Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

and stuff. Hello. Welcome, Teo. Age to healthcare. Siris minus for Cuba. I'm gonna be manning the A moderating the chapped this evening. This is our mental health session. Such a day session that will be hosted by Doctor 10 Foster is a photo him with a call in the capital cake and Charlotte Newman. Uh, um who is insistent psychologist in West London community Mental health Team. Every time we share this slide, just it's about making the most in session to take notes if you want to. It's a really good way to help remember things and still things in your memory. Ask questions. The more you participate, the more you'll get out of it, the more you'll learn on. Do you enjoy your particular bits, please? Do you feel free to email us and some more information with more than happy to send you additional resources? Any queries? That's my email address. Most you should have it cause I send this personally gratified email. We're also on Instagram and Facebook. I am trying to get better having these, but I'm bad at them. That least follows um, Facebook on then these are the next set of sessions we're coming up. So this is the last one we did. Now, these are our sessions. April through June. We'll talk more about that in the future. Good spear. Where there's what's going to come up. And without further ado, I will now hand over to whoever is gonna be sharing the screen when you go show your slides. Very good. Good. Right. Let me to this this since and live that you go. You have to, um, you Charlotte Rice. Can you hear me now? Better feel two seconds once I get back to my power points. Right. Hi. Everybody said. Morning, Charlotte. I'm an assistant cycle. Just like, ready mentioned. And on 10. Yeah, that's him. Area story about that. I had a bit of a glitch. Manage him forced on the doctor. I'm an f y two, which is meaning that time in my second year outs out of university into being No. Um, yes, I'm already mentioned. I'm assistant psychologist. I work kind of part of my time in our commitment health team for adults, and I work the other part of my, um, my job in a community eating disorders team. So yeah, today we're gonna be running a special mental health. Don't if you got anything to have to let him so I can see your face. So really? Yeah. Now I think it's just when I'm sharing my slides, I can't see your face. So joys of teams only lasts me. Share one person's face at once. That's the case. You're going to change in between pulling any faces that's get to him. Okay. You know, introduce the content. Eso of it is what we generally looking to go over today. So we're looking at two models off. Ah, off mental health is how we approved approach. Um, I'm sorry. Uh, let me just answer Freddy's crushed in 99 to 99 a go, eh? So we're looking to protest to meant to mental health. So my mental health, we have the medical approach in the therapeutic approach on. We'll go a bit more into the details of that and how they both interact and how they interplay. We'll be talking about free main diseases as these, but more actually capture the mains. Broad spectrum off mental health. However, there are a lot more conditions on. This is very much the tip of the iceberg we were will have an overview off some of the treatment options, primarily looking to therapy and into medications on. But we will also have a look about comparing the two and seeing what the difference is between I primarily to, um, also on, I think probably as you're seeing throughout the session, there's, I suppose, the real different approach between visible medical model and, um, or kind of therapeutic model that I might use in my day to day work. And hopefully we can see how it kind of interacts and how it how it kind of works together in some ways. Yeah. So as with all things with mental health, everyone comes in with different experiences and different levels. We're not trying to trigger anyone today. We're not trying to cause anybody any harm on diffuse Do need to take a step out. Please. Do you take a step out? If you're really bothered by anything, then please do let us know on. We will stick around the end of session if you do need to. If something does come up, it does trigger something and you do want to talk about it. Okay, I think everything. You can't necessarily stay behind. But we've also going to go emails and stuff that are also available in this well, so we can be contacted in that way. So I like to start everything off by, uh, doing a little bit quicker to get you all engage. Get you thinking in the right. So if we get old, followed a link which I put into the meeting chat. If not, go to kohut dot icty or use? Yeah, on the pen code is also in the tract. Rigid. 1649 to 99. I don't know how many people are currently in the, uh, meeting. I have three people in Kohut, thie joys of the teams live event is that it updates incredibly slowly as to how many people are on here. There's only about 32nd delay between what you say. What people here and then it normally takes about a good five minutes to update newer than a new attendee has joined. So I'm not sure how many They're all right now. We'll get that. Well, give us a minute, then. Um, Tim, what was the code again? Once a full what? 9 to 99. Brilliant. Thank you. On you able to share the Kohut screen. Ah, I should go straight to the device so they won't need to share. Yeah, we're going. We're getting a trickle through more of people here, so All right, Good. We still against the more river? 30 seconds of no more joint and I'll click styled. But then people can always join in later if they need to. A couple more trickling in. All right. Okay. I'll leave it open. So if someone does doing later than more than welcome to join So the presentation will be our mental health. One will do a couple questions and we'll work from there. Okay. So, chris, question Where does the majority of mental health problems originate? Is it a side effect of physical health? All in your head? Bad life, circumstances, last experiences or all of the above? You have 20 seconds. Anyone answer, Tim, I'm not sure if it's just me, but I can't see the questions. When I joined on my phone, I think we need to be sharing there. The actual coupon age. Well, I can see it's at the red, blue, yellow, green. This Ah. Huh. All right. And which cause we might start again. No words. This sheet, please show questions on dancers. There we go. I found a way of sorting that out. Okay, Um, never mind. We all know what the answer was. Is thie. Majority of mental health problems come as a combination of all three. So it would be a side effect of physical health. Bad life experiences on on aspect off mental health as well, right? No worries about that one. I have another question I have. What age do mental health problems present? Now, can someone confirm that they can see the question? And the answer is I can see. Yes, I can see things were working. Sorry about that. Teething issues wouldn't be an option. Fantastic. Yes, that is correct. Generally, mental health tends to affect people at a younger age. This is not saying about people of an older age. Don't get mental health problems is actually incredibly prominent in the elderly community. However, the vast majority of people are actually first seen with a symptom of a mental health disorder by the age of 14. So I think that's my initial two questions for this current model. If we want to go into next line, I'm back on two sides. So in the medical aspect of things, we use something called the Biopsychosocial model, which is, as you can see on screen splitting between biological, psychological and social aspects off mental health. So in the biologic biological aspect, we have biological symptoms off mental health, which can be feeling title the time. Poor sleep poor appetite. But we also do have thie physical health disorders, which can mimic or represent mental health illness. Some of the most common ones of feeling tired all the time getting them down and be anemia or thyroid disease, particularly Hypo Thyroidism, which is a low thyroid hormone on diabetes as well as a very common cold. Psychological lives more into the mindset of the individual looking exactly where they're four star on whether or not there are any signs off psychosis, which would indicate a more severe disease or whether or not there is an alternative diagnosis. Use social aspects helps us put all of that too level of context for us on. Therefore, it helps us determine the severity of the disease as it is affecting their life so some people can't feel very down but are highly functional and therefore are safer to stay out in the community. However, you do have some people which may, theoretically well technically by scoring system, have a milder disease, but it is more greatly affecting them on. They just feel that they can't go to work and take care of themselves. Can see friends about, increases the risks off deterioration I from the So I'm going to stop my slide around. So from the psychological site, we also consider the bias like social model of mental health and the things that I suppose you could contribute to somebody presenting in distress. But we are, suppose is psychologists. We really think about things just of the individual, the understanding of somebody's difficulties through different therapeutic models, one of them being formulation. So formulation is really the idea of working with somebody to try and create an understanding of somebody difficulties kind of what they look like now and how they might have developed over time on behind of how they're maintained throughout somebody's life. So when we think about formulation a psychologists, it's usually a process. We try