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Eviljaffacake

Reddit URLhttps://www.reddit.com/user/Eviljaffacake
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  • Speaking as a weegie shrink - worth accessing our mental health services for treatment on top of the self help support groups? by Eviljaffacake (Wed 11th Sep 2019 7:30pm)
  • Why not? Arent people entitied to care and treatment if necessary amd appropriate? by Eviljaffacake (Thu 12th Sep 2019 11:33am)
  • Well neither of us actually know that! Obviously up to OP to decide what's best for her own mental health needs but the option should always be there rather than it to be excluded. by Eviljaffacake (Thu 12th Sep 2019 11:51am)
  • From a weegie shrink, good luck. Though you've already got diagnoses of GAD and PTSD? There will be a lot of options for you depending on your mental health needs - self-help to psychiatry and much in between, so hopefully you'll find what's most suited to you. Good luck! by Eviljaffacake (Tue 24th Sep 2019 12:36am)
  • Except in "high cost areas" (eg London) where a supplement is paid. by Eviljaffacake (Sat 4th Jan 2020 10:37am)
  • Having worked in both systems, you'll be glad to work in Scotland (and Glasgow)! Outside of car parking etc there isn't other major differences (esp around clinical decision making), and id be very surprised if identifying differences would be part of any interview process. However I do feel that people in NHS Scotland (even management, dare I say it) have a more compassionate philosophy when it comes to service provision and service change. My gut feeling is that it is related to the funding model (England has a payment by results model whereas Scotland receive funding based on prior provision). Dont lose your English experience though - one thing that I gained from working down south is being flexible to change and thinking of more entrepreneurial ways of improving local services (through Quality Improvement activity). Anyway, a convoluted answer basically saying that theres not that much practical difference outside of overall funding and provision! by Eviljaffacake (Sat 4th Jan 2020 10:36am)
  • Welcome to my world. And the people you saw in this - they're the more functional ones. Support your local addictions service. Theres been so many cuts the past few years, and such staffing shortages, we are practically firefighting and could do with all the help we can get at the moment... by Eviljaffacake (Mon 10th Feb 2020 5:18pm)
  • 101 quoting reference number 1448 of 22nd February. https://www.glasgowlive.co.uk/news/glasgow-news/appeal-trace-vulnerable-woman-who-17795321 by Eviljaffacake (Sat 22nd Feb 2020 1:46pm)
  • Quick question - do you guys report drug paraphernalia (needles, spoons, needle bins, saline flushes, etc etc etc) to anyone if you find them? by Eviljaffacake (Sun 23rd Feb 2020 4:33pm)
  • Just asking because the data is useful for both police, health and social services... Worth reporting to agencies in some form. by Eviljaffacake (Sun 23rd Feb 2020 7:47pm)
  • Im glad all of this is getting traction. However beware. This whole issue is becoming politicised way too much by both Westminster and Holyrood, and it's getting toxic. Theres a couple of drugs summits approaching (somewhat arranged in haste). Those that work in addictions know what we have to do - its clearly evidence based - but we have to pander to politicians of all colours with vested/unrelated interests who are likely going to slow down progress rather than speed it up. Both governments are at fault. Drug laws from London are too prohibitive, and Health and Social Care Partnership budgets have been cut by Edinburgh. I hope the compassionate general public will put the pressure on both governments to make the changes recommended by us before more of our service users face an untimely, and unnecessary, death. Im a senior clinician, but I doff my cap to my keyworkers who have to firefight their way though chaos and trauma on a daily basis and somehow have the resilience to do it on a daily basis. Keep up the good work guys. by Eviljaffacake (Mon 24th Feb 2020 6:36pm)
  • This isnt strictly true. Drug policy is part of the issue but the main issue of late is the lack of service provision through underfunding. Opioid dependence in the main is unrelated to chronic pain treatment options (of which cannabis has very poor evidence and I wouldnt recommend it as an alternative), though there are some that are dependent on prescription drugs in our service. Our prescription drug problems are a tiny fraction of an issue compared to (unregulated) USA. There are NO evidence based analgesia for chronic pain - essentially they are all being prescribed for "shit life syndrome", and cannabis would likely do the same. by Eviljaffacake (Mon 24th Feb 2020 6:41pm)
