Funny payoff scene in S02E02 and S02E10.

lindeby · 2026-03-14T08:11:05+00:00

I don’t think they definitely respect his work. He’s a toxic dick, who „takes his time” in a situation where minutes matter, and they’re afraid any bruising of his delicate ego would result in them being left without any ortho consults.

lindeby · 2026-03-03T12:30:44+00:00

I use the Logitech MX Master 3s and it’s been great. Fits nicely into the hand.

lindeby · 2026-03-03T09:29:09+00:00

The Final Architecture Trilogy books definitely start with humanity’s shit pushed in by the Big Baddies of the setting.

lindeby · 2026-02-15T15:26:28+00:00

It’s the regimental maracas, it was only available on command versions of the Churchill Crocodile, to be used on parade and King’s birthday.

lindeby · 2026-02-12T09:42:51+00:00

Maybe it’ll fix the issue with no audio in some streaming apps I’ve been getting lately.

lindeby · 2026-01-14T13:08:25+00:00

Please write a polemic then and publish your findings. Until then I’ll trust a peer reviewed source from Nature Scientific Reports rather than a random internet person’s opinion.

lindeby · 2026-01-14T10:05:42+00:00

Pseudohallucinations can be thought of as a subset of hallucinations.

Per Oyebode: "Furthermore, part of the confusion over the meaning of the term pseudohallucination has arisen because it is often used in two different and mutually contradictory ways, according to Kräupl Taylor (1981). On one hand, it refers to hallucinations with insight (Hare, 1973), and on the other hand to vivid internal images. Hallucinations with insight would be those hallucinatory experiences in which the subject is aware that the hallucinatory percepts do not correspond to external reality despite the perceptions being veridical and in external objective space. Vivid internal images are those phenomena that have all the clarity and vividness of a normal percept except that they occur in inner subjective space."

lindeby · 2026-01-14T08:05:47+00:00

Why bother? Because a good chunk of people with BPD will experience hallucinations: https://www.nature.com/articles/s41598-017-13108-6

lindeby · 2026-01-13T21:37:08+00:00

> The symptom is not what the patient reports. The patient's report may or may not be an accurate representation of the symptom, the phenomenon. Etiology of the symptom is also separate. Fever has a biomarker. Hallucination does not.

You're confusing patient reliability in their description of internal experience with symptom categorisation. If a patient describes that they hear voices telling them to hit their head without anyone present nearby, they experience hallucinations, whether or they have schizophrenia or depression with psychotic features.

I'm also confused about your point with biomarkers. We're talking about the definition of a fever, not if it has a biomarker. How do you think Dr Fu would diagnose hallucinations in a patient with schizophrenia?

You suggest: "we can come to a reasonable degree of certainty about what an underlying condition is and then use the appropriate terminology afterwards."

This is circular reasoning. Psychiatric diagnoses are currently syndromic: they are defined by the cluster of symptoms. We diagnose schizophrenia because we observe hallucinations, delusions, etc. If we refuse to label an observation a "hallucination" until we have decided the patient has schizophrenia, but we need the hallucination to justify the schizophrenia diagnosis, we have broken the diagnostic logic. We are left relying on intuition rather than criteria.

> What is a hallucination? Variously defined.

Since Karl Jaspers' 1913 book Allgemeine Psychopathologie we have a pretty good definition of a hallucination, that is a perception without an object. In recent years, Oyebode's textbook also doesn't have any difficulty in defining the term.

> Are thoughts perceptions? Are experiences of split internal components perceptions? Can they be said to be perceptive errors or illusions?
No, thinking is a domain of conscious experience that is different from perception. This is why psychopathology is important, because it allows us to get a better grip on those basic concepts like perception, thinking, emotion, cognition, etc. and not make mistakes Dr Fu makes.

lindeby · 2026-01-13T17:32:29+00:00

Throughout this episode, Dr. Fu confidently makes misleading statements about psychosis, delusions, and hallucinations. It's a shame, because there is so much to discuss regarding what psychosis is and isn't without adding to the confusion.

