During our psych small group discussion today, everyone kept forgetting that mental disorder due to substance abuse is part of EVERY differential diagnosis in psych.
I am hoping the following two words will burn into people's brains that drugs alone can make you completely, utterly, mother-freaking insane:
Amy. Winehouse.
You're welcome.
Friday, January 29, 2010
Thursday, January 28, 2010
Great Quotes from Lectures Today...and a TV Show
"I am not giving up. I never give up...I'm...transcending the situation." -Sheldon, from 'Big Bang Theory' (How I've felt about the past...approximately...week.)
"We finished that lecture a little early, so should we take an extra long break before the next one? There might be other people coming...What? Ok then, screw 'em." -Dr Z
"No, you don't want to give lorazepam to someone who's already intoxicated. They have a tendency to stop breathing." -another lecturer
"The appearance of oligodendrocytes on section is mostly due to artifact...but we're just neuropathologists, so a reproducible artifact is good enough for us." -yet another lecturer
"We finished that lecture a little early, so should we take an extra long break before the next one? There might be other people coming...What? Ok then, screw 'em." -Dr Z
"No, you don't want to give lorazepam to someone who's already intoxicated. They have a tendency to stop breathing." -another lecturer
"The appearance of oligodendrocytes on section is mostly due to artifact...but we're just neuropathologists, so a reproducible artifact is good enough for us." -yet another lecturer
Saturday, January 23, 2010
Psych is not crap.
Why is it that people...even other physicians...treat psychiatry like the Special Olympics of the medical specialties? "Oh, I have a cousin who's a psychologist!" (Psychiatrists are physicians. Psychologists--even those with PhDs--are not. Doctors, sometimes, but not physicians. Psychiatrists can prescribe drugs. Psychiatrists are required to complete medical school, residency, and generally fellowship. Psychologists go to graduate school, and are fantastic, gifted, and frequently delightful people, but they aren't doctors).
In the words of one of my instructors, when they heard I was interested in psych, "Oh, you guys have come a long way from the days of id, ego, superego...you're getting really...scientific now." He's an ID (infectious disease) guy, and I wanted to reply, "Yeah, and you guys don't believe in miasmas and evil humors anymore. Good job." So instead I said, "Yeah, I did research this summer using co-registered structural MRIs to perform volumetric analysis of paralimbic brain regions associated with early-onset major depressive disorder. It was pretty...scientific."
And we're doing psych now, and a lot of my classmates are talkin' smack. Not all of them, but a lot, and a number of folks have been pretty effing insensitive. So, for the record, I've had some psych issues myself--early onset, partially genetic, partially environmentally induced. Anxiety and severe depression. Life-shattering, oh-crap-it's-hospital-time depression. An eating disorder thrown in. And I'm not particularly ashamed of it. Know why? Because if more people were willing to admit these things, it might be normalized, and people would calm the hell down with the guilt trips--"Oh, I NEVER let myself get depressed. I just don't have time."
"Maybe if you stopped thinking of yourself and started thinking of other people you'd feel better."
"It's all in your head."
"Snap out of it."
"Pray harder and Jesus will heal you."
"Just eat something."
My views on psych meds are...complicated, and more suited for an extended essay than for this venue. But hey, just for fun, let's talk about how difficult it is to get yourself euthymic (ie, OK) on meds. It's hard. I've been sampling various medications since I was eleven, trying to 'get right,' and in that time, guess what I've taken? Oh, you don't have to ask, I'll tell you. *This is why I haven't had to go to many of the psychopharmacology lectures.*
Sertraline, venlafaxine, fluvoxamine, trazodone, lorazepam, alprazolam, clonazepam, valproic acid, gabapentin, mirtazapine, quetiapine, lamotrigine, lithium, topiramate, zolpidem, aripiprazole.
How many? 16, ladies and gentlemen. The majority of diabetics have an easier time managing their condition than I've had keeping this under control. And I don't even get any MedicAlert bling for my trouble.
In the words of one of my instructors, when they heard I was interested in psych, "Oh, you guys have come a long way from the days of id, ego, superego...you're getting really...scientific now." He's an ID (infectious disease) guy, and I wanted to reply, "Yeah, and you guys don't believe in miasmas and evil humors anymore. Good job." So instead I said, "Yeah, I did research this summer using co-registered structural MRIs to perform volumetric analysis of paralimbic brain regions associated with early-onset major depressive disorder. It was pretty...scientific."
And we're doing psych now, and a lot of my classmates are talkin' smack. Not all of them, but a lot, and a number of folks have been pretty effing insensitive. So, for the record, I've had some psych issues myself--early onset, partially genetic, partially environmentally induced. Anxiety and severe depression. Life-shattering, oh-crap-it's-hospital-time depression. An eating disorder thrown in. And I'm not particularly ashamed of it. Know why? Because if more people were willing to admit these things, it might be normalized, and people would calm the hell down with the guilt trips--"Oh, I NEVER let myself get depressed. I just don't have time."
"Maybe if you stopped thinking of yourself and started thinking of other people you'd feel better."
"It's all in your head."
"Snap out of it."
"Pray harder and Jesus will heal you."
"Just eat something."
My views on psych meds are...complicated, and more suited for an extended essay than for this venue. But hey, just for fun, let's talk about how difficult it is to get yourself euthymic (ie, OK) on meds. It's hard. I've been sampling various medications since I was eleven, trying to 'get right,' and in that time, guess what I've taken? Oh, you don't have to ask, I'll tell you. *This is why I haven't had to go to many of the psychopharmacology lectures.*
Sertraline, venlafaxine, fluvoxamine, trazodone, lorazepam, alprazolam, clonazepam, valproic acid, gabapentin, mirtazapine, quetiapine, lamotrigine, lithium, topiramate, zolpidem, aripiprazole.
