Apytele

I do actually like this version better ty! I'm unsure that the order is the same as I'm used to.

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.

Dude sometimes we still give thorazine. And tbh ime the 3rd gens don't do shit for my typical patient. For context also though, I'm essentially providing ICU level care, so when you say the word "symptom control" it's often referring to like, fists.

We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I've actually seen quite a few pregnancy delusions and they're almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn't take it anymore she would just come scream at me for the thorazine.

I'm unsure if you don't work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that's flush with people stuck in a cycle of drugs / homelessness so I'm also not going to tell you that any of this is the best solution, just that it's the only one avaliable to any of us right now due to shitty government policies.

To the extent that men can lactate! It's one of the possible side effects of risperdal, which I have to be aware of because I give it fairly regularly. It's all the same structures it's just a matter of the hormone signals they're getting.

an oldie but goodie

And she is mighty.

You know this is the recommended stance when deescalating violent psych patient because it keeps your hands visible (as in, not hiding something) and in front of your body / face in case they start swinging. I've never really felt comfortable doing it though and this kind of explains a possible reason why. I actually had a guy the other night who asked why everyone else was scared of him and I didn't seem to be. There were probably a couple other reasons though (I've dealt with waaay wilder men, and also he mostly struck me as young, dumb, and loud, and dumb in the young sense not in the cognitively not there sense). But as far as this pose idk it just always seemed really patronizing to me. I usually stand more like One of these where at least one hand is on the neck or side of the head. Usually with my hands overlapping but my fingers not intertwined so they're easy to separate and throw up in front of my face but not overtly defensive.

Honestly my biggest issue is getting randomly banned from trans spaces for expressing my own lived experience with surgery and how I view my own body and gender. They're so "inclusive" that they start excluding people that don't use their very specific language or share their beliefs exactly. They keep kicking people out then wondering where all the people went!

I actually love this comment and this style of humor and wanted you to know that I'm absolutely chuffed.

Or you're night shift and look like death and they just kind of look really guilty while they ramble on for a few minutes before mumbling that you can just go.

For poop:

• the bristol stool scale
• and your frequency (anywhere from daily to weekly is normal and varies a lot person to person so learn your normal)
• color can vary a lot so that's less important but here's a few common ones other than brown:
  • bright red. This is a small amount of blood and from very close to the exit so it's not great but you'll be fine. Be nicer to your butthole though: stop eating taco bell and use more lube. Maybe put some A&D on the outside until it stops doing that.
  • dark black like tar. This is what a lot of blood from very deep in you looks like. Go to the ER immediately.
  • light grey / white. This means your liver isn't putting old trash red blood cells into your poop like it's supposed to and you should go to the ER immediately and find out why not and where it's putting them instead.

For piss:

• should be light yellow "straw" color and clear
• not cloudy and DEFINITELY never chunky.
• Also should not be a syrupy consistency, I've legit seen diabetics pissing and it looks like they're pouring syrup into the toilet also that's how you get horrible bladder infections bacteria love that sugar.
• You should also pee about 4-10 times daily and it can vary a lot depending on how much you're drinking and how much you're losing other ways like sweating or vomiting.
• if your pee turns a little dark throughout the day that's fine and you just need to drink more water.
• if your pee suddenly turns dark brown go to the ER.
• beets have a dye that can change pee color and that's harmless
• some medications can change your pee color and sometimes that's fine and sometimes it's bad talk to your doctor about it but for example
  • pyridium turns it red and that's fine
  • I can never remember which b vitamin but it makes your piss super bright yellow and so people use it to help fake drug tests because it makes their urine look less dilute when casually observed. They'll be able to tell what you did if they look closer though.

I've been told I'm annoying and need to shut up as long as I can remember. Probably since I started talking.