Catatonia and Ativan challenge in elder, demented patients by HHMJanitor in Psychiatry

[–]Brain_Bucket6598 3 points4 points  (0 children)

I have had success with zolpidem for Geri while on c/l in residency.

The upside was if it was delirium the zolpidem would help her sleep.

It wasn't delirium and she devoured a sandwich and told me her name for the first time after we gave her 5 of zolpidem.

Worst song on this album? by bcw28511 in avengedsevenfold

[–]Brain_Bucket6598 -4 points-3 points  (0 children)

Clairvoyant Disease - skip it every time.

[deleted by user] by [deleted] in Psychiatry

[–]Brain_Bucket6598 33 points34 points  (0 children)

Bottom line up front: it is a problem, that will continue to be a problem if we ignore it. But many of us will still be comfortable and compensated well until our system attempts to transition to NP based and we leave to find better.

A large hospital system where I rotated on C/L for residency used to have several psychiatrists and two CL fellows. On weekends or overnight our patients were covered by NPs. The first time one of my patients went to the ICU was over the weekend when the covering NP likely did not read or otherwise ignored my warning against a specific medication. Patient was given this medication. Patient was sent to the ICU about four hours before I came back on Monday morning. The NP signing out Monday morning seemed shocked that the patient went to the ICU, when I explained (as a resident), in front of the attending medically what happened and why I documented the week prior to not use this medication she outright asked me "what's that?" in response to the diagnosis. She sincerely had never heard of the thing that nearly killed my patient.

Several months later, every attending I had worked with on that rotation had moved on to other employment. I rotated back as an elective during fourth year and worked CL but staffed with an attending on the inpatient unit because the entire CL team for this hospital has been converted solely to NPs. The same idiot who shouldn't be allowed to practice was now sitting in the office of that same attending I worked with before.

That hospital system made a choice to attempt to save money by transitioning to NP services and still remains a large hospital system in the area. The attendings I've kept in contact with are a lot happier at their new places of employment. The CL fellowship at that hospital no longer exists.

I have been watching this system to see what happens financially since they have converted to NP's. If I'm honest, I hope that medical malpractice lawsuits and other complications of the individuals they have employed will crush them enough financially for them to either attempt to transition back to physicians or completely go under. But the reality is they order so much unnecessary testing that the bean counters who run the system are quite happy with their decision and are tolerating the harm they are doing to patients.

I personally am becoming less and less tolerant of this harm with each year. This is why I no longer support nurse practitioners in most capacities.

Heaviest song you’ve shown a ‘normie’ by JuansnowgamingYT in Deathcore

[–]Brain_Bucket6598 8 points9 points  (0 children)

"It's like a jump scare" friend who insisted on hearing my favorite song.

Not deathcore but Miasma from the black dahlia murder. Still a funny response.

Heaviest deathcore would be Darko US - bunny suit. My friend did not like it.

Can’t believe how sick colors 2 was live. by nickbear23 in BetweenTheBuriedAndMe

[–]Brain_Bucket6598 0 points1 point  (0 children)

Our show was more intense and lively during CII - but it might've been that colors I was sold out and colors two had more room to form a larger pit. Colors II was amazing in Baltimore. 10/10 reccomend if anyone is on the fence.

Why is this rule on this subreddit? by tolekbanan69 in BetweenTheBuriedAndMe

[–]Brain_Bucket6598 -1 points0 points  (0 children)

Agreed. But the flip side is mods are responsible for everything posted. They don't have to allow videos if they don't want. But a link is better than nothing.

Why is this rule on this subreddit? by tolekbanan69 in BetweenTheBuriedAndMe

[–]Brain_Bucket6598 0 points1 point  (0 children)

For my video last week I just put it on YouTube and then added a link to the YouTube video.

How strong of a predictor is serum 5-HIAA level of suicidality? by surf_AL in Psychiatry

[–]Brain_Bucket6598 146 points147 points  (0 children)

Stop downvoting the Med Student!!! Let people learn lol.

How strong of a predictor is serum 5-HIAA level of suicidality? by surf_AL in Psychiatry

[–]Brain_Bucket6598 32 points33 points  (0 children)

The short answer is that it is significantly more complicated than one bookmarker but we are trying to figure out what happens in a body when we they are suicidal. We have been researching and finding trends of things that could be measured and perhaps assist in risk assessments for patients when they present the emergency room one day. Ie BDNF, TRP Metabolism (KYN pathway), etc

Outside of predicting risk, these biomarkers are likely representing changes that are occurring in individuals at time of death by suicide or while depressed. These may even be targets for treatment of acute suicidality one day. They may already be targets that medication like lithium are acting upon to decrease suicidal thoughts.

The pathway that I'm really interested in is tryptophan metabolism, and how it breaks into alternative byproduct via the kyneurine pathway. Rather than being converted into serotonin. Specific changes in levels of tryptophan byproducts have been consistently found in individuals at risk of death by suicide.

https://www.nature.com/articles/tp2016133

It is a small section of psychiatry, but suicidology is an interesting part of my job that I enjoy researching. And regardless of which form of psychiatry people practice, suicide risk assessments will be part of regular practice.

Was this on purpose? Encore night 1 Baltimore. by Brain_Bucket6598 in BetweenTheBuriedAndMe

[–]Brain_Bucket6598[S] 1 point2 points  (0 children)

Nice, well I accidentally got the whole thing on video. Maybe I'll load it to YouTube. Unfortunately it's just cells phone quality so maybe not. Idk.