Podcasts about haldol

Cannabinoid Hyperemesis Syndrome (CHS), also known as "scromiting," is a debilitating condition characterized by severe nausea, vomiting, and abdominal pain that affects heavy cannabis users. Dr. Casey Grover explains this increasingly common syndrome caused by high-potency cannabis products, which paradoxically improves with hot showers and proves challenging to treat with conventional medications.• First identified in 2009 and named "scromiting" to reflect the combined screaming and vomiting patients experience• Cannabis potency has increased dramatically from 1% THC in the 1970s to 25-30% THC in today's products• Patients experience cyclical episodes of diffuse abdominal pain, nausea, and vomiting lasting 24-48 hours• Compulsive hot bathing is a hallmark symptom, with patients focusing hot water on their abdomen for relief• Standard anti-nausea medications like Zofran don't work well; psychiatric medications like Haldol often provide better relief• Many patients question the diagnosis because cannabis is thought to help nausea rather than cause it• Treatment requires cannabis cessation, though symptoms may persist for months after quitting• Multiple theories explain CHS, including nerve hypersensitivity and paradoxical stress responses from high-dose THCTo contact Dr. Grover: ammadeeasy@fastmail.com

Today, we will be discussing one of the most commonly used first generation anti-psychotics, Haloperidol (Haldol). Answer to Poll Question Below (SPOILER) —————————————————— Answer: Choice C (Fluphenazine) --- Support this podcast: https://podcasters.spotify.com/pod/show/psychrounds/support

Episode 263! KLM-crew haalt een spuit met rustgevend middel (Haldol) tevoorschijn voor een unruly Duitser. Russen storen de navigatie van het vliegtuig van Engelse minister. Doodgewone Amerikaan koopt private jet van Elvis. Tenenkrommende video van Transavia. Natuurlijk over duurzaamheid. Burgemeester Haarlemmermeer promoot het boek "De Tawl" van Philip Dröge op TV. Menno Swart bij Traffic Radio over Boeing-problemen. Speciale kreet van Koninklijke Luchtmacht tijdens proefvlucht Reaper in Balkanië. Pas op voor Batik Air. Reis gecanceld: de Vakantiekoning laat PH-GOV noodgedwongen staan. Jubileum voor antieke Dragon Rapide. Ook feest voor een ander iconisch vliegtuig, gebouwd in de Amerikaanse staat Georgia. De winnaar van de prijsvraag. En nog veel meer. Bron fragmenten Marjan Rintel: NH Nieuws. Muziek: Burning Love - Elvis Presley. Alle platen uit de podcast staan op http://tmhcplaylist.nl Op http://luchtvaartplaat.nl vind je bijna 600 vette vliegtuighits. Michiel Koudstaal is onze voice-over. Voor al je inspreekwerk ga naar voxcast.nl LAST CALL FOR AFVAL!

Medicines gonna med, surgeons gonna surge. What do we change and do in the perioperative period? Join us for some bites from the MHP 2023 talk on Perioperative management updates, a few JHM articles around NPO status and buprenorphine continuation, and the start of a summary series on SPAQI position papers on what to do with various medications in the perioperative period. | 00.22 - TOC | | 01.17 - MHP-1 Post-operative AFib and Anticoagulation [Siontis 2022 - Associations of POAF w/ subsequent outcomes] [AHA 2023 guidelines] | | 02.50 - MHP-2 ASA for DVT ppx in Ortho trauma cases [METRC study - large multi-center trial of ASA vs LMWH] [ICS-VTE position papers by location of surgery] | | 04.20 - MHP-3 Post-op delirium [AGS Guidlines] [Kim 2022- Haldol vs atypicals] | | 05.11 - Perioperative NPO status: When should we start? [JHM 2021] | | 06.37 - Buprenorphine in the acute pain and perioperative settings [JHM 2019] | | 07.18 - SPAQI position paper on Endocrine, Hormonal, and Urological meds | | 09.56 - Summary | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Music by Amit Apte. Surgery Vectors by Vecteezy

When my husband, Sid, was 60, he fell in a parking lot. He didn't think much of it, but over the next few months his legs weakened and he fell more often. We visited neurologists, orthopedists and internists who gave him MRIs, CT scans, spinal taps and psych tests. There was vague talk of "softening of the brain tissue at the cerebellum." No one seemed to have answers until Sid was diagnosed with a progressive neurological disease, spino cerebella ataxia. My able-bodied husband went from a cane to a walker to a wheelchair. He lost control of his bladder and bowel. He developed dysphasia; his food had to be pulverized and liquids had to be thickened. He had difficulty catching his breath. His arms atrophied. Although there was no treatment and no cure, his incredible intellect and sense of humor never wavered. He did not want to die. He had two grandchildren whom he adored and wanted to dance at their weddings. But after seven years of losing ground, Sid told me he had enough. He asked for my help to kill himself. I refused - the hardest decision of my life, and one that haunts me still. I extended his intolerable existence. Sid decided that he would stop eating and drinking. As his body slowly shut down, he developed terminal agitation and his extraordinary hospice nurse had to lie on top of him because no amount of Haldol could control his outbursts. My husband spent his adult life in recovery from alcoholism, anxiety and depression. He had joked that he wanted to know when he had three months to live so he could have some Johnny Walker Blue. His best friend, Mike, brought over a bottle, but Sid declined. He said he was proud of three things in his life: his daughter, his marriage and his 36 years of sobriety. It took 12 days for my husband to die. He left on May 5, 2014. Because of Sid's unnecessary suffering - and the effect that suffering had on our family, a factor that is often overlooked - I advocate what has become known as medical aid in dying. Through that work, I met Laura Kelly, a Mount Kisco resident whose father, Larry, dying of colon cancer in 2015, asked for help just as Sid had. His death, like Sid's, was unnecessarily traumatic. The Medical Aid in Dying Act (A995/S2445) was first introduced in the New York Legislature in 2015. It would allow terminally ill, mentally capable adults with a prognosis of six months or less the option to obtain prescription medication they could decide to take to die peacefully if their suffering becomes unbearable. Although there are similar laws in place in 10 states, including New Jersey, the bill has never come up for a vote in Albany. We are hoping that will change in 2024. Assembly Member Dana Levenberg, whose district includes Philipstown, is a co-sponsor of the bill, but please let Assembly Member Jonathan Jacobson, whose district includes Beacon, and Sen. Rob Rolison, whose district includes the Highlands, know that it deserves their support.