  • Theres no point undertaking cognitive testing so quickly after an unplanned detox. What role was this? by Eviljaffacake (Mon 24th Feb 2020 6:44pm)
  • Im a consultant addictions psychiatrist. I liaise with other specialists including pain specialists. My esteemed colleagues literally told me on Friday that the evidence base for chronic pain is poor. Most analgesia is indicated in for acute pain only. They are not hopeful for cannabis being of much use over and above current options. Cannabis will unlikely be an effective alternative to benzodiazepines either, and in practice we should use neither at any significant dose for any significant time. Methadone and buprenorphine are the only effective treatments for opioid dependency. Other interventions such as residential rehabilitation have the same outcomes as no treatment at all. We are now prescribing diamorphine but to a select few when all else has failed - but they still need to show motivation for recovery which includes being able to contain their chaos to a point where its safe enough to prescribe in the first place. Polydrug use is a problem everywhere, not just a West of Scotland phenomenon. Its just we prefer downers over uppers. by Eviljaffacake (Mon 24th Feb 2020 7:16pm)
  • I bet it was! by Eviljaffacake (Mon 24th Feb 2020 7:25pm)
  • You do realise that polysubstance misuse could be only 2 drugs, one of which could be alcohol, cannabis, tobacco, or a prescription drug? Its very common globally, and the global drugs surveys reflect this. Which guy are you referring to that said that it was uncommon? by Eviljaffacake (Mon 24th Feb 2020 7:48pm)
  • I work with the EDTS. I know him - will have a chat with him when I next see him! I suspect theres some crossed wires here. by Eviljaffacake (Mon 24th Feb 2020 8:02pm)
  • Please dont use the word junkie... However it is far better to do this than to give to any homeless/roofless person directly. by Eviljaffacake (Tue 3rd Mar 2020 7:15pm)
  • Oh I dont doubt that - but then we should give them what they need not money in itself. Thats what this intervention might achieve. A significant number of the roofless population in Glasgow are primarily sourcing income for their addictions needs and we have had a spike in HIV diagnoses due to some really vulnerable and chaotic behaviours that they are victim to. We need to find a way of providing what they want without increasing their problems with heroin/cocaine/street valium use. by Eviljaffacake (Tue 3rd Mar 2020 7:59pm)
  • The word is dehumanising and lumps a bunch of people together who have quite varied reasons and experiences for bring in the situation they're in. And it perpetuates a kind of blame culture which doesn't really help in encouraging the initiation of supports like this started by the Simon Community. by Eviljaffacake (Wed 4th Mar 2020 4:53am)
  • It's no longer a study, it's fully operational now. by Eviljaffacake (Wed 4th Mar 2020 4:50am)
  • We're finalising our plans on things like psychiatric outpatient clinics and inpatient admissions. Expect major changes in both expectations and practices. I'm emotionally exhausted from just the meetings we've been having, and it's only just starting... by Eviljaffacake (Tue 17th Mar 2020 7:54am)
  • https://www.gov.uk/guidance/dvla-coronavirus-covid-19-update by Eviljaffacake (Tue 14th Apr 2020 7:55am)
  • A patient of ours recently said that he was spending the pandemic watching porn. I suspect that's the real answer for most of us... by Eviljaffacake (Thu 16th Apr 2020 8:30pm)
  • I approve of this thread. by Eviljaffacake (Thu 23rd Apr 2020 8:16pm)
  • Oh jeez dont ask... It goes hard instead of soft so I tend to go with cake. Im fairly sure people might disagree! by Eviljaffacake (Thu 23rd Apr 2020 8:26pm)
  • Frankie Boyle interviewed the artists, iirc. by Eviljaffacake (Sat 25th Apr 2020 8:12pm)
  • Whichever one where hes travelling around Scotland recently. Think it was a couple of English artists that did this, with a tiny bit of Frankies help. by Eviljaffacake (Sat 25th Apr 2020 8:44pm)
  • Do you have to sit at home for 14 days when you land? by Eviljaffacake (Wed 5th Aug 2020 7:56am)
