are you finding it?

HeadPig

Surely someone knows something about psych as a specialty!

A Neurotic

I'm only a wee student, but I'm on my psych rotation at the moment! Anything in particular I might be able to answer for you?

RobFowl

It would help in getting a reply if you were a bit more specific about what you wanted to know.
Remember all posters here are anonymous so if a psychiatrist they may not want to identify themselves...

locum-motion

HeadPig wrote: »

Surely someone knows something about psych as a specialty!

I'm sure plenty do, but they might not want to answer a question as vague as yours.

take everything

Psych:
If you're genuinely interested in psychopathology and the mind, do it. If not, don't.
If you are interested, it'll be enjoyable.
It's generally more easy-going than medicine- none of your "oh fcuk, what was your man's Sodium, the consultant's gonna kill me..." lark.
I'm being semi-facetious.

Having said that, a lot of mental illness is, unfortunately chronic. Not many quick fixes. But this is where continuity of care/developing a therapeutic relationship with the patient is important.

Symptoms of the Mind by Sims might be worth looking at if you're interested in psychopathology.
Also, (hope this isn't heresy) some (mostly manic) patients can be good craic.

sam34

op, I'm a psychiatrist, and am happy to answer any q's. will have limited net access for the next 5 or 6 days but if you post what you're interested in finding out, I'll answer when I can.

Maddenman

Hi,I am currently doing the Leaving cert this year. I hope to go to NUIG and do the Psychiatric Nursing course there for 4 years. I am just wondering,After the 4 years,What then are my options? Am I fully qualified Psych Nurse,Or do I have to specialise In an area E.g Child+teen etc. Is there a good one to specialise in?
Also the work load weekly,Is it much? Many hours a week?
I really don't know much about it as a career,So any help would be really appreciated

HeadPig

Sorry, I'll be more specific.

How is the work-life balance compared to other specialties?
Is it advisable to train in ireland or abroad?
Do you ever feel threatened by patients?
How stressful is it?
Is psychiatry a growing field?

sam34

hi op,

apologies for not replying sooner, i forgot about it.

i went into psychiatry straight after intern year and have been in a consultant post for 2 years now.

re training - i did all my training in ireland. i think that, moreso than other specialties, irish training is well recognised here and going abroad is not as necessary as it is for things like surgery etc, in fact, the year i got my post, all the others who also got consultant jobs were irish-trained, except 2. having said that, you have to look at things in the overall context opf training here now, working hours, lack of grant, NCHD shortages etc.

re work-life balance: certainly, its better than other specialties. mostly i now do a 50 hr week, plus on-call. consultants in other areas are likely to be working longer hrs, eg surgery/anaesthetics etc

being threatened by patients - yep, its an occupational hazard. what gets me is when the patient is not mentally ill but is a scumbag/thug/psychopath and is threatening you in an attempt to manipulate you into giving them something, be that an admission/letter for court/benzos etc etc etc. i find it much easier to tolerate threats from someone who is genuinely mentally ill and not in control of what they are doing. ive been assaulted by patients in the past, not seriosuly thankfully, but it's crap when it happens, its very unsettling.

re stress: lots of people would have you believe that all we do is 'talk' and offer tlc. the reality is that we are dealing with some seriously ill people, and that if we fcuk up the consequences can be disastrous, for that person but also for others.... you are always worried about suicide, but also the spectre of a psychotic or depressed person killing someone else, although rare, is a consideration you always have to have in mind. there is of course a human tragedy if that happens, but also there could be consequences for yourself in terms of professional reputation (cos these things hit the papers) and potential litigation.

more stress comes from everyone's expectations that anyone awkward/difficult/eccentric/odd/rude is automatically "psychiatric" and that we should be able to keep them in hospital forever more, or give them tablets, when in actual fact they are just awkward/difficult etc .

the general public's understanding of psychiatric illness is very limited, yet you will find that everyone has an opinion on what we should be doing, who we should be treating etc. you dont ever hear taxi drivers pontificating about oncologists or surgeons, but some of them think they are experts in mental health.

is it a growing field - absolutely. the biological knowledge is expanding hugely. in terms of servoces here, there are some policies that are being resourced and driven at the moment that are very exciting to be a part of.

i love my job, i truly do. it has its downsides, but i have to say that i have never ever woken up and thought that i didnt want to go in to work that day. i enjoy what i do immensley and, given the opportunity, i would do it all again.


i think i posted in a similar thread here before years ago, i'll see if i can did it up for you.

any more q's, fire away

sam34

found this post of mine from a few years back....

there are loads!

as with all areas of medicine, there's the immense satisfaction that you have done something that has made someone better. that sounds simplistic, but you can never underestimate how distressing and significant someones symptoms are to them, even if we think they "only" have "mild" illness.

people dont often think of psychiatric illnesses as life-threatening, but severe depression can be, not just because of suicide, but because of a patient not eating or drinking. i have seen ECT save many lives in these kinds of people, and seeing the relatively quick turnaround is immensely rewarding. to know that your timely intervention literally saved someone from death is amazing. (i just wish the anti-ect brigade could witness some of teh success stories, but thats another thread!)

