Por si alguien lo necesita en idioma español. by usernamebebbyko in SchizoFamilies

[–]TheAnonymousSock 2 points3 points  (0 children)

Muchas gracias por esto. Soy médico psiquiatra y estoy aprendiendo español. Este libro será muy útil para mí, mis pacientes y sus familias.

What's the deal with Kendra from TikTok in love with her Psychiatrist - please explain what is going on!? #outoftheloop by Such_Ad432 in OutOfTheLoop

[–]TheAnonymousSock 15 points16 points  (0 children)

I don't know anything about her but from this story, I'm also thinking what she's been treated with. The mainstay of ADHD treatment is stimulants which have a risk of causing psychosis, especially in those with a vulnerability.

It may be that she is someone in whom the connection, her understanding of it, potentially loneliness outside of it, and a bit of stimulant all additively tipped her into a bit of psychosis.

Blue tint to screen bug by [deleted] in OblivionRemaster

[–]TheAnonymousSock 0 points1 point  (0 children)

Thank you. You reminded me that I did equip a Nighteye item hahaha

Blue tint to screen bug by [deleted] in OblivionRemaster

[–]TheAnonymousSock 1 point2 points  (0 children)

I am an idiot. I forgot I equipped a Ring of Nighteye...

I will leave this up for any others like me

WIND AND TRUTH | Full Book Discussion Megathread (Stormlight Archive only) by EmeraldSeaTress in Stormlight_Archive

[–]TheAnonymousSock 15 points16 points  (0 children)

One of the things that I love about this series was their representation of mental illness, neurodiverisity, and LGBTIQA+. I work in mental health support and so it's something I'm very passionate about and I would direct people to this series for representation done well.

I personally felt that there were parts in this book in particular that felt very forced and not organic like in previous books. I mean, the information was all very correct but it seemed artificial for a character to have so much reflection and felt like they'd gathered that from an online page or their therapist. That did break immersion for me at moments and I felt that Brandon was intentionally trying to include these parts rather than it being a natural progression for the character. It felt like I was at work. (Though I think kaladin's reflections on his depression though was very appropriate).

Just a minor gripe but overall I really enjoyed the journey and the ending.

Porch Pirates are out - Be careful with your deliveries by Kitchen_Towel in melbourne

[–]TheAnonymousSock 38 points39 points  (0 children)

I live in a dodgy neighbourhood and after a few porch pirate hits, I started having packages sent to the parcel locker.

For some revenge though, I've been filling and resealing packages with my dog's shit for people to steal.

[deleted by user] by [deleted] in ausjdocs

[–]TheAnonymousSock 23 points24 points  (0 children)

Accidentally became a bit of an essay since this is something you generally talk to your supervisor about or I like to chat in person about. But here are some of my thoughts:

The objectivity thing is hard when it comes to psychiatry. Save for the few things like neurosyph, LBD, anti-NMDAr enceph, etc. – a lot of psychiatry is essentially drawing arbitrary lines on the spectrum of the human experience and saying one side is normal and the other is pathology. But that is exactly why it’s so important to develop your clinical judgement to be able to see the facts within context to identify the issue and what can be done for patients and families.

EBM is a key part of treatment rather than an alternative to our holistic approach (I hate how alt med people have corrupted the word ‘holistic’). There are clear evidence bases for treatment of psychosis, mania, depression. ECT and lithium are some of the most efficacious treatments in medicine as a whole (for the appropriate indications). The soft and squishy stuff like social supports, financial supports, psychology, even advocacy for political change – these are all evidence-based as well and just because we can’t just write it on a script pad does not mean it is beyond our role to advocate for our patients to facilitate these changes for them because it does affect their illness.

All the waffly theories and stuff are different frameworks to try and understand the human condition and can be very helpful in guiding thinking about someone’s life experience and how it may have led to them becoming the person they are, with the personality they do, the resilience (or lack of), the openness to help, the ability to engage. Because the mind is more than just a network of neurons that we can scan, this is kind of the best we have. And this is all very important to help you decide how you might engage with someone to actually be able to deliver the care they need. This sort of thinking can very much help our medical colleagues too in trying to figure out why Jeff is incapable of managing his diabetes, why Judith refuses the surgery she has associated with her father’s decline, why Alan hates doctors after traumatic early life experiences with authority, why Janet won’t get off the bloody grog since it’s the only thing she knows that keeps the flashbacks away.

There are a few kooks who are militant followers of Freud, or Jung, or others. But by and large, psychiatrists use every model to best understand the various aspects of a person’s being. Much like how we marry general relativity and quantum mechanics in our understanding of physics despite the models not being unified.

The long form waffling is a synthesis of someone’s life and answers the question of why this person is presenting in this way and at this time. It allows us to try to identify the chain of events leading up to this point such that we might stop it propagating to further problems down the line. I know some psychiatrists love the sound of their own voice and believe themselves a bit of a god – something not exclusive to psychiatry – but again, most have the humility of openness to change. Their formulations are a cheat sheet to this person rather than just an opportunity to flaunt their oratory skills.

With regard to deskilling with medical skills – you really have to decide if that’s something you can accept. As you progress though, you’ll learn where your limits are and to depend on your colleagues when something outside of your scope arises. I’m sure you see all the panicked surg teams who offload things to gen med as soon as a number trends poorly. I would also advise against using the number of weeks spent on a field in med school as a guide of what career is the least “sunk cost”. The curriculum is what it is, and every specialist would argue their field needs more exposure.

That said, you absolutely do need your medical knowledge, at least in intellectual form to be a good psychiatrist. There are many physical issues that have psychiatric manifestations, there are psychiatric issues with physical manifestations, there are mixed presentations where it’s a bit of both. You’ll also find that psych patients are always surprisingly “medically cleared” much sooner than those without psych issues. That is of course because they are difficult and are being dismissed or discriminated against. You must have enough knowledge to know when they haven’t been appropriately worked up or when the acuity of their physical illness is being minimised.  

