Dan Hall

51 posts

Dan Hall

Dan Hall

@psych_danh

Psychiatrist in Leafy London | Higher Trainee BMA LNC Rep | Psychopharmacology Research | Struggling Pianist

London, England Katılım Mayıs 2022
139 Takip Edilen24 Takipçiler
Dan Hall
Dan Hall@psych_danh·
@SimonKitchen20 Bipolar disorder can be very difficult to diagnose. An index manic episode with admission is a huge clue, without this, bipolar symptoms (depression, volatility) intersect with many disorders, a detailed history is needed along with observation of mood and treatment over time!
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Dan Hall
Dan Hall@psych_danh·
@drjanaway A biological substrate may actually be necessary is my guess! Replicating the functions of biology in silicon chips may just not be technically feasible
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Dan Hall
Dan Hall@psych_danh·
@nuwandiss People often seriously underestimate how much genetic factors and random environmental factors play into mental health problems and personality traits.
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Dan Hall
Dan Hall@psych_danh·
@drjanaway Whenever something goes wrong in mental health care, the outcome is that doctors weren’t restrictive enough and the act could have been prevented. The fact that suicide in an individual is stochastic and completely unpredictable is denied or ignored. A real rethink is needed!
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Dan Hall
Dan Hall@psych_danh·
@KemtrupTweets Too often the solutions offered to psychiatric management are utopian, too radical and completely un-pragmatic within resource poor mental healthcare systems where only brief clinical encounters are economically viable. Doesn’t mean we shouldn’t try harder though!
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Kemtrup
Kemtrup@KemtrupTweets·
The harshest professional critics of psychiatry and MH diagnosis, who say it’s inherently pernicious, to-be-abolished, and based on conceptual confusions (who bristle at being called “anti-psychiatry”) have little to offer as a positive vision of what would replace it.
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Dan Hall
Dan Hall@psych_danh·
@KemtrupTweets I agree! Reifying MH dx and treating them as natural kinds is a big error! The benefit though of ICD/DSM is pragmatism, reliability and ease. In resource poor healthcare settings (a lot of the world) this is invaluable as individual formulation takes serious time and training!
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Kemtrup
Kemtrup@KemtrupTweets·
So what does the medical model of psych dx and treatment tend to miss? I’d say three things (but again lots of great psychiatrists will explain they agree with all of this and treat and dx accordingly) 1. Mental illness is better thought of as a network of associated symptoms
Kemtrup@KemtrupTweets

A point I continually return to is that skepticism about HOW we carve up psych problems into different conditions, illnesses and diseases is warranted, but skepticism about the existence of psych problems is absurd. And psychiatry and psychotherapy only req the latter to be legit

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Dan Hall
Dan Hall@psych_danh·
@DrWinarick Strong agree and something that is rarely thought about or properly explored!
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Dr. Daniel J. Winarick
Dr. Daniel J. Winarick@DrWinarick·
Mood and anxiety disorders without co-morbid personality disorders or co-occurring pathological personality traits are mythological psychiatric constructs. They are fairy tales that academic psychiatrists tell their students.
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Dan Hall
Dan Hall@psych_danh·
@Diego_NajeraGB It is difficult but doable, I did them all through medical school and foundation years! The difficult part was actually interviewing and the visas, so many hurdles! Although things in the US are changing and some states are removing completion of a residency requirements!
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Dan Hall
Dan Hall@psych_danh·
@drjanaway Oh yes, patients and staff! lots to digest
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Dan Hall
Dan Hall@psych_danh·
@drjanaway PICU is amazing, you see seriously unwell patients transform and get better before your eyes, is a great experience!
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Dan Hall
Dan Hall@psych_danh·
@drjanaway Freud had a train phobia for a reason!!!
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Dan Hall
Dan Hall@psych_danh·
@FereldanWizard @Shrink_at_Large Yes it is a real mental health term, typically used to describe people with chronic psychosis, usually partially treated, who live fairly functional lives superficially, but whose experience is in fact profoundly fissured and have serious psychotic symptoms when interviewed.
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Peter
Peter@FereldanWizard·
@Shrink_at_Large Is the term 'double book-keep' a 'proper' term or one coined by you? Reason I ask is cause it describes me perfectly in the weeks leading up to a full episode before I found meds that worked for me
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Dr Jay Watts
Dr Jay Watts@Shrink_at_Large·
I am quite shocked how little people understand paranoia delusions in the public sphere. There are middling points where one can 'double book-keep' i.e keep some idea this may not be reality. But there can be points after that where it is a whole universe with its own logic.
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Dan Hall
Dan Hall@psych_danh·
@JTAuthor @justin_garson Nice, I like the pain analogy - a question of degree though? Pain disorders don’t lead to psychosis and catatonia, unlike say extreme low mood. It’s hard to see those changes being positively selected for, given the degree of problems they cause?
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James Turner
James Turner@JTAuthor·
@psych_danh @justin_garson Good question. My main response is that such changes are not good evidence of dysfunction. Pain also causes perceptual changes and a reduction in many executive functions. But clearly pain was selected for.
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Justin Garson
Justin Garson@justin_garson·
Excellent paper by @JTAuthor arguing most cases of depression are functional responses to circumstances, not dysfunctions - as most cases of pain are functional responses to bodily harm. This is crucial for healing, as it points us outward, toward the world and how we view it.
Justin Garson tweet media
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Dan Hall
Dan Hall@psych_danh·
@JTAuthor @justin_garson extreme low mood leads to perceptual changes and profound psychomotor dysfunction with adverse physical health sequelae, why would it be selected? More likely extreme low mood is in-built system vulnerability - positive feedback out of control? Curious to see your idea though!
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James Turner
James Turner@JTAuthor·
@psych_danh @justin_garson That's exactly it. Low mood was selected for coping with unpropitious environments, and when environments are extremely unpropitious, you get extreme low mood (the kind that meets the criteria for depression)
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Dan Hall
Dan Hall@psych_danh·
@JTAuthor @justin_garson Intriguing - you imagine an ancestral environment where depression was functional? I’m struggling to imagine it! But maybe that’s a failure of my imagination! Interesting stuff
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James Turner
James Turner@JTAuthor·
@psych_danh @justin_garson Thanks! I'm working on another paper that goes into much more detail regarding this issue. A note here though: the fact that depression doesn't increase fitness now (which I imagine is the case) doesn't mean that it's dysfunctional--it could instead be mismatched
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Dan Hall
Dan Hall@psych_danh·
@justin_garson Taking care of individuals that society otherwise rejects, stigmatises and impoverishes is itself an act of open-mindedness and tolerance!
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Siobhan Gee
Siobhan Gee@SiobhanGee·
Clozapine is not dangerous, nor difficult to use in patients with psychotic symptoms in Parkinson's disease, and yet it is woefully underprescribed. Instead we use quetiapine, a drug that failed 3 x DB RCTs. We need to do more to understand the barriers. sciencedirect.com/science/articl…
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Keşfet

@SimonKitchen20 @drjanaway @bykatewomersley @nuwandiss @KemtrupTweets @DrWinarick @Diego_NajeraGB @FereldanWizard