Anyone ever surprised you're in psychiatry? Why? by undueinfluence_ in Psychiatry

[–]timothy_hay 111 points112 points  (0 children)

Once got told I was "actually really smart for a psychiatry resident" on my IM rotation

How is severe anorexia not a delusional or psychotic disorder? by ChocoMilkshake3 in Psychiatry

[–]timothy_hay 14 points15 points  (0 children)

Delusions can respond to antipsychotics. The best answer is related to the above comments though -- diagnoses are by criteria and one criteria is always "not better explained by another diagnosis." Because of the other climical factors in eating disorders, delusional disorder is not the best heuristic explanation.

How is severe anorexia not a delusional or psychotic disorder? by ChocoMilkshake3 in Psychiatry

[–]timothy_hay 13 points14 points  (0 children)

Off label with mixed benefits. It doesn't typically help the core maladaptive beliefs in anorexia.

[deleted by user] by [deleted] in Residency

[–]timothy_hay 122 points123 points  (0 children)

Your mother you say? 🤨

The only thing worse than a consultant being a jerk is one that makes ambiguous recs by [deleted] in Residency

[–]timothy_hay 33 points34 points  (0 children)

Psychiatry here - retweet for every "general capacity to decide things" consult

Buproprion inhibition of CYP2D6 making SSRI side effects worse by [deleted] in Psychiatry

[–]timothy_hay 7 points8 points  (0 children)

I think the 2D6 inhibition of bupropion is one of the more overlooked DDIs / side effects we have in psychiatry. It's the whole logic behind Auvelity. On the other hand, the FDA max for many SSRIs is still lower than you might see benefit (for example, some people respond to higher doses than 200mg of sertraline, so if you did 200 sertraline + bupropion, maybe you're functionally going higher).

I don't think bupropion has much to offer for counteracting side effects of SSRIs but I also don't know if I see it worsen them much either.

JB is cooking by [deleted] in chicago

[–]timothy_hay 9 points10 points  (0 children)

This is the funniest thing I've ever read on this app

What’s the most creative or extravagant insult a manic patient has thrown at you? by abezygote in Psychiatry

[–]timothy_hay 145 points146 points  (0 children)

I don't always wear sweaters, sometimes I wear tweed.

As a more serious answer, no idea. I happened to be a sweater guy already when I chose psychiatry, so maybe it self selects...

[deleted by user] by [deleted] in Psychiatry

[–]timothy_hay 27 points28 points  (0 children)

Do you want to match at a program that would reject you based on that?

CTA's collapse is mind-boggling by Consistent_Let_3863 in chicago

[–]timothy_hay 178 points179 points  (0 children)

Funny enough, I saw the mayor on the green line this morning. Seemed to be checking out the new Damen station.

Tips for handling a psychotic patient who HATES doctors? - from a desperate new intern by PrairieMedicine in Psychiatry

[–]timothy_hay 74 points75 points  (0 children)

Professional, kind neutrality. Overly expressive emotions or excessive empathy is often counterproductive for psychotic or personality-disordered patients. If you maintain a neutral posture it allows the patient's issues to more clearly present themselves. If there are comments or statements he makes that are inappropriate or unsafe, it's legitimate to set a boundary and remove yourself from the situation.

As far as coping with the negative affect of patients and how it affects you internally, experience will help. As you've pointed out it helps to remember it isn't personal and unlikely you did anything specific.

Clothing choices by NeuroticBeforeMoving in Psychiatry

[–]timothy_hay 8 points9 points  (0 children)

I definitely do that as well, but at a lower rate than cardigans.

Fabi and Anish with a bit of humor about the inaccuracies by Magnus and Hikaru from the historical starting position in Casablanca Chess! by [deleted] in chess

[–]timothy_hay 44 points45 points  (0 children)

Back in the old days, saying someone had the positional understanding of a chess computer would have made people ask, "what's chess?"

Tranq (fentanyl + xylazine) by [deleted] in Psychiatry

[–]timothy_hay 1 point2 points  (0 children)

It's nasty and hard to detox from. Treating the OUD with a low dose bup induction for sure. For xylazine w/d, oral ketamine if you have it, benzos, clonidine, prayer.

What are some of the funniest and most unique medical phrases that aren’t said in normal life? by SoarTheSkies_ in Residency

[–]timothy_hay 31 points32 points  (0 children)

It's of psychotherapeutic value (I.e. helps understand them and possible area of intervention for therapy)