My favorite opening line of an academic article (this week) follows:Mental illnesses are prevalent, cause great suffering, and are burdensome to society.Welcome to the Frontier Psychiatrists. It's a newsletter that I write all by myself. I'm doing a series on medications, largely (but not entirely) in psychiatry. I'm a child and adult psychiatrist, and I still see patients. I've also been a patient since I was 16 years old. Please consider subscribing and sharing widely.The first antipsychotic introduced after clozapine would be a big deal—especially if it didn't cause life-threatening side effects. Risperidone was first developed by the Johnson & Johnson subsidiary Janssen-Cilag between 1988 and 1992 and was first approved by the FDA in 1994. It's one of the very few drugs with data for bipolar disorder that I, personally, have never been prescribed.Risperidone—Risperdal as a trade name—was ready to be a huge hit.It was presented as very atypical—this was the post-clozapine branding of choice. The “second generation” label was added years later. I have a confession to make. After residency, when the attending doctors told me, as a trainee, what to prescribe, I never prescribed risperidone ever again. I think this compound—and paliperidone, the metabolite— still has an important role in managing schizophrenia and bipolar disorder. There are more formulations of long-acting injectable risperidone and related compounds than I can remember. I think those are going to be useful drugs for a long time. Oral risperidone? Nope.Clozapine was an exciting drug. No horrible motor side effects? (Plausibly) More effective? It was better than every drug that came before. It had this pesky adverse effect that could lead to death called agranulocytosis, which I addressed in my first research paper in 2011. We needed more drugs that were this atypical!We—the field of psychiatry, at least— needed things that were not gonna kill you abruptly, in a terrifying manner, like clozapine had the rare potential to do. But we didn't want more of the same old antipsychotics. After Psychiatry got a taste of not having to explain permanent tardive dyskinesia as a likely side effect of antipsychotic medication, we wanted to keep doing that. Editors note: It is still a side effect of all non-clozapine antipsychotics, and we should never have let our guard down.Risperidone was the first antipsychotic that came to market after clozapine rocked the world of psychiatry by being better. Risperidone is similar, and they even use the accidental branding of clozapine— “atypical”—for this medication. The Food and Drug Administration (FDA)-approved indications for oral risperidone (tablets, oral solution, and M-TABs) include the treatment of:* schizophrenia (in adults and children aged 13 and up), * bipolar I acute manic or mixed episodes as monotherapy (in adults and children aged 10 and up), * bipolar I acute manic or mixed episodes adjunctive with lithium or valproate (in adults)* autism-associated irritability (in children aged 5 and up). Also, the long-acting risperidone injection has been approved for the use of schizophrenia and maintenance of bipolar disorder (as monotherapy or adjunctive to valproate or lithium) in adults.The “mechanism of action” of all of the drugs that have efficacy in psychosis was presumed to be dopamine D2 receptor blockade, a mechanism shared with all of the prior medication from Thorazine (chlorpromazine) through Haldol (haloperidol). The assumption—which clozapine disproved—was motor side effects were required for the drug's efficacy in psychosis. This primacy of the D2 blockade as a mechanism of action has since been disproven. This is the mechanism that leads to gynecomastia, leading to a bevy of lawsuits from men who developed breasts. It also causes related side effects like galactorrhea—breast milk from breasts that can be on men or women who are not nursing— and erectile dysfunction. Dopamine—it does a lot of work in the brain, not just pleasure.This motor side effect profile was not true with clozapine. It had various additional receptors, particularly in the serotonergic family (5HT-2a, for example), and alpha-adrenergic, histaminic, and other receptor sites throughout the brain. This broad profile of different receptors explains the wide range of side effects. But more importantly, these are complex, “messy,” and hard-to-predict outcomes given the complexity of the brain. The complex pharmacology allowed psychiatrists like me to think—hard!—about which particular witches brew of receptors we would choose to tickle (agonize) or antagonize. It's very satisfying. I also suspect this is a story we tell ourselves that is not as closely moored to truth as we'd like. We enjoy thinking about science-ish stuff. Receptor binding profiles are seductive— because they are knowable. Our patient's heart, hope, dreams, and heartbreak? Less so.The most important feature of risperidone today—and its 1st order metabolite, paliperidone—is that is deliverable as pills, rapid-acting dissolvable tablets, and long-acting injectable formulations, lasting between 2 weeks and 6 months between doses. A psychiatric treatment that isn't an oral once-daily pill? One you have to take twice a year? Medicine that is intended for people who often—like many—feel conflicted about taking a daily pill? That is a big enough deal. That is a real innovation— it considers human frailty, ambivalence, and common failures of mind. Not because it's a magic drug. Rather, long-acting medicine that doesn't make crippling relapse easy —thanks to good design— is exactly the kind of medicine that works. My second research effort was on the acceptability of such medicines in youth. It's responsible for my presence at the academic conference where I met my now wife.Oral medicines were popular because they were easy to sell. Novel medicines and technologies will be easy to take. The story of my fascination with the risks and benefits of these medicines doesn't end there, though.I still research these medicines and their adverse effects— funded by NIMH— for identifying Tardive Dyskinesia with Machine Learning and closed-loop Internet of Things physical medication compliance tech with my team at iRxReminder and colleagues at Videra. We are enrolling in a study at Fermata in New York and other sites. Thanks for reading.This article is another in my series about one drug or another. Prior installments include Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.Sponsored Content!One way of supporting this publication is buying stuff from Amazon, like a nifty box from Apogee that I used to record the voice-over: the BOOM. In fairness, it's just the A/D. I am also using the API 512c mic pre, plugged into an AnaMod 660 500 series compressor, nestled in a reliable RND R6 Lunchbox, and all of that plugs into the Boom into my Mac. It's a Microtech Geffel mic. Most of the audio post-processing is done with Izotope RX 10. I get money if you purchase any of these things— not a trivial amount since they upped my affiliate rewards.In case anyone was wondering if I was an audio nerd… This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we are analyzing the '90s movie "Girl, Interrupted" based on the memoir by Susanna Kaysen. This film depicts two years of a young adult woman's life at McLean Hospital in the 1960s where she was diagnosed with borderline personality disorder (BPD). This episode analyzes everything from why it's so hard to talk about BPD, psychoanalytic vs behavioral treatment methods, the deinstitutionalization movement, antipsychotics, and our opinions about Angelina Jolie's portrayal of sociopathy. We hope you enjoy! Instagram TikTok Website [00:10] Dr. Katrina Furey: Hi, I'm Dr. Katrina Fieri, a psychiatrist. [00:12] Portia Pendleton, LCSW: And I'm Portia Pendleton, a licensed clinical social worker. [00:16] Dr. Katrina Furey: And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows. [00:23] Portia Pendleton, LCSW: Our hope is that you learn some legit info about mental health while feeling like you're chatting with your girlfriends. [00:28] Dr. Katrina Furey: There is so much misinformation out there and it drives us nuts. [00:32] Portia Pendleton, LCSW: And if someday we pay off our student loans or land a sponsorship, like. [00:36] Dr. Katrina Furey: With a lay flat airline or a major beauty brand, even better. [00:39] Portia Pendleton, LCSW: So sit back, relax, grab some popcorn. [00:42] Dr. Katrina Furey: And your DSM Five and enjoy. We get started with this episode. We just wanted to add a trigger warning. Some of this content could be disturbing to listen to. We're talking about the film Girl Interrupted, and there are some themes of suicide, disordered eating, and I would say institutional traumatization. So again, if any of these themes hit too close to home or could potentially be damaging, please feel free to skip this episode and join us again next time. Otherwise, enjoy. Hi, thanks for joining us. Today we are going to talk about the hit movie Girl Interrupted. A real blast from the past from my favorite decade, the 90s. This movie is based on the 1993 memoir by Susannah Casey, who wrote about two years of her life spent at McClain Hospital in the 1960s in Massachusetts, where she was diagnosed with borderline personality disorder. Portia so when I recommended we covered this movie, I totally didn't remember the plot. I don't actually know if I saw the whole thing. I was just like, oh yeah, there's a movie with Angelina Jolie and she got an Oscar and it's probably really good. I totally forgot that the main character was diagnosed with Bpd, which I actually think is great for us to talk about because we've alluded to this diagnosis and some of our other know, I'm thinking like, what about Bob Succession White Lotus? And I still find that this is a tricky diagnosis to talk about with patients to explain to patients to explain to other. I thought, you know, Winona Ryder's character like, did a great job being like, what is it? On the borderline of what? What are you talking about? Right? [02:38] Portia Pendleton, LCSW: Yeah. And at the time, though, this was newish. Marsha Linehan hadn't written her book yet on DBT. [02:47] Dr. Katrina Furey: I don't even think there was DBT yet. Thinking about the 1960s, I thought this film did a great job depicting what it probably was like to be psychiatrically hospitalized in the 60s, which is so different from what it's like today. Place that is very true. So this film was filmed at Harrisburg State Hospital in Harrisburg, Pennsylvania. It was filmed in 1999, but it was based on McLean Hospital, which is probably the number one psychiatric hospital in our country for a long time. I think it is affiliated with Harvard, and I think they do still have some longer term units like this, but you see a lot of treatment. You know, she goes to therapy many times a week. She's sitting on the couch. Her therapist is sitting behind her. Unfortunately falls asleep at one point, which I don't think actually happens in real life, but speaks to how she felt probably like there was a disconnect and you hear about how she's there for two years. That just doesn't happen anymore. But in the did, that was the treatment. People used to be admitted and stay for a really long time until in the mid 1960s, in the Reagan era, there was this big move not just in our country but internationally to deinstitutionalize patients, right? So sort of close down these long term hospitals which we called asylums and invest more in community mental health centers. And I think I don't know this for sure, but I believe that coincided with the invention of modern day antipsychotic medication like Thorazine and the other medications that came from that, like Haldol, basically medications that could treat schizophrenia and thereby treat these patients in a way that hopefully they didn't have to live in an institution. Sadly, we haven't invested enough in the community mental health centers that were supposed to be created to sort of support patients and we've had some really awful side effects from that. Primarily homelessness and institutionalization in jails. That is the number one provider of mental health treatment in our country. How awful and disgusting is that? And again, it's because not enough money goes into these community mental health centers. So nowadays you might be admitted for a couple of days to really stabilize you, tweak your meds, but you're not getting this type of intensive, insight oriented therapy anymore that we see depicted in this movie. And I think that's really sad. You can get that if you can pay for. [05:29] Portia Pendleton, LCSW: I mean, it's wildly expensive. [05:31] Dr. Katrina Furey: Wildly expensive. And I think some places, like other, you know, hospitals might take insurance. I don't know if insurance would cover it. [05:41] Portia Pendleton, LCSW: Yeah, they take some and especially for some programs. Like, I've had some people go to McLean, I've known some people to go to Silver Hills. Those two places over the years have definitely taken more of an insurance route for some of their programming and other tracks that they have. Other parts of their residences or programs are not insurance based. [06:03] Dr. Katrina Furey: And I think that also just speaks. [06:04] Portia Pendleton, LCSW: To like there's not a lot of people who can afford to be somewhere for a year and pay that. So I think they've also just had to do that where it's like some of their income is insurance based and others they are able to get private pay. [06:19] Dr. Katrina Furey: And I would like to think that they would take insurance for more situations if insurance would freaking pay, right? But insurance is the worst. That's a whole nother tangent for another day. But they don't pay. They don't even pay know, short just it's really an abomination. Yeah. So anyway, getting back to the movie, we have an all star cast. So Winona Ryder is playing Susanna, the main character. We have Angelina Jolie playing Lisa, the woman with sociopathy. She won an Academy Award for this role. I think Winona Ryder did too. Or maybe she was nominated. I can't remember. We have Whoopi Goldberg playing Valerie, the nurse. Elizabeth Moss playing Polly, the girl who was a burned victim from childhood. Clea duvall is played. Georgina susanna's roommate. [07:12] Portia Pendleton, LCSW: And she is in the show Veep. [07:14] Dr. Katrina Furey: That I really love. I haven't seen it before, but I've heard really good. [07:17] Portia Pendleton, LCSW: I was like, oh, my gosh. Oh, my gosh, it's her. Yeah, I couldn't believe it. [07:21] Dr. Katrina Furey: And then we had Brittany Murphy, who played Daisy. Who. That's just a tragic death and weird circumstances on its own. But I loved her, and I loved her roles in the then we had Jared Leto, who knew? Playing Toby. [07:36] Portia Pendleton, LCSW: I was like, who? Before I looked at the cast list, I was like, who is that? Why does he look so familiar? I couldn't believe it. So young. [07:43] Dr. Katrina Furey: I know. [07:43] Portia Pendleton, LCSW: Like a baby. [07:44] Dr. Katrina Furey: They all look so young. And then we have Jeffrey Tambor playing Dr. Melvin Potts, her first psychiatrist. And then we see Vanessa Redgrave playing Dr. Wick, the female psychiatrist. And there's a lot of other characters too, but those are just some of the main heavy hitters. [08:01] Portia Pendleton, LCSW: Yeah. [08:02] Dr. Katrina Furey: So what did you think, Portia, about the opening? [08:07] Portia Pendleton, LCSW: A little confusing. I mean, I was like, Is this present know? And then I was confused because it starts with her in the hospital, right, getting her stomach pumped. [08:16] Dr. Katrina Furey: Then I think the very first thing is you see, like, a broken light bulb in a syringe, and the girl's like, in the psych hospital, and you're like, what's going on? And then it flashes. [08:24] Portia Pendleton, LCSW: So then she wakes up. [08:26] Dr. Katrina Furey: And I was like, okay. [08:27] Portia Pendleton, LCSW: So was that a flashback? Was that a memory? Is her stomach getting pumped real? I was confused with those two first scenes. [08:36] Dr. Katrina Furey: Yeah, totally. And I wonder I would imagine that was kind of intentional. And then we see her being pretty aggressively restrained. We see the tube down her throat, I think, pumping her stomach. And my first thought was, what did she overdose on? This looks like they're trying to treat her for an overdose. And then someone screams out, oh, she's a wristbanger. I was like, what does that mean? And she said something about, there's no bones in my hand. And I was like, what is going on here? But I think it did give a pretty good snapshot into her mental state at that point in time. I was like, okay, she's overdosed on something that's dangerous enough where they have to aggressively pump her stomach. Now, we can't wait. We have to hold her down before we even get a sedative in her. Maybe back then they didn't even really have sedatives. Honestly, I'm not sure when things like Adivan and stuff were invented. And that thing about not having bones in her hand made me think, is she psychotic? Is she not? What's going on? Then we see her lock eyes with that man in the hallway, who we later learn is, like, her dad's colleague who's married, and she's had some sort of sexual relationship with him. And then she's pretty quickly seeing a psychiatrist in his home. You see her looking out the door, seeing his family and looking out the window and seeing her mom unpacking a suitcase. And I was like, Uhoh, yeah. [10:04] Portia Pendleton, LCSW: And still does happen. But I think it was more common in the past with these kind of, like, voluntary, but involuntary getting someone to treatment. Right. So it's like, whether you're an adolescent, and it's not voluntary at all, and your parents are taking you there, so it's under their voluntary, but not telling them where they're going. So, hey, we're going to go for a car ride. They don't know their suitcases packed, and then we're taking you to treatment. Or the horror stories of those wilderness camps where you're, like, abducted in the middle of the night. I was kind of thinking of that with Susanna being an adult. Right. It's like, in my head, I'm like, at any time, she can kind of. [10:40] Dr. Katrina Furey: Back out of this. Well, can she? It turns out she couldn't. Right. [10:45] Portia Pendleton, LCSW: That was also my question was, why. [10:47] Dr. Katrina Furey: Was it different in the so I don't know the full rules, but I do know that a lot of things they depicted in terms of getting her to the hospital don't happen these days. So she's seeing this psychiatrist. So an old white man, by the way, and he doesn't do this anymore. He very readily volunteers that way to instill confidence in your patient. I thought he was very shaming. I didn't like the way he spoke to her. He was not connecting with her. It was very clear she was, like, a bother to him in that the way he was saying, like, I'm just doing this as a favor to your dad. Why are you doing this to everyone around you? I just thought it was awful. What a terrible way to treat someone who is just clearly attempted suicide, even if she's saying, I always just had a headache. I didn't mean to take that much. It's clear what was going on. And then he just puts her in a cab and trusts the cab driver to take her to the psychiatric hospital. Okay. Yeah. Okay. [11:49] Portia Pendleton, LCSW: That's his responsibility. [11:50] Dr. Katrina Furey: We 100% don't do that. If you need to send someone to the psychiatric hospital, hopefully you can talk with them and talk with their family and come up with a plan where they're on board. That's the ideal way, right, to sort of have their family bring them, and they're voluntarily seeking help. Sometimes people aren't willing to go and they need to go for their safety. And that's when, at least in the state of Connecticut, a psychiatrist can involuntarily hospitalize someone by signing what's called the Physician's Emergency Certificate or a PEC form. There's only two conditions in our state where you can basically take away someone's civil liberties by saying you have to be institutionalized against your will. That would be if you are an imminent threat to yourself or someone else. So in terms of like suicidality or homicidal threats or if you are so gravely disabled from your mental illness that there is fear of your being able to survive without immediate intervention. So people who unfortunately have something like a psychotic disorder, who aren't eating, who are harming themselves in some way but might not realize it like if they have diabetes and aren't taking their insulin, things like that. But it has to be really severe in order for you to be able to check that box. You can't check it for things like substance abuse. That's a different type of involuntary commitment and that one's really hard to get. [13:12] Portia Pendleton, LCSW: You can also send people involuntarily to the hospital just for the eval. You know what I mean? Like cops can do that. [13:20] Dr. Katrina Furey: You're right. Sometimes people will voluntarily sign themselves in. Once you do that, though, you can't voluntarily sign yourself out. Usually the team does have to kind of be in agreement that you're ready to leave. If not, then they could petition the courts to then involuntarily commit you to sort of see out your treatment. But it's not like, for two years anymore. [13:44] Portia Pendleton, LCSW: Yeah. So we learn later in the movie. But that Lisa has been there for eight years. [13:49] Dr. Katrina Furey: Not surprising, right, given her personality pathology. And it seems like she frequently elopes, which is the fancy word to say. [13:59] Portia Pendleton, LCSW: You know, my question was just thinking about is she making herself known? Is she kind of coming back? Is she presenting in a hospital somewhere? Like, how are they finding her? [14:08] Dr. Katrina Furey: Right. Are they finding her or is she finding them? Does she have some sort of tie of dependency to the institution that's been taking care of her? Because it seems like she's like the leader in some ways. Right. And I thought that I mean, what were your thoughts, Portia, of Angelina Jolie's depiction of Lisa with antisocial personality disorder? [14:27] Portia Pendleton, LCSW: I thought it was good because you can see how those people can kind of suck others in yes. [14:35] Dr. Katrina Furey: That charming. [14:37] Portia Pendleton, LCSW: And appear really interesting and powerful and fun and light and it's almost like they know what you need. So she was all these things to different people. [14:49] Dr. Katrina Furey: Yes. And then knows also how to get under people's skin. Like we see with Daisy in a really sinister way. [14:57] Portia Pendleton, LCSW: Oh, yeah. Like horrific. I mean, I didn't really, I guess, get the flair of oh, my. Like, I really don't like her. She's horrible. Until that moment. [15:09] Dr. Katrina Furey: Yeah. Right. [15:10] Portia Pendleton, LCSW: Until the because she doesn't let it go. It wasn't just like, oh, I kind of threw this out there. Maybe someone may do that. I'm thinking maybe who has, like, a borderline personality disorder. They're kind of pushing the limits a little bit, but take it that far is not typical, right? [15:26] Dr. Katrina Furey: And I thought at first in seeing her on the screen, I thought she was depicting Bpd because she comes in very provocative. You can tell, like, the staff is all up in arms, right? Like, Nurse Valerie, played by Whoopi Goldberg, I think is helping Susanna settle in and then gets some kind of someone comes in, like, whispers in her ear, like and then you see all the staff is ah. Some of the patients there get really nervous, but then some of them are excited to see her again. I think that actually displayed the concept of splitting really well. That these types of patients tend to rile people up. And some people are on the good side, some are on the bad side. And then you pit them against each other. [16:05] Portia Pendleton, LCSW: Really manipulative. [16:06] Dr. Katrina Furey: Really manipulative. And so at first, I thought that was the type of character she was portraying until the movie went on. And you'd see her get under people's skin and then not let go. And you could sense she got off on that. Even in the rolling chair when she steals the nurse's pen and has it at her throat with that sort of suicidal gesture. You got the sense they've done this before. You knew that this nurse had opened. [16:32] Portia Pendleton, LCSW: Up to her, which huge red flag. [16:37] Dr. Katrina Furey: Don't do that. [16:37] Portia Pendleton, LCSW: And also, though, it's like that is most likely to happen with that kind of a patient, 100%. They're really good at getting under your. [16:45] Dr. Katrina Furey: Skin and getting you to open up to feel safe and comfortable. This is how serial killers abduct people. This is how it happens. So I thought she did an amazing job portraying both sides of that. Like, both the charming, fun, playful nature that attracts people and then that sinister, manipulative, sadistic side. [17:07] Portia Pendleton, LCSW: I mean, not being impacted by Daisy's death. So, like, Susanna is very appropriate reaction. And again, I'm saying this like, ha ha. But even someone with a personality disorder. [17:23] Dr. Katrina Furey: It'S like, yeah, because she has appropriate. [17:25] Portia Pendleton, LCSW: Emotions that maybe are extreme. But like, wow, you see someone who a dead body, someone who's hanging very disturbing. And you have this emotional reaction because you're a human with you know, Lisa. [17:38] Dr. Katrina Furey: Is not she takes her money and she goes I think, again, that was just such smart writing and depiction. I guess I was reading that didn't actually happen. Like, they didn't escape together. I was reading a little bit on Wikipedia about the author's take on this movie and I think she actually didn't love it. But there were some things that didn't actually happen like that scene. So whether it happened or not, I hope it didn't for daisy's Sake. But it was really smart writing to portray these two women who are both struggling psychiatrically, but with different personality flavors. And I think you do see some overlap between the Bpd and ASPD antisocial personality disorder, which, again, are all under the same cluster of personality development, like the provocative nature, the splitting, the intense mood swings, the all or nothing way of thinking and feeling and relating to people. But you see how antisocial personality disorder is different, right? [18:36] Portia Pendleton, LCSW: There's lacking empathy, there's lacking people with Bpd can relate to others. They do experience emotions appropriately and sometimes extreme. It's not a lack of in most cases, it's intense. [18:48] Dr. Katrina Furey: Exactly. [18:48] Portia Pendleton, LCSW: Too many emotions. [18:50] Dr. Katrina Furey: Right. It's a very intense emotions for the situation, but you still experience them. And they're not always, quote unquote, too intense. Sometimes they're totally accurate. But even, like, the scene with Susanna and Valerie where Susanna's in the bathtub, and she says awful things to thought. I don't know about you, but I felt like that was the scene where I really saw the Bpd side of Susanna. Kind of like until then, I was like, I don't really know if I buy that she has this diagnosis or if she's just, like, a struggling. Like, maybe it's a little too early to diagnose her with something like this, but then she really throws out, like, racial slurs, really derogatory things. Because I think Valerie was trying to connect with her. And I think for someone with Bpd, that feels very scary. Right. It's like you crave attachment, and you also fear it because you might lose it. So I felt like that was her trying to push her away in a really extreme way. And then later, though, you see that Susanna has a lot of remorse and guilt for what she said, whereas someone like Lisa would not. Daisy's character as well, is very you. [20:04] Portia Pendleton, LCSW: Know, I think there's a lot there. I think also, if we're going on what Lisa said is true, which sounded like her dad was molesting her for. [20:14] Dr. Katrina Furey: And again, like, no one else had kind of brought that up. And I do feel like people with sociopathic traits have this uncanny ability to sniff these things out and pull them out. Right. I don't know how, but they do. They can sense this stuff and pull it out and really dig at you. Yeah. [20:34] Portia Pendleton, LCSW: We didn't know that until that scene where she was kind of pushed over the edge. But she talked about being wealthy a lot. It seemed like she was abusing laxatives. They were kind of trading colase for Valium, which can happen at residential or inpatient places. That's why you're typically supposed to show your mouth. You lift your tongue, move it around to show that you're not tonguing meds. [21:00] Dr. Katrina Furey: Right. Or cheeking them or throwing them up afterwards before they've been metabolized. Yeah. [21:07] Portia Pendleton, LCSW: So that's a part that's just I mean, it can happen, and it is. [21:11] Dr. Katrina Furey: What it is, but it does happen. [21:12] Portia Pendleton, LCSW: The trading is just so unhelpful, right? Because it's like you don't know what drugs you're trading something for that then you're taking could be interacting with something else that your prescriber is giving you that they don't know that you're doing this. Very dangerous do not do thought. And maybe you can speak on this a little bit. It was interesting, which I know would never happen. [21:30] Dr. Katrina Furey: Right. [21:30] Portia Pendleton, LCSW: So before she's seen by a medical and I'm talking about Susannah before she's evaluated or sees any psychiatrist, she's already taking medication and they're giving her laxative. Why? [21:40] Dr. Katrina Furey: I thought they were giving her sleeping pill at first. Well, I guess they also give her choli. Right? [21:45] Portia Pendleton, LCSW: Well, anyway, but any medication. [21:47] Dr. Katrina Furey: Yeah. So there were definitely, I would say, some positive elements of the movie about the way they depicted mental health treatment back at that time. As it was. It could be at these beautiful institutions where you would have, like, a nurse's station. Then the patients would have their rooms. There'd be a common area. There would be other rooms like the art room, the music room, stuff like that. I think even nowadays, at more residential type places, you try to have that stuff so that during the day, you're not just sitting around, there's some therapeutic intervention. Right. So that I thought was pretty positive and spot probably, I would imagine McLean still might kind of look like that. The things that I thought were not great was that, like you said, she didn't see a psychiatrist at all and she's already taking medication. Like, that doesn't happen nowadays, and she. [22:34] Portia Pendleton, LCSW: Wasn'T already on it. [22:36] Dr. Katrina Furey: Right. It's not like they were continuing what she was on. But even for that, if you're admitted to a psychiatric hospital and you get to the unit at 03:00 in the morning, there's a psychiatrist on staff who will at least come and do a physical exam. Listen to your heart, listen to your lungs, check your blood pressure. [22:52] Portia Pendleton, LCSW: You're getting labs. [22:53] Dr. Katrina Furey: You're getting labs done. Maybe you need an EKG just because they might have hurts like a murmur or you're on a medication, they want to make sure that your heart is functioning okay, especially her, who just had a recent overdose. And then you go through like, do you have any allergies? What other medications do you take? Do you have any dietary preferences? Nowadays they also ask you what are your pronouns? All of this stuff happens the second you hit the floor. It doesn't wait till the morning. You might not meet your primary treater and get into the therapy side of things at 03:00 in the morning, but you would have that done, and you would talk about what medications they were going to prescribe or not and why and why. So I didn't like that. And you can't force anyone to take medication. That's the other thing that was inaccurate and made me upset, is like when susannah would express, like, I don't want to take this. You can't force them. That is totally coarse. If you can't do that, you need a court order to give anyone medication, which sometimes you do have to apply for, and sometimes it is granted. Like, if you have a patient with really severe chronic schizophrenia who needs their injectable antipsychotic to maintain wellness, that gets really tricky. But for stool softener, no one's forcing you to take a stool softener, okay? And like you said, they do like, tongue and cheek checks and make sure you are taking your medication. And they depicted that sometimes, but not all the time. But yeah, the chicken carcasses. What do you think about that? Interesting. [24:20] Portia Pendleton, LCSW: I mean, it seemed like she does like, purge, right? So either laxative use or there was some alluding to maybe some binging, like some little bit of bulimia both at the unit and then when she was in her apartment. That made me think that again, I mean, I'm going very loosely making that diagnosis. I also would say that the other patient on the unit who appears to have anorexia, which the weird comment of she's like, yelling about wanting her clothes, and then the nurse says, then you'll have to eat something, does not happen. [24:50] Dr. Katrina Furey: Now you can't manipulate people to eat. [24:52] Portia Pendleton, LCSW: And also that's typically why there are now so many separate units. It's very unhelpful and doesn't happen frequently to have eating disorder patients within a general psych population. They are, I think, inpatient like, in a hospital can go to like a medical but even then there are very specific and I think there's really only like a couple in the country, but there's a Cute out west, and then there is Walden and McLean out east, where they have inpatient units specifically for that. Because I think it's so important for staff to be trained in a very specific way. [25:32] Dr. Katrina Furey: I did think some of the stuff they portrayed, like not giving you your clothes until you eat doesn't happen. Other stuff, though, that they portrayed, like her exercising all the time on the unit, super accurate. And that's one of the things that the staff get trained in is like, being able to pick up these subtle ways of exercising in an attempt to burn calories and things like that. [25:53] Portia Pendleton, LCSW: Well, a lot of patients will share that if they are admitted into a general hospital and they do have primary ed, it's often like the worst time, which, again, is probably for many different reasons. One, they're so medically compromised. Two, this is like the beginning of the long road of often. Then maybe you're switching to an inpatient ed unit and then residential and then PHP and then IOP. There is some controversy in the community with the ethics around tube feeding. There's even more controversy within it if you are being tubed placing and pulling same day or for each meal to get you off the tube, they want you to eat, and typically you're tubed if you're really malnourished or if you're refusing. Again, I don't think they can make you without a court order, but they'll do that if you're refusing. [26:44] Dr. Katrina Furey: Yeah, I think that gets really tricky. And it's probably when they call for a capacity evaluation where a psychiatrist I would believe a medical doctor could do it too. Medical doctor being like internal medicine, someone who's not a psychiatrist, but still a physician would evaluate, does this patient have the capacity to refuse meals when they're this malnourished? Or is that malnourishment causing impaired cognitive what is the ethical decision of like can you make this decision knowing it's going to hasten your death or not? I mean, that's probably a huge ethical. [27:18] Portia Pendleton, LCSW: And there was a case and the judge sided with the patient and the patient went on to die. They went into hospice. Just it's really horrible. Do not recommend. But these places are there for you because you are that know, you really need support. So anyway, Janet should be, I think, in a more specialized unit where she's getting meal coaching other than just being threatened or withholding other things. [27:45] Dr. Katrina Furey: Right. [27:45] Portia Pendleton, LCSW: I think there were some eating disorder places around Renfrew's really old. They started in Philadelphia. They're all over now, but they're like the oldest big center for eating disorder. So if they were open then she should have been there. I think she probably would have gotten better care and more specialized care. So she should transfer if it opens soon. [28:07] Dr. Katrina Furey: Well, and I'm just thinking too, back in that time, in the mid sixty s, I feel like a lot of the treatment was still very psychoanalytic. Right. So I don't know how much about. [28:16] Portia Pendleton, LCSW: Your mother, let's lie down and talk about your mom. [28:20] Dr. Katrina Furey: And as a psychodynamic, psychotherapist I so fully believe in, there's huge connections cases in certain instances. Right. [28:30] Portia Pendleton, LCSW: But we need meal coaching, we need behavioral treatment, which often is DBT, and we absolutely need but I will say, too, like at that level of care, it's really hard, I think, when you're also that malnourished to exactly do that. [28:44] Dr. Katrina Furey: That's what I was going to say. Right. Like at the right time for the right patients. I feel like back then and again, I don't know, I wasn't alive in the 60s, but I feel like that's what everyone got. [28:54] Portia Pendleton, LCSW: Yeah. [28:55] Dr. Katrina Furey: And maybe that was like all we really had back then. We didn't really have the antipsychotics and stuff were just starting to come out. Maybe like CBT, DBT, these things, I don't think they were really out there yet. So yeah, I would imagine Janet was getting substandard care based on today's standards. And then it's like, well, I think Susannah was getting really good care based on today's standards. The difference in the comparison is really interesting. [29:23] Portia Pendleton, LCSW: And I wanted to just if you haven't listened yet, check out our episode on Shutter Island. Because that was in, I think, around the same late fifty s the mid to early 50s. So that's not that far off from this movie. Maybe, though, ten years can make a difference. However, I think this is also, again, like a private institution versus a forensic state forensic unit. Right. [29:46] Dr. Katrina Furey: But you're right, it's really interesting to sort of watch both of those and kind of compare and contrast them and they do get some of the historical points accurate. And I feel like back in the 60s, again, that was when a lot of these hospitals were being shut down in an effort to have people be treated in the community. Which again, is like, great, let's do it. But the money to actually do it, guys. [30:08] Portia Pendleton, LCSW: Yeah, no, totally. That's a huge problem. Anyway, there was a lot of other things wrong, like the orderly having oh. [30:16] Dr. Katrina Furey: My God, sexual relations. Even like them allowing her to make out or have sex with her boyfriend. No, you're not letting when people come to visit you, you don't just get to go behind closed doors and have a conjugal visit. [30:27] Portia Pendleton, LCSW: It's like a therapy session or you're playing a game. It's out in the open visiting time. [30:32] Dr. Katrina Furey: There's boundaries, especially for a patient like her. And how did the girls keep escaping and going to the basement all the time? There's people on staff overnight. The room check thing was accurate. You do come in and do checks at first, they are every 15 minutes. So I think that's really disruptive to your sleep. And we know how important sleep is to your mental health. [30:51] Portia Pendleton, LCSW: So I've done checks. I only had to do one, thank goodness, because I'm not an overnighter gal. But when I worked at a residential, I did get mandated to stay once overnight. And having to do ten minute checks on a new patient, because typically when they're new, they're on the highest level of watch. [31:09] Dr. Katrina Furey: Right. [31:10] Portia Pendleton, LCSW: So it just sucks, a, because I wasn't used to being on night shift, but yeah, it's really hard to do as an employee or as a mental health professional. And then also, I'm sure the patient didn't love it either, right. [31:23] Dr. Katrina Furey: Because they're not just like opening the door to see if you're there. They have to make sure you're safe. Right. So if you're turned and facing the wall and sleeping, they have to shine the light in your eye, make sure not only are you breathing, but you're not hoarding some sort of weapon or things like that. So that actually was accurate. But then I was like, if they're doing the checks, there's no one in the hallways. That's just not how it happens. I don't think they would have been able to escape. I thought this scene with them all reading their files was fascinating. And to me, it kind of reminds me of like, nowadays when patients have access to their notes and stuff like that, and how that is interesting and I think different for someone reading their note from their primary care annual physical and their therapy work. Right. What were your thoughts about all that? [32:11] Portia Pendleton, LCSW: Yeah, I think we talked about this in another episode, but I'm going to bring it up again. You're supposed to write your note like there's a lawyer on one shoulder and the patient on the other. So I think though, with more electronic medical records and with more open chart things like we have my chart here, maybe that's international, maybe it's national. It's basically where you can log in, send a message to your provider, look at your lab work, et cetera, schedule appointments, also see the notes. And so there are some questions around is it helpful or not for that to be in the mental health world? And is there like a level of notes that should be shared versus not what's helpful? [32:51] Dr. Katrina Furey: What do you think? [32:52] Portia Pendleton, LCSW: I think that patients should absolutely have access to treatment plans. I think that having access to all of your notes all the time, reading them on your own, is unhelpful. I totally agree. I think if you need to see the notes, you should be going over them with the provider so you can explain things. So if there's any questions or context, they can ask questions and not feel any kind. It shouldn't be negative. And they might be like, oh, well, what is that? What did that mean? And then you're there to explain exactly what that meant. [33:29] Dr. Katrina Furey: Right. I think, though, kind of like these women reading their files, it can be jarring. I don't think I'd want to read my psychological assessment of myself by myself. I feel like that's like really I. [33:43] Portia Pendleton, LCSW: Think it's more damaging it can be. [33:45] Dr. Katrina Furey: And I think it can really damage the therapeutic alliance with your provider too, because not everything you're observing the patient's going to see and that's going to. [33:55] Portia Pendleton, LCSW: Be it might not be ready to see. [33:56] Dr. Katrina Furey: Right. [33:57] Portia Pendleton, LCSW: And I'll just say too, just for clarity, we're not talking **** about you in your notes, we're writing things from our perspective, from our professional perspective of what's happening. Sometimes maybe we're wrong too, interpreted something wrong. So it's really for documenting purposes, it's for billing. [34:17] Dr. Katrina Furey: Yes. [34:17] Portia Pendleton, LCSW: And sometimes we might not do it perfectly. So I think that's I would lead. [34:22] Dr. Katrina Furey: With that preference and I think with, again, notes and stuff like that being more and more open, I feel like they've just become less and less helpful. I guess you leave so much out and you just have to keep it in your head, right, that it's kind of unfortunate. I do find myself being like, well, if this person ever read this, how would they feel about this? And I do think that can go both ways. On the one hand, I think it can help you remain not compassionate, but help you stay in a neutral space. And a lot of times be mindful of your own unconscious biases and be like, well, why am I putting this word in? Does it really need to be there or not? And on the negative side, it can make you withhold things that really should be there, but you're worried about if they read it before they're ready, how is that going to affect them? How will that affect our therapeutic alliance and their future treatment? And is that worth it? [35:23] Portia Pendleton, LCSW: Right? [35:23] Dr. Katrina Furey: Is that potential negative effect worth it? It's real tricky. [35:27] Portia Pendleton, LCSW: It is. No, I totally agree. It's nuanced. I think most providers feel the same way we do. [35:42] Dr. Katrina Furey: But I did think how interesting that this film, filmed decades ago, based on a time even further in the past, is still, like, on the pulse with something really active, like, in the mental health field presently. And I also thought it amazingly depicted how mental health providers really struggle to tell people their directly. It seems like none of these girls really knew, what am I here for? What am I being treated for? Some of them did. They were like, oh, Elisa, you're a sociopath. We all know know. But, like, Susanna being like, borderline personality disorder? What is that? [36:19] Portia Pendleton, LCSW: And then when she's in her family therapy session, she's like, what is that? And apparently the doctor's been telling her parents, but not her. [36:27] Dr. Katrina Furey: Right? And she is an adult. This isn't like a 14 year old. And especially, I don't know about you, Portia, but I feel like in the mental health field, we tiptoe around this diagnosis, and so we're so hesitant to talk about it and share it with people. And why do you think that is? [36:44] Portia Pendleton, LCSW: I think because societally, there are negative connotations with it. And I think that at least that's my discomfort sometimes. Versus I think the more we accurately diagnose people who have Borderline and talk about it, the better care they will get, because then we know the treatment plan and they can get better. We have more than people to participate in studies, there's more research. I think we really should be accurately diagnosing the disorder and also teaching clients about it and giving them education is, like, best practice. But I think in our society, like, Bpd has a lot of negative even I think it's even, like, joked about, you're crazy, and it's females. Obviously, we're careful of that, but I think ultimately, it does more damage, not sharing or being, for sure, hesitant. But again, diagnosing someone with a personality disorder does not happen immediately. One assessment, you're getting there with tons of data and information, and over time, it's like, you're probably there, right? [37:47] Dr. Katrina Furey: Let's just call it what it is, right? But yeah, I think that reminds me of, like, early on in the movie. I think it's in this scene when she's reading her file and she sees a cluster of diagnoses at the beginning. I can't remember what they were. Do you remember what they were. Yeah, they're not accurate today anymore. We call them different things now. [38:09] Portia Pendleton, LCSW: So it says Psychoneurotic Depressive Reaction, personality Pattern Disturbance resistant, mixed type, and then undifferentiated schizophrenia. [38:21] Dr. Katrina Furey: Those were yeah. And then all of a sudden, at the bottom, it's like, final diagnosis borderline Personality disorder. So can you imagine? Again, it's like, okay, she's reading all these words. Like, even as a psychiatrist, I don't understand what those early diagnosis mean because we don't use them anymore. They're a lot of big words that are confusing. So it's really hard for her to make sense of, like, what does that mean? And she goes and grabs it, looks like a DSM or something, and starts reading about it and is, like, all up in arms. And I just think, what a sad way for her to find out and then to also hear it in the family therapy where her parents know before she knows, but we're all keeping it. [38:55] Portia Pendleton, LCSW: Quiet, like talk about it. [38:58] Dr. Katrina Furey: And I think I loved when she said borderline of what? Like, what does that mean? And, you know, the way I was taught to think about it and where I think the phrase comes from. And again, I will say I don't love that we call certain things personality disorders. I feel like even that phrase is really stigmatizing. I don't know of a better one, though. [39:21] Portia Pendleton, LCSW: So much of we find in patients who have borderline personality disorder, there typically is some sort of attachment trauma. [39:28] Dr. Katrina Furey: Yes. [39:28] Portia Pendleton, LCSW: And so I would love for there to be a more specific trauma diagnosis other than PTSD or complex PTSD that talks more about attachment and how that then impacts relationships. I think that would be so much more helpful, better fit for people to understand. [39:46] Dr. Katrina Furey: Right, 100%. And I think when we use the word borderline, I believe where it came from is, again, harkening back to those psychoanalytic days, which we see in this movie of thinking about what are the defense mechanisms different people with different illnesses tend to use to live with and cope with their illness. And when we think of people in broad strokes, we think of people falling into what we call, like, the neurotic realm of personality development. These are people with, like, anxiety disorders, OCD, things like that, eating disorders. And then we think on the other end of the spectrum are people with psychotic disorders who use different types of defense mechanisms that are disconnected from reality, whereas people with neurotic disorders are maybe like uber connected to reality or a little too in their head. Borderline falls in the middle, where you sort of display some neurotic defense mechanisms and some psychotic defense mechanisms that doesn't make sense to the average person. And even as I'm trying to explain it, it's really confusing. But these are patients she did say in the movie, which was accurate, with an unstable sense of self, unstable moods, like a lot of mood swings again, some safety concerns in the most severe cases, which we see with her right at the beginning. But, again, it's like what I also loved about this movie was when they captured her at this age because some of these personality traits, again, not the safety concerns, like, we'll put that over here on the side. But some of the other stuff, the big mood swings, the idealization devaluation, the splitting that is normal in development from when you're very young, like, born to as you're growing up into adolescence. And then as your brain matures and you mature, you're able to sort of hold on to good and bad feelings and thoughts simultaneously. But that takes time. It does. And so a lot of people are also really hesitant to make this diagnosis, I hope, in a teenager or young adult, until you really see these traits and these issues sort of being persistent and present across all different facets of someone's life and over a long period of time. Otherwise, it does raise the question of is this just quote, unquote, like normal adolescent angst, like the suicide attempt? No, but some of her questions to Dr. Wick, like, well, how many partners is promiscuous? And what is it for a man, like, totally trapped, right? [42:21] Portia Pendleton, LCSW: And for the time, just thinking of being in the think thinking of Susannah and then her mom, I would say probably very different expectations for how to behave. They talk the Vietnam War. There's a draft going on. So I think this is also just like, a very culturally changing time for so many behaviors might seem so unsafe besides the safety safety issues, like the promiscuity that they keep talking about to even the doctors, right? Because they're of that other generation as well, that maybe is having just more of that judgment or thinking it's more of a behavior than her. Just like right in the 60s as a young adult, like, expressing herself and her sexuality, right? [43:02] Dr. Katrina Furey: And then it's like, well, yeah, and having sex with an older man who's married. Again, I felt like there was so much almost blame put on her. But it's like, what about him? Right? [43:15] Portia Pendleton, LCSW: The mom are there at the ice cream store for that scene, and that wife and daughter come in, and Susanna susanna's trying to kind of hide herself initially. And then the mom sees her, comes over and is like, It's her fault. And it's also like, okay, but of course, right, like, you're so you're not blaming the adult in the situation, your husband, who's and, you know, she's single, she's young. Of course it's her fault, right? [43:41] Dr. Katrina Furey: There's all these assumptions and a lot of blame on her. But it's like, what about him? And taking advantage of a younger girl. And again, not saying that there aren't cases where maybe the younger girl is more of the instigator, I guess you could say. But still, I was like, I see her point here. [43:58] Portia Pendleton, LCSW: Well, and then he was continuing to want to follow up, and she remember at the beginning like, no. And kind of shuts the door on him. So even that felt like it was a little bit more on him, or else it was going to be more on him. But at the ice cream scene, I do think that that is when Susanna does kind of or Lisa's actions to kind of save Susanna is where Susanna does really align with her, and that's how that then, you know, then Lisa gets her trust on her. [44:24] Dr. Katrina Furey: And I think Lisa, with her sociopathic traits, can sniff out who's vulnerable. And I do think people with Bpd are vulnerable to attracting toxicity or finding themselves in these toxic relationships. Like, hearkening back to Tanya from White Lotus. As we're talking now, I'm wondering if that suicide attempt was somehow connected to that relationship with that man. Like if in some way she felt rejected and then attempted suicide. And if somehow, maybe the doctors knew that and we didn't quite hear that as a viewer. But that, to me would give more of more evidence for a true Bpd type of diagnosis where really the core inner wound and fear is related to attachment and feelings of abandonment or rejection are really hard to navigate, I think. As we wrap up, I wanted to just ask you, do you think Lisa would have actually been crying at the end? I did think her and the four point restraints were those are what restraints look like. Even these days, restraining someone is like the soul crushing thing that you have to do sometimes as a psychiatrist on inpatient units like this, when there's a real safety issue happening, we try to do it in the least restrictive way as possible. You do see another character earlier in the movie in a straitjacket. We really don't use those anymore, but what you saw depicted is what strait jackets looked like, and they were used back then. Do you think Lisa would have cried with Susanna's departure? [45:57] Portia Pendleton, LCSW: If the tears were real, they would. [45:59] Dr. Katrina Furey: Have to be about she's. [46:03] Portia Pendleton, LCSW: Yeah. [46:03] Dr. Katrina Furey: I don't think she's feeling sad to lose her friend. I think she's being manipulative. The tears are real about her to make Susanna feel bad for saying all those things. I think that is what it is. But I don't think a true sociopath is capable of having tears or really know if someone's coming or going. Right. [46:23] Portia Pendleton, LCSW: I also think, just like to add to Lisa is that the reason that we wanted to deinstitutionalize people is because you can become institutionalized, where you get used to living in a state like that, which I would also say you're around trauma a lot, and chaos. It's scary setting things. So I think that also, after eight years, I would imagine changes someone, and. [46:48] Dr. Katrina Furey: You become dependent on the institution. [46:50] Portia Pendleton, LCSW: Like, why she's there, sure. But for her to be there for eight years, I think also must impact her everything. So I'm just curious, even just thinking about what has that done to her? That's why we like to keep people in the communities, in their communities. It is what's best when there are enough resources. So I think that's also just something to think about, like, how have the eight years been there for her, impacted her? [47:19] Dr. Katrina Furey: Right. It's kind of like what we see when people are in the criminal justice system for a long time, then they get released and they reoffend and come back. Sometimes they don't know how to survive anymore, like, outside of an institution like that. [47:32] Portia Pendleton, LCSW: All right, well, thanks for joining us today. We hope that you enjoyed today's episode. If you did, please feel free to rate the episode with five stars and then check us out on Instagram at Analyze Scripts and TikTok at Analyze Scripts podcast. And we would love for you also to subscribe. We have gotten a little bit of a bump this week and we're really. [47:51] Dr. Katrina Furey: Excited about it, so we do see. [47:53] Portia Pendleton, LCSW: Every subscriber add on. It brings us joy. So if you'd like to participate in. [47:56] Dr. Katrina Furey: That, feel free and spread the news. All right, see you next Monday. [48:00] Portia Pendleton, LCSW: Thanks. [48:00] Dr. Katrina Furey: Bye bye. [48:07] Dr. Katrina Furey: This podcast and its contents are a copyright of analyzed scripts. All rights reserved. Any redistribution or reproduction of part or all of the contents in any form is prohibited. [48:19] Dr. Katrina Furey: Unless you want to share it with your friends and rate, review and subscribe, that's fine. [48:23] Dr. Katrina Furey: All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended or should be inferred. This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time. Don't.