and do with the current with the person we're working with on and it's with the formulation. It's I tried it. I think of it of it like a map. Um, it can change over time. Kind of what you what? You put on the formulation. And I suppose your understanding of somebody's difficulties really change over time on this isn't really set in stone. Um, so yeah, I think also a formulation. It has its benefits that one. It kind of provide some understanding on context to somebody difficulties, but also can help us think about meaningful way forwards on how to kind of think about tackling some of the difficulty somebody like somebody might be facing in a a day to day life. So when we think about formulation, one of the most common models a formulation and psychology is called the five piece on. It's a model that we use kind of throughout mental health care. We kind of inviting. We we use it on a day to day basis, and it's not just psychologists who use it, but it's a model that we try and use. I thought the whole team, um, and we think about understanding somebody's difficulties in the context of these five piece, all kind of words, beginning with P S O. We kind of think about somebody's presenting problem. What? What they might be finding difficult kind of right here right now why they might have presented in a mental setting. We could think about predisposing factors. So things that may be made somebody more vulnerable to developing mental health difficulties or distress in the first place. We think about precipitating problems, a precipitating factors. So things that kind of happened in the recent past that maybe lead to, uh, this current episode of distress. Uh, we think about petrolatum factors. So things that kind of keep the problem going on detective factors. So things that things that help and things, that good things, that the person has going for them. So you I suppose from a psychological perspective, we really try to consider, um, the understanding of mental health. We try it, I suppose, try to consider the full like it like what a big picture off the person. We can use models like CBT as the cognitive behavioral therapy, which is something that you might have heard of before to maybe create an understanding of somebody's difficulties and think about the way in and how we can, how we can try and help. Um, so it might screen there. We gave. I think also something is psychologists. When? When we're talking about a month a half we we think about the wider context of somebody's life. Quite. I really like for, um um, got fame. Psychologist is where we live in existing context on by Think this this picture that I've got on the screen here kind of demonstrates how I suppose the multiple different levels at which somebody could be affected and, um no, wait. I suppose they're different areas where somebody could become distressed in their life. And when we think about all those different intersecting factors, we could think about things around the person that we can do to try and help. Um, so I suppose in terms of psychology treatment, it's not just that happy we try to think about. Yeah, it's not just talking therapy. We try to think about the person is a whole on different influences that somebody has on their life. Example like the microsystems around, somebody family school, things like that. All the way out until, um, the influences of, for example, the yeah UK politics or blow able politics, laws and kind of cultures that we live in that can really kind of have an impact on Somebody's going to help. So try and think quite ballistically Thank you about the context that somebody lives with him. And to build upon that we do. You have things called social prescribers now, which work upon building up fat macro system around them. Having groups was taken, attend, learning new skills, meeting other people, reason which change in the context of which they live and therefore change in the context of the mental health as well. So they all of these kind of areas that was listed on this diagram a kind of things that we can consider in terms of somebody's mental health. Um, because, know everybody necessarily wants therapy. Oh, know everybody wants medication s so we can think about lots of yeah, the other factors that play into somebody, something distress and why they might be presenting to tell services. Um, if that kind of leads me onto the different ways that we can, yeah, little ways in which we can support. Um, that assistant said they're kind of social prescribe is, um that can kind of support with that that micro system, but also where I work in our community mental health team. And I suppose we we try to, I suppose not. Not only just give medication and therapy, but think about the other influences, and it's kind of somebody's environment on them until health. So, for example, the physical health that can have kind of have really impacts on this house. And he's feeling your employment situation, how safe they feel and that the influences kind of family partner, how they're accommodation is and kind of how how helpful and supportive the services around thumb are. So these are all countries in areas we can think about in terms of mental health, kind of understanding somebody's distress and also kind of areas that we can we can try and change on and think about a little bit more in terms of something treatments. All right, So, back on security, everybody give you a second to get your phones back home. Do you want? There we go. Okay. So which of the following is not a potential sign of depression and this is all not on. I will be mean to you. One of these is a little bit of a beta switch. I wonder one. That's definitely not a sign of depression. Okay, I can see people ask circling rifle. That would be difficult. Question on, uh, I got to make it. I got a difference. You have some people who look, someone's gonna Okay, yes. So I I will admit wholeheartedly. This was a mean question. So in medical school, we use something called single best Answer methods is not in every single medical school, but it is very common off which you might have a right answer. But there's one which is more right on. So hearing voices which are hallucinations, are not typical off depression. However, you can get a type of depression called delusional depression, a little old depression with hallucinations. So while it is technically in the category of depression, it is very, very uncommon and does prompt a mawr intense look into their diagnosis. The only one there, which definitely does not fit into depression, is extreme agitation of having too much energy that fits into a diagnosis called mania, which is on the opposite end of the spectrum. You can get irritability and depression, but not to and extent where you have an excessive amount of energy. Single single best answer things. Not something I'm used to. No, it's It's not very nice, Onda. Oh, you just came a little bit early, but here we are. Easy to so electroconvulsive therapy is a barbaric, outdated method of treating mental health. True, false. I'm a little bit making with my questions. Are you opposed to us? Oh, so they're very cool. So elective convulsive therapy has come a very, very long way since how it was used in the past. In the past, it was absolutely barbaric. They would essentially connect a car battery to people's brains and Friday and now the modern time we use today Shin. We are very, very selective with our patients on so visa for people with massively treatment resistant mental health issues, those who have experienced a symptom catatonia, which is where you can still sense an external stimulator so sense light coming into your eyes or touch on your skin, but you can't react to it. It's a very, very severe form off mental health disorder on. So only in these very extreme circumstances do we use it. The patient does not feel any pain. They while there are risks involved. Generally we're not looking to cause him any pain. We don't burn their skin, we don't do so. You know, we don't not do it in a way, which is where we're strapping them down and holding them against your will. So it is still there. It is very selective, but it has some absolutely fantastic outcomes. I've personally seen it myself. Where we've had people go from this catatonic state Too much, much better on it is still a valid form. So if we go back to the slides so again, from my side of things, I'm looking to diagnose. So we have essentially our core symptoms and additional criteria for diagnosing depression. There is obviously a lot more nuance here, but when I'm initially seen someone, I want to figure out what's wrong with them quickly and get them on to the right treatment pathway. So essentially, the core criterias, whether or not you feel either of those two symptoms on the side Onda if acid in the case that maybe I should be looking at a different potential diagnosis. However, sometimes we do start with someone saying I'm having really poor concentration. And now that I think about it, actually, yeah, I'm not feeling is Ah, happy as I used to be before. It's particularly common in the elderly population, off which we can get something called pseudo dementia where they present like a dementia patients. But actually the for sad they have depression and therefore the ability to concentrate and maintain focus has deteriorated. Onda leads to this presentation so people can get Ms diagnosed again. We split the symptoms into biological, psychological and social. So in terms of psychological reintegrate, we combined feelings and fourths and so feeling down. Depressed, hopeless Onda little pressure doing things on, then terms of the biological. We have disturbed sleep belt appetite, fatigue on. Do what I mean, Vice