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Post by nemo on Oct 22, 2012 18:03:20 GMT
As I've moved to South London I've had to be re-assessed for ADHD, for some reason. Saw the PCT today and he told me that my prior DX was wrong because ( stop me if you've heard any of this lot before ):
1) I couldn't be inattentive because I was following what he was saying. 2) I couldn't have ADHD because I wasn't jigging about impatiently. 3) I have a good job with a well known successful company. 4) I have university qualifications.
Instead, he stated that (in his opinion) my symptoms were due to chronic anxiety and mild OCD. He started to bring up Asperger's but I stopped him in his tracks on that. Consequently my MPH prescription is being stopped and replaced with Modafinil and Promethazine.
He genuinely seemed well meaning, sympathetic and knowledgeable but only seemed to concentrate on my anxiety and relationship problems in his questions so consequently I can't help feeling sceptical about his conclusion.
Am happy to give the new meds a try but feel a bit discombobulated given that it took ages to accept the first DX.
Not angry just baffled. What can/do I do?
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Post by odat on Oct 22, 2012 18:54:04 GMT
Request a second opinion? Can you go back to your old psych and explain what's happened?
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Post by nemo on Oct 22, 2012 19:06:31 GMT
Didn't think of that - good point. I'll drop him a line.
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Post by Deleted on Oct 23, 2012 9:15:32 GMT
How dare he! I've had three dx now (long story) and each time, the docs were at pains to square away any points of disagreement between each other. Basic professional courtesy - as in, hope you don't mind, old chap, but I've taken a different view, for the following reasons...
Then, idiot! Is he an ADHD specialist? If not, tell him to get lost and leave your dx alone - he's not qualified to override it.
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spok
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Post by spok on Oct 23, 2012 16:56:45 GMT
Nemo when you say you saw the PCT what exactly do you mean; who did you see? A specialist in general psychiatry? A specialist in ADHD? Somebody else?
Did you ask why you had to be re-assessed?
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Post by Deleted on Oct 23, 2012 17:42:02 GMT
Why accept this docs diagnosis?
First off they don't sound like an ADHD specialist - if you were diagnosed by one then they don't have a leg to stand on.
Not only is can you contradict a more senior medic (unless it's patently obvious and you're willing to stand up to the senior medic in court) but it's only an opinion which is flawed - any fule can see that.
I would refuse to take the meds and report this doc to the PCT as not being a competent person to take such a stand against a good diagnosis - a second opinion by an expert (ie ADHD specialist) is the only sound opinion.
They will find that The Maudsley is just round the corner.
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Post by nemo on Oct 24, 2012 0:10:50 GMT
THanks for all your replies. These are all good points. I may have been getting my terms mixed up so apologies for that.
I had to be re-assessed as I had moved from East to South London. My GP told me that the guidelines were different and although he eventually managed to get my prescription cleared it was conditional on my attending a referral to local Mental health Services once a year.
However, I suspect I may have fallen foul of weasel words to a certain extent.
The original clinical psychiatrist I saw was ( as far as I am aware ) not a specialist but he seemed pretty clued up and specified in his diagnosis letter to my GP some detailed criteria by which he came to conclude that I had 'a long standing history of difficulties with attention'. He does not explicitly state that I have ADHD/ADD in the letter, though he used those terms to me in person.
The second doctor I saw told me he is a specialist in Personality and Mood Disorders. He stated that the lack of explicit diagnosis in the letter is the original DR hedging his bets, just in case, and therefore left it open interpretation. I think he made valid points regarding my anxiety problems and also regarding some problematic aspects of the original Dx. However, it is his opinion that the symptoms I have are better explained by chronic anxiety and possible OCD.
Personally, I don't think I have OCD, Asperger's, or a Personality Disorder. But I definitely have anxiety problems and depression problems. I am now conflicted as to the whether they are secondary problems relating to ADHD or the main problem as both explanations seem reasonable to me.