This week on Wellbeing we are talking with Melody Moezzi about her journey with bipolar and experiences with the bipolar recovery sector. This is the 9th instalment in our series on bipolar. Melody is an author, attorney, activist, and visiting professor of creative nonfiction at the University of North Carolina Wilmington. She authored a bipolar memoir in 2013 called Haldol and Hyacinths: A Bipolar Life in which she covers her experiences with the condition. In this interview we cover her perspective on the bipolar recovery sector and its faults but also the solutions to fix those faults. In this episode Melody talks about her journey with bipolar, the impact mania had on her daily life, the criminalisation of mental health, the challenged ability of law enforcement to manage and identify mental health, the racism that may be present in the public recovery sector, how depressive episodes impact daily life, and the brilliance those who are not not neurotypical can bring to the world around them. "One of the things for me to talk about is I am very lucky that I was hospitalised and not put in jail. Where I live, and in a whole lotta of other places in the US at least, we have criminalised mental illness to the point that the largest mental health facilities are actually and jails and prisons." - Melody Moezzi on this episode of Wellbeing Tune in next week when talk with Jaime Lowe about her bipolar journey. We would love to hear from you! If you would like to suggest topics, give us feedback, or just say hi, you can contact us on wellbeing@2nurfm.com Host: Jack HodginsWellbeing website: https://www.2nurfm.com.au/wellbeingSee omnystudio.com/listener for privacy information.

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name haloperidol Trade Name Haldol Indication Schizophrenia, mania, aggressive and agitated patient Action Alters the effect of dopamine Therapeutic Class Antipsychotic Pharmacologic Class butyrophenones Nursing Considerations • extrapyramidal symptoms, tardive dyskinesia • use caution in QT prolongation • may cause seizures, constipation, dry mouth, agranulosytosis • assess for hallucinations • monitor hemodynamics • monitor for neuroleptic malignant syndrome (fever, muscular rigidity, altered mental status, and autonomic dysfunction) • monitor CBC with differential

Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we analyze the 2013 psychological thriller "Side Effects." Did ya'll remember that Channing Tatum was in this movie becauwe we didn't and it was a nice surprise! Too bad he died. In this episode, we explore Rooney Mara's portrayal of what we initially believe is major depressive disorder but then discover is actually manipulative behavior more consistent with malingering of a sociopathic level. We also discuss all sorts of medications and their side effects, including antidepressants, mood stabilizers, and antipsychotics. We hope you enjoy! Instagram TikTok YouTube Website [00:10] Dr. Katrina Furey: Hi, I'm Dr. Katrina Fury, a psychiatrist. [00:12] Portia Pendleton: And I'm Portia Pendleton, a licensed clinical social worker. [00:16] Dr. Katrina Furey: And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows. [00:23] Portia Pendleton: Our hope is that you learn some legit info about mental health while feeling like you're chatting with your girlfriends. [00:28] Dr. Katrina Furey: There is so much misinformation out there, and it drives us nuts. [00:31] Portia Pendleton: And if someday we pay off our student loans or land a sponsorship, like. [00:36] Dr. Katrina Furey: With a lay flat airline or a major beauty brand, even better. [00:39] Portia Pendleton: So sit back, relax, grab some popcorn. [00:42] Dr. Katrina Furey: And your DSM Five and enjoy. [00:57] Portia Pendleton: Today we're going to be talking about side effects, which I had never seen before, which I think some people might find, like, shocking. This is like a movie about a lot. Therapy, mental health, medications. [01:10] Dr. Katrina Furey: Yeah. [01:11] Portia Pendleton: So we're going to be talking about that today. I'm really excited, and I kind of just wanted to say briefly, wow. Like, Channing Tatum was in it, and I was like, is this why everyone watches the movie? Hello, Andrew Law? [01:26] Dr. Katrina Furey: Yeah. [01:27] Portia Pendleton: How long did it take you to figure out who was running the show? [01:32] Dr. Katrina Furey: So I've seen this movie several times. The first time not till the very end. I remember being really surprised. What about you? [01:41] Portia Pendleton: Same. [01:41] Dr. Katrina Furey: Yeah, right. I didn't get it the first time I watched it, I thought I think I thought this was supposed to be a medication side effect. And that was like the whole premise. And then when they got into the insider trading and all this stuff, I was like, oh, whoa. Yeah, I didn't see that coming at all. And then when I rewatched it before recording this episode, I remembered the plot. And so I was really watching Rooney Mars character a lot more closely to see if I could pick up on sort of subtle things that would suggest she was malingering. And they even used that word correctly, which is kind of feigning symptoms for what we call secondary gain, which means, like, to get out of work or to get money in a settlement or to stay out of prison or stuff like that. What did you think about Rooney mara's portrayal of what we think at first is a woman with depression? [02:41] Portia Pendleton: I thought it was great. I thought it also shows how we can be, like, functional. [02:47] Dr. Katrina Furey: Yes. [02:48] Portia Pendleton: So she's working, she is dressed well, but behind the scenes, like someone who's really suffering with kind of it appears, maybe more like major depressive disorders. She's having these episodes versus kind of more persistent depressive disorder, which would just be like persistent depressive depression with periods that you can also have major depressive disorder popping into. [03:13] Dr. Katrina Furey: Right. And they allude to again, I think we'll talk about her before the twist. So when we think she's just depressed and I'm saying just depressed, not to minimize the depression, but because there's more that comes out later, but I thought her eyes. She just looks subdued. She looks sad. She looks flat. She's not really super joyful. Even when they get him out of prison, she hugs him and stuff, but there's not a lot of animation there. And again, maybe that's just her personality, but she does have this suicide attempt where she rams her car into a wall in a parking garage, and when Channing goes to the hospital, he's like, oh, I thought we moved past this to suggest, like, this has happened before. And that's where she meets Jude Law's character, Dr. Banks, in the Er as the psychiatrist evaluating her. [04:08] Portia Pendleton: So what did you think of that? [04:09] Dr. Katrina Furey: Who was he evaluating before her? [04:12] Portia Pendleton: Oh, the man who was kind of delusional. No, I'm sorry. He was not delusional. [04:17] Dr. Katrina Furey: He was Haitian. Yes. [04:18] Portia Pendleton: And so he had seen the ghost of his father driving a cab, and so he kind of attacked the cab. [04:26] Dr. Katrina Furey: I'm glad I brought that up, because I remembered that's a good portrayal. I think that's something we do learn about in our training is putting the symptoms of various mental health conditions within a cultural context, because sometimes what we might think of in the American culture as delusional, like seeing ghosts of relatives who have recently died in other cultures, is not it's, like, normal in those cultures. So that was an interesting depiction of that. And again, an interesting depiction of a black man in New York City coming in and speaking a language the officer can't understand and wanting to sort of restrain him or punish him or take him to jail. And the doctor, in this case, being able to apparently speak French or Creole I think it was French and get a sense for what's really going on and keep him out of jail. So that's an example of not malingering. That's not malingering. That's like the law psychiatry or mental health interface, like, working appropriately. [05:32] Portia Pendleton: That was really great, and I thought it was just, like, a good check mark for him, for his character. [05:40] Dr. Katrina Furey: Yeah. And then now that we're talking about it, like a really interesting juxtaposition to him then moving next door, wherever, and evaluating Emily. Again, a white woman, someone later calls her, like, a fragile bird, attractive and just I guess you're right. I do pick up a lot on the background or the setting. I didn't love that. He didn't close the curtain right away. He starts the interview standing over her. I didn't love that. Just, again, like, a man towering over you and you're feeling really emotional and vulnerable. I don't love sit down so you're level. Don't get too close, though. I like that he didn't get too close. I think eventually he sat. Eventually he closes the curtain. I thought his line of questioning was pretty good in the way that she was saying, like, oh, my head hurts. They said I might have a concussion. And he's like, well, we got to wait for the CT scan. How's your head been lately? That's kind of weird. That's kind of a clunky thing to say. He didn't introduce himself as a psychiatrist right away. I'm not sure why or if that was intentional to see again. Maybe he already suspected she'd withhold things. If he did so, maybe he wanted to see if she'd reveal anything before she knew. That. That, to me now that I'm saying it should have been his first sign that something was off here. He says to her, usually when someone's in a car accident, there's skid marks. You try to avoid hitting the wall, but you went right for the wall. So to us, that suggests a suicide attempt. I can't believe she wasn't hospitalized. [07:27] Portia Pendleton: Well, that was what I was thinking. I was like, she didn't come in with kind of a thought of suicide and now is presenting, after waiting in the air for many hours as safe and has a caregiver or a partner and is evaluated and is sent home and non hospitalized. That happens a lot. Maybe sometimes it shouldn't, but this was an attempt, and this was a really serious attempt. [07:52] Dr. Katrina Furey: Like she rammed her car into the wall. I thought, though, that they did a good job portraying what we sometimes look for, which is called future oriented, like having plans for the future. Like, oh, no, I can't be outside. I have to go to work tomorrow. My husband just got home. I can't do that. At the same time, when I was working in Ers with evaluating patients like this, I don't care how future oriented you are, when you ram your car into the wall, you need to be hospitalized. And the fact that she was able to talk him out of it when that was his first instinct to me is, like, in retrospect, red flag number one. Yeah, right. The fact that she's like, you have an office, right? I'll come see you a handful of times. [08:33] Portia Pendleton: And to me, that was red flag number two, because I don't think that that happens often. I don't know of the ethics behind it, but I just don't think that that's typically available. [08:46] Dr. Katrina Furey: No. Right. [08:47] Portia Pendleton: Like, you'd be referring to, like, a PHP partial hospitalization program, tense about patient program through your hospital. You know what I mean? That would be the treatment exit. [08:55] Dr. Katrina Furey: Not just like, I just ran my car into the walk. I'm going to go see an outpatient psychiatrist. That's not an appropriate level of care for that severe thing that just happened. I think you need at least a couple of days. But again, unfortunately, this should always happen, right? Unfortunately, there's not enough hospital beds. Patients wait and wait and wait in the Er forever. Sometimes insurance won't cover it, even after something like that. I'll never forget my training, working on the inpatient child unit and being told by insurance it was my job to do the peer to peer review because they were denying ongoing a hospitalization for like a twelve year old girl for suicidal thoughts and depression because she hadn't actually attempted anything. So they thought we should discharge her. And it was like, unreal that they told us they're not going to pay for it because she hadn't made an attempt drives me nuts. But anyway, she had made an attempt. She should have been hospitalized. So the fact that she was able to manipulate him into going against his better judgment by appealing to well, I'll see you in your practice. I couldn't tell if he was affiliated with the hospital. It didn't seem like it. It seemed like he was like what we call moonlighting or like picking up. [10:11] Portia Pendleton: Side shifts, which he does talk about later because he's working all these multiple jobs. [10:16] Dr. Katrina Furey: Right, exactly. So maybe he's like, oh, a patient, oh, a couple of times a week maybe it seems like he needs the money. And then we sort of start seeing her meeting with him. And again, the boundary crossings just continue our favorite. So, yeah, we see her starting to open up to him. He starts talking about medication, which again is is warranted. Yeah. When someone presents with significant symptoms of depression status post a suicide attempt, I think that's when she brings up Dr. Seabird's name, which is played by Katherine Zeta Jones, and she gives consent for them to talk to each other about her case, all of which is normal. And then somehow he sees Dr. Sebert at, like it looks like a pharma. By pharma I mean pharmaceutical company, like dinner or talk or something. And Dr. Sebert like, very casually mentions, oh, oblixa, I did write down, being a psychiatrist, the medications Dr. Sebert said she had tried Emily on, wellbutrin, Prozac affects her, and she apparently had problems with sleep and nausea. So that's interesting because those can be common side effects. And we have medications in different classes. We have Prozac, which is an SSRI, effects are an SNRI, and then Wellbutrin, which has a different mechanism of action in which we think of as sort of in this category of medications called like, atypical antidepressants, which just means, like other they work in different ways. So looking at that, my thought as a psychiatrist is did she have adequate trials on any of these? Like, could she tolerate them long enough to see did they really work because these medications take several weeks to kick in? Or did she stop them pretty early because of side effects? Problems with sleep and nausea are really common early side effects that usually go away if you can stay on it and you can prescribe things to sort of help with that in the early stages. It's weird to me that she was only on one SSRI. Then we jump and again, I'm assuming we started with Prozac because that's typical practice, but maybe we didn't. But then you jumped to an SNRI then you jumped to this other thing. It's pretty atypical to jump around so quickly. And then it sounds like she was taking, as prescribed by Jude Lav's character Zoloft, 100 milligrams, which is a pretty high dose. So pretty high to get to 100 so quickly. Those are kind of my thoughts. [12:47] Portia Pendleton: Is that dosage more like along the lines of an OCD patient? [12:53] Dr. Katrina Furey: Not quite. That's a great question. So usually, like with Zoloft, you start around 50. You could start lower if you've never been on medication before to help ease the side effects as you're starting them, or if it's like, a young person or really thin person, you might start lower. 100 is, like, a pretty good dose for depression. I think the way it was depicted in the movie, I just felt like they got there really quick, which, again, you might want to given the severity of her suicide attempt, but usually you might go a little slower. But maybe again, I'm just assuming this was, like her first dose was 100. OCD definitely responds to higher doses of SSRIs compared to things like anxiety and depression. So for Zoloft, the therapeutic windows anywhere from 50 all the way to, like, 400 milligrams for OCD. Oftentimes people with OCD end up somewhere between two to 400, depending on the situation, but 100 could do it. Okay. Some other early boundary crossings that we see between Emily and Dr. Banks first, not hospitalizing her. The second, I would say, is when she found him. It looks like in it looks like maybe like some common area. So his office must be near the hospital or something. Almost gave me the vibe of, like, a cafeteria or something like that atrium that's right where he was sitting with his wife, who was preparing for a job interview, and he gives her a Pranal, and I thought, oh, gosh, he doesn't have great boundaries. You should never prescribe for your spouse or for someone you know? I mean, do do doctors do that sometimes? I'm sure proprietary is a pretty benign medication, but I think it just speaks to his own poor boundaries and why a patient like Emily might be able to sort of sniff that out and use it to her advantage. So all of a sudden, he gets a call with Emily kind of rambling on the phone, I think after she had tried to maybe jump in front of the subway train. And then the officer saved her at the last minute. But then she shows up as he's. [15:09] Portia Pendleton: Trying to his wife staring at a poster of oblixa right in the train station for a while, just like looking at it. And then she kind of walks over. [15:18] Dr. Katrina Furey: To the edge and then toes it. I didn't notice that, but you're probably right, because we'd heard about Oblixa from Dr. Sebert, like, in the scene before, and they kept talking about how you see the ads. You see the ads, and I will say, I hear this all the time from patients. I remember when I started my training, Abilify, there were a lot of ads out there for Abilify, and I had a patient who was like, I want to switch from this medicine. I've been on and been stable on for 20 years to Abilify. So this does come up. I thought that was I wanted to. [15:49] Portia Pendleton: Ask you, so if a patient comes in and they have seen like, a new medication on TV and it looks and they're excited about it, does that typically make it work better at all? I think Placebo mentioned that in the movie a little bit. [16:06] Dr. Katrina Furey: Yeah, you're right, she did. She was like, I think with your positive endorsement, it could work better. I mean, so certainly we know that the placebo effect is real. So by the placebo effect, I mean, they've done studies and stuff where if you give patients, like a sugar tablet, but you say it's an antidepressant or something, then sometimes the patients start to feel better, like they believe in what you're giving them. And that is part of the art of prescribing medications, I think, is not necessarily using that to your advantage. But it's really important when you're prescribing a medication, whether it's for psychiatric issues or something else, to get buy in, right? Like, if you're prescribing a medicine to someone because they have high blood pressure and you want them to work on it with lifestyle modifications, like with diet and exercise, you want to get buy in that all three methods of targeting the problem are going to be effective. So I think that's the kind of thing where if you come to me and I'm like, well, we could give you Zola, but it doesn't really work, are you going to be like, sure, I'll take that. [17:15] Portia Pendleton: That makes sense. I feel like even with therapy, I think some protocols actually, I don't want to say require, but really you're supposed to kind of speak to the results that have been studied. You're supposed to really kind of like, I don't want to say Hype up the program, but Hype is effective. This works for people, really, to get the bind. So it sounds like it's almost along that line. It's not necessarily like placebo effect in our practice, right? That's a lot of in research trials and stuff like that. But you have to get people's kind of excited to what you're trying to have them do. [17:52] Dr. Katrina Furey: Right? And I think patients will show up having seen ads and commercials and stuff like that for newer medications and wonder about it and some I mean, gosh talk about like buy in. I mean, the the like people like, make these commercials with the goal of, like, kind of manipulating you into wanting to take this specific medication so they can make money from it. And some of these commercials are really intense. [18:18] Portia Pendleton: So I thought at this point, in the movie, this was where we were going. Right. I thought like big pharma was like trying to kind of push this pill. I almost felt like in a little bit of a way it was going to be like the oxy. We secretly know that it's not effective or there is this really bad side effect. We're brushing it on the rug, don't tell anyone. Prescribers. [18:39] Dr. Katrina Furey: Push it, push it. [18:40] Portia Pendleton: But that was not the way this movie ended. But at this point that's what I was thinking. [18:46] Dr. Katrina Furey: Yeah, that's what I thought too is it was going to be all about Big Pharma. And I think unfortunately, you're right. There are stricter laws now about you see, in the movie pharmaceutical reps taking doctors like out to lunch or dinner. And they talk about how back they could be a quote unquote spokesperson for a pill and be flown out to some conference in an exotic location, give a talk for 15 minutes and have their whole vacation comped. Those sorts of things did used to happen. I didn't get to do any of that because they have these stricter laws which are good. Which are good because they did find like surprise, surprise, doing stuff like that did in fact influence physicians prescribing practices. Which makes sense. [19:33] Portia Pendleton: Yeah. And I was thinking same along the lines of this used to be a big practice for residential treatment centers, doing kind of the same thing with big pharma as big Pharma. So they would invite you to come tour their facility in Palm Beach and then you're going to refer your patients with substance use disorders there. It really primarily was kind of a big business with substance use all around this kind of same time. [20:01] Dr. Katrina Furey: Right. [20:01] Portia Pendleton: I feel like this is really popular to do. They want kind of to push patients. And now we are seeing and have seen the effects of this. So specifically talk a little bit about the state of Florida kind of being famous for having a lot of rehab centers. There was kind of in the news, a lot of unethical drug testing. So they'd be billing at really high rates these really expensive complex blood tests and labs and that's kind of how they're getting paid. And all these people have ended up in Florida and then kind of like homeless and then using drugs. Again, like a halfway highland houses. There's this whole pipeline. [20:40] Dr. Katrina Furey: It's very interesting that's the thing is, unfortunately, there is a nefarious pipeline. Where? I don't remember all the details, but unfortunately there have been then, like, big business partnerships, I guess, between a rehab center and a halfway house or where the patient would go afterwards, where then the patient does rehab. They pay out the wazoo they charge for these tests, like you're saying. Then they go to this halfway house that's contracted with the rehab center. And then the halfway house, they get reintroduced to the drug, sometimes on purpose. I think that's the most nefarious egregious thing that's come out. I mean, how disgusting is that? And then they go back to the rehab and it's just a cycle, and it's all for money making, and that just makes me want to vomit. [21:25] Portia Pendleton: Yeah, I mean, it's horrible. And I think that's right. And we've seen that with Big Pharma too, and that's why we don't get this anymore. [21:33] Dr. Katrina Furey: But I thought this was going to be like a movie, like anti Big Pharma. Anyway, we got derailed, but hey, big Pharma. So Emily somehow finds where he is in the atrium again, like, how unclear? And interrupts his combo with his wife. You can tell his wife's annoyed. She's, like, wanting some emotional support from him. This is a really awkward conversation to have in public. Again. He's like, if this just she sort of makes a provocative comment alluding to, like, sort of happened again. And he's like, well, if that's the case, I need to admit you to the hospital. Yes, that's the right step. And then she's like, no, I just need five minutes. I have to get to work. Can we go talk somewhere? And the answer is no. The answer should be no. But she manipulates him or something. [22:24] Portia Pendleton: I thought that it was interesting that his wife was I understand why she was upset. Like, she needed support, and her husband was kind of getting called to this work duty. But I feel like I'm assuming that this doesn't happen ever. This is a strange thing, right? Like a patient coming up to him. So I felt like her reaction almost felt, like, a little strange. If I was out in public and out to dinner with my partner, and we're sitting there and a patient comes up to me and starts talking about what seems to be, like, active suicidality, that would be not normal. My partner would be like, what the **** is happening? [23:06] Dr. Katrina Furey: They wouldn't even get up and leave. [23:08] Portia Pendleton: Right? Sad or mad at me. They would just be like, this is strange. [23:14] Dr. Katrina Furey: Weird. Yeah. [23:15] Portia Pendleton: So I felt like her being mad. [23:17] Dr. Katrina Furey: Just, like, felt off. I think she was mad that he chose to go, but I feel like. [23:25] Portia Pendleton: Within the context, you have to handle that. You don't need to meet with him. You know what I mean? But you have to handle the situation. Whether it's like talking to them outside and saying, this is wildly inappropriate. [23:38] Dr. Katrina Furey: I don't know. Asking her wife, can you go get a security guard? [23:45] Portia Pendleton: Maybe she was pretty. [23:46] Dr. Katrina Furey: That's the thing. I was wondering if there was some competition and if that was intentional. I think now we know it probably was to stir up some feelings of jealousy and stuff. And then they have this mini session, like, on some couch somewhere, and there's that Victoria Secret. Yeah. So they're sitting, like, really close together. Their body language was interesting because she's, like, face toward him with her legs up on the couch. You can see her bare legs. She's just sort of talking to him and pulls out, like, a Victoria's Secret bag, saying, like, I'm really trying. And he acknowledges again, I was like, oh, ick, ick, ick, ick, ick. Yeah. [24:23] Portia Pendleton: And again, the boundary crossing is when he agrees to meet with her also, like, in this public place, so on and so forth, and just meeting with her. But besides that, what he's saying. He's not flirting with her. He's not doing anything, like, inappropriate. Inappropriate in that moment within that context. But I think then we learn later a picture gets taken of them in this moment where she is holding up this Victoria's Secret bag, and they're comfy, quote, unquote, on this couch. But it's like, that is not what was happening. [24:58] Dr. Katrina Furey: Right, exactly. That's why you always have to be so careful. Totally. And this is why boundaries are so important. And this is why it's important to listen to your own gut feelings when you're evaluating new patients, because I think you could pick up some of these subtle red flags really early on and see how this could unfold. And so again, he doesn't hospitalize her against his better judgment, and then things really unravel. So he's like that's when she, Emily, asks, can you start me on Oblixa? Like, my friend so and so is on it. I hear it works. And he'd heard that from Dr. Sebert, who then we find out is, like, really pushing Oblixa. I loved what Dr. Sebert was like. Oh, you can have an Oblixa pen. Yeah. I was like, we should make analyze script pen. [25:49] Portia Pendleton: I have a lot of residential treatment pens. [25:52] Dr. Katrina Furey: I bet you do, right? It's just so classic. So then he puts her on Oblixa instead of Zoloft. And getting back to one of your questions, certainly there are more and more new antidepressants out there. Oblixa. I thought it was so funny the way they picked this fake name because it was like a combo of Abilify. And I thought, like, Trntilix, which are both too. Abilify has been around longer. What about Selexa and Selexa oblixa? They just sort of, like, combined it all. [26:22] Portia Pendleton: And it sounds real. It totally sounds like a medication sounds. [26:26] Dr. Katrina Furey: Like a medicine name. So I thought that was funny. And then I think it kind of starts to work, but she starts having these quote, unquote, like, sleepwalking episodes, which seemed convincing right at first, and then that's why he eventually prescribes this new medicine deletrix or something, which, again, sounds like a convincing medicine name. And that's where he's now participating as a consultant with a pharma trial being paid being paid, like, $50,000, which, again, sounds like a lot. I would have cautioned Dr. Banks to say, okay, after taxes, how much are you really getting, and is it worth it? [27:07] Portia Pendleton: And he does disclose that he did it. Again, it seems some things pretty by the book he's with another patient who he's telling about this trial that he's in and that he is being compensated for it. And he gives her this information that she'll receive the medication at no cost. And it's like, that why people agree. [27:27] Dr. Katrina Furey: To the trial, right? And that's what I think the pharmaceutical industry uses to its advantage. They still provide free samples, which I. [27:35] Portia Pendleton: Think can be right on the one hand, a way to assist people who cannot pay for it initially, or there's just problems with that, too, but that still happens. People still do get free samples of lots of things. Birth control antibiotics, or, like, Vivams, like. [27:56] Dr. Katrina Furey: A new Stimulant, which is really expensive, works great. I prescribe it a lot, but it can be expensive if you don't have good health insurance coverage. So they might give you, like, a quote unquote drug coupon where you can get, like, the first month free, and then you have to pay $600 the rest of the time. Anyway, as we're thinking about this, shout out to Mark Cuban's Pharmacy because they are providing a lot of medications at very affordable rates. Mark Cuban, if you want to sponsor the podcast, please feel free. Anyway, so they add in this new medicine, and then it turns out she murders her husband, basically, right? Like, she again has another one of these quote unquote sleepwalking episodes, ends up stabbing him multiple times, and then goes to sleep and he dies. Before we saw the end of the movie. What did you think about that whole scene? [28:45] Portia Pendleton: I thought that it was I was shocked, but based on another episode of prior episode of her kind of sleepwalking, I was like, I don't want to say, like, it wasn't surprising, but that didn't shock me. Something was going to happen in the movie. I was like, okay, this is it. And then she's going to be like, how are they going to go after her? [29:04] Dr. Katrina Furey: Right? [29:06] Portia Pendleton: Are they going to blame the drug? Are they going to blame her? How will they do this? That's what I was thinking. I was sad to see Channing Tatum go. Martin is his name in the movie, right? [29:21] Dr. Katrina Furey: He's not a Martin. I'm always sad to see Channing Tatum go. Yeah. I like to watch him walk away. Yeah. [29:30] Portia Pendleton: But he you know, he did not walk away. He laid on the floor and blooded out. [29:35] Dr. Katrina Furey: So then she gets shirtless. I know. [29:37] Portia Pendleton: Like, come on, haven't they seen Magic Mike? [29:40] Dr. Katrina Furey: What did you think about Rooney Mara's acting in that scene? Did you buy it? [29:46] Portia Pendleton: I did. [29:46] Dr. Katrina Furey: Yeah. Too the first time. Totally bought it. And that's where I thought the movie was going. Let's see what happens here. And I thought, actually, their depiction of the whole legal process, the not guilty by reason of insanity, the NGRI, I thought that was actually pretty accurate. And again, I'm not a forensic psychiatrist. We hopefully will be having one on in. The next couple of months. But I thought overall, that was a pretty accurate depiction of how that process works. And thank God for things like not guilty by reason of insanity so that people who do commit crimes or murders or what have you when they are in the throes of a mental health episode instead of just being locked up in jail, which unfortunately has become how sad is this? The largest place where mental health treatment is delivered because we don't have enough mental health hospitals in the country. That's a whole other episode and issue. But anyway, those patients can go to, like, a forensic psychiatric unit and receive treatment. Unfortunately, I think oftentimes what then happens is once their sanity is restored sometimes, then they're tried again. I'm not a forensic psychiatrist. Do you understand that differently? [31:01] Portia Pendleton: Yeah. And I think it's interesting why it would go either way. Right. Some people are charged with not guilty by reason of insanity go on to serve their time in an inpatient unit and then are let out right into society. And other people are get off temporarily not guilty by reason of insanity, receive the care and then have to and then are tried. [31:25] Dr. Katrina Furey: Yeah, exactly. [31:25] Portia Pendleton: I'm curious what the differences are. I'm sure it's clear. I just don't know it. [31:29] Dr. Katrina Furey: Well, hopefully when we have her case. [31:31] Portia Pendleton: It sounded like she got the she was going to get R. Right. [31:35] Dr. Katrina Furey: And that's the part where I'm not sure. Does that actually happen? When we have dr. Tobias wasser on in a couple of months, we will ask him. [31:43] Portia Pendleton: And it was a really short time. Right. And I think they also had to kind of convince her because at first she was like, no, I don't want to have to go there. I'm not going to be able to leave. And they were like, no, this is the golden egg. You got the best offer. It's 1% that this actually works. [32:00] Dr. Katrina Furey: I thought it was really weird that the state and the defense both wanted her psychiatrist to be their expert witness and that he would agree either way. Didn't you think that was weird? [32:14] Portia Pendleton: So I thought at first, before the twist, that the state was involved somehow with big pharma. I thought it was very strange that he was being approached. That lawyer, that guy. [32:29] Dr. Katrina Furey: I just felt like that would, like. [32:31] Portia Pendleton: It seemed like he had some other motive. [32:34] Dr. Katrina Furey: And that's what I was just like. [32:36] Portia Pendleton: And I was wondering if they were trying to get him, the psychiatrist on board so that he could speak to that it's not the drug. Right. And try to get the drug off. That's what I was thinking. [32:47] Dr. Katrina Furey: But again, Dr. Banks, like, what a conflict of interest. I feel like that's pretty like Psychiatry 101 where you should not be you. [32:58] Portia Pendleton: Can'T be the actions treating and her psychiatrist. You have to be one or the other. [33:05] Dr. Katrina Furey: Not only her past treater. Like when this happened, but you continue to treat her while she's in the forensic unit. Again, that doesn't track for me. That's not really what happened. No, I think any psychiatrist who would unfortunately find themselves in this situation would a, call your malpractice, who will appoint your defense, and B you're not involved anymore. [33:28] Portia Pendleton: Right. [33:28] Dr. Katrina Furey: So the fact that he kept getting involved, I think speaks to how she kind of had her hooks in him and he felt compelled, do you think, to clear his own name? [33:37] Portia Pendleton: I think so. [33:38] Dr. Katrina Furey: I think it was both. [33:39] Portia Pendleton: I think he wanted to clear his own name because at this point, he was being harassed by people who were really unhappy with him. His wife seems unhappy with the situation. His practice seems unhappy with the situation. I think he was trying in half to clear his name and then on the other half, I think he felt sorry for her and wanted to help her. [34:03] Dr. Katrina Furey: And he probably felt like some degree of responsibility, having been the prescriber. And I think prescribing something that he's in getting a kickback for. And even though he's, like, upfront about it, I think maybe he had some guilt there. But in the real world, that's not what happens. Actually, this does happen where attorneys will try to get you to be their expert witness. That actually happens all the time. But you're taught pretty early on and pretty clearly that that's a really bad idea because it's such a conflict of interest. Even if it's like your patients involved in a lawsuit and you're not really related, but your testimony, I guess, could support they're getting more damages or something. That's such a conflict of interest because if you do it or you could just affect the therapeutic alliance and you don't want to mess with that. [34:54] Portia Pendleton: We only really do it if we are like, subpoenaed. And sometimes subpoenas, I think we really only have to follow through if it's like they're from the state. I think you can kind of fight sometimes a subpoena or push back on it for what they're asking for when it's like a private attorney. [35:12] Dr. Katrina Furey: And that's why you always just call your malpractice and they tell you what to do. So anyway, I don't think his malpractice. [35:18] Portia Pendleton: Would have advised him to do this. [35:20] Dr. Katrina Furey: You see his colleagues telling him, like, you need to stop. Get off the case. And then he asks his colleague for Adderall because he's kind of a mess. And I was like, oh, gosh, no. [35:38] Portia Pendleton: So then this twist happens, right? [35:40] Dr. Katrina Furey: So then, you know, we love a twist. Like, one day we'll have a boundaries jingle and then we'll also have, like, a twist. Yeah, that sounds like a tornado. [35:48] Portia Pendleton: So I feel like for me personally, I got a little confused initially. Like, I maybe I was doing two things at the same time. I wasn't totally engrossed in the movie. I don't know. It took me a couple of minutes to be like, okay, so we're going. [36:05] Dr. Katrina Furey: In a totally different direction here, right? Yeah. It felt like whiplash. Yeah. [36:09] Portia Pendleton: So Rudy Mara's character is Malingering. [36:12] Dr. Katrina Furey: Yeah. Turns out this whole time we see. [36:14] Portia Pendleton: That she is working with Katherazada Jones's character. Dr. Sebert was her old psychology and love interest. Yes. Which is very inappropriate, obviously. I feel like we don't even need to talk about that. It's obviously inappropriate. [36:27] Dr. Katrina Furey: And I feel like Hollywood loves to depict psychiatrists and patients boning. They just do. And it just really drives me nut. Yeah. [36:37] Portia Pendleton: It's really like any other really horrible thing to happen in any other field. Yes, it happens, but it's so rare, so bad. This isn't the norm. [36:50] Dr. Katrina Furey: So teacher thing. That's like, less, probably less. Right. But I did not see that coming. Like, the first time I saw this movie that turns out like they've been in cahoots the whole time and to get money. [37:08] Portia Pendleton: So that's their plan is to get this payout from causing which is kind of wild to think about all of these chain reactions to make them rich. That's how it is. So they apparently have been kind of planning to take down Dr. Banks. Right. They send him pictures. They send his wife pictures of him and her, Emily, together, which looks really sexually compromising. They float this past patient of his into his practice. So they want him out. It sounds like there was, like a death of a past patient. She took her life and she named. [37:46] Dr. Katrina Furey: Him right, in her suicide note. And he said, this is all delusional. This relationship never happened. [37:52] Portia Pendleton: Which I don't think it did. [37:54] Dr. Katrina Furey: I think he's telling the truth. And unfortunately, things like that do happen. Yeah. And so, gosh, what a lot of planning. [38:02] Portia Pendleton: It almost seems like too much, too. [38:05] Dr. Katrina Furey: Far fetched for it all to fall into place that way. [38:08] Portia Pendleton: But he starts to get, like he starts to figure it out. And he is appearing to be, like, crazy. Right. He's, like, staying up late. [38:15] Dr. Katrina Furey: He has this whole wall of all these pictures they always do with, like, a red pen and X's and, like, string taped up. And then he does give the sodium what is it? Ambutol? Truth serum. Basically. He supposedly gives her truth serum to. [38:31] Portia Pendleton: See if and at this point, we still think that he did. [38:34] Dr. Katrina Furey: Right. [38:35] Portia Pendleton: So we find out later that it was just like saline when he is telling the police or the lawyer for the state about it. And first of all, what he did is so unethical. Like unethical. And he can get in a lot. [38:48] Dr. Katrina Furey: Of trouble for it. [38:48] Portia Pendleton: So the lawyer is like, I don't. [38:50] Dr. Katrina Furey: Want to hear this. I don't want to know. [38:51] Portia Pendleton: You need to delete this. You need to get rid of it. [38:53] Dr. Katrina Furey: Because he films her. Right. [38:54] Portia Pendleton: And you can't be tried twice. So the lawyer is like, even if this is true, we have these laws that prohibit double jeopardy, I think it's called. Again, things are moving really fast, and we're starting to see that apparently she has concocted this plan with her old psychiatrist, and they were going to pin. [39:11] Dr. Katrina Furey: It on whoever evaluated her. It just happened to be him, and he just happened to have this history that sort of helped with their case. And then he's like, oh, no, you're not going to pin it on me. I'm going to pin it on you. And then it turns out that then Dr. Sebert and Emily are sort of pinning it on each other, but he starts lying and deceiving and manipulating almost as bad as Emily was to begin with. Yeah. So it's just really interesting. [39:37] Portia Pendleton: So it seems like they get her to wear a wire, emily, when she goes and meets with Dr. Sebert and gets her to kind of confess what's going on, and then Dr. Sebert feels because they're going to have sex. So she feels this pack on her back, and then the door opens and the police are there. [39:57] Dr. Katrina Furey: I know. [39:57] Portia Pendleton: And then I'm like, oh, Emily gets away. [40:00] Dr. Katrina Furey: Right? [40:01] Portia Pendleton: You think that she made this deal, she can't be tried again, and that's not the case. [40:08] Dr. Katrina Furey: So then you see they're all trying to pin it on Dr. Banks. They want her to be restored to sanity so that she can be discharged from the unit and sort of go live her happy life with Dr. Seabird. But she's supposed to keep seeing him to avoid being hospitalized. And she thought it was just going to be like, okay, let's pretend I'm seeing you, but not really. Like, you know the drill. I was malingering the whole time. I don't really need medications, blah, blah, blah. But then he's like, no, I'm going to prescribe you Thorazine and Depicote, both of which are they work. They're heavy hitters, man. Like, Thorazine is really sedating Depicode again, the side effects they mentioned from these meds were spot on. You can lose your hair with Depicode. You also gain a ton of weight. You're really sluggish cognitively. You can get a lot of acne. [40:57] Portia Pendleton: So who would be prescribed those? Like, what kind of a patient would be prescribed Thorazine and Depicote? Or either? [41:05] Dr. Katrina Furey: Yeah. So Depicote is under the class of medications called mood stabilizers, which we use for things like bipolar disorder. You do not use it in women of childbearing age because it has been shown to be associated with a birth defect, specifically neural tube defects, which lead to things like spina bifida. In pregnancy, you always take a high dose Folate, and you can take extra. If you have to be on Depicode, if that's, like, the only mood stabilizer that's ever stabilized your bipolar disorder, then by all means, you need to stay on it. But it's not the first one we use. Also, so many side effects, and there's newer mood stabilizers like lamctal. Lithium has been around forever. But it's like a really good one that's effective. It has low side effects, too. And then Thorazine is an older antipsychotic, which he does acknowledge and is true. It's what we call like a typical antipsychotic like Haldol that is used for psychotic disorders. So things like schizophrenia, we use it a lot in the emergency room and inpatient setting to also help with sedations. Like, if you're so psychotic or manic that you are unable to sleep, you'll often get Thorazine to sort of help promote sleep. So you can imagine how much fatigue goes along with it. Sluggishness. It can be very drying. Like your mouth is really dry. It's not pleasant. So he's basically, like putting her into a pharmacological prison is basically what he's doing and making sure that she has to go get drug tested to show that she's actually taking it or she's going to go back in the hospital. So he gets the final one over. [42:38] Portia Pendleton: So she is like, no, right, and runs out of there, tries to escape, and that's when she is not then right following. And I think he knows this, that she's going to have this reaction. So she kind of goes to get in the cabin, run away, and the police are waiting for her. He kind of knew all along. [42:55] Dr. Katrina Furey: I think he tipped him off that this is going to happen. He probably didn't say, like, I'm going to do this and she's going to do that. He probably was like, she's been acting odd. Can you be waiting? And then she goes back, I think to the forensic psych unit, which honestly, that's where she belongs. Yeah, that's where she belongs. Given everything that happened. Gosh, that movie had a lot of twists and turns, lots of ups and downs. I feel like there's probably so much more we could talk about, but this episode has already been really long. I thought it was interesting, Portia, that you didn't seem as into this movie as I was. Do you think it's because I prescribe? [43:30] Portia Pendleton: I don't know. What's funny, too, is that one of my friends who's not in the field at all, really loved this movie and recommended it. And I don't know, I feel like. [43:42] Dr. Katrina Furey: I was a little bored, actually. Yeah, you yawned a lot as we were recording this. [43:48] Portia Pendleton: I don't know what that says. [43:50] Dr. Katrina Furey: That's why I feel like I also. [43:51] Portia Pendleton: Missed things throughout it. [43:54] Dr. Katrina Furey: Do you think it's because we've been talking a lot about psychopaths, like with you, and maybe you're just kind of over it for right now. Maybe Tatum died. Yeah. Maybe this Zach grief is too much for you to bear. Maybe, yeah. [44:09] Portia Pendleton: I have no idea. I think that's interesting though. I was like bored. I feel like, oh, no, pay attention. Pay attention. [44:16] Dr. Katrina Furey: I know. And I couldn't wait for us to record this episode and watch it again. And you're like, over here, yawning. And I'm like, and then they got the side effect right, and then they did this right. Then they did this wrong. Maybe someday we'll have a patreon and we can record a bonus episode where we explore that reaction further. Maybe. [44:34] Portia Pendleton: This felt unbelievable to me. [44:36] Dr. Katrina Furey: I think it did. [44:37] Portia Pendleton: It did. And I think that's where I was. [44:39] Dr. Katrina Furey: Just like, this wouldn't really happen. No, it's totally I mean, again, I think once the twist came into play, then you're like, oh, God, that's what this movie is. That's so unbelievable. You know what? I think it's important that we do analyze scripts that we don't like. Yeah. All right, well, I don't want to hold you up any longer. We'll wrap up this episode. Thanks for listening. I hope that whoever's listening isn't Yawning. We'll see. Please don't forget to rate, review and subscribe follow us on Instagram at Analyze scripts. DM us. Send us an email, analyze Scriptspodcast@gmail.com and let us know what you want us to analyze next. Put you to sleep. Like this movie put portion to sleep. [45:23] Portia Pendleton: Thanks so much for listening. [45:25] Dr. Katrina Furey: See you later. Bye. [45:31] Dr. Katrina Furey: This podcast and its contents are a copyright of Analyzed Scripts. [45:35] Dr. Katrina Furey: All rights reserved. [45:37] Dr. Katrina Furey: Any redistribution or reproduction of part or all of the contents in any form is prohibited. Unless you want to share it with. [45:44] Dr. Katrina Furey: Your friends and rate, review and subscribe, that's fine. [45:47] Dr. Katrina Furey: All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended. [45:56] Dr. Katrina Furey: Or should be inferred. [45:58] Dr. Katrina Furey: This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time.

