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One of the things my parents did understand correctly as “new money” is that a significant portion of piddling etiquette rules about what color to wear at what times of the year and which fork goes on the left were largely ways for the bourgeoisie to attempt to maintain their advanced standing against the increases in (the potential for) equality that capitalism initially brought about. Unfortunately my parents are also a very “well we got ours so everyone else must be lazy” type of people who think that’s as good as equality can or should get.

Eeeeh. I kinda get why it fell out of favor. For context, the weird thing about the nursing perspective vs the MD perspective is that you don’t get as much of the benefit of large studies, but you also aren’t as sensitive to big pharma marketing studies either which… good AND bad. Like for school I had to take a class on evaluating the validity of drug trials and one of the studies mentioned was taking advantage of the fact that there’s basically no equivalent doses between different antipsychotics but you can also look at the doses from an experienced clinician perspective and be like huh they’re saying this drug has less side effects compared to 20mg of Haldol daily, but literally ANYTHING has less side effects than 20mg of Haldol daily; that dose is insane. The nursing perspective also tends to be more sensitive to variations in the needs of local populations, you’ve lived in an area and worked within that specific demographic and environmental setting for a few decades vs the doctors main body of knowledge often even includes studies from across the world. Just giving some background as to the upsides and downsides of my perspective.

So back to my point, I can tell you I associate lithium with being a last resort med for really sick patients who nothing else cuts it for. I associate it with horrible side effects including crazy weight gain and thyroid problems as well as fluid and electrolyte balances, and depakote and tegretol aren’t gonna cause that last one at all and also do have that advantage of blood level monitoring. I don’t see tegretol prescribed as much but depakote is probably what I see as the most prescribed med even before lamictal. Now lamictal I completely understand why I’m not seeing in the inpatient setting; you can’t rapidly titrate without risking the death rash (SJS/TENS), and the objective of inpatient care is always rapid stabilization with tweaking to occur in the community. And also maybe I’m associating lithium with all these horrible side effects because I’m seeing it used for patients suffering from both the direct effects of severe mania, especially those with the cumulative effect of multiple manic episodes over time, as well as all the other horrible things those episodes put them at risk of such as homelessness, substance abuse, and general increased risk of injury and illness due to decreased capacity for self care.

I guess the TLDR is, it wouldn’t shock me if the inability to patent salt was the reason lithium isn’t preferred, but I also associate it with being a pretty old-school heavy hitter like thorazine is for psychosis, and while my perspective has the advantage of being more experiential, that comes at the disadvantage of being less empirical (but its also often difficult to tell how empirical some studies are due to the influence of capitalism on the development of pharmaceuticals).

As a professional I’d basically be required to say the above, but I’m also watching from the inside as my country’s health system decays starting with populations that were underserved to begin with like the mentally ill. In other news I have a hospice interview tomorrow. If nothing else I’ll just get to focus on making people comfortable. That sounds so relaxing. I’m getting tired of having to tell people no all the time.

Yeah the line between adhd and bipolar is thinner than ppl wanna admit. Lemme find The Infographic.

Well its mixed because he still wants to be able to force his mistresses to get them. He just wants the poor to keep reproducing at uncontrollable rates because the best way to have parents not care that you’re having sex with their children is to make sure they have too many to keep track of.

I am absolutely awestruck by the amount of bravery and critical thinking under stress that it must have taken to understand that you needed to sign a DNR for your 7 year old. Most parents in your situation would barely be able to add up 2+2, let alone comprehend enough of what the doctor was saying to make that kind of decision.

I’m also so happy for all of you that you wound up not needing that DNR. I hope she’s adapting well to her life with those limitations, but often children that age have enough neuroplasticity to work it out. She’s also certainly got parents who know how to put their own emotions aside and make sure she gets the care she needs, so under the circumstances she’s got a lot going for her. <3

Yeah like tbh the original comment thread wasn’t worth banning them. Kinda silly but whatever. Literally everything after that was worth a ban though. They picked a molehill and just… fought to the last breath on it.

And if you’re really dedicated to being a person who saves lives and its a big part of your personal identity, you’d also be risking the lives of the future people you’d be able to help and your identity as a person who saves lives. You can’t help this one person in this specific life threatening situation but there’s other peripartum hemorrhages you could help and many more you could try to keep out of that condition to begin with. But to do that you have to let this one person die despite knowing how to help them too. Absolute shit sandwich.

I’m working on developing a better work life balance but for the longest time working as a nurse has been the thing I stuck around on ye olde mortal coil for. It’s what was worth sticking around to try and get through all that therapy for. I won’t try to say it’s healthy but if I lost my license I don’t really have a whole lot left to stick around for.

Bingo. This is my interpretation as well.

On a related note, I’ve been thinking lately about how many older men have gone absolutely batshit on me for suggesting that they may not be able to safely pee standing up anymore. Its so hardwired in some of them that sometimes even bilateral amputees with enough dementia will insist that they need to stand up to pee. I’ve literally pulled back the blankets to show them their missing legs and they look right back up at me and keep yelling at me to get out of the way.

