psychopharmacopeia
@psypharmacopeia
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šØš¼āāļø psychiatrist | šŖ veteran (USMC & USN) | š„ļø psychopharm website creator | šø wannabe guitarist
Mentor, OH
Joined July 2017
@uhshanti 1/4: Public spaces belong to everyone. Step 1: Law enforcement must actāremove individuals who endanger others. Safety first, always.
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If you haven't memorized and forgotten the Krebs cycle at least three times, I'm not interested in your opinion on COVID-19, or anything medical, for that matter.
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@queerBengali Lot of these types simply canāt live in society. Chronically in and out of jails, psych wards, group homes, shelters ā¦ at some point we need to consider longterm asylums again.
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@RepGosar Iām a Democrat and an atheist. I served in two branches in two wars. Do I hate America, too?. And remind me, where and when did you serve?
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@ANicholsJDMD Honestly, patient rights have gone a little too far, and when it comes to violence and verbal abuse (I mean, this is flat out hate speech), I think security should toss the patient out into the street. No, Iām not kidding. Healthcare workers have rights, too.
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1) To prevent my patient from having to undergo multiple pelvic exams. 2) Iām a psychiatrist.
Why are you consulting OBGYN for vaginal bleeding without doing a pelvic exam? Do you also consult cardiology without listening to the heart?.
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So hospitals want:.1) to be restraint-free.2) have zero falls.3) not pay for 1:1 sitters . Somebody help me understand how to do this in a geripsych population.
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@CalvinLeEasy @latestinspace Humans place a great value on being entertained. Itās silly to complain about how much musicians/actors/athletes get paid because society values it.
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@dtheavenger @Thom_Hartmann @augie_pup Weāre not in denial, or too feckless or weak, but without a true majority (thanks to Manchin/Sinema), we donāt have the votes. Maybe if we pick up seats in November, but we donāt have the votes now.
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My goal is to move out of this awful MAGA state in the next 12 to 18 months. With the country turning into a dystopian MAGA hellscape, the best I can do is surround myself with like-minded people. So where is a liberal enclave where the cost-of-living isnāt too insane?.
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And after 48 years, I finally have a word that explains why I am overweight.
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The 5 psych meds Iād hate to practice psychiatry without:. 1. Bupropion .2. Lithium.3. Clozapine.4. Mirtazapine .5. Vortioxetine. What are yours?.
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@ChrisAlbertoLaw @Ash_Stewart_ @POTUS Weāre not trying to āpreserve neutrality,ā weāre trying to prevent thermonuclear war and the deaths of tens of millions of people.
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@PA_Stressed_ Because phlebotomy isnāt the role of a physician. I know itās well-intentioned when a doctor pitches in and helps, but we should all be working at the top of our licenses. If a doc is drawing blood, thereās been a systemic failure somewhere.
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I hate what weekends do to discharge planning. Discharging a patient on a Saturday evening should be just as easy as discharging someone on a Wednesday afternoon. We need to staff hospitals (and nursing homes) accordingly. Fight me.
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I wonder what might be causing delirium in an octogenarian who is prescribed tramadol, alprazolam, and a combination medication including butalbital and codeine? š¤.
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@GuardianUS Heās absolutely right. It should be illegal to bring a semi automatic rifle to a riot. If you say it out loud, it sounds crazy.
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@JBDerek87 Better than leaving, is staying, protesting, VOTING, and fighting for change. This country can be great. It just isn't yet. š¢.
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@DrCasteelEM Doctors really canāt win here. For every time I hear someone complain that we only āthrow pills at problems,ā I hear another complaint that āall the doctor will do is tell me to diet and exercise!ā.
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@DrGeropsych @KeriCrewsonMD Youāre well aware that pain is undertreated in the geri population. Besides round-the-clock Tylenol, what else is available? Many donāt have the kidney fcn for NSAIDs. Tramadol prescribing is universally admonished. Do you just go straight to low dose opioids?.
