I saw X on 27th March 2016 for a detailed psychiatric assessment. X came across as a bright, articulate, and thoughtful young lady who has shown an amazing sense of resilience in the face of repeated experiences of invalidating and marginalising experiences. I did an appreciative inquiry interview to discover X skills and abilities. Based on a number of episodes in her life, we were able to discover a number of skills such as being thoughtful, reflective, generous, selfless fair, determined, forgiving, optimistic and kind. She has a mixture of strong traditional family values and liberal values, which can be a source of distress at times. She is quite organised, has good observational skills and is resilient. X was pleasantly surprised to discover her skills and abilities and was willing to acknowledge that despite being compassionate towards everyone, perhaps she has not been able to show compassion towards self. X reported that she has had an episode of Psychosis in 2010, characterised by both prominent mood symptoms and persecutory and bizarre delusions and was treated with antipsychotics. She responded well to treatment and was able to go back to work. However she was unable to go off antipsychotic drugs as every time she tried, she has had significant mood swings and she chose to remain on a small dose of antipsychotics. X told me that her mood has deteriorated over the previous 6 weeks after her father was diagnosed to have brain tumour. She reported feeling low most of the time with social withdrawal, partial anhedonia and irritability, mixed with frequent episodes of high moods which could last from a few hours to a few days- the longest period was for about 3-4 days. The above episodes are characterised by being on the edge, increased energy, increased levels of anxiety, difficulty in sitting still, increased libido, decreased need for sleep, and increased tempo of thoughts, with disconnection between the thoughts. She was particularly concerned about an impulsive act, which she found as both embarrassing and exciting. She joined a dating site and agreed to have sex with a young man she barely knew, which is very much against her deeply ingrained traditional family values. She did not report any perceptual phenomena, delusions or over activity. She did not report any Schneiderian first rank symptoms. Her affect was well preserved and the predominant affect was one of sadness and anxiety. She did not report any suicidal ideas or ideas to harm others. She has insight in to her difficulties and was keen to engage in treatment. Family and personal background X was born and brought up in the UK. Her parents are of Indian origin, who migrated to Kenya. X told me that she has always been a worrier and has had a difficult childhood. She has had a number of seizures as a toddler and was on antiepileptics (Sodium Valproate) until the age of four years. She was unable to tell me whether the seizures were related to febrile illness or not , but she told me that she has had a strong family history of epilepsy and that may have influenced the decision to keep her on anti-epileptics until she was 4 years of age through she was seizure free for almost 3 years. X told me that she was a shy reserved child, who was not close to anyone in the family. She was subjected to severe bullying throughout the primary and secondary school and has received corporal punishment from mother for not doing the home work. She reported having low mood from a very young age and has engaged in two suicidal attempts, once at the age of 11 years, when she tried to kill herself by putting a pillow over her face and at the age of 19 years, she took an overdose of tablets. X was a good student and has got a university degree in sociology. She has been working as an administrator for most of her life and has had frequent job changes- almost 10-12 jobs since she left the University. She has experienced difficulties in interpersonal relationships at work place and she is concerned about her difficulties in holding down jobs and not being able to achieve her full potential. She does not drink or use any drugs. X told me that she has not experienced any major physical illnesses. Clinical impression / Diagnosis X has shown features of a psychotic illness with prominent mood symptoms and past history of both persecutory and bizarre delusions. Even though her affect is well preserved and she is not showing any clear cut psychotic symptoms or signs, she appears to have had difficulties in going off antipsychotics and it is unclear whether she has returned to her pre-morbid level of functioning. She told me that she was diagnosed to have schizo-affective psychosis by her NHS psychiatrist and she was keen to get my opinion regarding the above diagnosis. I told her that I was unable to give a definitive diagnosis after a single consultation and that I need to get more collateral information including past medical notes and information from her family members before I could hazard a guess. In any case, only longitudinal follow up can help delineate the finer aspects of diagnosis with absolute clarity. From a pragmatic view point it is worth treating the current episode with either an increased dosage of antipsychotics or a combination of mood stabilizers and the current dosage of aripiprazole. X was keen to try the mood stabilisers as she has experienced side effects from increased dosage of Antipsychotics in the past. She told me that she has polycystic ovary syndrome and was worried about weight gain. So I have advised her to commence on an empirical trial of Carbamazepine after doing the base line investigations. Plans/ Recommendations 1. I would really appreciate if you would commence X on Tegretol Retard after doing some base line investigations such as FBC, Hemoglobin levels Vitamin D levels and liver function tests. Please commence X on Tegretol retard 200mg nocte x 1 week followed by 200mg BID x 4 weeks and I shall see her for a follow up after 5 weeks. 2. I would appreciate it if you would continue Aripiprazole 5mg nocte. It may be worth considering tapering off and stopping Clonazepam, unless sleep difficulties are really problematic. 3. She would benefit from engaging in regular practise of mindfulness exercise to enhance her emotional resonance and resilience . 4. I have advised X to seek support from a clinical psychologist to address her difficulties in relationships and difficulties in pursuing a life with autonomy and independence. The above could wait until the current episode of illness is brought under control. I am planning to see X in 4-5 weeks’ time and I shall keep you posted. Should you wish to discuss ideally on the email address above
Hey ish. Is this from your private appointment? Is very detailed.
Yes it is 
I will see him again
Good luck with the plan ish.
Your Doc wrote…
“She has a mixture of strong traditional family
values and liberal values, which can be a source of distress at times.”
I think that’s been your issue in a nutshell.
Good luck, @anon80629714!! Looks like you’ve got a good guy there!
Very detailed report indeed.
Your seizures could have something to do with psychosis.
Sounds like some form of bipolar to me.
This person seems to know what they are doing.
Congrats on going private.
a few days later my NHS consultant who i never met before booked me in to see her so I went . I said this in another post she thought my mother was trying to take me to sri lanka and force my marriage. I have no clue where she got that info from but seems like she got my records mixed up with someone elses. I thinkf rom now on even if I go less and cost money i’ll go private. My next consultation will be £200 for 30 mins instead of the £400 i paid for the first one. also have not had a sezuire since the age of 4.
From my very small experience with doctors reports tells me this doc is GOOD. Think you did well in paying to see them. NHS is good and all that but if I had the money I would go private.