Eeeeh. I kinda get why it fell out of favor. For context, the weird thing about the nursing perspective vs the MD perspective is that you don’t get as much of the benefit of large studies, but you also aren’t as sensitive to big pharma marketing studies either which… good AND bad. Like for school I had to take a class on evaluating the validity of drug trials and one of the studies mentioned was taking advantage of the fact that there’s basically no equivalent doses between different antipsychotics but you can also look at the doses from an experienced clinician perspective and be like huh they’re saying this drug has less side effects compared to 20mg of Haldol daily, but literally ANYTHING has less side effects than 20mg of Haldol daily; that dose is insane. The nursing perspective also tends to be more sensitive to variations in the needs of local populations, you’ve lived in an area and worked within that specific demographic and environmental setting for a few decades vs the doctors main body of knowledge often even includes studies from across the world. Just giving some background as to the upsides and downsides of my perspective.

So back to my point, I can tell you I associate lithium with being a last resort med for really sick patients who nothing else cuts it for. I associate it with horrible side effects including crazy weight gain and thyroid problems as well as fluid and electrolyte balances, and depakote and tegretol aren’t gonna cause that last one at all and also do have that advantage of blood level monitoring. I don’t see tegretol prescribed as much but depakote is probably what I see as the most prescribed med even before lamictal. Now lamictal I completely understand why I’m not seeing in the inpatient setting; you can’t rapidly titrate without risking the death rash (SJS/TENS), and the objective of inpatient care is always rapid stabilization with tweaking to occur in the community. And also maybe I’m associating lithium with all these horrible side effects because I’m seeing it used for patients suffering from both the direct effects of severe mania, especially those with the cumulative effect of multiple manic episodes over time, as well as all the other horrible things those episodes put them at risk of such as homelessness, substance abuse, and general increased risk of injury and illness due to decreased capacity for self care.

I guess the TLDR is, it wouldn’t shock me if the inability to patent salt was the reason lithium isn’t preferred, but I also associate it with being a pretty old-school heavy hitter like thorazine is for psychosis, and while my perspective has the advantage of being more experiential, that comes at the disadvantage of being less empirical (but its also often difficult to tell how empirical some studies are due to the influence of capitalism on the development of pharmaceuticals).

As a professional I’d basically be required to say the above, but I’m also watching from the inside as my country’s health system decays starting with populations that were underserved to begin with like the mentally ill. In other news I have a hospice interview tomorrow. If nothing else I’ll just get to focus on making people comfortable. That sounds so relaxing. I’m getting tired of having to tell people no all the time.

There’s also practical benefits. As someone without children I’d really like to see more funds and attention paid to education because I’m getting really fucking sick of interacting with stupid people.

I was just talking to someone a few hours ago about how sex ed in the US is so bad that a huuuge number of my psychosis patients will tell me they know someone came in to their room and sexually assaulted them overnight because they woke up with a boner or wet vagina. In nursing school they also told us that the average learning level of a US adult (particularly in terms of reading level) is about the fifth grade. My school did sex ed in 6th, so that checks out. In the US its just normal to not know how your genitals work. Especially about the opposite sex and especially when it comes to women’s anatomy, but also just in general. I’ve had multiple men tell me their morning wood is proof of a sexual assault. And you always get shit from police having to file these reports because like yeah obviously we have cameras proving no one did more than poke their head in the room for routine safety checks and this is clearly just a hallucination / delusion but also it’s their right to report it and it’s your job to write it down so like???

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

Yeah even if it is weird as shit where I am now is already weird as shit.

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.

You know this is the recommended stance when deescalating violent psych patient because it keeps your hands visible (as in, not hiding something) and in front of your body / face in case they start swinging. I’ve never really felt comfortable doing it though and this kind of explains a possible reason why. I actually had a guy the other night who asked why everyone else was scared of him and I didn’t seem to be. There were probably a couple other reasons though (I’ve dealt with waaay wilder men, and also he mostly struck me as young, dumb, and loud, and dumb in the young sense not in the cognitively not there sense). But as far as this pose idk it just always seemed really patronizing to me. I usually stand more like One of these where at least one hand is on the neck or side of the head. Usually with my hands overlapping but my fingers not intertwined so they’re easy to separate and throw up in front of my face but not overtly defensive.