Okamoto. Retardation is where you start moving very, very slowly, so it takes you a lot longer to do things you just don't have the energy on. On the other side. We do have agitation way are a bit irritable, and you might just be twitching your hand or you might be moving around and you just know comfortable, poor concentration, worthlessness And then, of course, on the extreme aspect. So over of these are present. We do consider it to be a a severe ah, depression off suicidal thoughts or plans or acts to do them, some of them on. But there's an entire spectrum. There are people who it's a fleeting four, but I'd never do it enough on down there it was, they would never do it. And it's something that they never considered. That's on the moderate. And then we do have two people who are actively making plans, hiding them. Putting this sets in order affairs in order on dehydrate themselves, leaving notes, etcetera. Visa to people we were very much worry about. Think you kind of mentioned, you know, like mild, moderate and severe kind of throughout this presentation, in the kind of the world, the medical model world, the world of psychiatry, are these diagnosis kind of splitting tea? Mild, moderate, severe? We do vote to be honest, with very little value to it. We essentially, if it's, um, if someone presents with a severe level, I'm more likely to start them on medication straight away. However, if you present with a mild version, I'm more likely to hold off on but, uh, refer to therapies as the first line measure. However, for most of well, every patient which comes with depression, I do refer to the's psychological therapy is because while I stand by, medications are absolutely fantastic. Um, maybe not side side effects, but they are very effective. The talking therapies is the gold standard of treatment. It is incredibly effective on go. Often the medication won't cure you, but it will get you into a state where you're ready to undergo therapy and therefore ready to be cured from depression. If you could ever be killed. Absolutely. And that's kind of my My experience is well working in the psychology side that I suppose no medication isn't for everybody. But sometimes medication can really help get somebody to a state where the therapies is helpful. Sometimes sometimes they're, you know, there are people who could be difficult on. Sometimes the medication can get. Let's get that based, uh, talking about therapy. Um, so from the from the psychology side speaking, it's via think in psychology world. Um, we don't We don't diagnose cycle just don't like nose. We don't, um, do that. That's more on the medical side. But what we do think about, we think about the impact of somebody's in this case depression on their life. So here we can kind of really, like set quite area the encyclopedia we try and think about actually how just depression helps the Depression affect you on How can we try and understand that in terms of your your thoughts, your feelings, your behaviors and how about kind of affect you physically as well? So I've kind of I feel like I use the word formulation quite a lot in this in this presentation so far. But that's really the core, um, and really, really kind of key aspect of what we do in the in the psychology world is kind of create that that shared understanding of somebody's difficulties and how they might impact impact them. Um, so here I've got a little model. It's kind of cognitive behavior therapy formulation. I don't expect anybody to remember. This is we like, off diagrams and I kind of our pictures. So it's something to kind of to share with you all. Um, but yeah, in the second world. We kind of think about how the house of these thoughts, behaviors, kind of feelings and physical symptoms all interact together and are influenced by the situation that they find themselves in. We try and kind of break things down, um, into what's actually really impacting the person day today on bowel. Can we try and break the cycles eso In cognitive behavior therapy, for example, we can think about the you know, the points in this diagram that we can we can intersect, for example. We can't change somebody sorts. We can't exactly change how you're feeling directly You can't You can't make yourself feel better straight away. But we can think about how we can influence the situation or influence our behaviors. Um, to try and break this cycle Aw, change things within the cycle. Um and also yeah, within the it's supposed yes, within therapy deserves is we think about what what I spoke about earlier said Thean flu Ince's of the world around us on all day to day activities. When we think about kind of treating things that depression, Yeah, so yeah, in terms of depression treatment. So from the psychology side CBT Cognitive behavioral therapy, um, is often a first line kind of psychological treatment. There are different kinds of therapy as well that CBC is probably the most common at CVT all kind of branches. CBT, for the most common and absolutely could probably definitely go for hours into DBT and the rest of them, which, yeah, our options. My favorite one. What's the name of the one where you have to move your eyes left and right or tap your face? And I Yeah, and er, that's, um, you kind of use bilateral stimulation. Eso kind of stimulation on both sides of your brain or both side of your body, and it's It's a form of kind of trauma processing, but yet they're I could do a whole evening. One different kinds of therapies replicate REM sleep because I have always, for the medical side of things been moving forward. It's the antidepressants on the electric convulsive therapy we've already talked about. The CT antidepressants come in many, many, many forms. Um, are most common ones are something called an s S. R I, which is a selective serotonin reuptake inhibitor. Um, maybe people have heard of these fluoxetine is the teleprompter. Two of the most very common ones way even have other medications. So s and our eyes, which is a selective north nor adrenaline reuptake inhibitor on Ben. We are also then looking at more advanced medication such as the tricyclic anti, uh, depressants. A swell. So just on the trips link Also just for I was just from the car into paper therapy sides on. Although there are tons of different therapies coming, more therapies that I even know myself, I'll focus on CBT for now. That could be that could take the form of many years that could take many, many different forms. It's not always just one toe, one with psychologist, it can take the form of, um, group therapies eso kind of the same material that delivered in a group format. It could take the form of things like I did self help, which would usually be done alongside a condition but might be a bit more self directed on D. There's forms of contraception for therapy called behavior activation, which is using kind of come into Pedro therapy principles. But yeah, somebody takes lots and lots of different forms and can look look quite different, but is usually based on the same kind of principles. Yeah, no. When I get to see them, yeah. Yeah. So the loss of loss of myths and rumors about them, they're people. Most commonly, we go. It changes my personality. It makes me so now what? It just don't enjoy. Life is much. Now there are side effects to these medications. I won't lie, Teo. All medications do, and antidepressants work on your brain. They work by changing your brain chemistry. You will feel different if you take thumb. However, the goal is not to. Between side effects is to change the mood. So there is always a little bit of playing around. I think there is a rule of thumb saying a third of people are fine with their first anti depressant. That's completely fine. I've been another third fight and have to have a second, and I'll never forget, Then have to go to the foot on. That's a general kind of rule of thumb for the medications, and so there's a little bit of weaning around. The first two weeks are particularly rough, but after that people tend to get better. It can take up to six weeks to actually be effective because we're trying to change the brain chemistry and rewire it a little bit for a bit more of a punch of than the fine tuning you see with therapy, which we do. Our Ben try to rewire ourselves. That's there is a lot of myths out there. There are good medications. They are effective medications on. They do provide a lot of benefit to a lot of people in the world. That's what I have. Uh, once I was thinking about when when you were speaking about, I suppose, depression and the influence, in fact is in terms of depression. And I think often, you know, sadness and depression is seen as a really bad and negative thing in your life. But I suppose I think so. I have depression. Sadness is often a not quite normal reaction to certain life events as well. And Tim from from the medical side, When does sadness become depression like, you know, maybe after you suffer loss or like a traumatic experience, Often there is a period of sadness afterwards, when when is it kind of defined Mr Question? Because it is quite normal reaction in some way, so that, like exactly sadness, is a useful emotion. It's a good emotion toe have without sadness. We never know how to ask for help or when something is hurting you want to do or when we need to change something in our lives was going to say drug from the therapy Too excited. We think about emotions in terms of their function. Um, and how you know it happens in depression can And I supposed to us to try to weaken. Um, I can't hey, Charlotte, but continuing on from from that force, the way their time, when the sadness becomes depression is essentially the effect it has on your life. It is okay to