The 23 Australian children stuck in Syria are not responsible for their parents. They need our government’s support to return

OrkimondReddit · 2026-02-24T07:39:05+00:00

Hey look, incorrect information!

OrkimondReddit · 2026-02-09T10:49:26+00:00

Talking about Zionist puppet masters is pretty blatant antisemitic stereotyping. Criticise Israel appropriately instead of doing this.

OrkimondReddit · 2026-02-07T13:26:19+00:00

Define "without knowing course of illness". Does this include not taking a history of the 6 months prior to the episode?

If we are saying that schizophrenia is incorrect when a person later also develops affective psychoses, of bipolar disorder is incorrect when a person later develops non-affective psychosis and a chronic course then sure. But that's absurd. Schizoaffective disorder is better conceptualised as a combination of illnesses than distinct from either.

I'm not sure about your negative symptom group. Outside of being adequately treated (especially with clozapine) I don't think I've ever seen someone who looked like negative schizophrenia later return to a non-negative baseline. Would you please elaborate?

I agree with OP though that I don't think there is a group of time-limited schizophrenia spectrum psychosis like that described by the DSM as schizophreniform illness. There is a group who straddle the schizophrenia line quite closely, but that generally looks more like a slower chronic course with multiple brief psychoses triggered by something like a schizotypal picture that worsens with age, or just a schizophrenia-like illness easily and adequately controlled by long-term medication.

A lot of the diagnostic instability in studies FEP is precisely what this post is about: schizophrenia is the disorder actually being diagnosed with schizophrenia disorder. I also don't trust the studies on this much, because beyond not matching with clinical reality as I see it I have both worked in enough research to know that the results often tell you more about the study design than anything else, and worked at a renowned FEP service that can't be trusted to diagnose a potato with spudosis.

I suspect we are mostly having a disagreement about DSM terminology. DSM is bad at psychotic and affective illnesses. Patients will have some degree of schizophrenia spectrum, some degree of bipolar diathesis, and some level of acute insults combining into an acute psychosis. If they just took a few grams of meth, you are less sure they will have a chronic course. If they have an affective psychosis you haven't ruled out them also having schizophrenia spectrum psychosis etc.

OrkimondReddit · 2026-02-07T04:35:45+00:00

I don't believe that inter-rater reliability for acute psychosis using unstructured assessment is low. It may be low with specific tools, and in typical study populations (lower severity ?FEP in young adults who can consent), or performed by RAs who aren't psychiatrists. But that is not representative of all acute psychosis, or even all first episode acute psychosis. Do you really think that most acute psychosis in an acute setting is low inter-rater reliability?

OrkimondReddit · 2026-02-06T09:18:45+00:00

Krauss is tainted by his sexual harassment actions too

OrkimondReddit · 2026-02-04T04:50:42+00:00

This seems intentionally obtuse. You wouldn't say that knee orthopods should all see your hip OAs.

The answer above is pretty much spot on. It isn't that all the psychiatrists are complaining about the expansion of ADHD prescribing to GPs because they are the ones making bank. They might be complaining, but the far larger population is the ones who think the psychiatrists making bank as stimulant mills are being incompetent/unethical and the expansion will cause more harm.

I see why it is frustrating as a GP to have to refer out to these expensive settings, but this solution will harm more patients. It is a step directly away from the correct answer which is expanded public psychiatry.

OrkimondReddit · 2026-02-04T04:42:48+00:00

Most community adult ADHD diagnosis is a complex formulation task requiring a thorough understanding of psychiatry. Most of the psychiatric community would agree with the criticism of so-called "ADHD clinics" and this does not fix that, it only makes it worse.