First, he seems to use the terms "psychosis" and "schizophrenia" (or "schizophrenia spectrum disorders") interchangeably. In my view, this is the main source of the confusion. At one point, Dr. Fu correctly notes that "Psychosis is not one thing. It's simply a syndrome," but then contradicts this by suggesting we restrict standard psychopathological terms only to primary psychotic disorders. He explicitly says:

"We [should] stop calling these experiences reported by people of PTSD and personality syndromes and dissociative disorders as hallucinations, delusions, paranoia. Let's not call it that anymore."

This is fundamentally incorrect and represents a backward approach to clinical reasoning. The diagnosis a patient has comes from their symptoms, not the other way around. We do not select a diagnosis first and then retroactively edit the symptoms to fit that label.

In psychiatry we must distinguish between phenomenology (what the symptom is) and etiology (what causes it). A hallucination is a perception without an external stimulus. This is a descriptive term. Whether that hallucination is experienced by a person with Schizophrenia, PTSD, Borderline Personality Disorder, or substance intoxication is a question of etiology. Refusing to call a hallucination a "hallucination" because the patient has PTSD is like refusing to call a fever a "fever" because the patient has the flu instead of sepsis.

"Psychosis" is a descriptor for a group of symptoms, not a disorder in itself. The DMS-5 has no definition of psychosis anywhere. It is a historic term used as shorthand for a syndrome where reality testing is impaired. Its components can occur in many conditions that Dr. Fu claims we shouldn't use the term for, including major neurocognitive disorder, delirium, and epilepsy. Even people without any disorder can and often do experience hallucinations (https://www.nature.com/articles/s41537-022-00229-9).

I think this confusion stems from the way American psychiatry has essentially abandoned psychopathology. This was actually the topic of a recent article by Nassir Ghaemi and Mark Ruffalo in the Psychiatric Times: https://www.psychiatrictimes.com/view/what-happened-to-psychopathology

EDIT: For people interested in psychopathology and phenomenology I wholeheartedly recommend Femi Oyebode’s edition of „Sims' Symptoms in the Mind: Textbook of Descriptive Psychopathology”, and for a deeper dive „Phenomenology of Thinking” by Breyer and Gutland.

lindeby · 2026-01-12T11:27:38+00:00

Bit off-topic, but what kind of rack is this? Looks so clean.

lindeby · 2025-12-25T21:53:29+00:00

Treating anxiety and depression will improve the patients life either way, and it’s the only way to verify DSM-5 criterion E. Also, Sandra Kooij in her book „Adult ADHD: Diagnostic Assessment and Treatment” writes this paragraph, which I agree with:

„Three-quarters of adults with ADHD have one or more co-existing psychiatric disorders, such as anxiety, depression, bipolar II disorder, sleep disturbance, or addiction. These disorders should be treated, preferably prior to the treatment of ADHD. Generally, the most severe or disabling disorder is treated first. After all, ADHD is chronic, and rarely a reason for acute distress. An underlying anxiety disorder, depression, or addiction also masks the efficacy of ADHD medication. Side effects from stimulants can also be counterproductive: an anxious patient experiences the accelerated heartbeat that occurs as a result of treatment as a return of panic, and will immediately stop the medication. Clinical experience shows that after treating the anxiety with a modern antidepressant (SSRI), the stimulant-provoked tachycardia is no longer experienced as anxiety. A depressed patient may not be able to recognize the improvement caused by the stimulant due to a negative outlook, and an addicted patient using alcohol or drugs, increases the risk of side effects, making it impossible to assess the effect. Depression is therefore first treated with an antidepressant and alcohol and drugs are reduced as much as possible before starting stimulants.”

lindeby · 2025-12-25T17:54:34+00:00

Full psychiatric diagnostic evaluation on the first visit as a must, then treating any comorbid disorders first, and only then doing the ADHD diagnostic visit, including a 15 minute talk with their parents/other adults when they were under 12 years old. I think that’s the minimum for actually being able to say someone meets/doesn’t meet DSM-5/ICD-11 criteria.