  • Obviously got no idea - but bear in mind that there has been staffing issues due to COVID that are probably similar to other areas (social care) - people shielding or off or self-isolating. It doesn't take much to cause chaos with rotas etc. So it might be the only way to actually provide a service. However if its for more arbitrary reasons, then people have a case. by Eviljaffacake (Fri 5th Feb 2021 12:33pm)
  • At least I know I'll still be in a job. by Eviljaffacake (Tue 16th Feb 2021 7:20am)
  • It's weird as Glasgow has a broader range of students compared to other bigger universities (eg Edinburgh) but there's still some pricks. Thankfully I dont deal with them much in the medical school. by Eviljaffacake (Thu 18th Feb 2021 12:55pm)
  • If you feel there's an acute risk to someone's wellbeing you don't have much of a choice other than to call the police (use 101 in this case unless it's an emergency). The police in Scotland are more sensitive to mental health and trauma than other parts of the world. by Eviljaffacake (Sun 21st Feb 2021 8:07am)
  • After Easter. by Eviljaffacake (Sun 21st Feb 2021 8:13am)
  • Some of us actually just support a team, not get involved in politics or sectarianism or suck up the history. Shame that we had to see the scenes yesterday, though I doubt it would have been exclusive to us if other teams were in the exact same position. by Eviljaffacake (Mon 8th Mar 2021 2:08pm)
  • Weegie shrink here. You ain't coming into the asylum for this - as my esteemed GP colleague says, go have a chat and consider your options. by Eviljaffacake (Thu 18th Mar 2021 1:26am)
  • What's your budget? by Eviljaffacake (Fri 2nd Apr 2021 1:20pm)
  • DELETED Ah yes, the amount you give to a friend that you secretly want to smash with. Its kinda an in between amount - not really enough for a nice restaurant, and if you want to go somewhere for coffee you just go, really. But im a cranky old soul who would just prefer money or a very generic gift card... Hopefully someone will come and give some actual proper suggestions! by Eviljaffacake (Fri 2nd Apr 2021 1:31pm)
  • The usual global conglomerates work fine. Bit impersonal but the worst thing about a gift card that is for a specific venue is the effort in having to go to it... by Eviljaffacake (Fri 2nd Apr 2021 1:51pm)
  • Hahah im sure you wont :) You've got more compassion than me and there's a couple of sensible suggestions here now, good luck! by Eviljaffacake (Fri 2nd Apr 2021 1:56pm)
  • Glasgow psychiatrist here. It will depend on where you live and what service you've been referred to (childrens or adult services). However the honest truth is that its a mixed bag when it comes to waiting times, and truthfully we are still firefighting our most vulnerable individuals whilst working in a limited service. The other issue is that most ADHD referrals arent ADHD but a number of other conditions (even no disorder at all). So keep an open mind on your own mental health needs and be open to all types of care and treatment. Private ADHD assessments are unfortunately somewhat exploitative and mainly very poor quality. As such we have to reassess from scratch - and many of the positive cases are very clearly not the case (much to the frustration of everyone involved, not least the poor patient in the middle of it). GPs rightly won't prescribe without a robust assessment and they are also aware of the issues too. Anyway hope your assessment goes smoothly and hope your mental health needs are met, whatever they may be. by Eviljaffacake (Mon 1st Nov 2021 4:33pm)
  • Such as? by Eviljaffacake (Fri 12th Nov 2021 5:08pm)
  • Absolutely not. They have their own monitoring requirements and potential harms with unregulated use. by Eviljaffacake (Fri 12th Nov 2021 8:40pm)
  • Youll still need the diagnosis to justify the treatment - whilst we docs can be flexible with some meds, these ones we cannot. Sorry! by Eviljaffacake (Sat 13th Nov 2021 7:50am)
  • There's many homeless, a few roofless. There is emergency accommodation available. There are also homeless GP/mental health/addictions services available. by Eviljaffacake (Thu 18th Nov 2021 8:09pm)
  • Ask people in r/Edinburgh and do the opposite of what they say. by Eviljaffacake (Sat 20th Nov 2021 1:29pm)
  • Don't use the word junkie. Thanks, from your local addiction psychiatrist. Edit - oh and all the people on my caseload speak in all ways imaginable, like you and me. by Eviljaffacake (Fri 4th Mar 2022 8:10pm)
  • I dont care about what you think, I care about what my patients think and how it influences their recovery. https://www.bbc.co.uk/news/uk-scotland-59542090 by Eviljaffacake (Sat 5th Mar 2022 9:13am)
