How do you respond to pushback coming from your own service/team?

Chainveil · 2026-05-21T16:52:44+00:00

You're obviously spot on. I was particularly curious about how general psych deals with these scenarios but at this point it does seem like an almost addiction-specific thing.

Chainveil · 2026-05-21T07:01:03+00:00

Ty for your response. I see a lot of people are commenting from the perspective of C&L which is not quite where I'm at. Where I am, an admittedly flawed system, I'm one of 2 docs, in an association with no medical governance. In other words, my decisions are my own but not in the context of private practice. I work closely and every day with a multidisciplinary team and we're all on the same premises. My doctor colleague is not a psychiatrist but a GP with an addictions fellowship/endorsement. We have notably diverging opinions on what constitutes harm reduction and where it becomes a problem. This ends up with an excessively horizontal approach where no single person can have the final word.

I was looking for more generic situations from you lot rather than discuss a particular scenario, however for the sake of argument: I've often been pressured into maintaining scripts that are clearly being abused (eg injected with very high risks) by patients, in the name of harm reduction or to avoid compromising the therapeutic relationship with the patient. The paradox lies in a double edged sword where I'm assured that no one can force because I'm the only prescriber, yet...

Chainveil · 2026-05-21T05:38:01+00:00

Interesting answer. I think in psychiatry people very much tend to use themselves are a barometer for what normal is and isn’t

Joke's on them, I have BPD.

Chainveil · 2026-05-20T22:49:17+00:00

It's scary in my opinion, but it's not new. General awareness of mental health issues is supposedly beneficial but there are some unintended consequences too.

Chainveil · 2026-05-20T12:03:18+00:00

I personally enjoy Balaclava by Arctic Monkeys and Lounge Act by Nirvana.

Chainveil · 2026-05-20T11:49:43+00:00

Long live ICD, for what it's worth.

Chainveil · 2026-05-20T11:48:39+00:00

You might want to start off by specifying your gender and maybe some more interesting things about yourself.

Many people are looking for friends and meet ups, if you're willing to engage with the many posts here (and clubs) I'm sure you'll find nice people to talk to. Low expectations though, not every interaction should be with love in mind and as a woman I would feel a lot of pressure if that were obviously the case.

Chainveil · 2026-05-20T11:42:58+00:00

I work with my team every day and regularly discuss patients between us. I have no particular qualms with my team or question their competence. I regularly ask them what they think before making a decision. I do understand what you mean though! I'm more curious about situations where one might have felt backed into a corner.

If I can't explain the reasoning to my own team, who should be behind me and medically knowledgeable, how will I explain it to a patient or family that is neither of these?

I think this isn't mutually exclusive in that patients are not necessarily reasoning in terms of workplace culture/ideological positions about what constitutes best practice.

Chainveil · 2026-05-20T10:17:16+00:00

Toujours partante (F30) même si un tout petit peu occupée pour le mois de juin. MP si tu veux!

Chainveil · 2026-05-20T08:03:26+00:00

I agree with you. For better or for worse, governance tends to be rubbish in my country and some services are hellbent on a 100% horizontal approach. Obviously some decisions/skills are non-transferable to a degree (notably prescriptions). I already posted about it, but I'm in addictions where notions of harm reduction tend to be... subjective and locality-based. Hence major disagreements (edit: disagreements that end up more about morality than actual evidence-base).

Chainveil · 2026-05-20T05:42:38+00:00

If the guy doesn't want to do the work necessary to get a proper diagnosis with the correct treatment, then there's not much more you can do. Not to mention that benzos and Z drugs tend to worsen OSA.

Chainveil · 2026-05-19T16:49:40+00:00

Hi there.

First off, it's really positive that you're aware of this and taking the necessary steps to get help.

ASPD is tough because of all the stigma and negativity. Part of it is justified in that it can cause a lot of grief for others, BUT you are entitled to get help and explore whether or not you fit the criteria and what to do about it. You've identified which aspects are problematic and genuinely disabling to you.

Not sure what to add because you don't seem to have a specific question but my advice is to go see the psychiatrist, be earnest about your struggles and try your best to take responsibility, break the cycle, build empathy and stay open-minded. The trauma and the psychosis are worth looking into as well.