feel sad is okay to be down, and that can be for a couple days. But it shouldn't be for two weeks. You shouldn't feel continuously down for two weeks on, but we do have the complication, obviously, with grief reaction. So a normal grief reaction can be up to six months. Say I would be personally devastated if I lost one of my parents as I would feel down and there would be points years coming from now when I would think back, and I would be sad. Buts. What would make a grief reaction abnormal would be if it then started to heavily affect my sleep and my concentration. I started withdrawing from people. I wasn't taking care of myself, and I also started to internalize that sadness and boot begin having force off guilt. Maybe I didn't love my parents enough. Or maybe I'm heavily regretting the time I accidentally scratched my dad's bike alone. Lives have been going for the sports and internalizing and then creating this negative story line about myself. But I was only one form of depression. There are other forms of depression which don't involve internalization on. That's how we differentiate between but are goods. Rule of thumb is looking for how long it's lasting On. Definitive is a continuous just feeling low, for I say, even longer than a week, what a week to two weeks past when I start thinking okay, something's not right. Look at yourself. Figure out what could be causing it, and if you can't and if you have no idea or it's just persisting on, find someone, speak to someone, maybe they can help. Yeah, I think it is really helping to think about, I suppose or sadness response in response to kind of to a little bent and how I suppose, up to a point. It's absent. A period of depression is normal after some events, but and yeah, the difference is interesting to kind of think about the difference. Yeah. So I guess I was accent in each myself clear, and I don't have it. That or it's a bad cycle through it. And while everyone's getting back on to that we do is worth mentioning that we do have elements off. Uh, we go. Yeah. Sorry. I did use this in order. Teo, just break things up a little bit. A bit about fair. A piece of obviously one of the founding for far bit of, uh, psychological analysis. Was Sigmund Freud tried on signal for it was safer. Perhaps someone here was a little bit too interested in this own mother. And maybe he didn't like it's bad. Too much, uh, perfectly way we could do. We could do a whole interesting session on for it and some of his ideas. Sorry to him. We've been asking the chat. Could you give a little bit more warning before going to poop because there's the 32nd verbal delay. So you say it and then click on who. It's basically run out of time before they've managed to hear it click over. So say, yeah, give it 30 seconds, then give a press. All right? Absolutely. I do apologize. So ah, one thing before I do before we move on to the next question, I do want to point out the issue off mental health in terms off societal ideas about mental health. Ondimba that for different cultures depression means different things on. They even have different diagnoses. There's not to say that are one is the best one. There are many other countries which presents in completely different ways. On Do that. It's essentially into how, ah, as a culture, they have protected their mental health. So when we do, you think about when the sadness become mental, over actually varies a lot across the world with different people on depart of that is actually just knowing yourself. So anyway, back to the fun levels of good Uh huh. So loaded question that being too happy can't be a bad thing right Pretreat before answers What's created on system? Is it like, say, I just remembered that the one he did the breathing rest rest system session and the questions that came up with that Tim and Co. Who? Tim and I don't know who was yellow, But maybe we should talk afterwards. Uh huh. You ever picked the yellow on? So I am the night I eat and breathe Darkness. Ah, maybe really talk afterwards. But that's okay. Go. How Know you're in the lead Kept on d, giving away the next topic But like depression, mania could be handled just with therapy. So mania, if it wasn't clear, is where we are experiencing opposite end of the spectrum. So while it's low, so very good, most of you got it. Um, the reason why mania can't just be handled with therapy is due to the level of the diagnosis. So if we go back to the slides, if we go ahead. So with mania, one of the key criteria for it to be diagnosed as a manic episode as opposed to something called Hypo mania, which is essentially low mania below mania, is, ah, the presence of delusional forms so if we look at the bottom criteria off this massively inflated ego, which is known as a little grandiose self delusion on hallucinations, so these can present in multiple different ways and varies person to person. But generally we do tend to notice people thinking I am the absolute best of this. I have cured cancer. I am. I'm going to be a pop star. I'm going to be a fashion designer on this might be a little same person. They might be thinking all of these at the same time on degeneracy had this quite very. I am the vest and I'm amazing on. Sometimes they also associated with while I think I'm amazing because God personally told me, I'm amazing. So on there are there are obviously different types of loose nations as well, but for it to be mania. And there is a usually this aspect off a disordered forth pattern, um, or a formal four disorder, as we tend to call it off where I've we have hallucinations and altered perceptions, or we have a loss off coordination between our faults and how were expressing them. So we have something called the Flight of Ideas which is why we jump from one idea to another idea. To double idea whenever I do on each idea is fantastic and you want to express it very quickly. You then also go one step beyond that, where we have something called nights Move thinking, which is where Essentially, if you imagine like a night on the chessboard, you go up and went to the side. You have a very, very loose association, but you don't follow that path with them. You just kind of jumped from the point. But there is a loose association on. Then there is something called word salad, which is every single word cannot be put together whatsoever. It's disc complete gobbledygook, and you have no idea what they're saying. But they want to tell you very, very enthusiastic. It sounds like flu for people in combining it. It makes sense to them, but it doesn't necessarily make sense to everybody around. No, it's ah, it's a very interesting disease, eyes fascinating. It also awful to go through. Despite the fact that one of the main symptoms is feeling excessively happy. It is exhausting for these people to go through and with the inhibition that happens with it. People can lose the for picking those fortunes. They can lose their car, the house, Teo gambling. And then also there I suit of infidelity is well, which, because they're in this hyped up state and it's almost like being drunk and high at the same time. They just lose the rational force that tells them to act in the way they normally would want to on they lose control. Yeah, very disruptive to people's kind of lives more practically as well. Like he says, I could have massive kind of financial and practical implications as well. For both the person and people around them is, Well, okay, so on our aspect of things, there is still therapy. So, uh, from my experience, from what I've seen is that fair if he tends to focus around recognizing recognition off, this is mainly a visit. Depression on, do everywhere in between, on down also educating about the condition, educating family about the conditional so that they don't feel that they've bean ah, perfectly targeted by say then, uh, partner, going off in dramatic episode and sleeping around and doing cramps and the rest? Absolutely. I think it was with therapy, there could be, you know, it can certainly have, you know, really help that the therapy that does need to be a certain level of, I suppose, attachment to reality and what's going on right here and right now for things to really be effective. Eso in this case, therapy might take more of the form of yet, like to him said, supporting Family's supporting somebody when they're, I suppose, a bit a bit more in touch with kind of what's going on right here and right now, maybe recognizing when things are starting to get worse. Um, And when somebody isn't in kind of maybe a more extreme state of mania thinking about how that's with the influence of their thoughts and behaviors on bowel, we can try and reduce some of the factors that maybe maintain the main year old that trigger the mania. Yes, on then, on the medical side. So here is where medications become a lot more of a requirement. Uh, for these people, we often start them on a mood stabilizer, which is different to an antidepressant so antidepressant that generally meant to bring people up. However, if you give an antidepressant for someone with, um say bipolar disorder, which is the main aspect off mania. Mania tends to form as a result of bipolar, sort of how it can actually be a. Technically, it could be just a symptom off drugs. Use it. Ah, in a manic episode because of cocaine. But if you have too manic episodes without a clear cause when we call it bipolar yeah, with bipolar disorder, if you give them an antidepressant, they might go into mania. Some people are on antidepressants with bipolar. However, these are very, very controlled doses on. So these medications are meant to reduce these extremes because we all all of us, will have a normal variation off mental health. We will have our