Throwaway05
10d ago
The rebrand of BPD as emotional dysregulation syndrome or something similar does a lot of work in capturing the much of the practical matter of the illness.
I think a lot of people also miss that most people with APD aren't true sociopaths and are also rendered miserable by the illness (especially later in life).
...and both seem to be mostly caused by a combination of genetics, trauma, and other shit you aren't in control of.
Man I miss free will.
Throwaway05
10d ago
I'm sure they did (again assuming not BPD).
Imagine you thought you had two arms but you actually have three arms. You have two arms. "Has anyone ever told you have three arms?" "No why would they do that, I only have two arms."
What's that third arm then? "What third arm" "THAT ARM" "I don't know what you are talking about."
It's a delusion because you are convinced, which is why that shit is scary af.
Generally people with delusions will tell you matter of factly or you'll have to be careful about them coming out because "do you have any delusions" always gets "of course not."
Throwaway05
11d ago
She did not understand that her delusion had been all in her head. She told me about it as though it had really happened. She didn't seem to have made any connection between the delusion and the anti-psychotic she was on. I could not convince her to tell her doctor about the drug use.
While someone else down thread points out this person probably has BPD (and I agree) it is worth noting that this is how delusions work (although in this case it is not likely a true delusion 'cause BPD).
Delusions are delusions because they are fixed, sometimes they clear or improve with medication but often they don't. If you like you can consider this kinda like "cognitive burn-in" (as in like a monitor), even if the conditions change such that the cause of the fixed and false belief is gone your brain is so used to thinking that...well it's stuck.
Many psychotic illnesses in general have a large component where patient's are in denial as to their illness (Anosognosia).
Borderline functions a bit differently, and while it is somewhat misleading to draw attention to this, the borderline in borderline is the borderline between psychosis and neurosis.
The cause of "delusional" thought content in the two conditions is wildly different on a substrate and biological level however they do appear somewhat similar superficially.
Throwaway05
11d ago
This post was beautiful and uncomfortable and made me need to forcibly reboot my brain in order to go about my day in the way that the best Old-Scott posts did.
Well done and also screw you for dredging up those feelings from that time in such a rich way.
Throwaway05
26d ago
Antibiotic resistance is more of an ongoing process instead of a binary state, one issue we run into is that sometimes we do have agents available but they may be slower (and therefore less helpful in severe disease) or more commonly they are way more dangerous.
We'll run out of drugs that treat you without killing your kidneys well before we run out of drugs period.
Incidentally- penicillin still works great (and is the drug of choice) for syphilis.
Throwaway05
26d ago
I have a hard time understanding how I ever needed checked baggage, let alone feel constrained by only having an allowance of one.
Keep in mind that the size of the person makes a huge impact - I have enormous feet, any time I need more than one pair of shoes (lets say I'm traveling for a wedding and need dress shoes and sneakers) then my packing is totally fucked. Same stuff applies to most of my clothing, although to a lesser extent.
In contrast my various partners I've had in my life have been mostly petite women who could fit an entire wardrobe in my suit bag.
Throwaway05
29d ago
Some women insist that the man pay for things on a date, some women legitimately don't care and some women lie about which category they are in.
Nobody is penalizing you if you just pay so that is the best strategy, especially since nobody knows the ratios of the above.
Same thing goes for a lot of dating norms.
Throwaway05
1mo ago
It is still entirely unclear what you are going for with this and what your motivation is. My original post's reference and your own link are both supportive of treating insomnia with CBT-I.
Throwaway05
1mo ago
it’s convinced society that pretty much everything negative that happens to you is traumatic in some way.
This is not the fault of the "mental health industry." Ask any clinically practicing therapist, social worker, or psychiatrist what they think of "little t trauma" and they will BITCH.
The problem is some combination of wokeism/snowflakeism/safetyism/influencer culture etc.
You will find professionals supporting this kind of garbage but it is more often non-clinical/non-practicing people.
You will find that people in mental health find the current paradigms on these matters to be extremely deleterious to human development and flourishing.
Additionally, something that often gets missed when therapy is mentioned - the goal of therapy is to stop therapy. Competent therapists will emphasize this early and often and actually do it.
Throwaway05
1mo ago
I noticed the water-to-flour ratio has changed, so I had it explain why,
I would love to hear more.
Throwaway05
1mo ago
Sure, a hospital, and maybe my doctor, is going to put on this big show of paranoia when it comes to disclosing my PII to each other.
I can tell you it's not a show, if I'm in an elevator talking about "John Doe" or even like Dingle McCringleberry the nursing administration gestapo are going to crawl straight up my rectum.
I suspect the rest of your stuff would be resolved if you actually talked to someone who knew what they were talking about and wasn't worried about covering their ass (for instance an HIE in this context probably refers to routine health record sharing that you want in case you are in a car accident in another city).
Granted something like 23 and Me is a different story.
Throwaway05
1mo ago
I'm not particularly interested in litigating how to analyze research quality which is an extremely complicated topic.
The thrust of my post is that several (referenced) practice guidelines all reports that medications are not a good option and suggest lifestyle modification be done first, which is the recommendation I relayed in my post.
If you want to discuss what appropriate exclusion criteria are I'm not your guy in this setting.
Throwaway05
1mo ago
I think one of the kernels was that women are surprising consumers of lesbian and solo female porn for similar reasons that men are surprising consumers of big dick porn. Focus on aspirational anatomy and the pleasure of the specific genitals the viewer has.
Gay porn is often also produced with an aim towards the (gay) male gaze - women like gay male romance novels and such (at least Japanese ones do) but it is quite different to actually viewing the railing as it where.