Episode 10! In this episode we rambled a little bit and limited ourselves to just our new article which was "Haloperidol for the Treatment of Delirium in ICU Patients" published by Andersen-Ranberg et al in NEJM 2022. Of note, we go back and forth a little bit between "haloperidol" and the brand name "Haldol" but we hope it is similar enough it doesn't impede your listening!AID-ICU: https://pubmed.ncbi.nlm.nih.gov/36286254/AID-ICU Bayesian: https://pubmed.ncbi.nlm.nih.gov/36971791/MIND-USA: https://pubmed.ncbi.nlm.nih.gov/30346242/If you enjoy the podcast please share on social media or by word of mouth! Thank you!Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

A while back, we did a mini-series on peptides and sexual wellness. We covered PT-141 (bremelanotide), a peptide therapy used to help women and men with low sex drive. And Kisspeptin-10, a peptide that helps with increased arousal and may help with infertility. But we really didn't focus on what causes a low sex drive. So today, we'll touch on the possible mental and physical causes that may affect your sex drive, but we'll focus on medications that may lead to a decreased interest in sex. It's important to know that a low sex drive can affect both men and women. Medical conditions like depression, hypothyroidism, diabetes, and high blood pressure, may all cause a low sex drive. Even hormonal changes (e.g., during pregnancy, after childbirth, or while breastfeeding) can decrease interest in sex. And some people who use alcohol, have relationship issues, or certain infections (e.g., vaginal yeast infections, urinary tract infections) have a low sex drive. Certain medications may cause low sex drive as a side effect. But remember that not everyone taking certain medications will have the same issues.  Some antidepressants and antipsychotics are more likely to cause a low sex drive than others. For example, selective serotonin reuptake inhibitors (SSRIs) like Paxil, Zoloft, and Proac are more likely to cause a low sex drive than Wellbutrin or Remeron. While older antipsychotics like Haldol, used to treat schizophrenia and bipolar disorder, are more likely to cause a low sex drive than Risperdal.  Benzodiazepines like Xanax, Ativan, and Valium, used to treat anxiety and seizure disorder, can lower your sex drive. Many people with heart failure report having a low sex drive. This is because people with heart failure need different medications to reduce how fast or hard their heart has to work and medications that get rid of extra fluid. Unfortunately, some heart failure medications like Digoxin, Spironolactone, beta-blockers, and other water pills like hydrochlorothiazide can lower their sex drive. Acid reflux or "heartburn" happens when stomach acid travels back into the esophagus. And people who take medications for "heartburn" (e.g., Pepcid and Zantac) have reported a lower sex drive. Even medications that affect sex hormones (e.g., estrogen, testosterone, and progesterone) can decrease libido. Examples of these medications include birth control and Lupron (used to treat prostate cancer). And lastly, people who use opioids like Norco and Ultram to treat pain can also have a lower sexual desire. How to improve sex drive caused by medications? Always talk to your healthcare provider first. They can determine if your low sex drive is due to your medications or if there's another cause, like an infection or hormonal changes. If your medication is causing a low sex drive, your healthcare provider may have you stop the medication if it's not needed. Or they may switch you to an alternate medication that doesn't cause a low sex drive. But don't stop your medication without speaking to your healthcare provider first. Your healthcare provider may suggest other medications or peptides like PT-141 or Kisspeptin-10.  What is PT-141? PT-141 (bremelanotide) is a melanocortin receptor agonist peptide. Melanocortin is a natural hormone in your body that works on receptors in your brain and nervous system to cause sexual arousal and influence sexual behavior. However, we don't know exactly how it works to improve sex drive. It can also work on receptors in cells that produce skin color (melanocytes). You may know PT-141 as Vyleesi. This medication was originally FDA-approved in 2019 to help low sex drive in women who haven't gone through menopause yet. While it's not approved for low sex drive in men, some may use it off-label.  In these cases, men also use PT-141 to help improve erections, libido, sex drive, and performance. What is Kisspeptin-10? Kisspeptin-10 is a neuropeptide involved in reproduction, sexual behavior, and sexual attraction. It helps increase activity in the brain associated with sexual attraction and arousal.  Kisspeptin-10 also stimulates the hypothalamus to release gonadotropin-releasing hormone (GnRH), which in turn signals the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones play a role in the production of both testosterone and estradiol.  Thanks again for listening to The Peptide Podcast. You can find more information at pepties.com. We love having you as part of our community. If you love this podcast, please share it with your friends and family on social media. Have a happy, healthy week! Pro Tips We're huge advocates of using daily collagen peptide supplements in your routine to help with skin, nail, bone, and joint health. But what do you know about peptides for health and wellness? Giving yourself a peptide injection can be scary or confusing. But we've got you covered. Check out 6 tips to make peptide injections easier. And, make sure you have the supplies you'll need. This may include syringes, needles, alcohol pads, and a sharps container. They work to kill bacteria (bactericidal) by preventing them from making their own protective coating in your body.

On this episode of the Real Life Pharmacology podcast, I discuss haloperidol pharmacology, adverse effects, drug interactions and much more. Haloperidol comes in multiple dosage forms. Be very careful with the use of injectable haloperidol as there is an immediate and extended release formulation. Haloperidol is a dopamine antagonist which means that EPS adverse effects are going to be concerning. In hospice patients, haloperidol is frequently used for its antiemetic properties as well as its potential to help end-of-life restlessness and agitation.

Way back in episode 64, we discussed the Caged Graves in Catawissa, PA, and how those were most likely installed to keep out Resurrectionsist from Ohio. Today we finally get to tell the tale of these brazen folks that caused so much consternation from Michigan all the way to Philadelphia. Our featured music today is from Haldol with their song " Taphonomy". Our promo is for Autumn's Oddities Podcast. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/missionspooky/message Support this podcast: https://anchor.fm/missionspooky/support

We are on debriefing no. 25, and it's been a fun ride! And we're reporting straight out of our night shift. We're coming off working the last two nights., and we're happy to flex our Cup of Nurse's unit merch! Check out the link to our shop below, grab your Cup of Nurses jackets and represent your unit!

Contributor: Lessen, Aaron MD Educational Pearls: Ketamine can be given at 0.2-0.3 mg/kg as subdissociative doses for pain control in the ED Ketamine coadministered with Haldol may reduce agitation A recent study in Iran compared subdissociative Ketamine given with 2.5 mg Haldol to 1 mg/kg Fentanyl for pain control in the ED Ketamine with Haldol had better pain control than Fentanyl at 5, 10, 15 and 30 minutes  Ketamine with Haldol less frequently required rescue medication  Ketamine with Haldol did have increased agitation at only the 10 minute mark Of note, there was not a Ketamine only group to compare  Ketamine with Haldol is a viable alternative combination for pain control    References Moradi MM, Moradi MM, Safaie A, Baratloo A, Payandemehr P. Sub dissociative dose of ketamine with haloperidol versus fentanyl on pain reduction in patients with acute pain in the emergency department; a randomized clinical trial. Am J Emerg Med. 2022;54:165-171. doi:10.1016/j.ajem.2022.02.012 Sin B, Ternas T, Motov SM. The use of subdissociative-dose ketamine for acute pain in the emergency department. Acad Emerg Med. 2015;22(3):251-257. doi:10.1111/acem.12604   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Download the cheat: https://bit.ly/50-meds  View the lesson:  https://bit.ly/HaloperidolHaldolNursingConsiderations    Generic Name haloperidol Trade Name Haldol Indication Schizophrenia, mania, aggressive and agitated patient Action Alters the effect of dopamine Therapeutic Class Antipsychotic Pharmacologic Class butyrophenones Nursing Considerations • extrapyramidal symptoms, tardive dyskinesia • use caution in QT prolongation • may cause seizures, constipation, dry mouth, agranulosytosis • assess for hallucinations • monitor hemodynamics • monitor for neuroleptic malignant syndrome (fever, muscular rigidity, altered mental status, and autonomic dysfunction) • monitor CBC with differential

In this second episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the various treatment modalities for substance-induced psychosis. They explore pharmacologic treatments, inpatient and outpatient treatments, and ways that emergency providers can improve their care for psychiatric patients with comorbid medical conditions. Lastly, they consider the different causes for repeat visits from mentally ill patients.    Key Points:   Pharmacologic treatments for substance-induced psychosis are similar to those for other types of psychosis; these include medications like Zyprexa, Haldol, and, as a third-line treatment, IM Thorazine.  Droperidol is used more commonly in the emergency setting, compared with the psychiatric setting.  Given the risk for respiratory depression from Zyprexa combined with benzodiazepines, psychiatrists may choose to use Thorazine or Haldol/Ativan/Benadryl instead.  It is important to reassess patients after substances wear off to determine whether they meet criteria for admission to inpatient psychiatry, though psychiatric assessments are limited by geographic constraints. The admitting psychiatry team will reassess the patient to differentiate substance-induced psychosis vs other psychoses; often this includes obtaining collateral. Helpful notes from the ED include: medications administered or restraints placed (can help extrapolate a patient's level of agitation), vital signs, prior records.  Some people will be more open about suicidality while intoxicated and less open about it while sober so it is important to obtain additional information for corroboration.  On average, patients stay in the detox unit for 3-4 days, though some may stay longer for protracted substance-induced psychosis if they have a long-standing history of daily substance use.  It is important to discharge patients with quick follow-up and potential placement into the various mental health programs including partial hospitalization, residential, or outpatient programs. Emergency rooms can improve by taking psychiatric patients seriously, especially when they are transferred to the hospital from a psychiatric facility for medical management.  Repeat visits stem partially from the ambivalence that accompanies substance use disorders, including patients' difficulty in giving up the substance due the purpose it may serve in their lives.  Many substance use disorder programs are siloed from the medical system, which pose a challenge to interdisciplinary communication. 

