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???

English is pictured as such a smooth, almost perfectly normalized bell curve. On one hand it's such a versatile language that (largely due to colonialism) has undergone so much evolution and mixing with other languages that I can believe that. On the other hand it looks almost too normal. Odd.

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

Yeah even if it is weird as shit where I am now is already weird as shit.

Soap is decreasing friction. The dental floss done correctly should apply compression to the tissue and force fluid out of the area. This is especially helpful if a lot of tugging has resulted in swelling.

And she is mighty.

Nah. Weirdly enough it was the character with the arthropod features I was investigating the concept for but now I wonder if I should've done that for the illithid so I might look into that. It was relevant to the other character because the actual arthropod features (wings) are missing by the time of the story so it was going to be one of the "hints" that they had her labeled as the wrong species but first of all it just didn't fit creatively, it was much too overt to the extent it didn't even make logical sense for the mixup to happen but also as you see here the science doesn't follow either it's only spiders and the like that have it, not dragonflies.

No he "got away" with decades of war crimes by becoming disillusioned of the society he was born and bred in and becoming a political enemy of the state and putting his physical wellbeing at risk to free the people his country had waged war on all while mentoring the person who would take over that country and try to create a better country and a better world. One of the most poignant moments is when he says he didn't realize his visions of conquering ba sing se would be him taking it back for its own people.

I knew about the hemocyanin because I was trying to figure out if one of the characters in my tentacle porn should have blue blood but decided against it. Cool to learn about the others too though.

If you'd like to edit the thing I wrote for free at 2am to include your edits for clarity and more localized bureaucratic knowledge, I'm happy to link right to you at the beginning. Other than that, you're welcome.

If you're as disabled as you say and either you have documentation (such as state benefits) or it's just obvious I would try APS (adult protective services) over the cops. Things will move faster and more effectively if you do some of the legwork (hypothetically speaking) for them ahead of time.

1. Get in touch with the family that might take you in. Try to find three options who confirm they will take you. Write down or keep in a Google doc or whatever their: full names, phone numbers, email addresses, and physical addresses. The number one thing I see holding up cases like yours is housing, and if you have all those details worked out ahead of time a caseworker can do a lot more for you a lot faster. A lot of the time our psych social workers can get someone a uber / lyft or bus ticket easily enough, the problem is figuring out where they're going. If you have the contact info of someone they can call right there and then who has already agreed to take you, you are a slam dunk open and shut case. Get three so you have backups.

2. Arrange for a ride locally such as a friend or acquaintance or literally anyone else who has a car and is willing to help you for 24-48 hours. This should not be hard to talk someone into. Many people want to help a person like you but don't have the resources to house someone for weeks or months. For this acquantaince you are an easy way to help and feel good about themselves. Use that. Tell them to wait for you to contact them. Again, try to get three options set up so you have two failsafes.

3. AFTER you've done that, call your local APS (adult protective services) or file a report online. Do whatever you can to keep your family from knowing you called because it might take a few hours up to maybe even a day or two for them to get to you and you don't want your family tipped off in the meantime. Tell them you're being held by your family and kept from accessing your legal identifying documents like your birth certificate. If you get state benefits your documentation or papers regularly mailed to you may also have a compliance / abuse reporting hotline number somewhere on it. You could also try a crisis hotline through an organization that does community outreach. Tell them they have abused you in the past and you are in fear for your life. Tell them you HAVE A PLACE TO GO you just need help getting your documents. Again, you are easy to help in this situation, they don't need to worry about setting you up with benefits or housing or anything, just transport maybe. This is what the numbers and addresses are for, they may want to confirm you have somewhere to go and even have options. Just play up the danger and that they're keeping you from your documents. If you get an asshole worker wait six hours and try again (change of shift) or try calling a different agency or the next town over. You may also be able to find other places to call or worst case scenario call 911.

4. The SECOND they show up and if they're able to get you those documents, get the hell out to that person who's helping you locally and block your family and do not tell or hint or give them any other indication of where you're going. Don't even tell the person giving you a ride if you think it will get back to them. If necessary tell them an entirely different final destination and just get them to get you to the airport / bus terminal and get out.

5. while you're waiting, get all your medications, medical equipment / supplies, any valuables or sentimental items, and 3-5 changes of clothes all in the same area of the house. Make sure to pack sentimental clothing but especially pack accessible clothing that's easy for you to dress yourself with. Get them into a bag if you think you can do so discreetly, but a box or even just a pile in an out of the way corner is fine. If you have any special skin safe shampoo or other non-medicine but important toiletries stash them too or just make sure they're all in the same place in the bathroom. Get everything into 1-3 discreet / hidden piles so you just need to throw them in a trash bag and go. If there's any valuables you think your family will try to dispute ownership of, try to get any receipts or photos of you wearing or using them or texts from someone who bought them for you or whatever else you can find and put them in a Google drive folder or email to yourself. Worst case scenario though, be willing to leave some things behind if you have to.

Good luck and godspeed. :)

Another fun fact: the psychiatric term for my speech pattern (well, typing, but they're both revealing of thought content), is "tangential!" It can be indicative of mania or psychosis but in this case it's just ADHD so bad the neuropsychiatrist thought I was faking for drugs. They said my recent memory tests like I have dementia (sort of, mostly the rote part when they ask if you remember the random words they told you at the beginning). I'm really good at a bunch of the hands-on stuff but the EMR really saves my bacon on remembering everything.

As a millenial nurse watching gen z new grads hunt and peck with their index fingers to write a shift note, 100%. I don't think my parents really appreciated how much constantly being on AIM with my friends as a tween actually really benefited my typing skills in a way that's been much more valuable to my career than algebra.

All the math you need to be a nurse is ratio / proportion and kitchen measurements to track I/O. With a modern EMR system (electronic medical record) that does most of the math for you you don't even need that. The rest is latin and greek root words for various body parts and fluids and a vague understanding of how they're all related (hyper-tension in the cerebral is bad because the cerebral is surrounded by a bone case and bones no stretch. That means the cerebral pops out of the bone holes and once it's done that it does NOT go back in correctly like a squeezy ball toy). That gets you through the board exams.

After a year or two in practice you've just seen the same shit with a millimeter of difference over and over and over that you either know what to do about it or who to call to do something about it. And when shit is about to go REALLY wrong that's also happened enough times that you get a weird feeling and just start calling everybody because your psych patient has been trying to kill you for the past week and an hour ago they suddenly stopped trying to kill you and now you have to explain to an RRT nurse (rental ICU nurse) why you're upset that the patient isn't trying to kill you.

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.

Apple pie has entered the chat.

That's DOCTOR Marijuana Pepsi Vandyck to you.