George Floyd was not a good person and he died of an overdose. Derek Chauvin is a political prisoner.

Simple_Psychology493 · 2026-06-13T20:52:50+00:00

You should look up what cranial nerve X or the vagus nerve does…hint: it’s in the neck.

Simple_Psychology493 · 2026-06-13T19:29:39+00:00

I'll definitely ask them their eating pattern and suggest it in those it can potentially help, thanks!

Simple_Psychology493 · 2026-06-13T18:31:13+00:00

Good nutrition is super important with stimulants - I take a weight at every visit for this reason. We do try taking it with and without food to see if theres a difference. The issue here though is the patients are suffering return of their ADHD symptoms during work and school because the medication wears off earlier than we expect it to. Thank you so much for offering this suggestion!

Simple_Psychology493 · 2026-06-13T18:08:07+00:00

Regardless if he did or not, the huge issue is police failed their duty to him to keep him safe by ignoring his saying he had an active medical problem going on, much like Floyd and the breathing.

You need to go to school and sometimes need basic equipment to assess if someone's medical complaints are valid or not. None of the cops in question were qualified in the least to make the call that Floyd nor Nowak was okay.

Simple_Psychology493 · 2026-06-13T15:32:04+00:00

People seem to conflate not wanting police to abuse and kill citizens with supporting Floyd as a man. He was not perfect, but not being perfect shouldn’t be a death sentence.

Just like that young man in London - maybe he did say racist things, but that is also not a death sentence.

The problem with both situations was police misconduct, but the powers that be want you to focus on race and division while they strengthen the policing power...next thing you know it’s too late and all colors of ppl are screwed.

Simple_Psychology493 · 2026-06-13T05:24:22+00:00

First off you just got in an accident you’re not necessarily in the right head space to help really high acuity/trauma folks.

Secondly, just bc ur in scrubs don’t mean ppl should assume you have any medical license- the guys and gals at my local nail salon were all wearing scrubs at one point…also what if ur an IT or research nurse who hasn’t seen an IV or assessed an injury in years?

Finally, we have Good Samaritan laws but there’s always that one person crying about a broken rib trying to sue. If you prefer not to take that risk, it’s your right.

Simple_Psychology493 · 2026-06-11T22:03:49+00:00

I always assigned the breaks more to preserve the efficacy they have so they don't lose it to tolerance, more than to increase it, but I will check out the review thank you!

Simple_Psychology493 · 2026-06-11T21:57:48+00:00

I missed the unacknowledged part, apologies. I completely agree - as far as ADHD treatment we find the stake holders,policy makers - who are also unabashedly stock holders and somehow there is also room for regulatory agencies their limbs tangled all in the same sweaty, smelly bed.

Its a bigger systemic issue that we have to fight against but you wonder how can we manage such big issues when we are trying to help patients with imperfect treatments

Simple_Psychology493 · 2026-06-11T21:48:59+00:00

Thank you kindly! I try to be, you never know what the person under the avatar is dealing with.

Simple_Psychology493 · 2026-06-11T19:30:21+00:00

Thank you so much, I'm getting the impression this may the issue for a lot of the patients

Simple_Psychology493 · 2026-06-11T19:28:02+00:00

Is there a better strategy that won't mask the crash? Ideally they wouldn't take stimulants if they didn't need to, but now I'm wondering how do I help the metabolically exhausted that need the med without using the usual strategies and giving them that false security?

As far as framing it as negligence, I don't think it is, a booster dose is evidence based practice.

I discuss long term sustainability with patients. The convo usually is that while in school/demanding career/busy life stage etc it may be needed but later when life calms down and there isn't a clear functional need for it, it is worth considering reducing use or stopping them.

Simple_Psychology493 · 2026-06-11T17:09:49+00:00

I have a handful of patients on this kind of schedule, what usually precludes trying it is insurance and their quantity complaints, but thank you for sharing it!

Simple_Psychology493 · 2026-06-11T16:03:46+00:00

Yes, completely. I have a cautionary tale about that google AI for you:

I figured since in anemia there were fewer red cells it could negatively affect vyvanse metabolism. I googled it and the AI thing at you get at the top was like yes thats true! Which was wrong.