How many? 16, ladies and gentlemen. The majority of diabetics have an easier time managing their condition than I've had keeping this under control. And I don't even get any MedicAlert bling for my trouble.
Friday, January 1, 2010
Do It Now.
I think I've made my views on this clear in the past, but you need to go get emergency contraception. Right now. Plan B is now available as a single pill. In the past, it was necessary to take two pills, twelve hours apart. This is a great step forward (anyone who thinks having to wait 12 hours to take a second pill is no big deal has never been, or had to deal with, someone who actually needed to use EC...the condom broke, or there was an assault, or there was a night of drunken irresponsibility, or whatever; waiting 12 hours to take the second pill and 'be done with it' can seem like torture).
It's available over the counter if you're over 17; with a prescription if you're younger. Buy some for yourself, and encourage your friends to do the same. If you have a teenaged daughter, take her to the doctor for a prescription and get it filled (assuming, of course, that if she's sexually active you've already been a responsible parent and taken her to an OB/Gyn to get on the Pill, had a long talk with her about the importance of taking charge of her own sexuality, only being sexual with someone when she's ready, not when some sixteen-year-old Lancelot starts panting about 'If you really loved me...' and, for the love of all that is holy, USING PROTECTION).
Oh, and obligatory myth-busting--EC doesn't cause an 'abortion.' In fact, it won't work if you're already pregnant. So, on this particular point, right-to-lifers--chill. Also, EC is safe--safer than aspirin (though the more I learn about NSAIDs in med school, the more terrified I am by the prospect of using ibuprofen, or aspirin, or any of those ilk anyway).
When/if the need arises, you'll be glad you have it in your medicine cabinet.
It's available over the counter if you're over 17; with a prescription if you're younger. Buy some for yourself, and encourage your friends to do the same. If you have a teenaged daughter, take her to the doctor for a prescription and get it filled (assuming, of course, that if she's sexually active you've already been a responsible parent and taken her to an OB/Gyn to get on the Pill, had a long talk with her about the importance of taking charge of her own sexuality, only being sexual with someone when she's ready, not when some sixteen-year-old Lancelot starts panting about 'If you really loved me...' and, for the love of all that is holy, USING PROTECTION).
Oh, and obligatory myth-busting--EC doesn't cause an 'abortion.' In fact, it won't work if you're already pregnant. So, on this particular point, right-to-lifers--chill. Also, EC is safe--safer than aspirin (though the more I learn about NSAIDs in med school, the more terrified I am by the prospect of using ibuprofen, or aspirin, or any of those ilk anyway).
When/if the need arises, you'll be glad you have it in your medicine cabinet.
Exploding Stomachs
...or, as a professional would say, 'gastric rupture.'
I was cleaning out our fridge and idly picked up the box of baking soda that's been in there for, oh, six months, and which is no longer absorbing odors (and which I rather suspect of harboring rogue odors of its own--the Yemen of my refrigerator). And as I looked at the box, you know how you do, I saw a paragraph on the back describing how one might use it as an antacid. Why, in the era of proton pump inhibitors, one would do this...well, it's cheap, I guess. But it also contains a buttload of sodium (yes, that's the SI unit of measure), and there was a severely worded, bold warning on the side of the box: TO AVOID SERIOUS INJURY, DO NOT TAKE UNTIL POWDER IS COMPLETELY DISSOLVED. IT IS VERY IMPORTANT NOT TO TAKE THIS PRODUCT WHEN OVERLY FULL FROM FOOD OR DRINK.
Being of the science-y persuasion, and remembering the vinegar and baking soda demonstration from fourth grade, I conjectured: Baking soda + stomach acid = internal volcano? But could a slug of baking soda after a big meal (and really, isn't that when you have indigestion anyway?) truly cause your stomach to explode? After a few minutes Googling around, I found my answer:
I was cleaning out our fridge and idly picked up the box of baking soda that's been in there for, oh, six months, and which is no longer absorbing odors (and which I rather suspect of harboring rogue odors of its own--the Yemen of my refrigerator). And as I looked at the box, you know how you do, I saw a paragraph on the back describing how one might use it as an antacid. Why, in the era of proton pump inhibitors, one would do this...well, it's cheap, I guess. But it also contains a buttload of sodium (yes, that's the SI unit of measure), and there was a severely worded, bold warning on the side of the box: TO AVOID SERIOUS INJURY, DO NOT TAKE UNTIL POWDER IS COMPLETELY DISSOLVED. IT IS VERY IMPORTANT NOT TO TAKE THIS PRODUCT WHEN OVERLY FULL FROM FOOD OR DRINK.
Being of the science-y persuasion, and remembering the vinegar and baking soda demonstration from fourth grade, I conjectured: Baking soda + stomach acid = internal volcano? But could a slug of baking soda after a big meal (and really, isn't that when you have indigestion anyway?) truly cause your stomach to explode? After a few minutes Googling around, I found my answer:
NM Downs, PA Stonebridge, Department of Surgery, Royal Infirmary,Around the same time, apparently (the late 1980s were evidently as bad for stomachs as they were for fashion), a young man in Denmark had a large meal of sausages and soda pop, took some sodium bicarb to help settle his tummy, and caused HIS. STOMACH. TO. EXPLODE. So be careful out there, kids. Even the most innocuous things, used in a--comment se dit?--stupid manner, can kill you. Pay the extra money for Prevacid--or (and here's a concept) don't eat so many sausages that you are literally at risk of rupturing your internal organs. Cheers!
Edinburgh. "Gastric rupture due to excessive sodium bicarbonate ingestion"
Scott. Med. J. 34(5) 534-5 (1989)
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