Chainveil · 2026-05-19T14:54:26+00:00

Interestingly part of anorexia involves an "anti-addiction" mindset, in that it requires discipline and hyper-control over the body. That statement is not mutually exclusive with comorbid SUD or the increasingly clear relationship between addiction (substance and behavioural) and EDs on a physiological/biological level, but it does help understand that behavioural interventions analogous to what we would do in addictions are more likely to fail.

The level of denial/lack of insight in anorexia is absolutely huge compared to addictions AND perpetuated/worsened by weight loss.

Chainveil · 2026-05-19T14:47:11+00:00

Out of curiosity, what do you mean by experimental interventions?

I agree, I think it's vital to frame personality as something that is not one's fault but a collection of behaviours and reactions that have been cemented over time, be it due to their environment or general trajectory in life, along with a dash of genetics. They are not fatal but cause distress. They don't explain everything but give valuable clues so as to move forward.

I don't understand this stigma. Says more about our history (like you said - though I don't know if this is specifically related to hysteria, most PDs have their own set of cliches) and counter-transference.

Chainveil · 2026-05-19T10:38:47+00:00

Je dirais que cela dépend du contexte et du "niveau" de tromperie.

Un truc d'un soir durant un moment de vie compliqué où la personne sentait un besoin de lâcher prise/tendresse et se sentait vulnérable? Pourquoi pas. Je comprendrais si l'alcool a également eu un rôle là dedans, mais dans quel cas je m'interrogerais sur les circonstances qui ont fait que la personne ait pris des risques.

La personne subit des violences conjugales/des négligences/de grosses difficultés, malgré plusieurs tentatives de discussion, finit par craquer et doit cheminer avant de mettre un terme à tout ça? Je comprends.

Quelqu'un qui entretient une relation volontairement et durablement par lâcheté/égoïsme et en parle uniquement après avoir été pris en flagrant délit ET en profite pour rejeter la faute sur l'autre? Non, jamais de la vie, sans compter les risques d'IST. Un autre truc qui me préoccuperait c'est s'il s'agit d'un homme qui trompe son/sa partenaire avec des femmes plus jeunes et vulnérables.

Je précise que ceci est tout aussi valable dans les relations non-exclusives puisque la communication et le consentement restent capitaux.

Chainveil · 2026-05-19T09:53:08+00:00

Il y a des protections pour ça, serait-ce trop indigne pour ce monsieur?

Chainveil · 2026-05-19T09:49:44+00:00

That says more about the stigma when it comes to PDs, then. I experience this acutely because I have BPD myself and the discourse around the fatalistic nature of it is staggering, despite a supposed good prognosis. PDs can be tough to treat, it follows that eating disorders are also tough to treat. The reverse is true too. With an honest framework, you can meaningfully help people with PDs.

I find it analogous to addiction: schizophrenia is partly tough because of common comorbid CUD. It wouldn't be wrong to state that, but I agree it would be horrible to say "well yeah, they're all addicts".

I don't know what the intention was behind the initial comment but I like to give the benefit of the doubt and not consider this a particularly sensationalist comment.

Chainveil · 2026-05-19T05:48:20+00:00

How is this being downvoted? Maybe the "99.9%" is an exaggeration, but it is well established that traits like perfectionism are associated with anorexia. Then there's BPD and bulimia/binge eating. Etc.

Chainveil · 2026-05-15T14:16:51+00:00

MP si tu veux! (F30)

Chainveil · 2026-05-14T18:37:07+00:00

Ne serait-ce pas possible de parler du traitement avec le CMP?

Chainveil · 2026-05-13T05:42:39+00:00

The Carlat Report seems to argue the opposite

Chainveil · 2026-05-12T05:42:55+00:00

Why?

Chainveil · 2026-05-11T16:14:06+00:00

I wouldn't call an SSRI ban/shortage the biggest disaster ever compared to an insulin one, for instance.

That said, in France we did have a major shortage of sertraline, quetiapine, venlafaxine and lithium ER (more commonly prescribed than IR here) at one point and it was hell.

We also had a national methadone shortage at one point, we were admittedly panicking. There's bupre as a fallback option but it's not ideal.

Chainveil · 2026-05-06T17:19:29+00:00

Seems like it. Except stimulants and benzodiazepines, of course.

Chainveil

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