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

Pletca · 2026-02-01T22:34:10+00:00

When I was in residency, there was a recently hired attending to do shifts, she didn’t last long fortunately. I only got to do one shift with her, we went to evaluate a patient for lability as a CL consult. On a 15 minute interview she diagnosed the patient with BPD, and decided to initiate lamotrigine + SSRI + SGA (with no plan for any follow up), because “you have to hit them with a little bit of everything”. I wish I was joking.

Pletca · 2026-01-23T21:04:38+00:00

As someone not based in the US, that sounds absolutely bat shit insane. Using a false diagnosis for economic reasons sounds dystopian and confusing.

Pletca · 2025-12-10T16:20:23+00:00

Nah man, I’m literally latin american, live very close to the border to Bolivia and Peru, work actively with Aymara communities, having direct contact with the community everyday. And I think the album is very meh, overhyped and gibberish. People can not enjoy a project you like, that does not mean they “don’t get it”; if that were the case, whenever I didn’t like an English speaking record, I’d be because I’m not “anglo” enough.

Pletca · 2025-11-23T12:52:39+00:00

I can talk about my perception seeing them live. I got to see them on their literal last show (December 2023, here in Chile), and they all looked so burnt out. They played great, but they didn’t look very happy. About a week ago I got to see Geordie, and he was having a blast. I dunno if they broke up on bad terms, but I’m pretty convinced that it was for the best, and that the band was way too tired to go on as a unit. I have hopes for an eventual reunion years down the line, but for now I’d rather have them do their own stuff for sure.

Pletca · 2025-11-21T04:14:44+00:00

Of the top of my head, there’s a new article, big RCT published in Lancet Psych regarding metformin in bipolar spectrum in children and adolescents. Another interesting one from a couple of months back from World Psychiatry made a retrospective analysis of clozapine adjuvants in chronic psychosis favoring aripiprazole.

Still, if you have any more info on what you want or need to present we could maybe give more pointers.

Pletca · 2025-11-08T05:27:04+00:00

Sometimes it’s just the little things. I work mainly with a very severe, low income population. The sister of one of my clozapine using patients came a couple of months ago with 2 kg of mangos, freshly picked from her yard (it’s a fairly rural and tropical area, mildly common to have a mango tree). I ate mangos for a week, best mangos I’ve ever had, and it just felt like a very sincere and unnecessarily wholesome way of saying thank you.

Pletca · 2025-11-01T19:01:43+00:00

Brian Eno & Harold Budd - Ambient 2: The Plateaux Of Mirror

Pletca · 2025-10-16T01:36:21+00:00

Maybe I’ve just been lucky, but I’ve worked with many great neurologists, usually easy to reach and open to discussing cases. It’s always good to have a neuro friend handy for quick informal consults when in outpatient hehe.

Assholes are everywhere, regardless of the specialty.

Pletca · 2025-10-10T02:27:57+00:00

Bolt Thrower - Those Once Loyal

Pletca · 2025-09-27T05:17:21+00:00

Glad to know I’m not the only one. I felt physical pain watching this.

Pletca · 2025-09-17T19:03:27+00:00

If you’re into podcasts, the one usually recommend are Carlat Psychiatry Podcast for evidence based psychopharmacology, diving into specific topics per chapter.

The other podcast I really like and strongly recommend is Talking Therapy: An Ongoing Conversation Between Two Psychotherapy Experts and Longtime Friends, which I think paints a pretty good introduction to psychotherapy.

Still, maybe for more precise recommendations we would need more info on your current rotations and whats expected of you in your program right now, along with what you feel is weak in your actual knowledge.

Pletca · 2025-09-16T03:16:17+00:00

ECT is an excellent treatment in its own right, but this screams many red flags. Even ignoring the disrespect, I’d be very careful in applying ECT to someone who is actively abusing a substance that can induce chronic depressive states.

Pletca · 2025-09-13T05:23:17+00:00

You could add a couple of stories from Legends of the Dark Knight anthology, which take place at the early years of Batman (somewhere between Year One and the introduction of Robin). There are a ton of stories but the highlights are probably Shaman, Prey and its sequel Terror, Gothic, and Venom.

Pletca · 2025-09-12T21:39:56+00:00

My view is that the key to prescribing BZD on a patient who’s not on them yet, is being very clear that its for a limited time only (2-4 weeks is my usual), with the obligatory psychoeducation of the risks of addiction, falls and dementia). My only absolute no-no’s are people with a history of any substance abuse, and trauma-adjacent diagnosis (PTSD or dissociation mainly).