    Slam the Gavel welcomes back Amy Gedeon back on the show for updates on her daughter held hostage in a Guardianship in a group home. Amy was last on the show Season three, Episode 39.    Amy states that her recent court experience was not a positive one and the group home continues to sedate her daughter 24/7, using Haldol and Luvox. Unfortunately Amy has only seen her daughter for one hour last month. Her daughter has deteriorated tremendously. The Guardian sees her daughter every 90 days for 5 minutes on video. Now they want Amy to be supervised when visiting her daughter because Amy was questioning their care of her daughter.    Family dynamics play a role in this scenario of Amy and her children's lives. Amy states that she will not give up until she gets her daughter home and safe.  The power and control the opposing attorney and Guardian ad Litem have over a Guardianship is overwhelming. Family and the attorneys/CPS want Amy to, "just admit that you are sick."  The narrative that is being painted is that Amy is too sick to take care of her children. Amy is not sick and never has been.    Amy states she wants her KIDS back, her LIFE  back, "and this didn't have to happen, I want my PEACE  back."To reach Amy: chef_amy@yahoo.comSupport the show(https://www.buymeacoffee.com/maryannpetri)http://beentheregotout.com/http://www.dismantlingfamilycourtcorruption.com/Music by: mictechmusic@yahoo.comSmart Passive Income PodcastWeekly interviews, strategy, and advice for building your online business the smart way.Listen on: Apple Podcasts Spotify Reality Life with Kate CaseyThree times a week I interview directors, producers, and stars from unscripted television.Listen on: Apple Podcasts Spotify Do you want to change the world?Insight Out reveals transformational insights that can change your life and the world!Listen on: Apple Podcasts SpotifySupport the show

Slam the Gavel welcomes back Amy Gedeon back on the show for updates on her daughter held hostage in a Guardianship in a group home. Amy was last on the show Season three, Episode 39. Amy states that her recent court experience was not a positive one and the group home continues to sedate her daughter 24/7, using Haldol and Luvox. Unfortunately Amy has only seen her daughter for one hour last month. Her daughter has deteriorated tremendously. The Guardian sees her daughter every 90 days for 5 minutes on video. Now they want Amy to be supervised when visiting her daughter because Amy was questioning their care of her daughter. Family dynamics play a role in this scenario of Amy and her children's lives. Amy states that she will not give up until she gets her daughter home and safe. The power and control the opposing attorney and Guardian ad Litem have over a Guardianship is overwhelming. Family and the attorneys/CPS want Amy to, "just admit that you are sick." The narrative that is being painted is that Amy is too sick to take care of her children. Amy is not sick and never has been. Amy states she wants her KIDS back, her LIFE back, "and this didn't have to happen, I want my PEACE back." To reach Amy: chef_amy@yahoo.com Support the show(https://www.buymeacoffee.com/maryannpetri) http://beentheregotout.com/ http://www.dismantlingfamilycourtcorruption.com/ Music by: mictechmusic@yahoo.com

    Slam the Gavel welcomes Amy Gedeon to the show to discuss her difficulties with CPS interference and a guardianship involving her now 19 year-old daughter.      Amy came to NC from Florida escaping Hurricane Irma on September 10th, 2017. While in NC, Amy bought a home in the country awaiting her house to be rebuilt in Florida.    While living in the house, Amy noticed a problem with mice as a neighbor also complained of  the mice. After losing her job and going through a divorce, Amy began working 7days a week while raising 2 daughters, one with special needs.     However, on August 20th, 2019, CPS came to Amy's doorstep, questioning the issue with the mice. They told Amy that her girls could not stay in the house while Animal Control shows up and takes away the family pets but would return them after a vet check. The pets were never returned.     The next day, CPS called Amy to tell her she would never see her children again and went ahead and enrolled the girls in a school one hour in the opposite direction. CPS also paid their psychologist $1,000.00 to say Amy had a BiPolar mental health issue and was too sick to care for her kids.     Amy did get her own psychological evaluation stating that she did not have a BiPolar mental health condition and she was not sick and could take care of her own children. As she went to court she was ordered to have a psychological evaluation which also stated that there were NO concerns about Amy's mental health. Seeing a therapist for the last 32 months, Amy's therapist stated she was not mentally ill and should have her kids back.   Amy's concern is to get her children back and to get her 19 year-old daughter out of a guardianship where they have moved her 7 times to unlicensed homes/institutions. In the institution, they had began medicating her on December 4th, 2020 with Haldol and Luvox as well as stopping her menstrual cycle with the Depo shot. Her daughter has now been sedated 24/7 for the last 15 months. She also is showing signs of mouth tics, crippling of the hands/fingers, a skin pallor of yellow/green and weighing 120lbs. at 5'7" and now completely non-verbal.      The current appeal in Raleigh shows Amy was fit and cooperative but also has been denied her seeing her youngest daughter for the past 32 months with no visitation  with is against the law in NC. To reach Amy Gedeon: chef_amy@yahoo.comSupport the show(https://www.buymeacoffee.com/maryannpetri)http://beentheregotout.com/https://monicaszymonik.mykajabi.com/Masterclass  USE CODE SLAM THE GAVEL PODCAST FOR 10% OFF THE COURSEFor 2022 PA Retreat: For more information, contact co-organizers:Maryann Petri at maryannpetri3@gmail.com Ann O'Keeffe Rodgers at okeefferodgers@gmail.com  http://www.dismantlingfamilycourtcorruption.com/Music by: mictechmusic@yahoo.comSupport the show (https://www.buymeacoffee.com/maryannpetri)

Slam the Gavel welcomes Amy Gedeon to the show to discuss her difficulties with CPS interference and a guardianship involving her now 19 year-old daughter. Amy came to NC from Florida escaping Hurricane Irma on September 10th, 2017. While in NC, Amy bought a home in the country awaiting her house to be rebuilt in Florida. While living in the house, Amy noticed a problem with mice as a neighbor also complained of the mice. After losing her job and going through a divorce, Amy began working 7days a week while raising 2 daughters, one with special needs. However, on August 20th, 2019, CPS came to Amy's doorstep, questioning the issue with the mice. They told Amy that her girls could not stay in the house while Animal Control shows up and takes away the family pets but would return them after a vet check. The pets were never returned. The next day, CPS called Amy to tell her she would never see her children again and went ahead and enrolled the girls in a school one hour in the opposite direction. CPS also paid their psychologist $1,000.00 to say Amy had a BiPolar mental health issue and was too sick to care for her kids. Amy did get her own psychological evaluation stating that she did not have a BiPolar mental health condition and she was not sick and could take care of her own children. As she went to court she was ordered to have a psychological evaluation which also stated that there were NO concerns about Amy's mental health. Seeing a therapist for the last 32 months, Amy's therapist stated she was not mentally ill and should have her kids back. Amy's concern is to get her children back and to get her 19 year-old daughter out of a guardianship where they have moved her 7 times to unlicensed homes/institutions. In the institution, they had began medicating her on December 4th, 2020 with Haldol and Luvox as well as stopping her menstrual cycle with the Depo shot. Her daughter has now been sedated 24/7 for the last 15 months. She also is showing signs of mouth tics, crippling of the hands/fingers, a skin pallor of yellow/green and weighing 120lbs. at 5'7" and now completely non-verbal. The current appeal in Raleigh shows Amy was fit and cooperative but also has been denied her seeing her youngest daughter for the past 32 months with no visitation with is against the law in NC. To reach Amy Gedeon: chef_amy@yahoo.com Support the show(https://www.buymeacoffee.com/maryannpetri) http://beentheregotout.com/ https://monicaszymonik.mykajabi.com/Masterclass USE CODE SLAM THE GAVEL PODCAST FOR 10% OFF THE COURSE For 2022 PA Retreat: For more information, contact co-organizers: Maryann Petri at maryannpetri3@gmail.com Ann O'Keeffe Rodgers at okeefferodgers@gmail.com http://www.dismantlingfamilycourtcorruption.com/ Music by: mictechmusic@yahoo.com

Haloperidol also known by the brand name Haldol is a first generation antipsychotic. Haldol is commonly used in the treatment of Psychosis and Tourette Syndrome. There is also an off label use for acute agitation. When using Haldol it is important to use the lowest effective dose. A common dosing range is between 0.5-2 mg which is taken by mouth and divided two to three times daily. In severe treatment cases the treatment range can be as high as 3-5 mg PO 2-3x daily. The mechanism of action is proposed to be from selective antagonism of dopamine D2 receptors. Haldol is widely distributed throughout the body and is 92% protein bound. There is a black box warning for dementia-related psychosis. Haldol is not approved in dementia-related psychosis due to an increased risk of cardiovascular or infectious events that can lead to mortality in elderly patients. Amazon Affiliate link: https://amzn.to/31OkKVe for NAPLEX Math Review: The Foundation of a Logical NAPLEX Prep Strategy. FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I'd really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com to leave feedback, request a drug, or say hello! DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist. --- Send in a voice message: https://anchor.fm/drugcardsdaily/message

Já pensou em prestar Psiquiatria? Tem ideia da rotina? Sabe como dar os primeiros passos nesse mercado de trabalho? Para tirar essas e outras dúvidas, convidamos a Dra. Rachel, preceptora do estágio de psiquiatria da FMUSP. Dúvidas, críticas e sugestões: @gui_n.k -> https://www.instagram.com/gui_n.k/ @albertokanasiro -> https://www.instagram.com/albertokanasiro/ Dose do Haldol??? https://www.hipocampo.wiki.br/psiquiatria/agita%C3%A7%C3%A3o-psicomotora

People who go to see Gaetano Donizetti's Lucia di Lammermoor spend the entire evening waiting for the famous Mad Scene, to hear the soprano's incredible acrobatics, and to feel her intense emotional changes over the course of the lengthy showstopper. But the Mad Scene is more than a vocal showpiece: it's a window into what it means to lose touch with reality and the ways women's real-life challenges can go ignored or, even worse, pathologized as illness. In the opera, Lucia has no control of her life; her brother betrays her and forces her to marry a man she doesn't love. Alone and out of options, Lucia escapes in the only way she can: she murders her new husband and descends into madness. But how do we understand her crimes and hallucinations? And what can Lucia teach us about how we diagnose and treat mental health conditions today? Host Rhiannon Giddens and her guests dive into the history of women and madness, as well as the story of a woman living with bipolar disorder today. Soprano Natalie Dessay had a thriving career as a coloratura soprano before cashing in her opera chips and turning her talents to theater and jazz. When she sang the role of Lucia at the Met in 2011, she approached it a bit like a circus performer, adding physical challenges to match the vocal ones. Dr. Mary Ann Smart is a professor of music at UC Berkeley. As a grad student, she wrote her dissertation on mad scenes in 19th century opera, and she has since authored multiple books, including Siren Songs: Representations of Gender and Sexuality in Opera. One of the things that she finds most poignant about Lucia's Mad Scene is the fact that Donizetti spent the end of his life being treated for physical and mental illness.  Activist and writer Dr. Phyllis Chesler has written more than 20 books, including the seminal work, Women and Madness. Her work deals with freedom of speech and freedom of thought. Her recent books include Requiem for a Female Serial Killer, and her memoir An American Bride in Kabul. She believes writing is most definitely a form of madness. Author and attorney Melody Moezzi wrote Haldol and Hyacinths: A Bipolar Life in order to capture her experiences as an Iranian-American Muslim woman with bipolar disorder, and to help others with this condition feel less alone. She is an advocate for destigmatizing mental health conditions, and she believes that sometimes, what looks like madness can actually be a rational response to an irrational world.

Contributor:  Jared Scott, MD Educational Pearls: Around 30 patients with cannabinoid hyperemesis syndrome (CHS) randomized treatment in three arms with 8mg Zofran, Haldol 0.05 mg/kg, and Haldol 0.1 mg/kg Haldol arms performed better on all measures compared to Zofran Extrapyramidal symptoms were significantly higher in the Haldol group than Zofran, especially the high-dose Haldol group References Ruberto AJ, Sivilotti MLA, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Ann Emerg Med. 2021;77(6):613-619. doi:10.1016/j.annemergmed.2020.08.021 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.  Donate to EMM today!