The ADHD explanation seems more plausible though given the length of time spent on the original diagnosis and the comparatively cursory ( and sometimes ill informed ) nature of the second Dx.
I think I'll discuss with the GP and see what the options are.
I did notice that Modafinil has off-label use for ADHD so is it worth giving it a try anyway just to see if it works?
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Post by Deleted on Oct 24, 2012 9:00:37 GMT
See the NICE guidelines, there are versions for everyone (medics, patients, those with too much time on their hands etc etc).
If you have a reasonable confidence that you might have ADHD then you need that diagnosing properly.
That doesn't mean you want a positive diagnosis, you are looking for a definitive yes or no.
Only a specialist can diagnose you properly - anyone else is taking a guess, they're just not qualified enough.
From what you say both medics you have seen aren't qualified to say - and a specialist in mood disorders is going to see mood disorders......which is a problem since mood disorders are classic/common symptoms of ADHD (I spent 25 years taking my mood disorders to my GP before I was headhunted by an ADHDer).
There is a nettle to be grasped here.
Insist on being sent to The Maudsley - do not let your GP say no and point out that unqualified medics can't diagnose what they're not qualified to diagnose (which is why GPs refer you on in the first place).
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Post by Deleted on Oct 24, 2012 9:11:30 GMT
On the Modafinil issue
It's not a mainstream ADHD drug (not as effective) so it's not worth kowtowing to the system to have it - have it anyway, but only as a stop gap.
Viagra also works as a heart drug but you wouldn't accept that when there are proper heart drugs.
You deserve proper treatment and that needs a proper diagnosis.
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Post by nemo on Oct 24, 2012 15:34:00 GMT
Thanks PD.
I'll take along the NICE guidelines to see my GP when I'm off work in a few weeks talk it out with him. I've emailed the original consultant psychiatrist too.
I also want to point out to my GP some of the fallacies that the second dr quoted in his Dx. I know most popular ADHD books list 'Myths & Facts' with a view to debunking misconceptions but are there official or standard sources for such info? i.e are there a definitive documents that unequivocally/scientifically refute misconceptions regarding ADHD?
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Post by nemo on Oct 24, 2012 16:11:38 GMT
Doh! I really am dozy pillock.
I just reread the letters from the original consultant psychiatrist to my GP at the time, discharging me back to his care and it says in big bold letters:
Diagnosis: Attention Deficit Disorder General Anxiety Disorder
That seems pretty damn unambiguous to me. Surely that has to count?
I unwittingly presented this letter to the second doc amongst others. His conjecture of no explicit ADD diagnosis is now invalid surely?
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Post by Deleted on Oct 24, 2012 21:22:30 GMT
I'd say so...
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Post by nemo on Oct 24, 2012 21:54:29 GMT
I feel a bit daft now. I could saved a lot messing around if I'd noticed that (and not wasted all your time). Sorry about that. Thanks for all your help.
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Post by Deleted on Oct 24, 2012 22:59:07 GMT
Yeah, like none of us has ever missed the bleedin' obvious!
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Post by nemo on Oct 24, 2012 23:25:47 GMT
;D
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Post by odat on Oct 25, 2012 15:52:27 GMT
But the psych didn't notice it either?? ;D
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Post by andy12345 on Oct 25, 2012 15:56:58 GMT
nemo, anyone would think you might have add with that missing clearly the diagnosis of the first "expert"
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Post by nemo on Oct 25, 2012 23:33:42 GMT
But the psych didn't notice it either?? ;D I suspect it was because it was the last letter in the pile and he'd already made his mind up before getting to it. 5 months of appointments and a Dx with the first psych dismissed in 5-10 minutes of leafing through those letters. Wish I'd noticed it at the time though. Could have set him straight on the spot.
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Post by nemo on Oct 25, 2012 23:36:11 GMT
nemo, anyone would think you might have add with that missing clearly the diagnosis of the first "expert" :-) It depends on who you ask it seems ...