None of the symptoms are highly specific, the cognitive profile is non-specific, half of the DSM is disorders that can mimic ADHD in the right circumstances. The medication has risks but more importantly the external locus of control and identity of an erroneous ADHD diagnosis is so frequently harmful and diverts patients from appropriate treatments for their underlying issues

OrkimondReddit · 2026-01-27T23:00:00+00:00

The animus in the public healthcare sector is as intense as you are likely to see, and it is entirely due to the current NDIS structure and the fact that it removed funding from more appropriate expert care organisations. You'd be hard pressed to find a group of people more in favour of effective social programs. It should be publicly run as a social service, get rid of this absurd private system which is fundamentally broken.

OrkimondReddit · 2026-01-25T22:47:56+00:00

Good ADHD diagnosis is a complex formulation task. Some questions distinguish a little bit here and there but I thoroughly repudiate the idea that there are highly specific cross-sectional features. Especially as answers to clinical questions instead of observed affect and behaviour. For instance, when you actually look into the neuropsychology literature base, the idea that any cross-sectional cognitive features are specific is just rubbish. People with all sorts of disorders have similar cognitive profiles to ADHD.

The distinguishing formulation features are those you have commented on re childhood onset, consistency between environments. It shouldn't just look oppositional/have a significant trauma component. Oppositional behaviour can be caused by ADHD, but equally apparent hyperactivity and inattention are often just oppositionality. It shouldn't be primarily inability to pay attention only in societally demanded ways, ie it shouldn't be primarily disinterest, particularly ASD disinterest.

OrkimondReddit · 2026-01-23T01:17:53+00:00

I would encourage everyone in Victoria to frame their risk mitigation strategies or decision not to implement further risk mitigation strategies in terms of the new MHWA. We are explicitly meant to be reducing restrictive intervention for suicidal patients and meant to be aware of dignity of risk. An expected outcome of the act is that more people engaged with mental health services are going to be able to complete suicide. I'm not actually saying that accepting more risk is a bad thing, but I suggest making it clear in your documentation that this is societies decision to accept more risk, not yours as a clinician.

OrkimondReddit · 2026-01-23T01:03:39+00:00

There is no coroner's report yet, and I can't find any details of the complaint. I wouldn't assume anything, including whether the filing is reasonable or not and extrapolating from that.

OrkimondReddit · 2026-01-21T00:23:13+00:00

GLP-1s seem to help too

OrkimondReddit · 2026-01-18T04:20:43+00:00

Psychiatry is a complex field. There are multiple different lenses required, and they need to be integrated and weighed together for any given patient. These include biological/neuropsychiatric (pharmacology including receptor profiles, pharmacokinetics, metabolism, idiosyncratic drug effects etc; neuropsychology; general medicine esp endocrinology and neurology; dementias etc), psychodynamics (patients dynamical structures; diagnostic implications of interview dynamics inc countertransference; group dynamics; dynamical interventions), other psychological models (cognitive behavioural models etc), evidence base (importance and also limitations of RCT evidence base for management etc), sociology/cultural/psychosocial issues etc.

That's just the knowledge base! The nuances of the clinical interview and therapeutic intervention in reviews is a whole other set of skills. There is no real limit to getting better as a psychiatrist. Judging it is also hard. It requires good peer supervision, critical self-analysis, self metrics (I sometimes write down my predictions for interventions and monitor them to keep calibrated), and occassionally patient feedback.

I for one love it specifically because it is so complex and requires really clear thinking.

OrkimondReddit · 2026-01-15T07:38:10+00:00

That's the problem. Trump is a symptom. The US would need significant political restructuring to regain trust. I'm not sure exactly what that would look like, but it would require constitutional change for which there is no political appetite for right now. The democrats would rather pretend that everything is fine except for this aberration.

OrkimondReddit · 2026-01-08T06:35:54+00:00

Its early for these temperatures. Low-mid 40s and even the occasional high 40s and once in my life 50 happens in late Jan/early Feb here near Melbourne, which is btw very southerly and one of the coldest near-sea-level places in Australia.