Throwaway05
1mo ago
Do they? Last time I saw data on this I thought it said straight women didn't really consume gay porn.
Throwaway05
1mo ago
What do you imagine happens with this information?
Research for instance requires patient direct informed consent or your data to be totally anonymized. Your privacy is protected, although someone else may benefit from having cared for you.
Some information needs to be given to your insurance for instance so they can pay, that's the primary point of boilerplate like this.
To give an example of how restricted and scary HIPAA is - you do not require patient consent to reach out to a patient's primary care doctor to gather information on the patient. This is important because most patient's struggle to remember all of their health history, their medications, the results of recent lab tests you wouldn't necessarily want to duplicate, imaging results and so on.
Despite this most systems will require patient consent to be faxed to them anyway, even in situations where the patient is say, not able to consent due to illness severity.
If health systems are willing to let quality of care be damaged how free with your information do you think they are?
Throwaway05
1mo ago
Yes there are a lot of considerations, that was my point.
I'm really not sure where you are going for this.
Throwaway05
1mo ago
It's not actually FDA approved for neuropathic pain (or most of what it actually ends up using for) because there isn't enough evidence that the benefits outweigh the risks. Except you just pointed to a study? Shit is messy. One study does not equal consensus.
CBT-I is cheap and found to be effective in a variety of studies and has an extremely small harm profile. Medications for insomnia have been found to be ineffective more often than not and have side effects that include up to things like dementia and death.
CBT-I first.
Throwaway05
1mo ago
If I told you Gabapentin wasn't actually indicated for neuropathic pain would that alter your thoughts at all?
Throwaway05
1mo ago
I wrote a long comment here but I ended up deleting because their were too many edge cases and complexity but the short version is:
-
If a healthcare facility or employee abuses your personal information in ANY.WAY. the government will absolutely anally violate anyone involved with several rusty implements. They are extremely aggressive about this to the point where it has become counterproductive and directly harms patient care (ex: nobody wants to send care-critical records to anyone for fear of being beaten with the HIPAA spoon). Exceptions exist but are for the most part extremely well validated.
-
The above poster is not giving good advice. Having suicidal thoughts is not grounds for commitment. While some health systems are overly aggressive with commitment (so it is a real problem) tons of people are sent home from the hospital or leave their doctor's office after expressing suicidal thoughts. Something like a plan for how you would kill yourself is not the same thing.
Having suicidal thoughts and not telling your doctor or people in your life is for the obvious reasons much more dangerous to you.
Throwaway05
1mo ago
Ancient Greeks had a different ethical system, what seems immoral to us may not to them etc.
Throwaway05
1mo ago
If you are expecting a wide body of clear and convincing evidence you just aren't going to find it often in medicine, especially when something drifts more into psychiatry, nutrition, and the other more complicated domains.
CBT-I seems to have a good number of sources saying it does something helpful. That's enormously more efficacious than most of the medications which research often suggests do nothing or are counter productive.
Mechanistically this makes sense in the same sense that exercise is better for weight loss than medication. Yes implementation is hard, but working out actually works and medications of various kinds are significantly more variable.
Additionally some of the other sources (like the AAFP) are more positive.
Ultimately medical research is hard and is hampered by ethics and expense. The evidence base for ANYTHING is pretty poor but if it seems to work and makes biological sense, we run with it.
Most medications do not or run into clear issues which just doesn't apply to CBT-I.
Throwaway05
1mo ago
The way you write suggests to me that what I'm about to say may already be known to you, so mostly throwing out additional context for others-
Patient reported sleep issues are more about subjective experience in most cases (as opposed to objective). This is a big piece of why benzos can be popular while melatonin often isn't, since benzos effectively make you pass out more than they make you sleep but to patients that seems like a good deal.
Paradoxical agitation due to benzo administration in a hospital setting is a known quantity and dare I say it, the norm. However what to do about this becomes a complicated and long running fight. Yes, in some settings getting any sleep at all is the way to go (most classically: helping to abort a manic episode or substance induced insomnia) but more commonly we see nursing staff demanding benzo administration until the medical team or a consulting team gives up and recommends it to make nursing shut up.
Nursing isn't entirely wrong since an agitated patient takes away from others and can be dangerous in a variety of ways, but the literature suggests this is typically a bad idea.
For Quetiapine, Mirtazapine, and TCAs- for these managing the side effects is the primary problem. In the US we don't really use Quetiapine anymore because of concerns of weight gain, even in the setting of psychiatric comorbidity. Mirtazapine still has weight gain concerns but ultimately is better on that front so you see it more often. TCAs are a bit more complicated but probably the most commonly used option in settings where cost is a big factor.
Throwaway05
1mo ago
The only complaint I've had thus far is that the enemies can sometimes be overly damaging if you don't pull off the dodge/parry
Later you can make builds that rely less on this, but I found it helpful to know that one of the main developers is a Sekiro speed runner - the game is 100% designed around the realtime inputs. Once you give up and embrace that (and get gud) it becomes more enjoyable.
At least, that's the process I went through.
Throwaway05
1mo ago
Scott promotes CBT-i apps as a good way of doing CBT-i. One for the medico-commies - the best CBT-i apps (apart from ludicrously expensive prescription-only ones) were developed by the VA, and are free to users as a result.
Endorse this!
The biggest problem with CBT-I is that it can be hard to find someone who does it and even harder to find someone in your price range. An app will never be as good, but access is access and free is free.
This is called splitting and is one of the main coping mechanisms associated with the illness.
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