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Post by nemo on Oct 30, 2012 12:45:25 GMT
Got the 'official' letter from the second psych yesterday stating that my ADD Dx is wrong. There are many mistakes in his 'interpretation' of the answers I gave him to answers about my life. For instance, I told him that I'd hated school because I found it boring and restrictive. The letter states how much I enjoyed school.
The NICE guidelines state that hyperactivity and inattention in Adult ADHD may not be present during an assessment. And yet he is using the absence of inattention, despite my having taken MPH, as being proof.
Got to see the GP about this.
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Post by Deleted on Oct 30, 2012 15:29:45 GMT
Find out who the head of that service is; write to the psych; copy the head.
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Post by Deleted on Oct 30, 2012 19:36:10 GMT
It deserves an official complaint, that level of incompetence.
Good luck.
John
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Post by nemo on Nov 9, 2012 1:36:00 GMT
Just waiting to see the GP - have to wait a month. Sadly, my follow up appt with the psych is before that. Going to have to lock horns with him. The new meds just ain't working.
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Post by nemo on Nov 14, 2012 21:21:33 GMT
Well, so far have been put on Modafinil and Pregabalin. Procrastination has reached new heights (lows?). Should be doing homework now.
Luckily, just saw planetdave post the link to the site FAQ, which I didn't know existed. Reading points 5 & 6 have given me huge a boost against the latest psych's and ( sadly ) some friends assertions that my MSc proves that I can't have ADD. The library links is also invaluable. Thanks PD.
While I'm waiting for the next appt with the new psych, is it worth trying to get a private assessment to shortcut all this current bullshit?
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Post by Deleted on Nov 15, 2012 5:03:16 GMT
It seems fairly clear cut to me.
You got diagnosed An unqualified (to diagnose ADHD) Psychiatrist said you didn't have it. You tell said Psychiatrist that he is talking shite, and produce the evidence to support this. Psychiatrist then either referrs you to somebody that knows about ADHD, or plays ball and prescribes.
John
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Post by Deleted on Nov 15, 2012 5:05:17 GMT
Sorry, I didn't actually answer your question.... I would not (personally) go private when you are so far along the process, unless you can afford to pay for the repeat appointments, and the private prescriptions.
John
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Post by nemo on Nov 15, 2012 12:37:59 GMT
Thanks for your thoughts John
Well I was initially just thinking of a private assessment as a second opinion really just to corroborate the initial DX from the Clinical Lead Psychiatrist.
But I suppose, if I went to all that trouble I might as well get the better informed treatment advice as well. I can (probably) just about afford it
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Post by nemo on Dec 19, 2012 11:20:52 GMT
Right, saw an ADHD specialist via private referral yesterday . He provisionally (pending further 'character references') agrees with the initial diagnosis i.e mild-moderate inattentive ADD. It may still transpire that I am not ADD but at least I know the final diagnosis will be fully informed. I have to say it was a real relief to talk candidly with a sympathetic and knowlegable expert.
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spok
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Post by spok on Dec 19, 2012 13:07:15 GMT
Yeah I can imagine; dealing with people who clearly know little about the condition they are telling you you don't have can be very frustrating... Especially when they are so sure of themselves.
What happened when you saw the ignorant psych for the check up? Or the GP for that matter? You might be able to get your private psych to enter into a shared care agreement with your NHS GP so you can get treatment on the NHS...
I hope its all smooth sailing from here on for you..
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Post by nemo on Dec 20, 2012 23:14:53 GMT
Thanks Spok. It's been pretty nerve shredding so far. Especially with otherwise lovely friends opinions of my dx souring somewhat.
Had a good chat with the ADHD expert. Even had a laugh at times. And he indicated that he was amenable to a shared care agreement was possible from him.
Sadly, I doubt Croydon Health Authority will play ball i.e. because I'm not a hyperative child.
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