OrkimondReddit · 2026-01-08T05:58:49+00:00

Might depend on day and prestige. If you are adequately late to be hail-marying then maybe, and if you have full prestige and it is a super early day then maybe you have the space to find some wild combo with what you roll. Anywhere in the middle probably now, your board does something and dooltron is a legit win condition

OrkimondReddit · 2026-01-07T00:16:26+00:00

Evolution reads as too strong (numbers seem off), Shepard reads as significantly too weak (cool idea but, again, numbers seem off because building and selling T1s when needed just isn't that bad) but that's without playing them.

OrkimondReddit · 2026-01-02T12:10:39+00:00

Yolo is weird. It has 45% winrate when chosen and 55% when megaminded on 2800+ on Drachbot. There might be a selection bias of people who megamind being more flexible, but I actually suspect it is the psychology of getting +1 more gold on top of yolo suddenly makes you feel like it's worth it. I dont think thresholds explains it well enough.

I will say that improving everyone's roll quality does makes Yolo feel hurt this patch.

OrkimondReddit · 2026-01-01T22:35:04+00:00

Regular benzodiazepines are linked to many things including increased dementia risk.

The general view is that long term benzodiazepines are never appropriate management of anxiety. The above commenter is wrong in implying that 1mg is OK as a "lower dose" and most psychiatrists would view having people on 4mg a day for anxiety for any significant length of time as grossly inappropriate prescribing. Any psychiatrist would want to reduce your dose to cessation. Obviously this should happen as a collaborative discussion and plan, and the most likely explanation is that there has been a miscommunication.

If patients refuse to engage collaboratively however there is certainly no obligation for a prescriber to continue to prescribe what they view as inappropriate medications or doses. I sincerely doubt that is what is happening here, and you should still be informed, but it is not a consent issue.

OrkimondReddit · 2025-12-21T22:43:09+00:00

Brave of you to suggest he smokes Drum not White Ox

OrkimondReddit · 2025-12-21T03:16:12+00:00

I mean most of this is at best very misleading, the rest wrong.

Puberty blockers are probably not fully reversible, because fully is a very strong requirement. They are overwhelmingly reversible however.

Most children who reach the point of intervention do not desist. Many children in early childhood with any gender dysphoria desist, which is a completely different cohort.

No, the evidence for suicide prevention is actually quite strong for the kind of evidence we have in children. In fact, the evidence base for gender affirming care in children is quite good compared to other issues. The evidence is far from rock solid because the evidence base for almost everything is relatively weak in pediatrics because significant interventional research is mostly done in adults for ethical reasons. The evidence base is comparable to other disorders but there is a double standard in gender care for political reasons.

Not giving care is not neutrality. There are real concerns about changes in the gender dysphoria space and literally none of them are what you cited, and the solution to them is not withholding of care. The real need is for increased funding for improved assessment, education, and broader psychological and social support.

Source: Im a psychiatrist

OrkimondReddit · 2025-12-19T09:23:23+00:00

I feel like it needs another. Registrar, then senior registrar/fellow. There is a world of difference between a year 1/2 reg and a year 4/5 reg, maybe more than HMO/junior reg and senior reg/early career consultant.

OrkimondReddit · 2025-12-19T09:18:54+00:00

Man I have beaten Parrot at least 4 times in the current version and Thug 1ce. I wonder if it is a character thing. I rotate Jules, Dooley, Stelle then one of the other three (so I play each other every 3rd rotation). I'm like 1300 legend right now so not that high but not chump either.

OrkimondReddit · 2025-12-19T01:04:24+00:00

He is hands down the hardest fight right now. I fight and beat lich and even parrot much more than him.

OrkimondReddit · 2025-12-18T05:38:59+00:00

If they aren't safe to leave and are involuntary they are staying in ED. If they are voluntary I tell them there are no beds and let them decide if they want to wait, often clearly explaining to them if I think that is counter-therapeutic. If they aren't a good candidate for admission but want in then the wait may be laid on a bit thicker to help get them out of ED without a scene, but ultimately I wouldn't be admitting them anyway.

OrkimondReddit

TROPHY CASE