Bipolar Disorder & Eating Disorder

FY1 doctor with bipolar disorder and an eating disorder

Medical History

The doctor had a history of anorexia nervosa for a few years when at school, and also of self-harming behaviour- cutting her wrists and taking overdoses; She later developed bulimia.

She was diagnosed with bipolar disorder by a psychiatrist, in addition to the Eating disorder. She was then treated with CBT and medication, which resulted in stabilisation of her mood and completion of her medical studies.

Work History

She started work as an FY1 and felt able to cope with the normal range of duties.

She disclosed her condition to her consultant who was supportive.

A few weeks after starting the job she felt quite stressed and consulted her GP, who increased her medication but did not arrange psychiatric input at this stage.

Her weight remained steady and there was no relapse of anorexia or bulimia.

Six months later, on her third 4-month rotation, she was absent from work for two weeks with low mood and suicidal thoughts.

She had good insight into her condition and the potential effect on patient safety, and when symptoms became worse explained her situation to a colleague and left work.

She self-referred to the Practitioner Health Programme and an assessment was undertaken. Her medication increased and suicidal thoughts resolved.

She was followed up by the PHP and CBT was arranged.

Occupational Health Advice and Adjustments

A referral to Occupational Health resulted in an urgent appointment regarding adjustments, including phased return to work, following the depressive episode, associated with the bipolar disorder.

Her supervisor attended the end of the consultation and adjustments were discussed.

• Work Monday to Friday 8 until 5 only.
• No on-calls for at least the next two weeks.
• No weekend work until further advice by Occupational Health.

Follow up

After one week:

She was seeing a consultant psychiatrist at the local CMHT regularly and she had started CBT.

She returned to work and working with her team without problems.

There was a gradual increase in her duties over the next few weeks and she was considered fit to continue adjusted shifts as previously outlined but no on-call.

After 5 weeks:

• Health, mood improving slowly, though still fluctuating and worse when tired. She was having some problems with sleep - affected by alcohol consumption.
• Medication increased.
• 4 sessions of CBT - useful in managing fleeting suicidal thoughts and early identification of symptomatic relapse in future
• Working as part of on-call team in day and coping, but not worked any night shifts
• Advised ready to resume night on call work and long days.
• Will continue to need time off for appointments.

After 9 weeks:

• Continued improvement - sleeping better. Continuing psychiatric follow up
• About to change jobs and location. Some anxiety regarding finding new GP and use of local psychiatric and occupational health services. Has friends moving locally and will therefore have support.
• Discussed importance of new OH service being aware of history to support, particularly if she becomes ill and has less insight.
• Report prepared for new OH service
• Discharged. Fit with no restrictions at time of leaving post

Key points from the case study

This case illustrates some of the difficulties experienced by junior doctors with mental health problems, who move jobs regularly for training purposes. Continuity is difficult and it is hard to repeatedly build up relationships with all professionals involved in their care, as well as with their supervisor and consultant. It is especially difficult for those who are working in psychiatry and may need to be a service user within the same area.