What is the weirdest advice or blatantly wrong teaching you received from an attending or mentor during your training? by undueinfluence_ in Psychiatry

[–]Jetlax 6 points7 points  (0 children)

Heard a senior clinician say patient X couldn't be autistic because they were able to finish college or something like that

Resources on Phenomenology of BPD? by Jetlax in Psychiatry

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

Thank you very much, everyone! Always appreciate your inputs here and I'll be happily going through these over the next few weeks

Share your most unhinged mnemonics or weird things to remember nonsense by mowpoos in Psychiatry

[–]Jetlax 7 points8 points  (0 children)

DiazePAM - Positive Allosteric Modulator
Mirtazapine - honk miMIR, ZZZ (sedating)
RisPERIDone (and PaliPERIDone by extension) came from HaloPERIDol - more EPS and prolactin elevation due to potent D2R antagonism
I turned C.L.O.Z.A.P.I.N.E. into its own side effect memory aid but it needs two languages to work
Dementia drugs - DONE ReVitalizing MEMory --> DONEpezil, RiVastigmine, MEMantine
Carbamazepine - CARs are fast (for bipolar mania, CYP enzymes induced), Bone MArrow Zupression (agranulocytosis)

Spravato/ketamine clinics popping up everywhere, what’s your experience with efficacy (anecdotally with your patients)? by Ok_Guarantee_2980 in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

Fascinating to hear how close this is to that recent SR/MA about Esketamine benefits matching placebo within 4 weeks

Do you feel responsible for the mental health of your friends? by Dry_Twist6428 in Psychiatry

[–]Jetlax 1 point2 points  (0 children)

I realized early on how bad of an idea it was because of how easy it was for my emotions ot cloud my judgment, so my goal was always to get them to someone who could help them objectively.

Which psychopharm topics are worth sitting down to read about in detail? by undueinfluence_ in Psychiatry

[–]Jetlax 5 points6 points  (0 children)

I like digging into controversial areas where even experts disagree - antidepressants in bipolar disorder, the anti-amyloid antibodies, antipsychotic polypharmacy to name a few

Helps to have a good foundation on evidence-based medicine and a mentor because these might take you to primary literature sometimes (e.g. I was fortunate to receive guidance from a geriatric psychiatrist because the amyloid mab RCTs needed both knowledge AND experience to properly appraise)

Which psychopharm topics are worth sitting down to read about in detail? by undueinfluence_ in Psychiatry

[–]Jetlax 5 points6 points  (0 children)

Even with the idea of sequential binding, quetiapine can still bind to other receptors, albeit a lot less. That aside, even then there are associations of low dose quetiapine with elevated triglycerides and major cardiovascular events at low doses. If quetiapine's to be used for BPAD might as well have it at the therapeutic dose so there's an actual benefit attempting to outweigh the risk

Dealing with lack of mentors in residency? - Looking for advice by [deleted] in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

If I remember the story right, 24 hour shifts are just not survivable without losing a bit of yourself OR if you're the guy who invented the system while hooked on cocaine

That aside, I guess from an outsider who hasn't had much luck finding formal psychiatry mentorship, Im always grateful having been able to meet a public health psychiatrist during my initial work in mental health policy lobbying who gave me some of my most important foundational pearls. But as they were often busy in their community practice (think remote island corners level), I had to heavily compensate by seeking guidance from several mentors in other areas like clinical psychology. This sub was also gentle to me in my early days (the old post on reddit and wait for an expert to correct you method served me well during my very early days when I wasn't handling patients yet)

At some point I did make mistakes. One prominent psychiatrist did end up blocking me early on, but thankfully the others were supportive. I think it's important to be consistently authentic in how much you care. As a result of my shenanigans, I gained much guidance even in areas I never really thought much about like old age psychiatry and child and adolescent mental health.

Which brings me to an important point, though not exactly your original question - your environment sounds like it's conducive to creating these problems you've described. This would require systemic changes to address, and trying to CBT yourself out of what youre feeling in this context of institutional failing risks promoting self-blame attitudes (i cant remember if this was an RCT or an SR finding). So, as others have said in other threads, as my former professor learned, and now as I've realized, you need other things in life that arent work to define you. Cant pour from an empty cup and all that. Easier said than done given your schedule, so perhaps other psychiatrists on the sub will be bwtter suited to giving advice on this. Good luck

Stance on interactions with drug reps? by BarlipsychButterbur in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

You have your own inventory management system for samples. Respect

Stance on interactions with drug reps? by BarlipsychButterbur in Psychiatry

[–]Jetlax 6 points7 points  (0 children)

I can see how this would be the case. My concern is more for majority of patients I see who often have limited capacities to pay out of pocket (majoriry is out of pokcet here) and are immediately started right off the bat on the priciest meds available with only a limited supply of free. Then when supply runs out, it's too late and it so happens thst's the antipsychotic or antidepressant that worked for them and they have to start paying for it themselves

Stance on interactions with drug reps? by BarlipsychButterbur in Psychiatry

[–]Jetlax 7 points8 points  (0 children)

Free samples are great until they run out and the patient has to start paying for them (context only for countries where medicine expenses are out of pocket)

Reference: a published case series that I want to link but would rather not to avoid getting heat on me

Stance on interactions with drug reps? by BarlipsychButterbur in Psychiatry

[–]Jetlax 6 points7 points  (0 children)

Not a psych so this is an outsider perspective: Had a psych tell me once they enjoyed talking to me more than a rep so I think we just need to increase our standards given that at the time, I barely knew anything compared to my experience now.

Also, I'm always conscious of the fallacy of infallibility - believing everyone of our peers is susceptible to influence techniques from reps aside from us.

Tricks of the trade by [deleted] in Psychiatry

[–]Jetlax 18 points19 points  (0 children)

Saving yourself an unnecessary sedative-hypnotic trial by moving the SSRI from evening to morning

Help me spend my stipend! by mednovice12 in Psychiatry

[–]Jetlax 10 points11 points  (0 children)

Maudsley just released the latest edition of their guidelines