when dealing with people who have major major illnesses, really chronic and enduring stuff, the day to day rewards are quite limited, as change and progress tends to take time in these people. but when it happens, it's great!
i'm talking about the people who have been floridly psychotic for years, sometimes decades, who are totally treatment resistant and are (usually) in longterm institutional care. you just have to adjust your outcome measures and accept that improvement may mean them asking if they can have a shower instead of having to be bribed/cajoled/gently encouraged to do so!

i worked in one of the old style institutions for a good while. it was sad on one level, seeing people who had been abandoned by their families and communities, but i was delighted to work there - firstly, just for the opportunity, as these buildings will close forever over the next decade or so, and secondly because of the patient population - i saw mental illness and "madness" like i had never seen before. seriously off the wall stuff. it fascinated me, and intrigued me, and taught me a lot, and i look back on those days with fond memories. (does that make me sound very weird?:p)

again, while not wanting to sound odd, the process of detaining someone against their will is something that is very rewarding. why? because, by and large, when it gets to that stage, the patient is in distress, in not amenable to reason and needs someone to step up to the plate and take action. being able to do that, and able to initiate the process of recovery, (however long that may take) is satisfying. knowing that your action here may have prevented a suicide, or harm to others, or harm to self is a great reward.

psych is not always, or even often, about cures, but more about symptomatic relief. i work in old-age psych, and see a lot of people with dementia who have paranoid symptoms and agitation. management of these is delicate, and not just a matter of throwing benzos at them. i know their dementia will progress, but i like having a role to play in making their final days/weeks/months/years more dignified, less distressing and more comfortable.

i like the majority of my psychiatric colleagues. it's fair to say that those who are in psychiatry because of a genuine interest are decent, salt of teh earth people. unfortunately, psych gets a lot of NCHDs who are in it because it is a job, and the only job they could get. by and large, these people are not really interested and dont really give a damn, and their work ethic is poor. thats frustrating.

psych is multi-disciplinary and holistic. you and a team get very involved with patients and their families, and you get to know them quite well. i would hate to be in a specialty where you patch someone up, review them at 6 weeks and tehn never see them again. seems like a conveyor belt to me.

after a considerable time in psychiatry, i think its fair to say that i am officially no longer shockable i have heard and seen it all! when patients tell me something that they expect will elicit shock form me, and they are worried about taht, i love seeing the relief dawn when they realise im not disgusted or shocked.

part of me has to admit that sometimes i enjoy other peoples discomfiture when i tell them socially that i am a psychiatrist! it is literally a conversation stopper. they immediately panic and try to remember what theyve been saying to you, and are wondering if youre ananlysing them. its hilarious to watch. however, my mirth is usually followed by annoyance and frustration at the lack of unerstanding out there about what a psychiatrist is and does.

while im on a roll here i may as well mention what i ahte about the job:

one word: STIGMA

it is so pervasive in society

have a look at threads on these boards, you will see all kinds of crap propagated about the mentally ill and the psych services.

people are living in ignorance, which promotes (unjustified) fear.

but its not just the general public - i have to constantly fight with medical colleagues just so my patients will get the treatment they deserve, and not be dismissed as "just psych".

psych patients presenting with physical illness are not always taken as seriously as they should be. their symptoms are sometimes dismissed or attributed to being "in the head". it can be hard get medics down to see someone on teh psych ward sometimes, and nigh on impossible get them to transfer a medically very compromised patient to a more appropriate setting.

i absolutely hate that i have to defend my profession from scientologists and other morons who think that psychiatrists are interested in simply drugging everyone to the hilt, and that we drug people simply for being a little bit different, alternative or odd. i hate the fact that the scientologists picket conferences with signs depicting "dr death" injecting something directly into someones brain. i despise that, above all other specialties, we are perceived as having a very dubious relationship with the pharma companies.

i also hate the uninformed idiots who think anyone with any sign of mental ilness should be locked up, forever, away from so called civilised society.

you can be guaranteed that teh vast majority of our detractors know precious little about serious mental illness and its consequences.

now, are ya sorry you asked! i didnt intend to go on such a rant, but it kinda flowed!

edit, just re-read the post and i wonder if it comes across as if i think of myself as some unsung hero - thats certainly not the case and not the impression i was trying to give!

take everything

Have to say that both posts by sam there are very good.^

One thing that resonates is that reluctance to dope patients up by just adding on another antipsychotic (God i hate seeing antipsychotic polypharmacy on a drug cardex).

Having said that you often see patients on a few antipsychotics and they're still flying around the place. And you think Jesus nothing is hitting them.

HeadPig

take everything wrote: »

Have to say that both posts by sam there are very good.^

One thing that resonates is that reluctance to dope patients up by just adding on another antipsychotic (God i hate seeing antipsychotic polypharmacy on a drug cardex).

Having said that you often see patients on a few antipsychotics and they're still flying around the place. And you think Jesus nothing is hitting them.

Are multiple antipsychotics ever indicated? They all work the same way so I can't imagine a benefit of using more than one?

sam34

HeadPig wrote: »

Are multiple antipsychotics ever indicated? They all work the same way so I can't imagine a benefit of using more than one?

sometimes. they all have different receptor affinity so there is pharmacological sense in using certain combinations, but obviously you'd try and avoid it.

Studentt123

I was wondering if you could do anything for undergrad to get into med school in order to become a psychiatrist? I want to get a bachelors in psychology or neuroscience.