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If a patient in their 70s develops psychosis following surgery, itās not new-onset bipolar or schizophrenia. Medical/surgical colleagues, I love yāall, but you can do better than this. You guys should be able to spot postoperative delirium from across a room.
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@MayoIsSpicyy Uh, no, sheās not. Unless the justice department acts (they havenāt, and they wonāt), these hearings are nothing but a television show.
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@e_welchcarre @SaltyLikeSaline Families can be awful, and feeling constantly unappreciated by them is a more than valid reason to want to quit.
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@AZGOP Wait, hold up . you mean to tell me that holding unofficial āhearingsā in midrate hotel conference rooms is having no effect on Bidenās landslide victory? š¤£.
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Pro Tip: If a patient comes to you from a nursing home diagnosed with "Bipolar and Schizophrenia," rest assured the patient likely has neither.
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@librarycongress @lizzo This is awesome. This is an instrument, itās meant to be played. This is a way better way to appreciate this piece of history than looking at it behind plexiglass.
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I donāt think Iāve ever seen a better representation of nighttime rumination.
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@garyresists @joncoopertweets Hereās the thing ā¦ we donāt get to define ātheir best interests.ā Thatās a losing strategy. If we want to win any of these voters back, we need to quit telling them whatās important to them, and listen instead.
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Iāve been in a funk. Life stuff, maybe some depression. Itās been a rough year or so. Big step today: I ran. Very slowly. But I ran, and more importantly it felt like I flipped a switch mentally. Ready to commit to taking care of myself again. Making it a priority.
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@Variety I adore Bryce Dallas Howard, but heās a much bigger box office draw than her. Iām not saying this industry probably canāt do a better job of pay equity, but these two really arenāt in the same tier when it comes to star status, right?.
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Lost my dad yesterday, somewhat unexpectedly. He had dementia (bvFTD, specifically), but otherwise healthy. He lived on a locked āmemory careā unit. He actually died in a geripsych hospital ā his 4th such hospitalization. I havenāt even begin to process/unpack all this yet š¢.
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@AshleyGWinter Hyperbaric oxygen has been a solution, looking for a problem for as long as I can remember.
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Landlord just abruptly told us homeowners want to sell the house weāre renting, and have given us five weeks to vacate. We are a family of 6 (+2 dogs). Thereās not much out there in the rental market. I am officially freaking out.
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@RiviereTosh Sadly, a lot psychiatrists (dare I say a majority?) are skeptical (or outright distristful) of any adult with an ADHD chief complaint. A lot of them presuppose āif you werenāt diagnosed as a child then you must be trying to scam stimulants.ā.
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@MsDiGaeta @MikeNellis Translate this garbage tweet into a strategy to win. You canāt. Youāre still in the catharsis stage. You donāt actually have a plan to win.
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@kdqd3 @ejeancarroll 55% of white women voted for Trump. All the math in the world doesnāt change that fact.
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The most Christian friends I have are actually swingers. No shit. Church on Sunday, but Saturday night theyāre at swingers parties. Meanwhile, me and my wife, both atheists, are at home with our children, watching our dumb tv shows. 1/2.
I find it very disturbing that Christians still seem to believe that you can't be moral without a belief in god. How are we still stuck in this antiquated thinking? . We've grown up as a species, we no longer need a god to understand how we should treat other people.
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Any physicians here feeling burned out? Worry not! Management is diligently working on adding mandatory Mindfulness courses to your Healthstream account!.
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@sweetchinchilla How is this even still a thing? I swear 90% of middle management just needs to disappear.
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@ZaleskiLuke @elonmusk All the things he could do with his money and platform ā¦ and he chose to be the worldās biggest troll.
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For the 8000th time, a patient wanting to get out of bed and walk is not a reason for geripsych admission. The solution is to let them walk, and afford them whatever assistance is required in order to walk safely.
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@ccardyDNP The only people I expect to call me "doctor" are my patients. Outside of that, just call me by my first name. I know I'm a doctor - I don't need students and residents to remind me of my title.