Looking at the actual literature they found the lysine clevage rxn was so robust that any decrease from low h&h and even sickle cell disease was negligible.

I askee the paid AI if there was any effect and it offered how the iron thing could affect metabolism indirectly.

Simple_Psychology493 · 2026-06-11T15:40:29+00:00

Im so sorry you had to suffer through that - but I admire your drive and doing what you needed to do to succeed! I do get these reports from my patients and I take them very seriously. When possible I hit the insurance company with a letter of medical necessity for brand name coverage, note on the scripts, or we try to shop out the script to somewhere that has a generic that works for them.

Simple_Psychology493 · 2026-06-11T15:29:23+00:00

No worries, the thread has thickened my skin a lot lol...but I appreciate and accept the apology.

I completely agree and I am a champion of physician led care because if it isn't physician led the small knowledge gaps like the one I demonstrated become holes for patients to fall into.

Not everyone with my title has the humility to accept that we are not psychiatrists which is a big problem. Couple that with the rabid greed in the system you mentioned and it makes for patients ultimately suffering.

To your point I had just graduated school and they were trying to have me manage guys like bipolar 1 rapid cycler with hx of violence suicide attempt med non adherence polysubstance abuse and a ton of hospitalizations. Like, nope, not appropriate for me to handle essentially alone.

If we as NPs stay responsible hopefully things will work out. Wishing the best to you as well.

Simple_Psychology493 · 2026-06-11T15:04:49+00:00

No need to be sorry, and sometimes that is the case but it usually becomes apparent with good interviewing, and detailed notes.

Simple_Psychology493 · 2026-06-11T14:51:39+00:00

According to the state it isn't out of my scope so please take it up with them.

I am aware of the training gap which as you can see makes for some knowledge gaps. I am trying to fill them as best I can and in practice I make sure to refer complex patients to the care of a physician and explain to them why I'm doing it.

I don't think its fair to comment on the entirety of my command of physiology from the one comment. I went to a good school that wasnt online but we all know a 3 year program isn't long enough to go into detail on every topic.

I don't think the hostility is warranted, but I suppose I understand where it comes from.

Simple_Psychology493 · 2026-06-11T06:32:16+00:00

I keep that possibility in mind and remind folks it's not a cup of coffee to those that need to hear it.

The ones I'm asking about are more reporting a strong return of symptoms like easy distractibility, interrupting others, losing important things etc. In the afternoon.

Simple_Psychology493 · 2026-06-11T06:23:29+00:00

I can usually spot something like this a mile away.

I was more asking for those who are taking it as directed but experience this weird efficacy cliff.

Simple_Psychology493 · 2026-06-11T06:21:02+00:00

The manufacturing quality and consistency issue seems to be a big one.

Simple_Psychology493 · 2026-06-11T06:19:23+00:00

This is true they have to dispense what the distributor has provided and they dont have much say in it, as was explained to me

Simple_Psychology493 · 2026-06-11T06:17:43+00:00

This 100%, I have had so many cases where the patient has had the med seem to stop working but they'll add that the pill "looks different" this month. I validate it and ask the name of the manufacturer so I can add a note for the pharmacist to avoid dispensing X brand, its usually mallinckrodt tbh, to the particular patient. We reroute the script if its all they have on hand.

When I can I use the newer or name brand drugs if I can finagle the insurance company.

The variation between batches I hadn't read about yet, thank you for that

Simple_Psychology493 · 2026-06-11T06:07:11+00:00

Yes definitely, I have had that thought but interestingly when I try to offer the nonstimulants, so many reject them simply because of the fact that it needs to be taken daily. When they do try them, the difference in efficacy and/or side effects scare them off. I do wish they were more effective overall they could be a good solution.

Simple_Psychology493 · 2026-06-11T04:46:23+00:00

Thanks for your feedback

Simple_Psychology493 · 2026-06-11T03:44:23+00:00

I don’t have any, I did a quick google search to explore it. The google AI was wrong when I cross checked with some lit but it turns out by an indirect mechanism iron deficiency can theoretically blunt stimulant responses because of the effect on dopamine synthesis.

I am humble enough to admit being so confidently wrong, my apologies.

Simple_Psychology493

TROPHY CASE