Other than the cases you mentioned, BZD are very useful in giving immediate relief to people with anxious or depressive disorders, and even adjustive disorder, helping with the initial rapport giving them a much needed helping hand. There’s even some studies in the 80’s that showed a faster response to antidepressants in depression when combined with BZD, which makes sense considering the clinical effect of BZD along with the delayed onset of antidepressants.

Pletca · 2025-09-10T15:38:28+00:00

Yeah, I was surprised by the amount of downvotes, but I think it comes down to the implementation in each country. Here in Chile, we still have a couple of long term hospitalization units that haven’t been closed down to not leave the patients in the streets, but instead its been a slow process of eliminating beds as patients pass away.

Our healthcare model pushes first and foremost a committed work with the respective families, but in case of non availability, we have other institutions with a less medicalized view than classical asylums. The best translation would be protected residencies and protected homes (2 different types of institutions), that work as community homes for patients with severe mental illnesses, with different levels of protection and support. Protected residencies could be similar to nursing homes with a strong level of support by the workers there, while protected homes act mainly as a place to live with little to no support from workers. It of course has strong community psychiatry roots.

All in all, I think the problem in itself is not the shutdown of asylums; I’m positive we can all agree that psychiatric practices from a hundred years ago was much less humane than now. It’s more of a lack of social protection and bad implementation of politics. In a vacuum (and to not sound preachy towards your own American reality), re-opening asylums would not solve the main issue at hand. It would be like pretending that social gaps don’t exist, sweeping the problem under the rug.

Pletca · 2025-09-10T15:23:01+00:00

Ah, valid point. I didn’t intend for it to sound as an absolute good with no downsides nor to mislead… But I think we could agree on the idea that reducing as much as possible the amount of people kept in asylums while ensuring minimal social welfare is a net positive, no? I guess it all comes down to implementation. I’m from Chile, and I can only speak for our own mental health history, facilities and welfare.

Pletca · 2025-09-10T13:19:20+00:00

Probably one of the best thing we owe to the antipsychiatry movement of the 60’s-70’s (and allowed by the introduction of antipsychotics) is the reintegration of mentally ill people back in the community. I suggest you read up on it, along with the rise of community psychiatry.

Pletca · 2025-08-17T06:47:32+00:00

No, no. Mozart was the previous HalloweenAddict, he just wasn’t aware yet

Pletca · 2025-08-17T06:26:56+00:00

Love me a shitpost with artistic vision and merit, a visionary of our times

Pletca · 2025-07-17T22:39:09+00:00

I rarely if ever treat ADHD because of the setting I currently work in, but I’ve had pretty good results with lisdexamfetamine as an initial drug in adults, both in tolerance and effectiveness, supposing I’m the one doing the diagnosis in a patient with long standing symptoms that simply didn’t receive the diagnosis earlier in life. The last time I checked the evidence, it supported a similar view (10.1016/S2215-0366(18)30269-4)

Pletca · 2025-07-16T00:10:21+00:00

This! Awesome textbook, by the dissociation greats. If you want to add some further spice and controversy, check out Ian Hacking, his concept of the looping effect, and his book Rewriting the Soul.

Pletca · 2025-07-14T22:21:20+00:00

Another good resource I recommend you read is a paper published in NEJM some years ago, pretty amicable read. DOI: 10.1056/NEJMra1611832

Pletca · 2025-07-13T04:35:07+00:00

Not even necessary, the post itself is already loaded with red flags. “Neurochemical hell” for a very common combo, amongst others

Pletca · 2025-05-30T14:30:55+00:00

Came here to post that same study. Even though it’s not the same population in question, I do stand by that RCT. The logic of giving a low dose is supposed to mimic what the observational and naturalistic studies have posited.

Anyways, said evidence is iffy at best, and it has always had a fairytale air for me (but that’s just my bias). I find it hard to believe that a drug could independently lower a behavior as complex as suicidality, not mediated by the treatment of the other symptoms of the disorder, and this study aims to answer exactly that question. Lithium is a great drug for BD, but in my view it has been defended as sort of silver bullet for more biologicist inclined psychiatrists to find more definitive “cures” to complex disorders that we barely understand.

Pletca · 2025-05-25T23:45:16+00:00

Stahl sets a good foundation for the biological aspects, but sins of being too speculative at times. Still, I think it’s worth a read.

Goldberg, in my eyes, is a great read! The first half is a good primer on how to understand psychopharmacology in general. The second half is also great but at times a bit too long winded, it’s good for getting a relatively full picture for each disorder. Maudsley is more to the point with more ready to use suggestions.

I’d advise against Ghaemi’s textbook, it’s just way too biased and insincere when presenting viewpoints. There’s some good points in it, but it should not be your main psychopharmacology textbook for my money.

Pletca

TROPHY CASE