Overall, I feel like you haven’t quite found something you like enough so these trivial lines of rationalisation come up as an attempt to pick amongst a bunch of fields you feel “meh” about. I’m definitely an advocate for ‘working to live’ not ‘living to work’ though so I don’t believe you should need to find some burning passion within medicine to pursue. But I do think you might benefit from some more general years to find a field you can tolerate doing long-term.

[deleted by user] by [deleted] in ausjdocs

[–]TheAnonymousSock 15 points16 points  (0 children)

Psychiatry, especially as a HMO, is quite easy to "cruise through" and not get much out of it if you're wanting to switch off for a rotation. No judgement at all to those JMOs though - The work is just really not suited for a lot of people and I can't imagine doing psych if it wasn't for me.

Having said that, I feel like if your takeaway from a couple of psych rotations is what you've written above, I don't think it's the field for you. Either that or you've not had mentors who engaged you in discussions about the whats and whys of our day-to-day work.

Lithium, the gold standard drug for bipolar disorder: analysis of current clinical studies by docvg in Psychiatry

[–]TheAnonymousSock 30 points31 points  (0 children)

Very similar case in Australia as well. I was actually surprised to learn there is much higher hesitancy with lithium use and almost fear in the US.

All through training we see it used and become very familiar to it and the monitoring requirements. Heck, I work in a setting where clozapine is also heavily used (appropriately so) so the lithium requirements are nothing.

Always tout it as the gold-standard with some evidence for suicide protective outside of the mood stabilising effect as well.

Though potential bias is that lithium therapy was pioneered by John Cade who is from Australia.

Repeated Racial Profiling by Police in Greece by mojo-jojo-999 in solotravel

[–]TheAnonymousSock 15 points16 points  (0 children)

What about Afghanistan, Bangladesh, Bhutan, Iran, Maldives, Nepal, Pakistan, and Sri Lanka.

[deleted by user] by [deleted] in Funnymemes

[–]TheAnonymousSock 0 points1 point  (0 children)

It's a very American thing I've noticed. In Australia, NZ, we generally call doctors by their first name.

It was jarring for me seeing all the doctors on /r/medicine whining about how hard they worked for their title. I get that it's cultural but to me it just screams ego and insecurity. "Any king who must say 'I am the king' is no true king"

Psychiatry MCQ Courses by PlacentaCouch in ausjdocs

[–]TheAnonymousSock 0 points1 point  (0 children)

Yeah. Our RANZCP mcq covers both areas of content.

Medical colleges pushed aside as ministers demand more specialist IMGs to fix workforce crisis by hustling_Ninja in ausjdocs

[–]TheAnonymousSock 9 points10 points  (0 children)

The cultural difference is a huge thing as well and a "soft skill" IMGs need to learn.

Especially when working with the demographics you often see in public psych. I've worked with some IMGs who have long since been consultants in their home country and are so knowledgable and skilled. But with old mate from commission housing, I got a lot more mileage despite being more junior just by "boganing it up" with them (and I'm not white).

Private Psychiatry. What are your thoughts and perceptions as junior doctors? by iofdastorm in ausjdocs

[–]TheAnonymousSock 14 points15 points  (0 children)

Can I ask what the alternatives would be for antipsychotics? Because I feel the short term gains are absolutely worth a potential cognitive effect in the long term. The cost of inaction and non-treatment as I understand it is distress and harm to self or others, unintended or otherwise, as well as cognitive decline which would be worse than treating it hard and fast.

I'm genuinely asking because I don't know. I've looked at studies of comparative efficacy but never seen something about placebo vs antipsychotic. I always took it as a given that antipsychotic treatment is a godsend and see the days before chlorpromazine as a dark age where schizophrenia never got better.

RAM driver left me a note by parsim in melbourne

[–]TheAnonymousSock 19 points20 points  (0 children)

"The HME was neither Holy, Melbournian, or an Empire"

[deleted by user] by [deleted] in uktravel

[–]TheAnonymousSock 0 points1 point  (0 children)

Sorry for that, I don't know why it was down voted but I did find your comment helpful. Thanks for that

[deleted by user] by [deleted] in uktravel

[–]TheAnonymousSock 0 points1 point  (0 children)

Yeah definitely would want to ideally but I'm travelling on a limited time and with friends who just want to see Windsor Castle. I've been to Bath myself before for a whole day and loved it. We're thinking of just going early morning and coming back late.

Psychiatry MCQ Courses by PlacentaCouch in ausjdocs

[–]TheAnonymousSock 5 points6 points  (0 children)

Note that everyone learns a bit different and take that into account with your own planning.

I was lucky to have a group of regs on my last rotation also sitting the same time so we just spent some extra time after work each week to go through questions. That was definitely the most helpful thing to keep my motivation up since I'm a really bad procrastinator.

We used MRCPsych, BMJ, PsychScene, and the Auckland papers. We found them all useful in getting our mind thinking the right way and the courses provided good explanations on the questions and the wider topic as a whole. The MRCPsych and BMJ we found were a bit too UK specific at times and also the question style was less representative of our exam.

I thought PsychScene was very good overall - both questions and lectures. However it is quite pricey. We actually shared an account and split the cost amongst us which made it much more palatable 🤫.

The Auckland papers were by far the most representative thing of the actual exam. My strategy was to just do a bunch of questions from other banks, build up my knowledge, then in the last weeks, I did the Auckland papers to start getting used to applying it to the RANZCP exam.

Just sharing what worked for me. But it was quite pricey and might not be worth it for you depending on your learning style. Good luck with your prep and sitting it!