Yeah the line between adhd and bipolar is thinner than ppl wanna admit. Lemme find The Infographic.

English is pictured as such a smooth, almost perfectly normalized bell curve. On one hand it’s such a versatile language that (largely due to colonialism) has undergone so much evolution and mixing with other languages that I can believe that. On the other hand it looks almost too normal. Odd.

I’m surprised that particular aspect of the side effect profile comes into play with acute usage.

Well obvs. It’s basically,“idk which receptor is making them _____ (punch people, refuse to eat or drink, or whatever other immediate harm to themselves / others), but we need it to stop 3 days ago and can figure out the details or a potential cross-taper to something better later.”

Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.

Color me fascinated, lol. My guesses are personal experience / reading up on your own treatment or that of a loved one, tangential relation to the field such as clinical research, or just plain personal fascination. Given you linked to a drug that appears to be in trials my first guess is actually the second one. Hadn’t heard of it, and I’m hopeful, but after seeing abilify get approved for acute agitation I’m… skeptical.

i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.

Yeah a lot of people don’t realize the damage is additive, both people w/ these disorders and unrelated laypeople who think “talented artist stops taking their meds and continues to be talented but starts creating art with weirder subject matter as their brain boils” is a cool story.

I’m mostly replying to add though that risperdal also has the distinction of being avaliable as a long-acting injectable, and if you’re trialing oral meds before committing to an LAI, your options are somewhat narrowed. Zyprexa does have an LAI available, but I’ve actually never seen it used and while I can’t tell you why for certain, I do have a guess.

If you have a patient sick enough that you’re considering an LAI, you don’t want to take benzos off the table for an entire month, especially if it turns out to be inadequate after discharge and they wind up in an ED agitated and unable to report their own med hx and get B52ed and stop breathing. I’ve had a pharmacist tell me considering that interaction is going out of style but a history of that kind of adverse event is difficult for a med to shake. Accutane still has suicidal ideation in adolescents listed as a side effect but I have a strong suspicion that it’s less causation and more correlation with the impact of pizza face on the self and social esteem of a teenager.

Dude sometimes we still give thorazine. And tbh ime the 3rd gens don’t do shit for my typical patient. For context also though, I’m essentially providing ICU level care, so when you say the word “symptom control” it’s often referring to like, fists.

We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I’ve actually seen quite a few pregnancy delusions and they’re almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn’t take it anymore she would just come scream at me for the thorazine.

I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness so I’m also not going to tell you that any of this is the best solution, just that it’s the only one avaliable to any of us right now due to shitty government policies.

To the extent that men can lactate! It’s one of the possible side effects of risperdal, which I have to be aware of because I give it fairly regularly. It’s all the same structures it’s just a matter of the hormone signals they’re getting.

an oldie but goodie

Nah. Weirdly enough it was the character with the arthropod features I was investigating the concept for but now I wonder if I should’ve done that for the illithid so I might look into that. It was relevant to the other character because the actual arthropod features (wings) are missing by the time of the story so it was going to be one of the “hints” that they had her labeled as the wrong species but first of all it just didn’t fit creatively, it was much too overt to the extent it didn’t even make logical sense for the mixup to happen but also as you see here the science doesn’t follow either it’s only spiders and the like that have it, not dragonflies.

I knew about the hemocyanin because I was trying to figure out if one of the characters in my tentacle porn should have blue blood but decided against it. Cool to learn about the others too though.

Another fun fact: the psychiatric term for my speech pattern (well, typing, but they’re both revealing of thought content), is “tangential!” It can be indicative of mania or psychosis but in this case it’s just ADHD so bad the neuropsychiatrist thought I was faking for drugs. They said my recent memory tests like I have dementia (sort of, mostly the rote part when they ask if you remember the random words they told you at the beginning). I’m really good at a bunch of the hands-on stuff but the EMR really saves my bacon on remembering everything.

As a millenial nurse watching gen z new grads hunt and peck with their index fingers to write a shift note, 100%. I don’t think my parents really appreciated how much constantly being on AIM with my friends as a tween actually really benefited my typing skills in a way that’s been much more valuable to my career than algebra.

All the math you need to be a nurse is ratio / proportion and kitchen measurements to track I/O. With a modern EMR system (electronic medical record) that does most of the math for you you don’t even need that. The rest is latin and greek root words for various body parts and fluids and a vague understanding of how they’re all related (hyper-tension in the cerebral is bad because the cerebral is surrounded by a bone case and bones no stretch. That means the cerebral pops out of the bone holes and once it’s done that it does NOT go back in correctly like a squeezy ball toy). That gets you through the board exams.

After a year or two in practice you’ve just seen the same shit with a millimeter of difference over and over and over that you either know what to do about it or who to call to do something about it. And when shit is about to go REALLY wrong that’s also happened enough times that you get a weird feeling and just start calling everybody because your psych patient has been trying to kill you for the past week and an hour ago they suddenly stopped trying to kill you and now you have to explain to an RRT nurse (rental ICU nurse) why you’re upset that the patient isn’t trying to kill you.

Apple pie has entered the chat.

100%

How many of these anti abortion politicians have sent their mistresses out of state for abortions, probably even pressuring or coercing them using their more advanced legal, financial, and social standings?

<3

Randal Munroe is still my celebrity crush.

It’s been a minute but iirc she was liberal and female so I think it was good. It wasn’t the highlight of wild shit I did though I’m usually the weirdo wherever I go.

When in Rome do as the Romans do, and I do particularly love making hilariously taboo statements that mirror more conventionally acceptable fallacies. In early college I wrote an abortion focused “Modest Proposal” suggesting that men be forced to donate anatomical gifts (blood, skin, organs, etc) to their progeny to equalize the physical labor of men and women in procreation. The increased gravity of such a gift is balanced by the lower liklihood of its necessity (it might in many cases be harder on the body, but the odds a child will need it are much lower). I came at it from every angle and took each part of the argument to its most exaggeratedly ridiculous extent; Swift would’ve been proud. I’ve since lost the text, however.

Look at men’s bodies! They have prostates capable of being stimulated to climax. God designed men for the magnificent job of bottoming and what could be more beautiful than a man orgasming while getting railed up the ass?

To me the wildest thing about trump’s appearance is that he can obviously afford to hire a world class stylist and listen to their suggestions and they could nip, tuck, exfoliate, micro needle, microblade and whatever the fuck else they’re doing these days to people until he’s an immaculately polished if somewhat uncannily stepfordesque Hollywood perfect geri-ken doll. Instead he does shit like this.

The Grip of It by Jac Jemc and idk I’m not even done with it yet

Deadwingdork has a great 4chan series