ups and downs, but it won't get to a point where effects our ability to function. That's when we get above these lines. So with bipolar people, they might be just manic one so that we have normal function under to shoot up on, then come back down to shoot back up over one's very going up on all the way down and all the way up and all the way down. I'm just very, very distressing on. So we want to reduce those brackets back down on. So we get rid of the lows and the high highs and therefore bringing back into a normal realm on D with the antipsychotic. Sometimes that's used as well as a way of bringing down that top part of swell. It sounds kind of what we spoke about earlier, about how medications can supposed to have a Really, I did. I keto I'm blocking on the understanding and the more therapeutic side think that's really the case in things like mania as well, it could be really helpful. First step to allow somebody to access more kind of psychological treatments or dreams that are more grounded in the reality and the hair. And now, absolutely the old medications will come at a cost. But sometimes the benefit of the treatment are ways to cost. Uh, so we are going back on to a hoot again. So if everybody does want to get up, I'll hold off for 30 seconds and ah, uh make sure that everyone has time to transfer over. I'm enjoying it. How they the the kohut get longer and longer. Uh huh. Time I'm gradually becoming, I became more and more Monica One too many red bulls. So, um, I have a couple more seconds of a registry. Effects are available, Not sponsored. The Red Bull. Do you want to sponsor us with more than up for this? Convinced this monster s instead of record, please. Okay, we are moving onto schizophrenia next, so I feel like people might have gotten the answer. Uh, okay, so, um, I guess with the people have said yes does you could make the argument that if someone is in acute a psychotic episode, then they don't have control over their actions and therefore can pose a danger to other people, particularly if they're having particular orey delusions or ones off, um, of one that particularly comes to mind would be a fellow syndrome, which is a pathological belief that your partner has been unfaithful. Now, in these circumstances, there is a risk to another person. However vastly outnumbered are the numbers off attacks on people with schizophrenia off the levels of abuse to people with schizophrenia, and therefore they are much more likely to be the victim off a crime. Then v perpetrator off one. Yeah. Damn it Well, yeah. I get you free points. Uh huh. Uh, should have what? It was just a natural, sick way. It would be more or could if I hadn't stopped. Uh huh. I never got a Yes. Well done, everyone. Who? Little genius. Hopefully the delay. Oh, it might come up before. And then final questions. Schizophrenic. Okay, well done. S Oh, yes. People with schizophrenia if they get the right medication. Right, support on. But, uh, the right care could absolutely leave lead a normal life. There will be some people, as there is with every condition who do struggle a lot more, but that it more on the rarest side. But it is worth everything about people with schizophrenia. Do have a much lower life expectancy, then anyone else then? Not that anyone else. Then someone with out she gets the Freedia. We do know that the average age for someone to die with schizophrenia is about 50 paying quite sadly, the reason for that is because of treatment failure. It's not because they're more likely to get a heart attack or a stroke. It is because they unfortunately will take that life very, very sad and therefore something we need to work on it in society, to prevent no conditions like schizophrenia or often really, really stigmatized within the general population in society as a whole. On that could be some real barriers in terms of seeking treatment or even presenting to like your GP or or, you know, medical pressure, you know, with with symptoms of schizophrenia or psychosis. But the fear of you know, being section so locked away your you know that there are lots of kind of really stigmas out there that prevent people from accessing treatment. So think there's there's some real work within society that needs to be done to expose that, allow access or allow people to kind of access treatment. And there are really, I think they're They're already good aspects to treatment of the early intervention psychoses. Teens have lots of resources to, you know, to be able to support in the really from kind of my experience of really great Danes. Um but there were yeah, there's there's lots of stigma within society to a certain conditions in mental health on DNO thing that we do have a little bit of time. I would want to add onto anyone he didn't know. What section meant is so in the you in England on is different in stotland if you go from there on. So this isn't a Nintendo in a law, it'd are put local law. We have something called the mental health Fact. It was used as a level of protecting people who have mental health disorders, but also allowing there to be treatment off it should they try to resist, Unfortunately, is the sad thing is a sad case, particularly people who are psychotic, all very, very depressed. They can have difficulty with engaging with services on bear four looking to try and take their own life for looking to cause harm to themselves or others on there for we need to protect them. We need to try and get the treatment on on Go get them back to a state where they are logically making decisions again, as they would without the disease. So it is a disease. So we're not saying that if someone makes a decision with an active schizophrenic episode, we're not saying that that's what they're saying in the same way of someone is very, very high on cocaine. They're probably not in the best position to be making a choice on a pension plan or a mortgage, So we use this in order to protect them. We have ones to investigate. We have ones to treat. We have ones to take them from a public area to a place of safety. We have ones to take them from the homes to a place of safety on. We also have emergency holding powers. Should they be in a place where we are acutely worried and don't want them to leave because we are worried that they will hurt themselves or something else. These are all protected. They have a lot of rules and conditions about who can do them and who can't do them on. Do they can appeal them on any one of them could be appealed. You might see a patch in sequence because they run out very quickly. Things like like sectioning and detention, mental pack to be really difficult and emotional topic a swell, especially. It could be really, like, extremely distressing for somebody who is being held under section when they don't want to be. So yeah, it could be very hard, Okay, but there are lots of kind of process is in place from the healthcare side to make sure that that's being used as, Ah, there's a protective factor for for the client. And if anybody does worry some point, yeah, if a developmental health disorder, we don't want to keep people in. Generally, we really want to treat people in the community because it's so much better for them. Um, so it is a last resort. It is in that circumstance where we are incredibly worried on the behalf of someone where we actually use these powers. They're not something that we use lightly little, and it requires multiple people to agree. It's not one person going gonna section them now. Yes, no. And speaking of somebody who kind of works in mental health, where whenever clients have spoken to me about sexual voice always had much, much rather have that conversation on, But I suppose, have that understanding. It was something I'm working with them that be a worry in the background that you know somebody can't be open and honest because of fear of your bathing section door being take away from the family. So I think it's a conversation that lots of mental professionals would be really open to Well, if that's concerned on to be very clear as well. Just because you may be suicidal or you say that you are suicidal doesn't necessarily mean I'm going to section your wife for we don't like I said, We can try and treat it in the community. It just depends how worried we are. And then, if you want to come willingly and great, we can't section you anyway. Uh, again, that's another topic. So it's a free DNA if we move on. So schizophrenia is away from the effective disorders of which we call, uh, depression and bipolar, effective being primarily emotional aspect. So being a very high or very low, schizophrenia presents primarily within the mind itself. So development of psychotic symptoms of which the ones which most display to be likely the schizophrenia diagnosis are where we're having auditory hallucinations where people are talking about you. It could be one voice. It could be multiple voices. It could be an entire chorus of people. Sometimes you very will know who they are on be upset. Oh, that's John. He's the garden, which only I can hear or it could be general. I can hear the CIA in my head. I don't know who is speaking exactly, but it's the C I. The other aspects and his went mental health care Really interesting. Eso the mind is fantastically complicated, and the idea of self is brilliantly, um, convoluted and complex, and so we can get this odd phenomenon called Forteo Nation, which is the belief that someone is taking a four out of your head if it's withdrawal or putting forth into your head saying that that fort didn't come from me. It came from Bob, the gardener who only I can hear or something config. Kleeb block the fort on do stuff, and it's just belief. And there's a genuine belief. It's