Hi Fellow Nairalanders,
I am a United Kingdom based psychiatrist working for the National Health Service (NHS).
I would be happy to addreess your concerns and give support on issues of mental health.

doctorkk1:

Hi Fellow Nairalanders,
I am a United Kingdom based psychiatrist working for the National Health Service (NHS).
I would be happy to addreess your concerns and give support on issues of mental health.

Clap for yourself!!!
How is that going to put food on my table?

Doc, thanks for offering to give free advise here. I hope the first response did not discourage you. People need you.

snowdrops:

Clap for yourself!!!
How is that going to put food on my table?

if you feel that it doesnt concern you then dont comment. na by force?

@doctorkk1
nice to have you here, pls don't be discouraged by nairalanders' cynical remarks.

Thanks MadamL and Dominique. I can't be discouraged by Snowdrops cynical remarks. I have seen a few threads on depression, anxiety, schizophrenia and other psychiatric conditions and felt i may be able to offer support and advice where appropriate.
I presume snowdrops is unaware of the huge impact of mental health burden on the society as a whole.

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

rosejen:

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

Hi Rosejen,
Thanks for getting in touch.
From the brief history you've given, your cousin seems to be suffering from Puerperal Psychosis.
This is a condition that occurs in women shortly after birth. It usually starts within a few weeks or even months after childbirth.
It can really be confusing especially to the family and partner who struggle to care for both the mother and her baby.
It occurs about 1 in per 500 births.
The exact cause is unknown, but tends to recur in pregnancy i.e. is someone has it, there is a higher likelihood of recurrence in subsequent pregnancies. It is commoner in individuals with a history of bipolar disorder or family history of postnantal illness or those experiencing severe stress.

The common feautures are bewilderment, perplexity, disorientation and confusion. They can start talking to themselves, hearing voices (auditory hallucinations) seeing imaginay things (hallucinations) and become paranoid (suspicious).
Some can become overly concerned about their children. They would worry about the child's health, and even believe the baby is either deformed or even possessed or that people are planning to steal new born baby and it has led to some mothers actuallly harming their children (rare).
I will discuss the treatment in my next post.

rosejen:

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

The good news is that puerperal psyhosis is not the same thing as schizophrenia. Most patients with Puerperal psychosis recover fully from their illness.
My advice is that she is taken to a hospital with where she would be comprehensively assessed.
She will need to have blood tests to make sure her symptoms are not due to a physical cause such as - retained products, acute confusional state, side effects of medications, thromboemblic event etc. These need to be excluded before we can confidently diagnose puerperal psychosis.

She will need a lot of support from her husband and family members.
The family will also need to be educated on this condition, so, they can cope better.
She will need practical support with feeding the baby, washing, nappy changing etc.
She will benefit from medications called antipsychotics e.g. olanzapine, quetiapine, amisulpiride
If depressed, then she will need to be on antidepressnats e.g. citalopram, sertraline.
These will usually be started either by a psychiatrist or family doctor.

I have attached two links containing more educational leaflets
://www.puerperalpsychosis.org.uk/site/conditions/psychosis.html
http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/postnatalmentalhealth/postnataldepression.aspx

I hope these will help and don't hesitate to contact me, if you have more queries.

doctorkk1:

Thanks MadamL and Dominique. I can't be discouraged by Snowdrops cynical remarks. I have seen a few threads on depression, anxiety, schizophrenia and other psychiatric conditions and felt i may be able to offer support and advice where appropriate.
I presume snowdrops is unaware of the huge impact of mental health burden on the society as a whole.

HAHAHAHAHA
Very funny. Thank godness for the anonymity of the internet. Was only pulling your legs though.

doctorkk1:

Hi Rosejen,
Thanks for getting in touch.
From the brief history you've given, your cousin seems to be suffering from Puerperal Psychosis.
This is a condition that occurs in women shortly after birth. [b]It usually starts within a few weeks or even months after childbirth.[/b]It can really be confusing especially to the family and partner who struggle to care for both the mother and her baby.
It occurs about 1 in per 500 births.
The exact cause is unknown, but tends to recur in pregnancy i.e. is someone has it, there is a higher likelihood of recurrence in subsequent pregnancies. It is commoner in individuals with a history of bipolar disorder or family history of postnantal illness or those experiencing severe stress.

The common feautures are bewilderment, perplexity, disorientation and confusion. They can start talking to themselves, hearing voices (auditory hallucinations) seeing imaginay things (hallucinations) and become paranoid (suspicious).
Some can become overly concerned about their children. They would worry about the child's health, and even believe the baby is either deformed or even possessed or that people are planning to steal new born baby and it has led to some mothers actuallly harming their children (rare).
I will discuss the treatment in my next post.