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@maddow Saying a DO specializes in osteopathic medicine is like saying an MD specializes in allopathic medicine. The MD/DO degree is the general medical degree. Speciality is determined by residency & board cert. In this case, his āspecialityā is Emergency Medicine.
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Just saw a psychiatrist say he avoids trazodone in the elderly because of its anticholingeric burden so I thought I'd do this little PSA:. TRAZODONE IS NOT ANTICHOLINERGIC. Not even a little. Here's a great figure that illustrates how NOT anticholingergic trazodone is.
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@Jessicam6946 Iām generally opposed to the death penalty, but this gives me pause. Thereās a hell of an argument for exterminating that life.
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@AdamParkhomenko Iāve read a tweet like this at least once per day for the past year or so. So far, nobody in power has gone āthrough some things.ā Not one.
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@calling_ma65369 @wasphyxiation Crime is WAY down since the 80s. We live in the safest time in human history.
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@paulsperry_ This should be fun. 1. Trump is wrong. Thereās no constitutional right to social media. 2. I have a feeling FB and Twitter have better legal counsel than the Trump.
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Pls send good vibes. A pneumonia I had last month is now an parapneumonic effusion. Thoracentesis only got out 400mL of exudate, but pulm says CT showing 1500mL. Getting a chest tube today. If that doesn't work, sugery (VAT vs open pleural decortication).
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@yashar Psychiatrist here. I have never seen a case were someone was appointed a conservator/guardian unless they met one of these three criteria:. 1. Schizophrenia/schizoaffective D/O.2. Severe intellectual disability.3. Severe dementia.
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@dremilyportermd @WFKARS Did yāall not have a picture like this in your health class book?
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@allicovington This is great! Join me on inpatient rounds tomorrow and help me figure out which exercises will treat a schizophrenia relapse.
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@adamkotsko Rural? What about suburbs? I live 20 miles from my job? And how do we get 4 kids to and from soccer, music lessons, doctors appointments ā¦ how do we all go out to dinner ā¦ how do we run errands all over town? On busses? Are you high right now?.
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@Bubblebathgirl I donāt care what his name is. We need to do what Australia did and make guns nearly impossible to get. Yeah, that means amending the constitution (weāve done it before).
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#MedTwitter with all the fretting over "reports," "complains of," "endorses", "admits/denies" . why don't we just write: "The patient *tells* me he has been experiencing . ". Seriously, what's wrong with tells/told? Or for that matter, says/said?.
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Iām going cite āabundance of cautionā the next time an insurance reviewer wants to deny one of my weak admissions!.
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@JeannaHoch Not rape but also ā¦ ewww ā¦ if the consent isnāt gleeful and enthusiastic ā¦ just stop.
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@JRMajewski Hey remember that one time you said you served in Afghanistan, and you didnāt? . Sincerely, . Someone who served in Afghanistan.
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Love psych, but everybody has an opinion about virtually all aspects of psychiatry. Sometime I daydream about being a nephrologist, because random-ass people donāt have strong opinions about how to treat RTA.
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@DonChaney2 @RonFilipkowski She has a 4-year degree from The Citadel and Masters Degree from .the University of Georgia. I donāt like her politics either, but letās not straight up lie about her.
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How do I educate an entire community on safe prescribing in the elderly?. Seriously, some of these patient medication lists looks similar to the actual BEERS list. How about a geriatric pt on the following for fibromyalgia? Oxycodone 40 mg qd, Klonopin 2 mg qd, Elavil & Lyrica.
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@bruceburdock @Lekelitt @ninaturner Because many professions that are crucial to society are grossly underpaid (e.g. teachers, social workers, etc).
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If I were king, geripsych units would provide:.- thoughtful prescribing & #deprescribing, guided by collaboration of psychiatrist, geriatrician & pharmacist .- optometry & audiology assessment (letās optimize sensory input!).- neuropsych testing for dx clarity.- PT/OT assessment.