Apple pie has entered the chat.

THANK YOU.

It’s not gross because he’s not wearing gloves, it’s gross because he probably never washes his hands after digging in his ass all day.

Get your reasons this man is disgusting straight people!

I wrote a similar comment about this exact same situation on another post but from a more healthcare oriented perspective. Specifically that unless you have open cuts / sores on your hands as a healthcare worker, clean but nonsterile gloves do not protect the patient! They are an OSHA requirement in place to protect the worker from exposure to bodily fluids and caustic cleaning chemicals. And for chemo you glove twice.

Sterile gloves, which are used to protect a patient from infection and are used for surgeries and specific types of bedside procedures like urine catheterization, are packed in sealed packages in single pairs and must be applied in a highly specific way by a trained individual, the minimum license usually being an LPN and more often an RN.

Unless that beef patty is acidic enough to burn your hands while preparing it (and if it is I shudder to think what it would do to a stomach) gloves out of a 100-count box ain’t protecting anybody from anything and at their worst are bamboozling people out of washing their damn hands.

It probably doesn’t help that I’m incredibly irreverent of pretty much everything. I got really into western esoteric spirituality this past year (its really been helping me with introspection and integrating my personality in ways that neither secular therapy or my fundie upbringing ever quite fully did on their own) but at the same time I refuse to take any religion seriously, especially not my own.

Anyway someone in a related community got upset at me for having my irreverent attitude because I was “culturally appropriating” tarot cards from PoC and like dude. Look up where that shit is from its Northern Italy where my family is from just two generations ago they were fresh off the boat when the War was starting. You’re appropriating tarot from me. And if you want to get into the specific spiritual / divinatory usage that’s even fucking whiter. The closest you’re gonna get to claiming cultural appropriation is if you go all the way back before the tarot to the mummy dust the hermetic order of the golden dawn were probably mixing into the coke they were snorting while making that shit the fuck up based on their judeo-christian / classical mythology crossover fanfiction.

People just wanna be mad about shit and at this point I really don’t have the energy to spend appeasing people who have already decided to be mad at me. Imma just be over here using these cards to let my subconscious tell me which level of Maslow’s hierarchy of needs I fucked up this week.

Reminds me of the time somebody in r/nursing asked if they would run into any problems having tattoos. Most places don’t care too much these days and especially since they wanted to work psych which is pretty in-demand but I commented that if they’re gang related or look similar to gang related symbols there could be trouble because there’s a lot of crossover between the psych and corrections patient populations.

They told me “oh they’re just some norse runes.” Bruh. I thought you were gonna tell me it was a butterfly on your wrist or something you gotta be kidding me. They stopped responding before telling me which runes specifically but if an internet stranger clocked them from a few message board responses maybe they rethought some things.

Removal of gendered aspects without any additions.

I’m pretty apathetic to gender in general but I’ve had gender confirming surgery to be NB which I guess technically makes me trans and to be prefectly honest I’ve never felt more judged for it than by the lemmy LGBTQ+ community. The 50y/o southern man that was my nursing supervisor back when I was a new graduate was more respectful of my gender and lived experiences than these people. Honestly the thing they seem to hate most is specifically me expressing apathy for gender; I’ve mentioned that my transness expresses itself by not caring about the whole pronoun thing or needing to have any specific pronouns for myself personally, but that I understand it’s a matter of respect for others and I’ve literally gotten banned for saying that. Like almost exactly that. They’re absolutely hateful bastards for no reason other than that they’re upset and need everybody else to be upset too. I’m lucky I have a handful of supportive people irl because I sure asf wasn’t gonna find it here!

<3

Randal Munroe is still my celebrity crush.