  • I have everyone - including psychiatrists no less - in my caseload. It varies from from the teenager self medicating their childhood trauma/abuse, to the 80something with alcohol related brain damage from cumulative exposure to alcohol (those glasses of wine with dinner). Of course, a lot is to do with "shit life syndrome" - inequality, deprivation, poverty - but not exclusively so. Like with any health condition, its a mix of genetics (there are familial risks identified), the condition itself, and the social/lifestyle aspects surrounding the person. Trauma is definitely the big one when it comes to people I see - I'm usually working people up to engaging with my psychology colleagues for trauma-informed therapies. by Eviljaffacake (Sat 5th Mar 2022 9:17am)
  • I admire your effort to post these responses. Im usually not bothered, but the fact that its triggered you so much - *chefs kiss* by Eviljaffacake (Sat 5th Mar 2022 9:45am)
  • Ah youre also one of those people who must get the last comment too. Or will it be me? I cant wait to find out! by Eviljaffacake (Sat 5th Mar 2022 9:51am)
  • You sure? :) by Eviljaffacake (Sat 5th Mar 2022 9:55am)
  • Not being preachy to you, I would be exactly the same if I didn't work in the speciality. Problem with these words (relating to lifestyle or race or gender) is it unintentionally (or intentionally) perpetuate stereotypes. The obvious issue with that is the stigma and inherent discrimination this causes, also it has a massive effect on people seeking help (for fear of being labelled). Doctor in particular are horrendously anxious about accessing addiction services, and many die without seeking appropriate help. Anyway - its all about "people first" language - people who use drugs/alcohol. by Eviljaffacake (Sat 5th Mar 2022 5:29pm)
  • The last point is interesting because a good example of this was when a Labour MP complained about nitrous oxide being recreationally used, in the context of the silver cannisters rather than the drug use itself. Much of the "undesirable" behaviour (whether it be antisocial or acting out) has its roots in a lack of trust in society or its institutions (criminal justice, health, others), on top of a self destructive attitude when there's no obvious light at the end of the tunnel or an alternative way of living. I don't dispute your point but it does get generalised. There's certain words about race that were initially used to describe specific nationalities but have generalised to a race. The higher functioning individuals still worry about being considered "like a junkie/alchie/jakey". Whether it describes a behaviour rather than a person, it still has the effect of hindering access to services and perpetuating a certain stigma to people who may behave in a way that could be described as such. Language can certainly be complicated! by Eviljaffacake (Sun 6th Mar 2022 7:13am)
  • Some do some dont. The ones that do tend to express a great sense of hopelessness and have identified with its connotations. Also for some I don't think they have found a better way to describe themselves because there's a narrow range of descriptions. Imo we should get rid of 12 steps etc anyway but that's another discussion. by Eviljaffacake (Sun 6th Mar 2022 7:33am)
  • Glasgow Council on Alcohol SAMH do SMART groups which are great (I think someone else posted similar) There's Recovery Communities in NW/NE/South that are arms length to formal addiction services. AA is definitely a mixed bag for many. There's also "protective medications" that might help maintain abstinence but its specialist prescribing only through addiction services. by Eviljaffacake (Mon 7th Mar 2022 2:50pm)
  • Addiction psychiatrist here. You can self refer to your local community addictions team - in Glasgow we provide a wide range if services depending on the level of complexity of the situation and link in with a number of organisations in the area. https://www.nhsggc.org.uk/locations/community-addiction-services/ by Eviljaffacake (Fri 1st Apr 2022 6:55pm)
  • Addiction psychiatrist. Agree in principle. Ive previously mentioned my concerns about the use of certain words but you usually get the anti-PC police on your case explaining to be that its "banter", an argument I've heard about a number of words over many decades. Some of the arguments about antisocial behaviour - the behaviour (which I've also experienced first hand) is a result of a complete lack of trust in society and the lack of trust of institutions and individuals, from those with little expectation in their own lives. Usually as a consequence of deprivation, poverty, inequality, and multiple adverse childhood and adulthood life experiences. A more compassionate society and culture mitigates some of the side effects of trauma, but it starts with sympathy and empathy rather than a lack thereof. by Eviljaffacake (Tue 3rd May 2022 7:24pm)