not like an idea is a This is happening to me. Someone is physically taking afford out of my head, which is terrifying if you think about it for perspective, but fascinating. If you're a doctor on D, they ought to get phenomena. Starts has fought broadcasting where they don't believe they're forced air private anymore, so they presume that everyone else around them can hear what they're thinking, and this can lead to Ah, very old circumstance to let it get all most aggressive other people for believing that they've heard their fault. But I haven't responded. I'm very, very, very odd. Even get more hallucinations. The hallucination is a is a feeling without something actually coming in giving you that feeling. So if you see something that's not there, if you hear something that's not there, feel something that's not their taste or smell, something that's not can affect all of thumb and so somatic ones, the more of the touch we then move onto again one of my personal favorite types of presentation. Again, we're incredibly distressing. An awful I cannot express that enough in it, generally very distressing for these individuals, but we do get something called delusional perceptions on. This is where you have seen something, and then you make a causation from it, which makes absolutely no sense whatsoever. Onda. It is somewhere along the lines off the light turned green, so I know God chose me to be the Holy Messenger, and I know if you religion of multiple times, it is because people tend to have a focus on things which are incredibly important to them. so people will think about God's Angels devils with it's religious iconography. But they also think about stuff like CIA A. M I six, the government, Facebook as well, when they're having these solutions and then another one, which is again beautifully with it's Ah, Badee alienation. And it is the belief that someone is controlling the body on. Therefore, they might have a hand which just moves randomly around and grab things and do things on their genuinely in their self, believing that they are not moving. There are arm, so even if they smack someone is not them going? Uh, it's not me, it's my arm. They genuinely do not have control over it. And that's again what makes mental health? It's grizzly fascinating to date into. It's distressing for them, but professional curiosity. I think I should limit myself down rather than this maniac that I'm making myself felt to be, Uh, but it's very, very interesting as we get into the mind and we look at people fought for patterns and how their mental health is expressed, because essentially, what we seem to be reality is actually a perception of our brain on their four reality is whatever the perceptions of our brain is saying it is. And so there is a capacity of our brain to create things which are impossible, because it's just the only way of which we can perceive things on. That is how we lived towards mental health. Andi. The to these very, very peculiar forts and beliefs. And I highly recommend anybody's interested to go looking into some of these syndromes because they are fascinating code hards. The belief that you are dead, dead. You believe that you are dead but your breathing and walking around, but you believe you're dead thick. Larrin bows on our fellow syndrome. Will the rest really, really interesting case studies to look into highly recommend? I think mental health is just so it can be really fascinating from your pressure. Your osteo national distressing for the patient cannot enough. The world's so so different in the way we kind of form reality around us is so complex. But then I suppose that creates so much potential for as those difficulties, um, and you know, things, things to go to go awry. Um, but I think we'll get that in in terms of health care exposed. Weren't girl here because of some level of interest in healthcare? And yeah, it's we're here because it's fascinating, although despite kind of understanding that it could be really, really distressing for the individual who is kind of out of it. Yeah, it's like Red. I don't know with what we've got, something that we find fascinating, but there isn't necessarily great for the person experiencing it. So I don't find suffering fascinating for anybody who is. I mean, it's you know why we ever you know everyone. But you know, there's a big interested like serial killer. Documentaries on things like that is fascinating. Despite, um, you know everything else that's going on as well. Let's move on French rings again. So there is a again, a limited role of therapy instead of three know, depending on the patient. So if they're in acute of psychotic episode and have no grips to reality, therapy is not going to be as effective for them on. We need to try and get them down from that point to when we can then engaged with, um, educate them about schizophrenia, educate them to recognize the signs and how to perhaps control them, as well as educating the family and people around them to also support and help. Maybe, Ah, you have a bit more experience in that. The May Charlotte, I think, Um, yeah, absolutely. But when you look at the nice guidelines, which is the kind of that the recommended guidelines for treatment off the health conditions that you know that we follow in the NHS therapy absolutely has its place. But like I said earlier, there needs to be some level of attachment to reality And what's going on here and now on understanding that, I suppose these delusions, hallucinations are in some way separate to what's going on in reality now. There used to be that understanding to be able to make it's a meaningful difference in terms of that. But when we think about therapy here, we can think about support. Four families on Dunder standing but also in terms of against CPT, is often often a first line treatment for not that you know, first line therapy to treatment for different conditions. And when we think about therapy in terms of its spring here, I'm going to go back to where is it like CBT cycle um, weight's been too long on this because it can get big confusing. But when When we think about these kind of hellish nations and delusions on the thoughts that somebody might it be experiencing, think, think about the feelings that come up for that it must be absolutely terrifying. Kind of having this really this true belief that somebody is inserting thoughts in your head or parts of what you're doing are really low. Or and all things that I spoke about, that must be absolutely terrifying. So we tend to do things to try and protect against that. Fear is what we call in therapy safety papers. We, you know, maybe we locked doors or we don't go out. So we don't see things, and so it. So it makes us feel safer. Actually, in the long term, kind of helps maintain the cycle. If if we never challenge those thoughts, and if we kind of never challenge what's going on, we never see that it's it's not gonna be the case. So we think about kind of maintenance cycles in CT, but all the behaviors that the somebody might engage in so the function of protecting from those really must be terrifying feelings. But somebody is experiencing so we can try and break it down on find ways within this thing cycle and, you know, different cycles as well. This is just just one trying to trying to help on, find out of the way forwards. So, yeah, we can do that in It's Premium. But like I said, somebody does need to have a certain attachment to reality and what's going on in the hair. And now to be able to engage in that, what can help with that is what I'm gonna passenger swim for. So the primary line would be antipsychotics of reach. There are multiple generations of multiple levels. We usually start off with the ones with the fewest side effects. Andan forcefully. Like all medications, there are side effects, and they do tend to be stronger in those which affect the brain. But we are ultimately dealing with having a dry mouth versus being completely lost a reality Rich could argue. One is a bit worse than ever. The there can be playing around there could be tried multiple different ones. There could be then going up to the ones which are a bit harder and a little dangerous and a bit, which will require a bit more of a focused on the look on fine tuning to arrange are. But this is the main stay of treatment, and people may be on these medications for a very long time, if not forever. The next step off is your CT electroconvulsive therapy, like um, it before very highly selective. For people with schizophrenia, it would be people who are catatonic so that not responding to the world on there just going to hold a position. There is a very interesting sign with some people have catatonia, of which they get called something called waxy flexibility. Ah, where if you move the body, they will hold that position. And so obviously you don't play with the person. It's a clinical sign. But if you were to lift their hand up, they would just hold it there, and they would hold it there the entire day. They would just keep it there and he would not move. Their arm could be exhausted. It's just not a thing with their mind is processing of time. And that showed how incredibly severe that somebody's mental illnesses can get. Yeah, um, just another night on therapy. I know that I'm not sure about kind of I spent the medical understanding of, I suppose causes things like it's really, really I think we could probably do it again the whole evening on things like that. But within kind of psychology services, there is a There is an understanding that things like drama Committee play into somebody's vulnerability to develop conditions. Such a schizophrenia. Um, and actually, you know, a lot different than the health