Well i admit the history is brief but you cannot conclude it is peuperal psychosis. The lady may have had a history of schizophrenia, either diagnosed or not. In that case it may be a relapse of her previous illness.
It starts between 2 and 14 days post partum. What you described is postnatal depression.
Otherwise sound advice.
On treatments, remember the lady may be in Naija where resources are usually limited or unaffordable.

snowdrops:

HAHAHAHAHA
Very funny. Thank godness for the anonymity of the internet. Was only pulling your legs though.Well i admit the history is brief but you cannot conclude it is peuperal psychosis. [b]The lady may have had a history of schizophrenia, either diagnosed or not. In that case it may be a relapse of her previous illness.
It starts between 2 and 14 days post partum. What you described is postnatal depression.[/b]Otherwise sound advice.
On treatments, remember the lady may be in Naija where resources are usually limited or unaffordable.

You are wrong. Doctorkk1 is spot on.

beneli:

You are wrong. Doctorkk1 is spot on.

My guy, you simply dont know your psychiatry.

^^^

I shouldn't have time to respond to this, but what the heck!

rosejen:

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

The bolded parts are NOT symptoms of 'depression' even if it's postpartum. Once you have psychotic symptoms post partum, it's mostly likely puerperal Psychosis. As doctorkk1 rightly stated this is predominantly affective in texture, giving the impression of a manic episode with psychotic features. But it can still be predominantly a paranoid psychosis, as is the case described here. Of course psychotic symptoms are found in severe depression, so i can sympathise with snowdrops confusion, but once it is postpartum, 'Doctor', you are dealing with postpartum (puerperal) psychosis. And you should treat it as such because it is an emergency!

So if you are not out of your depths here and you happen to be a doctor, then i honestly advise that you brush up on your knowledge and communication skills. You'd be a lot safer that way, both to your patients and around your colleagues. I dare say, however, that your uncouth manner is most unprofessional. It's naughty to turn up out of the blues and try to spoil a thread started by someone who seems to KNOW what he is on about. Very naughty!

I apologise to doctorkk1 for this distraction. I promise i won't respond to this rude intrusion again. Like i said, you are spot on doctorkk1. Ignore snowdrops, he doesn't know what he is on about!

beneli:

^^^

I shouldn't have time to respond to this, but what the heck!

The bolded parts are NOT symptoms of 'depression' even if it's postpartum. Once you have psychotic symptoms post partum, it's mostly likely puerperal Psychosis. As doctorkk1 rightly stated this is predominantly affective in texture, giving the impression of a manic episode with psychotic features. But it can still be predominantly a paranoid psychosis, as is the case described here. Of course psychotic symptoms are found in severe depression, so i can sympathise with snowdrops confusion, but once it is postpartum, 'Doctor', you are dealing with postpartum (puerperal) psychosis. And you should treat it as such because it is an emergency!

So if you are not out of your depths here and you happen to be a doctor, then i honestly advise that you brush up on your knowledge and communication skills. You'd be a lot safer that way, both to your patients and around your colleagues. I dare say, however, that your uncouth manner is most unprofessional. It's naughty to turn up out of the blues and try to spoil a thread started by someone who seems to KNOW what he is on about. Very naughty!

I apologise to doctorkk1 for this distraction. I promise i won't respond to this rude intrusion again. Like i said, you are spot on doctorkk1. Ignore snowdrops, he doesn't know what he is on about!

Every line and every sentence of your post is filled with so much venom, insults and untruths that you bring disgrace and disrepute to your profession. It also calls your probity into question. I feel sorry for your trainers in medical school as they surely would not be proud of your behaviour as will your family who laboured to sponsor your training and your larger community.
The poster had made a brave effort at addressing the scenario above. As colleagues we are in the right to positively criticize any such effort because at the end of the day we all want the best for the patient/carer/relative concerned. There were some loopholes in his comments which i rightly pointed out. If you object maturely to my view point why dont you be more dignified and back up your counter arguements with appropriate references. Instead you resorted to cheap and childish blackmail. Shame on you.
For people showing signs/symptoms of a peuperal illness the past psychiatric history is very significant for the persons diagnosis, treatment and prognosis, Even my medical student will know that,
You cowardly evaded my other point where the poster said the onset of peuperal psychosis was weeks to months instead of 2 to 14 days.
I only wanted to elucidate this fact so we could cross-polinate knowledge but you have mischiveously trying to derail the arguement/discuss; galvanise my character; but i will not let you. I took the mick out of poster at the start, and if you had a microscopic sense of humour you would have realized that.

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist.
If she is resident in nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i didn’t confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist.
If she is resident in nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i didn’t confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist.
If she is resident in nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i didn’t confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
I have not forgotten to complete my post, but i am having difficulty on this site. I will try again tomorrow.

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadvertently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illness?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) Is she currently on any medications?

Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferably a psychiatrist. It becomes more emergent, if she is incorporating her baby in her abnormal belief system.
I know it may be difficult to asses help, if she is based in Nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on medications called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Apart from medications, the family especially her husband would need to be educated on her wife’s condition. This will help him cope better rather than feeling confused and helpless.
She will need practical support in form of helping with feeding and caring for the baby, washing, changing her nappy and playing etc.
If available, she would benefit from psychological (talking) therapy.

I hope i dididn't confuse you further. I have pasted a site that contains information leaflet to increase your understanding of this condition.
I also attached an educational leaflet to this post.


http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepression.aspx

Hi Rosejen,
Sorry for getting back to you late my messages weren't getting uploaded, so i have decided to format them into multiple postings. I actually posted my advice on treatment last night, but it apparently it inadervtently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illess?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) What medications is she taking?
(continued below)

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadvertently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illness?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) Is she taking any medications?
(continued below)

doctorkk1:

Hi Rosejen,
Sorry for getting back to you late. I actually posted my advice on treatment last night, but it apparently it inadvertently got deleted.
Like i stated earlier, the information you volunteered was inadequate. I would like to know the following:
a) How long after the delivery did she start behaving strangely?
b) Did she have similar symptoms in her previous pregnancy?
c) Has she ever suffered from any previous history of mental illness such as depression, schizophrenia, bipolar disorder?
d) Is there anyone in her family who has a history of mental illness?
e) Prior to acting strangely, did she seem depressed i.e. did she lose her appetite, sleep poorly, tiredness, feel low, lost interest in things?
f) Apart from the difficult labour, is she going through any significant stress?
g) Is she taking any medications?
(continued below)

------------------------------------------------------------------------------------------------------------------------------------
Although i still suspect puerperal psychosis as the most likely diagnosis, i would advice the family to take her as soon as possible to see a doctor or preferrably a psychiatrist. This would be more emergent, if she is incorporating her baby into her unusual beliefs.
I know she may have difficulty assessing help if based in Nigeria, i would suggest a teaching or general hospital.

Other conditions that could could have similar symptoms include:
a) Post natal depression with mood incongruent psychotic symptoms
b) Relapse of a schizophrenic illness or first episode schizophrenia
c) Organic conditions like- infections secondary to retained products, thromboembolic events (blood clots), acute confusional state, medication adverse effects.
She would need to have physical examinations and blood tests to exclude these organic conditions. The more reason why she needs to be reviewed in a hospital.

If it is confirmed that she indeed has puerperal psychosis, she will need to be on mediations called antipsychotics. Examples are olanzapine, sulpiride, quetiapine.
If breastfeeding, a judgement would have to be made on risk/benefit of continued breast feeding.
On the other hand, if depressed she will need antidepressants in addition to the antipsychotics as she is definitely psychotic. Examples of antidepressants are sertraline and citalopram.

Dear Shrinks,
Pls tell me, of what value is there in filling a Beck's Inventory in an already confirmed case of RESOLVING seasonal affective disorder ? Isnt it a waste of time ?

doctorkk1:

Hi Rosejen,
I have not forgotten to complete my post, but i am having difficulty on this site. I will try again tomorrow.

its the spam bots, they keep deleting messages they perceive as spam. i've reported the missing posts to the admin. lets hope they come up soon.

Fixed.

hi doctorKk1,

Thank you for taking out time to answer me.

there is no history of madness in the family even in extended family for decades

she has not suffered from depression, schizoprenia or watever before.

we noticed her strange behaviour like 6 months after her delivery

no she didnt have similar symptoms in her previous pregnancy

but i learnt she was depressed because the husband was kind of keeping late nights even sometimes with the children after picking them up from school and efforts to stop him proved abortive, that was during the fourth pregnancy that emanated this problem.

Please the problem now is that my cousin has refused to understand that something is wrong with her, she refused going to hospital and even when you force her to, at the hospital she will start shouting and create a scene.

the last time she agreed to go to hospital was when she complained of stomach ache , the family doctor who we have confided in about her strange behaviour administered an injection to her, gave her some drugs too

but i dont know the name of the injection or drugs that were given to her.the only thing i know is that the drugs makes her to sleep alot and she is beginning to dislike it cos she taut that the drugs were meant to stop the stomach ache, that is why she accepted to take them.

i learnt she has dumped the drug on the account that there is no more stomach ache problem.

hi doc.I am based in the UK and am doing a project on antipsychotic prescribing in the elderly:retrospective drug chart and case note review.
I dnt kno if u can be of help to me.
thanks.

Seun:

Fixed.

Thanks

when is a psychologist needed, as opposed to a psychiatrist?

doctor pls can i get ur email? pls i would like to get some advice... my email is beeyee18@gmail.com thank u