It’s happened so much at this point that I’m very desensitized to it. They’ll be threatening to kill me and I’m just “ah yes the good ol’ standing piss argument.” It’s practically as developmentally normal as a toddler not being able to share toys or a teenager having an unstable personal identity. Not sure what the female equivalent is, most of the violence I receive from that population seems to relate to trauma / fear related to sexual assault; they have difficulty calmly accepting assistance toileting because they’re worried I’m going to hurt them vs it being less common to be a pride issue with women. Although I suppose the pride just boils down to a fear of being taken advantage of for being weak.

TLDR; loss of independence is rough and in addition to the driving thing there’s a few other interesting manifestations.

There’s also practical benefits. As someone without children I’d really like to see more funds and attention paid to education because I’m getting really fucking sick of interacting with stupid people.

I run into troubled young men a lot, unfortunately. I was raised female so I often lack the context to truly empathize with their life experiences, and I’m really hurting for coworkers to consult who can.

Yeah when I got that report and responded all I could think was “this thread is basically incomprehensible. Why are these people arguing poetry vs theoretical physics? It’s like arguing whether or not TMNT is enjoyable based on it not being an accurate depiction of turtle biology???” There is a time and a place to get this heated about the fundamental concepts that define the universe we inhabit but a lemmy post about a Tumblr post that’s written like an overly dramatic fanfiction just ain’t it. The last time I got into an argument that dumb (somewhat coincidentally also on tumblr) was literally over half my life ago!

You hear this a lot in nursing too when people talk about how nursing assistants should make more. “But that’s what I make and I have more education and am responsible for more!” Correct, your pay should rise as well.

Well said. This is the only person I’ve ever personally banned and it’s because they went out of their way to start multiple fights over silly shit.

The harm I notice Peterson doing is setting back men’s mental health movements. A big barrier I run into working in mental health is not having enough male role models either locally in my area or public personalities online who are willing to discuss things like medication and therapy, but also to discuss the important lifestyle changes that have to be made, particularly in terms of healthy relationships. A big part of men’s mental health needs to be men supporting men instead of competing for women to then use as their sole emotional support. In addition to placing an unfair burden on women, it’s just frankly a burden that can’t and ultimately won’t be carried, leaving men with inadequate support when there’s a better solution to be had. Instead you have peterson (and others, but Peterson has a fancy psych degree to hide his bullshit behind) perpetuating these antiquated ideas that men should be competing with each other. Men deserve better.

I recently listened to “A Wizards Guide to Defensive Baking” recently and I was NOT expecting YA fantasy fiction to go that hard on the subject of “heroism” being a term used to excuse the phenomenon of pushing people into dangerous jobs way too young to cover for the systemic failures and often outright corruption of existing power structures. I had a good few years experience in Healthcare beforehand but I graduated nursing school mid-covid and that book really spoke to me.

Somewhat coincidentally iirc it was actually released mid COVID as well, and I imagine had been worked on for years beforehand. So it’s interesting to me that the author picked up on the already existing manifestations of this phenomenon in a way that would speak so well to the epic clusterfuck that ultimately occurred.

I was just talking to someone a few hours ago about how sex ed in the US is so bad that a huuuge number of my psychosis patients will tell me they know someone came in to their room and sexually assaulted them overnight because they woke up with a boner or wet vagina. In nursing school they also told us that the average learning level of a US adult (particularly in terms of reading level) is about the fifth grade. My school did sex ed in 6th, so that checks out. In the US its just normal to not know how your genitals work. Especially about the opposite sex and especially when it comes to women’s anatomy, but also just in general. I’ve had multiple men tell me their morning wood is proof of a sexual assault. And you always get shit from police having to file these reports because like yeah obviously we have cameras proving no one did more than poke their head in the room for routine safety checks and this is clearly just a hallucination / delusion but also it’s their right to report it and it’s your job to write it down so like???

I’m surprised that particular aspect of the side effect profile comes into play with acute usage.

Well obvs. It’s basically,“idk which receptor is making them _____ (punch people, refuse to eat or drink, or whatever other immediate harm to themselves / others), but we need it to stop 3 days ago and can figure out the details or a potential cross-taper to something better later.”

Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.

Color me fascinated, lol. My guesses are personal experience / reading up on your own treatment or that of a loved one, tangential relation to the field such as clinical research, or just plain personal fascination. Given you linked to a drug that appears to be in trials my first guess is actually the second one. Hadn’t heard of it, and I’m hopeful, but after seeing abilify get approved for acute agitation I’m… skeptical.

i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.

Yeah a lot of people don’t realize the damage is additive, both people w/ these disorders and unrelated laypeople who think “talented artist stops taking their meds and continues to be talented but starts creating art with weirder subject matter as their brain boils” is a cool story.

I’m mostly replying to add though that risperdal also has the distinction of being avaliable as a long-acting injectable, and if you’re trialing oral meds before committing to an LAI, your options are somewhat narrowed. Zyprexa does have an LAI available, but I’ve actually never seen it used and while I can’t tell you why for certain, I do have a guess.

If you have a patient sick enough that you’re considering an LAI, you don’t want to take benzos off the table for an entire month, especially if it turns out to be inadequate after discharge and they wind up in an ED agitated and unable to report their own med hx and get B52ed and stop breathing. I’ve had a pharmacist tell me considering that interaction is going out of style but a history of that kind of adverse event is difficult for a med to shake. Accutane still has suicidal ideation in adolescents listed as a side effect but I have a strong suspicion that it’s less causation and more correlation with the impact of pizza face on the self and social esteem of a teenager.