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@MrDanielBuck Thank the education major for this. Teachers should have degrees in the disciplines they teach, and then maybe take some education coursework as a minor.
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@lavern_spicer You may want to look into this, and recall something in high school civicsā¦ I actually donāt think rally attendance has anything to do with how we elect the Presidents. š¤·š¼āāļø.
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@JDCocchiarella Iāve seen some version of this āsomebodyās about to go through some stuff!ā tweet about 1000 times in the past few years. And then no one ever goes through stuff.
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@MrAndyNgo @WanderLinger @robbystarbuck Im a democrat and this is a straw man. Apparently someone took their kid to a drag show. What does that have to do with politics? Iām not aware of any Democratic policy that promotes this, are you?.
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@costareports This flirtations with avowed far right racists are a feature not a bug. Carefully calculated. Itās a wink-wink to their deplorable base while maintaining plausible deniability.
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@emily_fri Because our software isnāt designed for its users. Itās designed, by committee, the the specifications of people who donāt use it (administrators). The people who buy it arenāt the people who use it. Thatās why it sucks.
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@SarahIronside6 States and local governments will have to step up and assume responsibility for special needs programs.
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Any ideas for non-stigmatizing language to describe when a patient procures opioids or other prescription drugs that arenāt prescribed to them?. Off the streetā is stigmatizing and also likely quite inaccurate as a descriptor. āIllegallyā is stigmatizing, too. š¤·š¼āāļø.
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@sassistheword I know exactly whatās in my bag because I packed it. Itās called being a responsible adult. Iām also not an ammo-sexual so thereās 0% chance Iām going to randomly have a few extra rounds in my luggage.
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Iāve read a bunch of papers this week about palliative care in advance dementia and Iām, at once, energized and downtrodden. The direction we need to go into is clear, yet regulatory agencies arenāt on board. šŖ.
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@viviendoama Psych here:. When I do med floor consults, I always kick the families out of the room. Families bristle but thatās okay. I can always (with patientās permission) talk to families later if needed. (Not to mention, patients often arenāt as forthcoming if family is present).
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"Difficult" family members are often anxious. My early career mistake was to avoid them. Now I initiate conversations early and err on the side of over-communication thereafter. E.g. "Is there anything I can do today to help you feel more comfortable about your mother's care?".
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1/x. For the love of all that's holy, can we stop conflating the treatment of delirium with pharmacological interventions we use stop the behavioral manifestations of hyperactive delirium? They're not the same thing. I treat delirium by finding any treating any/all reversible. .
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@JackPosobiec Good! Fracking poisons groundwater, pollutes surface water, impairs wild landscapes, and threatens wildlife. We need to focus on renewable energy!.
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@sydneyesbrown When you get to a point where youāre faster, and you start having days where you purposefully run at slower paces (an āeasy dayā), you wonāt dread every run. I think when you can start staggering intensity and duration, thereās some variety, then not every run is a ball buster.
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The two most challenging behavioral manifestations of advanced dementia that often don't have a good solution. š§µ. 1/10.
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Just a reminder. if youāre working this weekend and run across an elderly patient with paranoia. before you start writing āschiz. ā. ā STOP š and remember that paranoia is often āthe last gasp of a failing mindā ā think dementia +/- delirium.
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@GOAVFund I wish red flag laws were even stronger, and universal. For starters, any DV convictions should automatically prevent firearm ownership. Lifetime ban.
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At first, I thought it was paranoia, but Twitter has changed. Iām not only seeing qrazy ultra MAGA posts more often, Iām seeing posts from far right accounts that Iāve muted. I guess I have to start straight up blocking accounts to not see their hateful drivel?.
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@xielody4 In this med studentās defense, he or she doesnāt have the context of any clinical experience to know what to value vs. devalue. The studentās mistake here is posting such a strong opinion about a curriculum that he/she has no possible way to have an informed option of.
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