conditions. So kind of it is part of the formulation. Like, spoke about earlier, that that picture and that kind of understanding of maybe what led somebody. Um, you know, I suppose what made somebody more vulnerable in the first place. There is an understanding that things like trauma can really increased somebody's risk on play into some of the main you know, maintaining uh, well, why somebody is currently experiencing. So it's free there. So trauma therapy's can can be suitable really dependence on the individual. But that's one way it's what is it? One understanding and one kind of my method of treatments as well. And it is absolutely worth noting at this point that it isn't just trauma you can have people who are completely fine on Bend genetically do predispose all. They just get it out of nowhere. What is very unfortunate for them, But we do know with twin studies that if one twin has it, there is a massive likelihood about the second Twin will have it even if they were separated out and didn't have one traumatic experience or another. It's a lot so complicated and so so individual. Well, isn't that on the other night? Please don't do drugs that can also cause you don't know which one. You're kind of pee wherever let you be the one that's final. The one that develops gets a free me A from just from smoking weed on. There is an association before, so I think that's why it's really important that I says treatments are really tailored to the individual. And it says that that story in there that kind of how they got to that point, um, well, which kind of brings us towards the end, I noticed that we are at the hour. 10 minute mark. We only have about 20 minutes left. Um, if there are questions. It might be well worth us taking a stopping point here if there are no questions, we can go into some case, though these and further delve into a bit more of a patient aspect. But it seems like a very good time to stop and try. And you've got nothing. Nothing asked at the moment. But I'm see anyone with any questions. Please don't put them in and please feel free expires mean as you like to temper questions as hard as you want with these questions, I just think his lovely Yeah, just the tip. Uh, he wrote that so Well, if you got dicey sort of philosophical questions farm away like I was in a philosophical question, Doc says, Well, you're the one he wrote. The question about the tree falls in the forest I took. I was trying to channel I in a psychologist that very well. I wonder if maybe everyone puts, um, if there are any questions, pop them in the chat. If not, we could maybe start maybe the first of the case studies. How does that sound? Yeah, people start if people start consolidating now, we don't want to just hold in silence. You keep going. So you put them into the chat, start building them up. We do the first case study? Uh huh. On. Then we'll answer it soon afterwards and less than anything that turns out. And it's burning and compulsive. So So I, um So with this case, um, so people might get the diagnosis straightaway. I've made it very typical often than not always as simple. It's worse on there. They're usually mix it in with it for lots of other potential diagnosis. But we have a standard is the first. So here we have a from my perspective. Now, if this is how I approach it and this is how I approach is a doctor, I see a young individual off you is female, of which females are more likely to present with the mental health problem than a man. However, it is worth noting that a man is of a higher source side risk than a woman visits because men tend towards more violent on, then presenting with 12 weeks. So I've got the onset of what's going on. And then D's act causes the low mood. So I've got a long history of a low mood. I'm already thinking they're low energy, so I'm already feeling that criteria of depression in my head and then some context of how it's affecting your life. I noticed, actually years in some aspect. She is staying in bed and she's eating. But so and not watching herself. So there's bad things, but she is also still eating, and that's very important to me. She has potentially poor social structure as the based of what husband's been saying on. But what I can tell from the bottom aspect is that she is an ethnic minority, which puts her at a higher risk of a mental health issue on. But she has also potentially have difficulties with expressing exactly what is going on with her mental health on, therefore may require little extra time might have more symptoms, which require bit more time to work into. So from my perspective, I see something with a lot of different risk factors, presenting with the low mood, low energy and biological and social symptoms of depression, and therefore I can start someone depression. Now what's we haven't said. There is very low risk. She hasn't mentioned any force of suicide. There's no history of self harm. She's never had Bean admitted into a psychiatric hospital on, but she doesn't have any other biological symptoms, such as fevers, change in the bowel habit. She's drinking a lot of time and really first in passing lots of water. So the over potential diagnoses, such as fire or disease or diabetes, are much lower in my mind set as my list of differentials, I would, of course, still want to rule these out. So for everybody, which we do a mental health diagnosis in, we do we do a blood screen. We check them for everything. On part of that could be making sure they haven't got a reversible cause and to making sure that any intervention we do, we don't cause thumb harm because they at with that without us knowing they've actually got some liver disease. And we had a liver by giving the medication. So that's how I approach this. I've wrote it very much. Looking for the answer, looking for the diagnosis in the person. Oh, what kind of treatment recommendations might you from the medical side term have for this this year already? So starting starting off we always say that CBT is the gold line now it varies area to area. How available visit In some areas, I you could have someone waiting free to six months or a year just waiting for therapy. And you do have to have that discussion with the patient on to determine how likely that is. Thankfully, where while I currently am in terms Words, we have a very good service which tends to respond to get the induction therapy meeting within a week. Wow, actually, very, very quick issue last Becht. But then the onward access to therapy and for therapy services can take a little bit longer after that. Yeah, and would you think about medication with this? This person? I was always think about medication. Um, the fact that she's spending all day in bed and having ah on not washing herself might also indicated she's not having a lot of energy to wash was well, I would consider medication. I'd imagine she had probably come to someone that was more of a moderate risk than a high risk. But it is saying that she's still going to work, So that's also protective factor. So I would always consider medication for just by every patient. But there are some patients, which I'll put a little bit harder. I love the patient, which I'll leave off a little bit on. But I would You probably use a scoring system like the PHQ nine, Uh, which is, uh, evidence based going system for determining a severity off, uh, depression for doctors. My guys. Very informal. It's Ah rather it's too formal on DA doesn't allow for nuance off disease. Yeah, Okay. I suppose from the psychological side, when I look at this case study, I feel a look at it quite differently. Um, we as I said earlier, the cycle just don't don't diagnose. But we try and treat kind of what what we see in front of us and what what the client is telling us on day telling us about the impact of their potential mental diagnosis. Often, we might repeat, you aren't formally diagnosed with mental condition. So I think this lady, somebody who might be seen in my apt, which is, um, short for improving access to psychological therapies. It's kind of the first, like line a psychological because it's year for every psychological services um what kind of accessing, Accessing pill Compare a piece and things like that. Um, so when I look about this, I think more about the context that the low mood is presenting in and kind of how it's affecting this, this person on a daily basis. So I think the first thing I think about is that the yeah, her kind of more social context on D. So I think about how you know what, what might have led up to this episode of depression. Um, so you see here that she and you know, she works in marketing? It sounds as though I suppose I might have embellish this case study a little bit, but, you know, she could work in quite a high stress environment. I would kind of wonder about her day to day stresses on how work is going for her. And it sounds as though something that kind of happened recently is the new boss at work with a new vision for the company. So I wonder what kind of pressures that might be adding to her life on about that might be affecting her day today. You know, she worried about her job is she worried about? Kind of that financial security. And you know what? What's kind of be interested in what's going on there? And I'd like to explore that a little bit more. What's led up to this? This episode of feeling, you know, being low. I think about, I suppose, the day today, the presenting problems, the day to day impact. It sounds as though she's feeling really sad. She's feeling really, really low, kind of low motivation. I'd be interested in knowing why thoughts were Onda, how she is, how she's feeling kind of hearing that from her on it sounds like she's kind of using. Eating