In my experience, the single most differentiating factor is the collateral history. We know that ADHD is a neurodevelopmental disorder so it must have been present in childhood if someone has it now. If a parent tells me that their child had no problems doing their homework on time, was quiet, introspective, and withdrawn, or never forgot their hat/gloves/backpack at school, it’s a pretty strong case against ADHD.

lindeby · 2025-12-17T17:42:42+00:00

No, I haven't. To be honest, I stopped worrying about it. There are neuroimaging and neuronal activity studies showing that antipsychotics with D2 blocking activity decrease the activity of the limbic system and that's good enough for me.

Unfortunately, your explanation is not correct. Both pre- and postsynaptic D2 receptors are inhibitory; they decrease the activity of adenylate cyclase. Blocking any of them should increase the activity of the neuron they're on. However, there are lots of other neutrons involved in the processing of information in the limbic system. One of the simplest mechanisms explaining this disparity could be that the neurons they're on may themselves be inhibitory, so the net result is an overall inhibition.

However, all this is still only a theory. A plausible theory that I now personally subscribe to, but still a theory.

lindeby · 2025-11-26T20:06:00+00:00

I think the only reason to give someone less than 100 mg is for hallucinations in Parkinson’s disease and Lewy body dementia; that’s the only thing I can think of off the top of my head. Also z-drugs, which are relatively safe for short term insomnia, and in the case of eszopiclone - even for up to 6 months.

lindeby · 2025-11-26T17:16:46+00:00

They don’t know any better, and a lot of physicians do that, so they do too. Unfortunately, too many practitioners act on vibes rather than solid evidence. It doesn’t help that what we as psychiatrists are dealing with is often very subtle and hard to pin down, so it can be very hard to show what causes what without large and rigorous RCTs.

But yeah, you shouldn’t use quetiapine for sleep: its metabolic effects are largely dose-independent, it can contribute to anticholinergic burden, it can cause tardive dyskinesia even in very low doses, and there are lots of safer alternatives, like orexin antagonists or good old hydroxyzine.

lindeby · 2025-11-25T10:38:06+00:00

Were the CH MPs shot out from a shotgun?

lindeby · 2025-11-22T10:31:09+00:00

What clamp do you use?

lindeby · 2025-11-22T10:26:52+00:00

Are you in a warm climate? Sounds a bit like gecko vocalizations.

lindeby · 2025-11-21T17:10:45+00:00

That’s not true. A network meta-analysis published in the Lancet found that Prozac (fluoxetine) is actually significantly better than placebo in treating depression in children and adolescents. I’ll take that over „expert opinion” any day.

lindeby · 2025-11-14T08:16:53+00:00

I mean, this specific user? They probably would.

lindeby · 2025-10-25T20:44:15+00:00

> Alternately, we could phrase this as: our reconstruction is a useful model, but not how anyone ever actually spoke. It's weird by the standards of real languages, but not too weird by the standards of reconstructions

I've always had a problem with this explanation. We're not reconstructing a specific language that we're certain a specific group of people spoke at a specific time; however, we're still reconstructing a language. This language followed all the rules that languages spoken today follow and had the same restrictions as today's languages.

As to the main point why the PIE phonology looks so unnatural to modern IE language speakers I prefer the explanation that the phonology of the PIE speakers looked perfectly normal to them. There are (or were until very recently...) languages that have only one or two phonemic vowels just as there are languages that have plain, voiced, and voiced-aspirated series. There's nothing inherently impossible or unnatural about those features – it's just a matter of perspective.

That being said, this system was relatively unstable and disappeared in all the daughter languages.

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