  • Don't know if it's OP s thing but it's certainly mine! Thanks for posting this suggestion. by Eviljaffacake (Mon 16th May 2022 7:17pm)
  • Addiction psychiatrist here - have you tried addiction services before? by Eviljaffacake (Mon 23rd May 2022 7:28am)
  • So I suspect that I know which clinic you're talking about. Many of their assessments have been reassessed and found not to be robust enough. On reassessment many don't have ADHD. I've heard some of your stories about treatment too. Sorry. by Eviljaffacake (Sat 28th May 2022 10:02am)
  • Is this how Brydon Mack and Mitchell are collating their answers for their show? by Eviljaffacake (Sat 28th May 2022 10:53pm)
  • I tell them who I am and they tend to run away. by Eviljaffacake (Mon 6th Jun 2022 10:13pm)
  • There's a few notorious places like this in Glasgow. Many of my patients/clients/service users are in there. Yep GCC tender to these hotels but conditions are very difficult when you have some of the most vulnerable people in the same place without much support, in a facility that doesn't involve trained staff. In practice the most important thing to do is to make these places unnecessary - more housing stock and more community support for vulnerable people including addiction and mental health supports/treatments. However I'm very conscious that GCC have financial issues and the only way to really deal with this is to increase council taxes, which is never a vote winner (though I would happily pay more as a high band resident). by Eviljaffacake (Tue 5th Jul 2022 4:31pm)
  • If we only had a drug consumption facility to mitigate this... by Eviljaffacake (Fri 26th Aug 2022 7:20pm)
  • Not enough evidence to help to stop smoking - I (as an addiction psychiatrist) wouldn't recommend. There's a smoking cessation service you could access? https://www.nhsggc.scot/your-health/quit-your-way by Eviljaffacake (Sun 2nd Oct 2022 8:17am)
  • Anyone can be a nutritionist as its not a protected term I believe. If you want actual advice find a dietitian. by Eviljaffacake (Sun 9th Oct 2022 4:27pm)
  • Oh god. So by all means do what you feel is right for you - but don't be surprised if any NHS mental health service reviews the assessment process and reassesses themselves due to the lack of rigour and quality of the original assessment. Weve had to reassess so many inappropriate diagnoses which causes so much distress to all involved. by Eviljaffacake (Tue 11th Oct 2022 7:02pm)
  • And theres ongoing work on ADHD pathways to manage the deluge of referrals. Those in the know just have to know the name of the person or company to know if a reassessment is necessary or not... by Eviljaffacake (Tue 11th Oct 2022 7:28pm)
  • Addiction psychiatrist in Glasgow here. Depends on how bad things are but you can self-refer to ADRS as another poster has said, as a starting point. Depending on your needs we can either take you on or signpost you to more appropriate resources. Good luck. by Eviljaffacake (Fri 28th Oct 2022 5:54pm)
  • Sinclair method is just about Naltrexone - theres nothing special about it and is one of the options that's offered in addiction services in general. Its not got a great evidence base in severe dependency though (most studies are also quite old, pre-2000, the newer studies are more mixed in terms of overall benefit) by Eviljaffacake (Fri 28th Oct 2022 5:53pm)
  • 80%?!?!? Are you able to cite that figure? As mentioned - we do offer it but it's definitely not a miracle drug. I have prescribed it to many people who have chosen to take it as part of their recovery, though in my own experience, most have relapsed at some point on it, which is the case for many alcohol protective medications. by Eviljaffacake (Fri 28th Oct 2022 10:10pm)
  • Rehab is a waste of money for most. Access the local community addictions team (via GP or self refer). There's a broader range of options including protective medications that might help maintain abstinence (if that's the goal) as well as other supports (eg mental health). Ultimately your dad needs to make decisions around recovery - it never works if forced, and repeated detoxes are actually quite harmful. by Eviljaffacake (Mon 31st Oct 2022 7:34pm)