is a coping mechanism to cope with it and really low. And so that's kind of something that I'm thinking about in terms of those presenting factors, Um, in terms of things that may be things that may be may tumble, one memorable in the first place, so predisposing factors I would think about kind of how you know she's. She moved to a new country at age 13. Um, I wonder if she was, that must have been quite a difficult. It could have been a really difficult experience coming to a new country, potentially where you can't beat the language coming to a whole new culture. Um, maybe being separated from your your family back home, I I'd really kind of think about the context of that and maybe how that's impacted her experiences. Um, and finally I I think about well, not finally, I think about things that kind of a to keep the problem going. So there's perpetuating factors. Um, so it sounds as though her husband is not very supportive, kind of telling her to get over it. And you know what? If you got to be sad about that, that really can't help when you're feeling really low. And that sounds that, you know, maybe maintaining, maintaining the low mood in the distress in the Depression. Um, well, it's staying in bed all day, and that can really when you maintain the low mood on. Lastly, I think about protective factors, so things that you know things that she's got the going well or things that can really help maybe lift her out of this this period. So she does have a husband that, you know, it sounds like things were kind of good between them at one point that you can be a real protective factor still going to work on. I wonder if a job or something that she enjoyed in the past. And so I yes, this is what I would kind of draw up a storm. Elation. Um, and I try and create, I suppose that kind of more understanding within a social context, but also personal context about what's impacting her right now and all these little bits, uh, things that we can we can intervene at. Um, in terms of the perpetuating factors, husband is really critical and unsupportive. So I wonder if he needs He needs a bit of, you know, psychoeducation hey, needs some kind of educating on what depression is and how to be supportive and just, you know, isolating herself and staying in bed all day. I wonder how we can intersect at that point. Yeah, I kind of think about it in this kind of five piece formulation. Uh, think about all those influencing factors and what we can do for each level. Oh, yeah. So we have nine minutes left, so I don't think we particularly have time to go into another case there. Are there any questions? Concerns Anything you like us to go over a little bit more What? We have time or anything that in particular you are concerned or worried about things in the fats. It's nothing posted moment. If you do have questions, guys, please do for free. Well, what? They did one just clarify. Because when Charlotte you were talking about individuals, you might see you use the word client. And I just wanted to say if you just wanted to clarify a little bit, it's twi. Yes, I'm facing that wall. So speaking as well s o each service, if I suppose that has, like a name that that they use for for patients, clients, service users and in different settings that I've worked in we've called, you know, the people presenting to us overseas patients. In the current service, we call them implants. The setting that I work in is outpatient people, you know, like CS for our a week or less, Um, mostly kind of living, living at home, living, living in usual lives, but coming for a little bit of treatment every so often, our meeting with a professional eso we we call people, clients or service users because they use the service. Um, we don't I think it's more of, ah, especially psychological services, more of a move away from that really medical diagnostic model on. So that's yeah. That's why we call people clients. And I mean, while I forget that there is another word for people over the patients, it is different. What different services she Travis's use on the reasoning behind that? Yeah, I think the cold. It's trying to move away from waiting Medical Lotto, uh, but create more of an understanding, a knack, knowledge mint that the person is more than just somebody he is using and services. There's a bit more than that. I think that's that's the rationale in in psychology, anyway. Yeah, it's good. So I think that's what your clothes on. I just went to see if anyone's going last questions to come through. I think Charlie got some slight just want to show the end there. Yeah, we just thought it's only things relevant to kind of explored the careers in psychiatry and psychology as well, being talking about it in half. Um, so yeah, from the doctor's side of things for medical school. It would be four years in the UK if you already have a degree 5 to 6 years. If you're doing as an undergraduate, you then have foundation training for two years as an f Y one F y, too. Then you choose your specialty trading at that point, or you can go off and do it locally for a while, you know, on the psychiatric training splits into three years, of course, raining on. Then you reapply. I've been going to highest like a higher psychiatric training for another three years. At the end of that, you'd have your consultancy exams. There would be multiple example the way through on. But then, so from start to finish, you are looking 12 to 14 years of training to get consultancy, and then we've been consultant consultancy. There are still areas to specialize in, and so you can become very high, hyper focused, or you could become very general. So that's that 12 14 years. Sounds like it's, um, kind of out like absolute minimum, and that way you can go off. You can do extra bits on the way. I'll take a little bit longer if you want to, but sometime. Yeah. So, from my side, I'm putting a, you know, a career when 10 psychology. So clinical psychologist is on. Yeah, it has done. We we call a doctor it it's like a like a clinical PhD. Um, so kind of cycle just can call themselves, you know, doctor, wherever they are on. But it's one of the highest levels in, but the therapy world. Disclaimer. Psychologists do more or do more than just therapy, but I'm not not going to get into that too much. So the kariva clinical cycle, just like something like, um, an undergrad in undergraduate degree s. I said here bps accredited beer. See, so everyone who wants to pursue a career in clinic psychology or really kind of most psychology fields there are different kinds of psychologist needs to have a degree that is accredited by this organization called the BP s, which is the British psychological Society. So if you're kind of interested in, um usually a career, yeah, in any kind of psychology on dure looking at courses, I would really encourage you to make sure that the courses bps accredited lots courses are I I don't He didn't do a psychology degree. I did a cognitive neuroscience degree, but that was accredited. Buy the D. P. S. So it's meant that I haven't had to do a master's kind of get that registration. Um, some people after their degree, they might do a masters. Uh, some people might do a masters if they don't have that bps credited degree, but the master's is completely optional, and I think the real difference little, not the one real difference. But any real difference between the more psychology like therapeutic site and um, like training as a psychiatrist is there isn't there is absolutely no one single route in psychology. It's very, very buried, and there's no kind of solid time frame for it. They, you know, the courses ask for it for relevant work experience and relevant can look like whole whole list of different things. But it might be something like what I'm doing, which is working, agreeing to mount a health team as an assistant psychologist. It might be working in, I asked, is a It's something called a psychological well thing. Practitioner, mindful of working schools, involved working care at kind of. There's no one set route. And so, in terms of that, there's absolute minimum kind of work experience of 1 to 2 years. But in reality it's more kind of like 3 to 5 or plus five or more years experience before people start training as a psychologist, Um, and during the security doctorate, which is three years. So that's whatever. Yeah, it's got a competitive program to get on to, which is why people can't have more than the minimum experience. But that takes about three years, and then you come up qualified as a psychologist, and I don't know how I think, because it's so varied. I haven't put a total like a number of years on it almost matches a consultant psychiatrist almost matches consultant, psychiatrist. I would say most people who qualify as a psychologist qualify maybe in the early thirties, on bats, even for people who start, you know, start out with the psychology undergrad when they're 18 19 s. So it's you're in it for the long haul. It's No, it's not quick career, but it's, um, rewarding. Grand early lot of people go for it, So yeah, so word of warning. If yeah, it's I that brings us. Hey, the ends. So, at present, still no questions, which is good. So that was good job picture, Charlotte. So we'll we'll leave it there. Thank you, everyone for attending this evening. But my can take over being the big picture. Yeah, I believe that. That so? Yeah. Thank you. Everyone who's attended. It's evening. We're very grateful to you for coming along. Um, Hope you have a good session. Um, if there's any more questions, please feel free to email them to me. I could pass some long of wise staging for the obsessions that I showed it. Start and then I want to have a good evening. Thank you. Well, I I