Challenges, obstacles and painful experiences — these are just some of things life throws our way when we least expect them. But no matter where you are in life right now, remember that you can push past the hard times. You can learn how to rise above life’s challenges. And if you feel lost, here’s a little secret: help others. Being of service to other people can help you find strength and a way out of your problems. In this episode, Robert Joseph Cappuccio, widely known as Bobby, joins us to share his inspiring story of defying hardships and helping others. It’s easier to succumb to self-sabotage and addiction. But you have the power to make your experiences an opportunity for change and hope. Bobby also shares the importance of helping others, especially as a business owner and leader. If you want to learn how to rise above trauma and be inspired to become a force of good to the world, then this episode is for you!    Get Customised Guidance for Your Genetic Make-Up For our epigenetics health program all about optimising your fitness, lifestyle, nutrition and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/.   Customised Online Coaching for Runners CUSTOMISED RUN COACHING PLANS — How to Run Faster, Be Stronger, Run Longer  Without Burnout & Injuries Have you struggled to fit in training in your busy life? Maybe you don't know where to start, or perhaps you have done a few races but keep having motivation or injury troubles? Do you want to beat last year’s time or finish at the front of the pack? Want to run your first 5-km or run a 100-miler? ​​Do you want a holistic programme that is personalised & customised to your ability, your goals and your lifestyle?  Go to www.runninghotcoaching.com for our online run training coaching.   Health Optimisation and Life Coaching If you are struggling with a health issue and need people who look outside the square and are connected to some of the greatest science and health minds in the world, then reach out to us at support@lisatamati.com, we can jump on a call to see if we are a good fit for you. If you have a big challenge ahead, are dealing with adversity or are wanting to take your performance to the next level and want to learn how to increase your mental toughness, emotional resilience, foundational health and more, then contact us at support@lisatamati.com.   Order My Books My latest book Relentless chronicles the inspiring journey about how my mother and I defied the odds after an aneurysm left my mum Isobel with massive brain damage at age 74. The medical professionals told me there was absolutely no hope of any quality of life again, but I used every mindset tool, years of research and incredible tenacity to prove them wrong and bring my mother back to full health within 3 years. Get your copy here: https://shop.lisatamati.com/collections/books/products/relentless. For my other two best-selling books Running Hot and Running to Extremes chronicling my ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books.   Lisa’s Anti-Ageing and Longevity Supplements  NMN: Nicotinamide Mononucleotide, a NAD+ precursor Feel Healthier and Younger* Researchers have found that Nicotinamide Adenine Dinucleotide or NAD+, a master regulator of metabolism and a molecule essential for the functionality of all human cells, is being dramatically decreased over time. What is NMN? NMN Bio offers a cutting edge Vitamin B3 derivative named NMN (beta Nicotinamide Mononucleotide) that is capable of boosting the levels of NAD+ in muscle tissue and liver. Take charge of your energy levels, focus, metabolism and overall health so you can live a happy, fulfilling life. Founded by scientists, NMN Bio offers supplements that are of highest purity and rigorously tested by an independent, third party lab. Start your cellular rejuvenation journey today. Support Your Healthy Ageing We offer powerful, third party tested, NAD+ boosting supplements so you can start your healthy ageing journey today. Shop now: https://nmnbio.nz/collections/all NMN (beta Nicotinamide Mononucleotide) 250mg | 30 capsules NMN (beta Nicotinamide Mononucleotide) 500mg | 30 capsules 6 Bottles | NMN (beta Nicotinamide Mononucleotide) 250mg | 30 Capsules 6 Bottles | NMN (beta Nicotinamide Mononucleotide) 500mg | 30 Capsules Quality You Can Trust — NMN Our premium range of anti-ageing nutraceuticals (supplements that combine Mother Nature with cutting edge science) combat the effects of aging, while designed to boost NAD+ levels. Manufactured in an ISO9001 certified facility Boost Your NAD+ Levels — Healthy Ageing: Redefined Cellular Health Energy & Focus Bone Density Skin Elasticity DNA Repair Cardiovascular Health Brain Health  Metabolic Health My  ‘Fierce’ Sports Jewellery Collection For my gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   Here are three reasons why you should listen to the full episode: Discover how to rise above adversities. Understand the importance of intention and knowing who you serve. Learn the difference between internal and external customers and why you need to start focusing on the former.    Resources Gain exclusive access to premium podcast content and bonuses! Become a Pushing the Limits Patron now! Harness the power of NAD and NMN for anti-aging and longevity with NMN Bio. Connect with Bobby: Website | Twitter | Facebook | LinkedIn | Instagram The Self-Help Antidote podcast by Bobby Cappuccio PTA Global The You Project Podcast by Craig Harper The Psychology of Winning: Ten Qualities of a Total Winner by Denis Waitley    Episode Highlights [05:49] Bobby’s Childhood Bobby was born with deformities. He was adopted by a man who had cancer.  After Bobby’s adoptive father passed, his adoptive mother entered a relationship with a cruel man. Bobby experienced all kinds of abuse throughout his childhood on top of having Tourette’s syndrome.  Doctors had to put him on Haldol, which damaged his brain.  Yet, Bobby shares that these painful experiences helped him resonate with others and thrive in his industry.  [12:48] How Bobby Got to Where He is Today  Bobby initially wanted to become a police officer for special victims.  He almost passed the written and psychological assessments, but there was an issue because of Tourette syndrome. At this time, he started working at a gym.  Bobby worked hard. Eventually, he caught the eye of the gym owner, Mitchell.  Mitchell became like a surrogate father and mentor to him. Listen to the full episode to hear how Mitchell shaped Bobby and put him on the path to success!   [20:31] Complications from Abuse and Empathy Some adults tried to intercede for Bobby when he was being abused as a kid. However, he avoided their help because he was scared of being harmed further. You can't just leave an abuser — it's difficult, and even simply attempting can hurt you. We should understand that abuse can affect anyone.  Confident and intelligent women may be particularly susceptible to abuse because they find themselves in a situation they didn’t expect.  [28:58] How Abuse Isolates People Abusers progressively isolate people by creating enemies out of strong alliances.  This can make someone lose their sense of self, making them more vulnerable and dependent on their abusers.  Assigning fault or blame to those being abused will not help anyone.  If anything, that stops people from coming forward.  [30:34] Help Others to Help Yourself Bobby learned how to rise above his traumas and negative emotions.  His mentor taught him to look beyond himself. It was only by helping others find a way out of their problems that Bobby found a way to help himself too.  He started to focus on helping people who were going through something similar to what he went through. [33:32] Focus on the Intention While working as a trainer, Bobby focused less on the transactional side of training and more on the transformational.  He wanted to help people find what they need at that moment and give them the support they need.  By focusing on his intention, he was able to get high rates of retention.  For Bobby, helping others means understanding their goals and wishes.  [36:12] Bobby’s Promotion Bobby’s exemplary performance led him to a promotion that he didn’t want. He was scared of disappointing Mitchell.   He did poorly in managing his team of trainers, which is when a consultant sat him down and gave him advice.  Mitchell also had Bobby stand up and speak in team meetings.  You need to know who you work for and who you serve. When your perspective is aligned with your work, you will bring that to every meeting and interaction.  Are you taking care of the people you need to be responsible for? Hear how Bobby figured out his answer in the full episode!  [43:14] Lessons on Leadership Companies often adopt a top-down mentality where bosses need to be followed. However, a company should not be like this. Companies are made up of people. Your business needs to care for your valuable customers, both internal and external.  Treat your team members with the same level of tenacity, sincerity and intention as your external customers. You can accomplish a lot if you hire the right person, set clear expectations and understand each individual’s motivations. Through these, you can develop the team’s capacity and channel it towards a common vision. [51:19] On Recruiting the Right People David Barton hired Bobby to work as his head of training.  Bobby asked David what two things Bobby should do to contribute the most to the company. David wanted Bobby to be a connoisseur of talent and to train them, train them and train them again.  Bobby brought this mindset throughout his career, and it’s served him well. Don’t be afraid to hire people who are smarter than you.   7 Powerful Quotes from This Episode ‘When you know that there's somewhere you want to go, but you don't know exactly where that is. And you don't have complete confidence in your ability to get there. And what a good guy does is they help you go just as far as you can see.’ ‘We form and calibrate and shape our sense of identity in the context in which we navigate through the world off of one another. And when you're isolated with a distorted sense of reality, and you lose your sense of self, you become highly incapacitated to take action in this situation.’ ‘So I started focusing on things and a mission and people outside of myself. Who's going through something similar to what I have gone through, even if it's not precisely the same situation? How do I help them find their way out? And by helping them find their way out, I found my way up.’ ‘I never saved anyone; you can't change anyone but yourself. But the reason why he called me that is anytime someone would think about joining the gym...I approached it from a transformational perspective.’ ‘And your job is to create and keep your internal customer by serving them with at the very least with the same tenacity, sincerity and intention that you are serving your external customer. If you don't do that, you're going to be shit as a leader.’ ‘I think the only people who don't have impostor syndrome are imposters. Because if you're fraudulent, you wouldn't engage in the level of self-honesty, and humility, and conscientiousness, to go, “Am I fraudulent; is there something that I’m missing?”’ ‘Anything I've ever accomplished, it's totally through other people. It's because I hired people that were a lot smarter than me.’   About Robert Robert Joseph Cappuccio, or Bobby, is a behaviour change coach, author, consultant, speaker and fitness professional. He is a trainer of trainers and at the forefront of the life-altering and ever-evolving industry of coaching.  For over two decades, he has been advocating and pushing the industry-wide and individual shift of perspective in development. Behaviour change is rooted in a holistic approach, not just goals to health and fitness. With his vision, he co-founded PTA Global. It has now become a leader in professional fitness development.  No matter how successful Bobby seems, it didn't start this way. His childhood was filled with neglect, abuse and traumas that could lead anyone on the path to drinking and addiction. Bobby is no stranger to hardship and challenges, but he uses these experiences to connect and relate to others, using his past hardship as a way to help others. Bobby is also the former head of training and development at David Barton Gym, former director of professional development at the National Academy of Sports Medicine (NASM), content curator for PTontheNet, development consultant for various companies including Hilton Hotels, Virgin Active, Equinox, David Lloyd Leisure and multiple businesses nationally and abroad.  With his forward-thinking mindset and work ethic, Bobby champions practical programs that help both corporate and industry personnel, including individuals, get what they truly want. He advocates the process of change mixed in with the mantra of ‘you can be free to play’.  Interested in Bobby’s work? You can check out his website and listen to his Self-Help Antidote Podcast! Reach out to Bobby on Twitter, Facebook, LinkedIn and Instagram.    Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends to offer them one way to rise above their trauma. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Full Transcript Welcome to Pushing the Limits, the show that helps you reach your full potential with your host, Lisa Tamati, brought to you by lisatamati.com. Lisa Tamati: Welcome back to Pushing the Limits, your host Lisa Tamati here, and today I have a fantastic guest all the way from America again, this man goes by the name of Bobby Cappuccio. And he is a world-famous fitness professional. He trains a lot of the trainers that are out there. But Bobby has an incredible story that I really want to share with you today. So, Bobby was born with a severe facial deformity. And he also had deformed legs, and he was given up for adoption. His mother couldn't care for him, and he ended up being adopted by another man. But he had a very, very abusive rough childhood. He also developed Tourette Syndrome at the age of nine. In all this adversity you'd think like ‘oh my gosh, what sort of a life is this guy going to live’? But Bobby has had an incredible life. He's a fitness professional, as I said, he's worked in many gyms. He was the founder and co-owner of PTA Global, which does a lot of the professional fitness development. And he has devised his own strategies and ways of educating people. And his programs are just second to none. When I told my business partner, Neil, that I just interviewed Bobby Cappuccio, he's like, ‘Oh, my God, he's a legend in the space.’ So yeah, he was really a bit jealous that I got to speak to him. So I hope you enjoy this interview. It's some rough topics in there. But there's also some really great gems of wisdom. And the funny thing is what Bobby is just absolutely hilarious as well. So I do hope you enjoy it. Before we head over to the show, though, just want to let you know that we've launched a premium membership for the podcast. This is a patron membership so that you can become a VIP member of our tribe, help support the podcast. This podcast has been going now for five and a half years. It's a labour of love, I can tell you. It takes up a huge amount of my time and resources in both getting these world-class gifts for you, and also in study and research so that I can talk really, and interview very well all these crazy, amazing doctors, scientists, elite athletes and performers. So if you want to support us in keeping the show going, and like what we do in the world, and you want to keep those valuable content being able to be put out into the world, we'd love your support. And for that, we're going to give you lots of member, premium member, benefits. So, check it out at patron.lisatamati.com. That’s patron.lisatamati.com. That’s P-A-T-R-O-N dot Lisa Tamati dot com. And I just also wanted to remind you about my new anti-ageing and longevity supplement, NMN. I’ve co-worked together with molecular biologist, Dr. Elena Seranova, to make sure that you get the best quality NMN there is now. I searched all over the world for this stuff, when I learned about it, and researched about it, and how it works and what it does in the body, and there is a huge amount of science on it. A lot of it's up on our website, if you want to do a deep dive into all things NMN and the NAD precursor, then check it out. It's all about longevity. It's all about slowing down the ageing process and even reversing the ageing process. So if that's something that interests you, and you want high performance, you want help with cardiovascular health, with neuro protection, with metabolic disorders, then this is something that you should look into as well. So check that out at nmnbio.nz, that’s nmnbio.nz, and go and check that out. The supplements have been so popular that I haven't been able to keep up with orders. So on some of the orders, there is a bit of a backorder. But bear with me while we will scale up production. But go over and check that out at nmnbio.nz. Right over to the show with Bobby Cappuccio. Lisa: Hi, everyone, and welcome back to Pushing the Limits. Today I have another very, very special guest and I was recently on this gentleman's show and now we're doing a reverse interview. I have Robert Cappuccio with me. Robert, welcome to the show. Robert Cappuccio: Oh, thank you. When you say you had a very special guest, I thought you were bringing someone else on. Lisa: You are a really special guest. Robert: Had a lot of anticipation like who is this person? What a surprise! Lisa: Well, you're a bit of an interesting character. Let's say that, throw that. Robert: Just the microphone. Lisa: No, I'm really, really interested to hear your story and to share your story with my audience, and to give a bit more of a background on you. And share gems of wisdom from your learnings from your life, because you've done some pretty cool stuff. You've had some pretty hard times and I'd like to share those learnings with my audience today. So Robert, whereabouts are you sitting at the moment, whereabouts are you in the States? Robert: Okay, so at the moment, I'm in a place called Normal Heights, which is probably a misnomer. It's not normal at all. But it's a really cool, funky neighbourhood in San Diego. Lisa: San Diego, awesome. And how’s lockdown going over there, and all of that sort of carry on? Robert: Oh, it’s great. I mean, on St. Patty's day, I've got my skull from our own green. I've just had a few whiskies. So far, so good. Lisa: This is a very interesting interview. So can you give us a little bit of background? Because you've had a very interesting, shall we say, difficult upbringing and childhood. And I wanted to perhaps start there and then see where this conversation goes a little. Robert: Is there any place you want to start, in particular? How far back do you want to go? Do you want to start from the very beginning? Lisa: Please go right at the very beginning, because you're intro to your backstory is quite interesting from the beginning, really isn't that? Robert: Okay, so I was born, which is obvious, in Manhattan, and I moved to Brooklyn early. So I was born, rather deformed. I was born with a significant facial deformity. And my lower extremities, my legs, quite never— like, if you saw my legs now, they're great. I have a great pair of legs at this moment. I'm not going to show you that because that would be a little bit rude. But my legs were kind of deformed and contorted. I had to walk with braces for the first couple of years of my life. I was given up for adoption. I'm not exactly sure, I have the paperwork on why I was given up for adoption, but I'm not really certain about the authenticity of that story. And I wasn't adopted for a while. So as an infant, I was parentless and homeless and really not well-tended to. I'm not going to get into why I say that because it's pretty disgusting. And then I was adopted. And then my adoptive father, this is kind of interesting, he had cancer, and he knew during the adoption process that he was probably not going to make it. He wanted to make sure that I found a home because nobody wanted to adopt me. Because when they came in, I was physically deformed. It's like, ‘Oh, this baby’s, it's broken. Something's wrong. Do you have a better baby’? And when he saw that, he thought, ‘Right, I've got to give this kid a home.’ So he passed. He passed when I was two. I didn't know him for more than a few months. And I hardly have any memory of him at all. My mother who adopted me, to be fair, she's developmentally disabled, and so she was a single uom with not a lot of skills, not a lot of prospects, terrified. And she basically, I think she met a guy when I was five, who I don't know if there's a diagnosis for him. He was mentally disturbed. He was a psychopath. I don't know if clinically he’s a psychopath, but that's pretty much how it felt. Lisa: You were a child experiencing this. Yeah. Robert: Yeah, I'm not like, I'm never sure in what direction to go with stuff like this. Never sure what’s valid, what's relevant. I spent my childhood in stressed positions, being woken up in the middle of the night with a pillow over my face, having bones broken consistently, and a series of rape, emotional abuse, physical abuse, and just every sort of trauma. Like imagine when I was nine years old, I was diagnosed, on top of that, with Tourette Syndrome. So I was physically deformed, going through shit like that at home. And then on top of it, I started losing control of my bodily functions. I started exhibiting tics, I started exhibiting obsessive compulsive behaviour. At some point, it was uncontrollable, like lack of control of my impulses, of the things that I would say, vulgarity. At some point, the doctors just thought that perhaps I was Scottish. Lisa: And you’re funny as well. Robert: And they put me on Haldol, which damaged my brain. That and the fact that, it's estimated, I've had at least over a half a dozen major concussions within my childhood — Lisa: From the abuse. Robert: — half a dozen to a dozen massive concussions. Yeah. Lisa: Absolute horrific start into life. Robert: When I was 10, I started binge drinking. And I thought this will help, this is a solution. But you know what? It's not. It's a little bit weird when you start a story off like this, because in some sense, it's not me being delusional, or Pollyanna, because I tend to think that I'm a little bit of a realist, sometimes too much, sometimes to the point of walking a fine edge between being hopeful and being a cynic. But I have to say that a lot of things that I experienced when I was growing up, turned out to be quite beneficial. It’s shaped me in a way and it helped me engage in certain career paths and certain activities that I don't think I really would have sought out, had this stuff not happened. So it's not like me, delusionally trying to create like all silver lining about stuff, it was shit. I understand the severity of what I went through. But I also understand where that led me. And I understand the good fortune that I had of running into certain people that resonated with me, and I resonated with them, largely in part because of my history. I don't think I would have related to these people had I not come from where I came from. Lisa: So you’re talking like people along the way that were, ended up being mentors, or teachers or friends or helping you out and through these horrific situations? Is that what you're meaning, sort of thing that would actually helped you? Because I mean, given a background like that, if you were a complete disaster and drug addict, and whatever, nobody would blame you.  You didn't have a good start in life, whatsoever. I mean, look at you now. Obviously you don't have any facial deformities, and you don't exhibit, right now, any of that stuff that actually you were and have been through. So how the hell did you get to where you are today? Because you're a very successful person, you have a very successful and a very strong influence in the world. What, how the heck do you go from being that kid, with brain problems and concussions and Tourette’s and abuse and rape and all of that, to being the person who comes across as one, number one, hilarious, very crazy and very cool?  How the heck do you get from there to there? Lisa: Just listening to, I can tell that you're someone who's highly intelligent, perceptive and an amazing judge of humour. So thank you for that. I think a lot of it was quite accidental. So I had thought when I was younger, that I wanted to be a police officer, originally. And I wanted to be involved with special victims, even before that was a TV show. Brilliant show, by the way, one of my favourite shows on TV. But even before that was the TV show, I thought, if I'm going through what I went through, and it's very hard because I had Child Services in New York City, they were called ACS. They were at my house consistently. But the problem is, I believed at a young age that my stepfather was nearly invincible, like nobody could touch him. Lisa: You were powerless against him. Yeah. Robert: And when they came to the house and like, look, I had broken bones, my arm was in a sling. A lot of times, I broke my tibia. They won't take me to the hospital because they thought they would suspect stepdad of doing it. I couldn't even walk. And these people were sitting down, said, ‘Well just tell us what happened.’ And I somehow knew that, at a critical moment, my adopted mother would falter. She would not have my back. She would rescind on everything she says. Lisa: She was frightened too, no doubt. Robert: She was frightened. I don't think she had the emotional or intellectual capacity to deal with the situation. That's all I'll say on that. But I knew once they left, I just knew they couldn't do anything, unless I was all-in. And if anything went wrong, he would kill me. So I would have to just say that, ‘Well, I fell.’ And it’s like, there's no way a fork, like I would go into camp and I would have stab wounds in the shape of a fork. And people are like, ‘What happened?’ And I said, ‘I was walking, and I tripped, and I fell onto a fork that went through my thigh and hit my femur.’ It's like, okay, that's just not possible. But I kind of knew. And I kind of felt like nobody's coming to the rescue. And I thought, if I was a police officer, and I was worked with special victims, maybe I could be the person that I always wished would show up for me. But then, there were issues with that. So I think I got like, out of a possible 100 on the police test. I did fairly well. I think I got 103, there were master credit questions. And I thought, right, yeah, I'm going. And then I took the psychological and by some weird measure, I passed, that seems crazy to me now. It kind of seems problematic. I think they need to revisit that. But then when I took the medical, and with Tourette's, it was kind of like, ‘Ah, yeah.’ It was a sticking point. So I had to petition because otherwise I would be disqualified from the employment police department. And during that time, I started working in the gyms. And when I was working the gyms, I kind of thought, there's no way I'll ever be as intelligent as some of these other trainers here. I'm just going to make up with work ethic what I lack in intellect. I would run around and just tried to do everything I could. I would try to clean all the equipment, make sure that the gym was spotless. But again, kind of like not like having all my wits about me, I would be spraying down a machine with WD-40. And what I didn't account for is, the person who was on the machine next to me, I'd be spraying him in the face with WD-40 when he was exercising. Lisa: They still do that today, by the way. The other day in the gym and the girl next to me, she was blind, and she was just spraying it everywhere. I had to go and shift to the other end of the gym, is that right, cause I don't like that stuff. Robert: I mean, in my defence, the members were very well-lubricated. And so, people would go upstairs, and like there is this fucking trainer just sprayed me in the face. And the owner would say, ‘All right, let me see who this guy is. What do you talk? This doesn’t even make sense? Who hired this guy?’ We kind of had like the old bowl, the pin. And like you could walk up top and look down into the weight room, and there I was just running around. And there was something about someone running around and hustling on the gym floor that made him interested. He's like, ‘Get this kid up into my office. Let me talk to him.’ And that forged a friendship. I spoke to him yesterday, by the way. So we've been friends for like three decades. And the owner of the gym became kind of like a surrogate dad. And he did for me what most guides do and that is when you know that there's somewhere you want to go, but you don't know exactly where that is, and you don't have complete confidence in your ability to get there. And what a good guy does is they help you go just as far as you can see, because when you get there, you'll see further. And that's what Mitchell did for me. And he was different because I have a lot of adults. So I grew up with not only extreme violence in the home, but I grew up in Coney Island. I grew up living on the corner of Shit Street and Depressing. And there was a constant violence outside the home and in school and I got picked on. And I got bullied until I started fighting, and then I got into a lot of fights. And you just have these adults trying to talk to you and it's like, you don't fucking know me. You have no idea where I come from. You can't relate to me. When you were growing up, you had a home, you were being fed. You were kind of safe, don't even pretend to relate to me. And he was this guy, who, he was arrested over a dozen times by age 30, which was not why I chose him as a mentor. But he had gone through some serious shit. And when he came out on the other end of it, he wanted to be somebody other than his history would suggest he was going to be, and he tried harder at life than anybody I had ever met. So one, I could relate to him, I didn't think he was one of these adults who are just full of shit. I was impressed at how hard he tried to be the person he wanted to be. So there was this mutual respect and affinity, instantly. Lisa: Wow. And he had a massive influence. And we all need these great coaches, mentors, guides, surrogate dads, whatever the case may be, to come along, sometimes in our lives. And when they do, how wonderful and special that is, and someone that you could respect because like you say, I've had a wonderful childhood. In comparison to you, it was bloody Disneyland, and so I cannot relate to some of those things. And I have my own little wee dramas, but they were minor in comparison to what you experienced in the world. So how the heck can I really help you out if you're a young kid that I'm trying to influence. And not that you have to go through everything in order to be of help to anybody, but just having that understanding that your view, your worldview is a limited, privileged background. Compared to you, my background is privileged. Robert: Well, I don't think there's any ‘compared to you’. I think a lot of my reaction to adults around me who tried to intercede — one, if your intercession doesn't work, it's going to get me hurt, bad, or it's going to get me killed. There have been times where I was hung out of an 18-storey window by my ankles. Lisa: You have got to be kidding me. Robert: Like grabbing onto the brick on the side of the building. I can't even say terrified. I don't even know if that encapsulates that experience as a kid. But it's like you don't understand what you can walk away from once you feel good about interceding with this poor, unfortunate kid. I cannot walk away from the situation that you're going to create. So it was defensive mechanism, because pain is relative. I mean, like, you go through a divorce, and you lose this love and this promise, and somebody comes along, ‘Oh there are some people in the world who never had love, so you should feel grateful’. You should fuck off because that's disgusting. And that is totally void of context. I don't think somebody's pain needs to compare to another person's pain in order to be relevant. I think that was just my attitude back then because I was protecting my existence. I've really changed that perspective because, like, my existence isn't threatened day to day anymore. Lisa: Thank goodness. Robert: So I have a different take on that. And I understand that these adults were well meaning, because I also had adults around me, who could have probably done something, but did nothing. And I don't even blame them because my stepfather was a terrifying person. And the amount of work and energy, and the way the laws, the structure, and how threatening he was, I don't blame them. And me? I’ll probably go to prison. But I don't blame them for their inaction. Lisa: Yeah, and this is a problem. Just from my own experiences, like I said, this is not even in childhood, this is in young adulthood, being in an abusive relationship. The dynamic of the stuff that's going on there, you're frightened to leave. You know you are going to be in physical danger if you try and leave. So, I've been in that sort of a position but not as a child. But still in a position where people will think, ‘Well, why don't you just go?’ And I’m just like, ‘Have you ever tried to leave someone who's abusive? Because it's a very dangerous thing to do.’ And you sometimes you’re like, just, you can't, if there's children involved, even, then that's even worse. And there's complicated financial matters. And then there's, whatever the case may be or the circumstances that you're facing, it's not cut and dried. And as an adult, as a powerful woman now, I wouldn't let myself be in a position like that. But I wasn't that back then. And you weren't because well, you were a child. See, you're even more. Robert: I just want to comment on that a little bit. And this is not coming from clinical expertise. This is just coming from my own interpretation experience. I think, obviously, that when a child goes through this, you would think, ‘Okay, if this started at age five, what could you have done?’ But a lot of times we do look at, let's say, women who are in severe domestic violence situations, and we say, ‘Well, how could you have done that? How could you have let somebody do that to you’? And I think we need to really examine that perspective. Because powerful, confident, intelligent women might be especially susceptible. Lisa: Apparently, that’s the case. Robert: Because you have a track record, and you have evidence to support that you are capable, and you're intelligent, and you find yourself in a situation that you didn't anticipate. And I think it's easier to gaslight someone like that. Because it's like, ‘How could I have had a lapse — is it me?’  And it creeps up on you, little by little, where you doubt yourself a little bit more, a little bit more, and then you become more controlled and more controlled. And then your perspective on reality becomes more and more distorted. So I think we have to be very careful when an adult finds themselves, yes, in that position, saying, ‘Well, why didn't you just leave? How could you have let yourself very easily?’ It can happen to anyone, especially if you have a strong sense of confidence and you are intelligent, and because it becomes unfathomable to you, how you got into that situation. Lisa: Looking back on my situation, which is years and years ago now, and have no consequences to the gentleman that I was involved with, because I'm sure he's moved on and hopefully, not the same. But the fact that it shifted over many years, and the control shifted, and the more isolated you became. I was living in a foreign country, foreign language, unable to communicate with my family, etc., etc. back then. And you just got more and more isolated, and the behaviour’s become more and more, more radical ways as time goes on. It doesn't stop there. Everybody's always lovely at the beginning. And then, as the power starts to shift in the relationship — and I've listened to a psychologist, I’ve forgotten her name right now, but she was talking about, she works with these highly intelligent, educated women who are going through this and trying to get out of situations where they shouldn't be in. And she said,  ‘This is some of the common traits. They're the types of people who want to fix things, they are the types of people who are strong and they will never give up.’ And that is actually to their detriment, in this case. And I'm a very tenacious type of person. So, if I fall in love with someone, which you do at the beginning, then you're like, ‘Well, I'm not giving up on this person. They might need some help, and some, whatever’. And when you're young, you think you can change people, and you can fix them. And it took me a number of years to work out and ‘Hang on a minute, I haven't fixed them, I’ve screwed myself over. And I've lost who I am in the process.’ And you have to rebuild yourself. And like you and like your case is really a quite exceptionally extreme. But like you, you've rebuilt yourself, and you've created this person who is exceptional, resilient, powerful, educated, influential — Robert: And dysfunctional. Lisa: And dysfunctional at the same time. Hey, me, too. Robert: And fucked up in 10 different ways. Lisa: Yeah. Hey, none of us have got it right. As our mutual friend, Craig Harper would say, ‘We're just differing degrees of fucked-up-ness’. Robert: That would be spot on. Lisa: Yeah, yeah, yeah. And totally, some of the most high functioning people that I get to meet, I get to meet some pretty cool people. There's hardly any of them that don't have some area in their life where they've got that fucked-up-ness that's going on, and are working on it, because we're all works in progress. And that's okay. Robert: The thing you said that I really caught is you lost your sense of self, and the isolation. And that is what abusers do, is progressively they start to isolate, and create enemies out of strong alliances and allies. And when you lose your sense of self, and you're so isolated — because as much as we want to be strong and independent, we are highly interdependent, tribal people. We form and calibrate, we shape our sense of identity and the context in which we navigate through the world off of one another. And when you're isolated with a distance sense of reality and you lose your sense of self, you become highly incapacitated to take action in this situation. And you develop, I think what Martin Seligman, called learned helplessness. And I think assigning fault or blame or accusation either to yourself or doing that to somebody else, not only does that not help, it stops people from coming forward. Because it reinforces the mental state that makes them susceptible to perpetual abuse in the first place. Lisa: Yeah, it's so true. So how did you start to turn around? So you meet Mitchell, Mitchell was his name, and he started to be a bit of a guiding light for you and mentor you, and you're in the gym at this phase stage. So, what sort of happened from there on and? So what age were you at this point, like, your teenage years, like teenagers or? Robert: I met Mitchell  when I was like 19 years old. And what he allowed me to do, and it wasn't strategies, he allowed me to focus outside of myself. Because every emotion, every strong emotion you're feeling, especially in a painful way, resides within you. So if you feel a sense of despair, or you feel disgust, or loneliness, or isolation, or any type of pain, and you would look around your room and go, ‘Well, where's that located? Where's my despair? I searched my whole desk, I can't find it’. It's not there. It's not in your outer world. It's your inner world. And what he gave me the ability to do is say, ‘Okay. I grew up physically deformed. And despite everything I was going through, my physical deformities were one of the most painful things’. But the irony, more painful than anything else because you could see me out in the shops and go, ‘Okay, this is a person who has been severely physically sexually abused, who's suffered emotional trauma’. You could see that as I walk through the aisles, because you say, ‘Okay, this is someone who doesn't look right. This is someone who —', and I can see the look of disgust on people's face when they saw me physically. And then there’s nowhere to hide, you couldn’t mask that. I started thinking, ‘Well, what about people who feel that about their physical appearance and they don't require surgery? What are they going through? And how do I focus more on them? How do I take a stand for that person? What's the areas of knowledge? What are the insights? What are the resources that I can give these people to be more resourceful in finding a sense of self and finding their own way forward?’ Lisa: Being okay with the way that they are, because it must be just— Robert: People are okay with the way they are, seeing an ideal version of themselves in the future. And engaging the behaviours that helps them eventually bridge that gap, where their future vision, at some point, becomes their current reality. So I started focusing on things and a mission and people outside of myself, who's going through something similar to what I have gone through, even if it's not precisely the same situation? How do I help them find their way out? And by helping them find their way out, I found my way up. Lisa: Wow, it's gold. And that's what you ended up doing then, and within the gym setting, or how did that sort of work out from there? Robert: Well, I became a trainer. And in the beginning, I was like an average trainer. But I became, what Mitchell called, like the person who saved people. I never saved anyone; you can't change anyone but yourself. But the reason why he called me that is, anytime someone would think about joining the gym, if they would sit down with someone, they approached it from, ‘Well, what can we do? Can we give you a couple of extra months? Can we give you a guest pass to invite some —‘. They approached it from a transactional perspective, where when I sat down with these people, I approached it from a transformational perspective. ‘What did you want most? What do you want most in your life in this moment? And what hasn't happened? What missed? What was the disconnect? Where have we failed? What did you need that was not fulfilled in your experience here and how do we give you those resources? How do we support you going forward?’ And it was also like, ‘Look, if you want to leave, we totally respect that. You've given us a chance to help you. And obviously, the fault was ours. I never blamed anyone. But if you had the chance to do it again, what would have made the difference? And give us that opportunity’. It’s like, ‘Oh, this person is like a retention master’. It's not that, my focus wasn't in retention, it was the intention rather, to relate to the individual in front of me.  Lisa: I’m hearing about the actual person and their actual situation and their actual wishes and goals, rather than, how can I sweeten the deal so you don't leave? Robert: Precisely, and that had some unintended consequences, because it put me in a bad situation, because I got promoted against my will. And I didn’t want to get promoted. And I thought, ‘I'm just getting a reputation for being somewhat good in my current job. And now they're going to promote it to my level of incompetence. And now I'm going to disappoint Mitchell, he's going to find out this kid's actually an idiot, he's a fraud — ‘I was wrong.’ And the one person who believed in me, I'm going to lose his trust and his faith, and that's going to be damaging.’ So me being promoted into management led to a series of unpredictable events that shaped my entire career. Lisa: Okay, tell us about that. Tell us about it. So you were pushed out of your comfort zone, because you just got a grip on this thing, the crazy worker. Robert: So Mitchell had a consultant, and his name was Ray. His name still is Ray, coincidentally. And he said, ‘Yeah, I think you should promote Bobby, just a small promotion to head trainer. Not like fitness manager, just head trainer’. And when they approached me, it was almost like they told me like, I had to euthanise my pet. It was horrible. I was not excited about this. I was like, ‘Oh, thanks. But no, thanks. I love where I'm at.’ Lisa: Yep. ‘I didn’t want to grow.’ Robert: Well, they had a response to that. They said, ‘There’s two directions you can go in this company, you could go up, or you can go out’. And they fired me that day. Lisa: Wow! Because you wouldn’t go up? Robert: They’re like, ‘You've chosen out. And that's okay. That's your decision’. And I was devastated. Like that my identity is connected to that place. And on my way out the door, Mitchell's like, ‘Come into my office.’ And he’s sitting across from me, and he kind of looked like a very muscular, like an extremely muscular version of Burt Reynolds at the time, which was very intimidating, by the way. And he puts his feet up on the desk, and he's leaning back, and he's eating an apple. He says, ‘You know, I heard a rumour that you're recently unemployed. And so I would imagine, your schedules opened up quite a bit this week. You know, coincidentally, we're interviewing for a head trainer position. You might want to come in and apply because you've got nothing to lose’. What a complete and total cock. And I say that, with love, gratitude, gratitude, and love. So I showed up — Lisa: Knew what you needed. Robert: I remember, I showed up in a wrinkly button-down shirt, that is not properly ironed, which was brought to my attention. And I got the job. And I was the worst manager you've ever met in your life because first of all, my motivation was not to serve my team. My motivation was not to disappoint Mitchell. And that was the wrong place for your head to be in, if you have the audacity to step into a leadership position. Whether you tell yourself you were forced into it or not, fact of the matter is ‘No, I could have chosen unemployment, I would have done something else. I chose this. Your team is your major responsibility.’ And that that perspective has served me in my career, but it well, it's also been problematic. So I had people quitting because for me, I was in the gym at 5am. And I took two-hour breaks during the afternoon and then I was in the gym till 10 o'clock at night, 11 o'clock at night. I expected you to do the same thing. So, I didn't understand the worldview and the needs and the aspirations and the limitations and the people on my team. So people started quitting. I started doing horribly within my position. And then Mitchell brought in another consultant, and he gave me some advice. I didn't take it as advice at the time, but it changed everything. And it changed rapidly. This guy's name is Jamie, I don’t remember his surname. But he sat me down and he said, ‘So I understand you have a little bit of trouble’. Yeah, no shit, man. Really perceptive. ‘So, just tell me, who do you work for?’ So, ‘I work for Mitchell’. He said, ‘No, no, but who do you really work for?’ I thought, ‘Oh. Oh, right. Yeah. The general manager of the gym. Brian, I work for Brian’. So nope, who do you really work for? I thought it must be the fitness manager, Will. So, ‘I work for Will’. He’s like, ‘But who do you work for?’ And now I'm starting to get really irritated. I'm like, yeah, this guy's a bit thick. I don't know how many ways I can explain, I've just pretty much named everybody. Who do you reckon I work for? He said, ‘No, you just named everyone who should be working for you?’ Lisa: Yeah, you got that one down. Robert: ‘Have a single person you work for? Who are your trainers?’  He said, ‘Here, let me help you out. Imagine for a second, all of your trainers got together, and they pooled their life savings. They scraped up every bit of resource that they could to open up a gym. Problem is, they're not very experienced. And if they don't get help, they're going to lose everything. They're going to go out of business. They go out and they hire you as a consultant. In that scenario, who do you think you'd work for?’ I was like, ‘Oh, I'm the one that's thick. I've worked for them’. Because in every interaction you have, it made such a dip because it sounds counterintuitive. But he said, ‘In every meeting and every interaction, whether it's a one-on-one meeting, team meeting, every time you approach someone on the floor to try to help them, or you think you're going to correct them, come from that perspective and deliver it through that lens’. And things started to change rapidly. That was one of two things that changed. The second thing that changed is Mitchell believed, because he would listen to self-help tapes, it inspired him. So he would have me listen to self-help tapes. And he believed that oration in front of a group public speaking was culturally galvanising. And in a massive team meeting where we had three facilities at the time, where he brought in a couple of hundred people for a quarterly meeting. He had me stand up and speak. Oh, man. I know you've done a lot of podcasting and you do a lot of public speaking in front of audiences. You know that experience where you get up to speak but your brain sits right back down? Lisa: Yeah. And you're like, as Craig was saying the other day, ‘It doesn't matter how many times you do it, you're still absolutely pecking yourself.’ Because you want to do a really good job and you go, ‘This is the day I'm going to screw it up. I'm going to screw it up, even though I've done it 10,000 times. And I’ve done a brilliant job. Then it’s coming off.’ Robert: If you’re not nervous in front of an audience, you've got no business being there. That is very disrespectful. I agree with that. I mean, this is coming from, in my opinion, one of the greatest speakers in the world. And I'm not just saying that because Craig's my mate, and he gives me oatmeal every time I come out to Melbourne. I'm saying that because he's just phenomenal and authentic in front of a room. But I had that experience and I'm standing up brainless in front of the room. And as I start to realize that I am choking. I'm getting so nervous. Now this is back in the 1990s, and I was wearing this boat neck muscle shirt that said Gold's Gym, and these pair of workout pants that were called T-Michaels, they were tapered at the ankles, but they ballooned out. You know the ones I’m talking about? And I had a lot of change in my pocket. And all you hear in the room, as my knees were shaking, you can hear the change rattling, which wasn't doing anything for my self-confidence. And just instantly I was like, ‘Right, you're either going to epically fail at your job right here. Or you are going to verbatim with intensity, recite word for word, like everything you remember from Dennis Waitley’s Psychology of Winning track for positive self-determination’. Sorry, Dennis, I did plagiarize a bit. And I said it with passion. Not because I'm passionate, because I knew if I didn't say it with fierce intensity, nothing but a squeak will come out of my mouth, Lisa: And the jingle in the pocket Robert: And the jingle in the pocket. And at the end of that, I got a standing ovation. And that’s not what moved me. Lisa: No? Robert: What moved me was weeks ago, I was clueless in my job. I got this advice from Jamie on, ‘You work for them. They are your responsibility. They are entrusted to you. Don’t treat people like they work for you.’ Now I had this, this situation happened. And my trainers avoided me a month ago when I got promoted. But now they were knocking on my office door, ‘Hey, can I talk to you? Would you help me’? And it just clicked. The key to pulling yourself out of pain and suffering and despair is to focus on lifting up others. Lisa: Being of service. Robert: That was it. I thought I could be good at something. And what I'm good at is not only, it's terrifying before you engage in it, but it's euphoric after, and it can help other people. I can generate value by developing and working through others. Lisa: This is like gold for management and team leaders and people that are in charge of teams and people is, and I see this around me and some of the corporations where get to work and consultants stuff is this was very much this top-down mentality. ‘I'm the boss. You’re doing what I say because I'm the boss’. And that doesn't work. It might work with 19-year-olds who have no idea in the world. Robert: It reeks of inexperience. You think you're the boss because you've had certain qualities, and that's why you got promoted — do what I say. You are a detriment to the company — and I know how many people are fucked off and calling bullshit. I don't care. I mean, not to toot my own horn. Like anything I've ever accomplished, I've learned I have accomplished through hiring the right people and having a team that's better than me. But I’ve been in so many management positions, from the very bottom to the very top of multiple organizations I've consulted all over the world, you are only as good as your team. And to borrow from the late great Peter Drucker, ‘The purpose of a business is to create and keep a customer. And your most valuable customer’s your internal customer, the team that you hire. Because unless you are speaking to every customer, unless you are engaging with every customer complaint, unless you are engaging in every act of customer service on your own —' which means your business is small, which is fine. But if it's a lot, you're not ‘— you could scale that, it is always your team. And your job is to create and keep your internal customer by serving them with, at the very least, with the same tenacity, sincerity and intention that you are serving your external customer. If you don't do that, you're going to be shit as a leader. And honestly, I don't give a fuck what anybody thinks about that. Because I have heard so many opinions from people who are absolute — they've got a ton of bravado, they beat their chest, but they are ineffective. And it's extraordinary what you can accomplish when you know how to be, number one, hire the right person. Number two set expectations clearly — clearly, specifically. Number three, understand what motivates each individual, as an individual person and as a team, and then develop that team's capacity individually and collectively to channel that capability towards the achievement of a common vision, of a common monthly target. Period. Lisa: Wow. So that's just, that’s one whole lot going on in one. Robert: That is leadership in a nutshell. Lisa: Yeah. And this is the tough stuff because it's easier said than done. I mean, I'm trying to scale our businesses and grow teams and stuff. And number one, hiring the right people is a very big minefield. And number two, I've started to realize in my world that there's not enough for me to go around. I can't be in 10 places and 10 seats at once. You're getting overwhelmed. You're trying to help the universe and you're one person, so you're trying to replicate yourself in the team that you have, and provide the structure. And then you also need those people where you're weak, like I'm weak at certain aspects. I'm weak at technology, I'm hopeless at systems. I know my weaknesses. I know my strengths, so. Robert: I resemble that comment. Lisa: Yeah, In trying to get those people where you, that are better than you. Not as good, but better than you. And never to be intimidated because someone is brilliant at something. They're the ones you want on your team, because they are going to help with your deficits. And we've all got deficits and blind spots and things that we're not good over we don't love doing. And then trying to develop those team members so that you're providing them and treating them respectfully, looking after them, educating them. And that takes a lot of time too, and it's really hard as a smallish business that's trying to scale to go from there wearing a thousand hats. And a lot of people out there listening will be in similar boats as ours, like, wearing a hundred hats and trying to do multitasking, getting completely overwhelmed, not quite sure how to scale to that next level, where you've got a great team doing a whole lot of cool stuff. And then realizing the impact that you can have as tenfold or a hundredfold. Robert: Absolutely. And I'm not really a good business person, per se, like I've owned a few businesses myself, I've worked within quite a few businesses. And I think what I'm good at, and this goes back to another person that I worked for shortly after Gold's Gym. So Gold's Gym was sold, that's a whole story you don't need to get into. This is an interesting guy. I was doing consulting, I was just going out and doing public speaking, I had independent clients. And I crossed paths with an individual named David Barton. This is someone you should get on your podcast. Talk about an interesting individual. And David Barton had the one of the most unique and sexy edgy brands in New York City. And that's when you had a lot of competition with other highly unique, sexy, edgy brands. And he was the first person — he coined the phrase, ‘Look better naked,’ it was actually him. That's the guy. It was on the cover of New York Magazine. I mean, he was constantly, like his club in Vogue, at Harper's Bazaar, he ended up hiring me as his head of training. And his company at that time in the 1990s, which is quite the opposite of the mentality, the highest position you could ever achieve in his company was trainer. It was all about the training, and it made a difference culturally, and it made a difference in terms of like we were probably producing more revenue per club and personal training at that point than almost anyone else in the world, with the exception of maybe Harpers in Melbourne. So this is how far me and Craig go back actually. Lisa: Wow. It’s that right. Robert: Yeah, because we had found out about each other just a few years after that. Lisa: Some of that Craig Harper. Robert: Craig Harper, yeah, when he had his gyms. So we were introduced by a guy named Richard Boyd, a mutual friend who's like, you got to meet this guy, because he's doing what you were doing. And it all started when I went into David Barton gym, and I just thought, this is a different world. This is another level. Am I in over my head? So again, it was that doubt, it was that uncertainty. Lisa: The imposter syndrome.  Robert: But I did. Yeah, and I think we all have, and I think the only people who don't have imposter syndrome are imposters. Because if you're fraudulent, you wouldn't engage in the level of self-honesty, and humility and conscientiousness, to go ‘Am I fraudulent, is there something that I’m missing’? Only a con artist never considers whether or not they're fraudulent, it's ‘Does that keep you stuck? Or does that help you to get better and more authentic, more sincere?’ So I had the presence of mind to ask David a very important question. And I said, ‘David, if there was like two things, or three things that I can do in this company, exceedingly well, what two or three things would best serve the member, the company as a whole, and of course, my career here with you?’ And David leaned back and he did one of these dozens of things he gave me, literally. And he sat there for — it must have been like five seconds — it felt like an eternity and I'm thinking, ‘Oh my god, that that was the stupidest question I could possibly ask. He probably thinks I should have this whole, like sorted out. After all, he hired me, or am I going to get sacked today?’ And then I was like, ‘I can't get sacked. My house just got ransacked by the FBI’. That was a totally different story. He comes, he leans forward. And he says, ‘Two things. Two things you got to do. Number one,’ and a paraphrase, but it was something very similar to, ‘I want you to be a connoisseur of talent, like a sommelier is a connoisseur of wine. I want you to hire interesting, and great trainers. That's number one.’ And he just sat there again. And I'm like, I think it was a power move. Looking back, it was a power move. Lisa: Using the silence. Robert: What’s number two, David? And he said, ‘Train the shit out of them. And when you're done with that, here's number three, train them again. Number four, train them again. Number five, train them again.’ And that stuck with me. And a year later, I wound up leaving David Barton, and I come back to work with him periodically over the course of many years, and I personally loved the experience every time. We’re still good friends today. And I went to NASM, and I became a presenter, senior presenter, and eventually I became the director of professional development for the National Academy of Sports Medicine. And I brought that with me. And trust me, there was times when I was quite a weirdo, because I thought quite differently than then a team of educators and clinicians. But it helped, and it served me well, and served me throughout my life. So I am shit at so many aspects of business. But I am really good, and probably because I'm very committed to recruiting people with the same level of insight, precision, intuition and sophistication that a sommelier would approach a bottle of wine. Lisa: Oh, I need to talk to you about my business at some point. I need the right people because I keep getting the wrong one. Robert: That, I'm very confident I can help. When it comes to recruiting and selection and hiring and training and development, that is my world. Lisa: That’s your jam. Robert: And because anything I've ever accomplished, it's totally through other people. It's because I hired people that were a lot smarter than me. It's funny because that's another piece of advice I got way back in my Gold Gym days, where one of the consultants was in the room and said, ‘You'll be successful to the degree that you're able and willing to hire people that are more intelligent than you’. And Mitchell quipped, ‘That shouldn’t be too hard for you, Bob’. Okay, yeah. Thanks, Mitchell. Yeah. Lisa: Oh, yeah, nice, friend. You need those ones, don’t you? Hard case ones. Hey, Bobby, this has been a really interesting and I feel like we probably need a part two because we haven't even touched on everything because you've had an incredible career. And I just look at you and how you how far you've come and there must have been so much that you haven't even talked about, have been all the really deep stuff that you went through as a child — Robert: No, I've told you everything. There's nothing else. Lisa: But how the hell did you actually turn your mindset around and how did you fix yourself and get yourself to the point you know where you are today, but I think we've run out of time for today. So, where can people engage with what you do and where can people find you and all of that sort of good stuff? Robert: Okay, well, I just started my own podcast. It's decent. Lisa: Which is awesome because I've been on. Robert: So if you are looking for, like one of the most dynamic, interesting and inspiring podcasts you've ever encountered, go to The You Project by Craig Harper. If you still have time after that, and you're looking for some decent podcast material, go to The Self Help Antidote, that is my podcast. And I'm on Facebook. Social media is not really where I live. It's not where I want to live. It's not where I like to live, but I'm there. I'm on Facebook. I mean the rest of the older generation, yeah, piss off kids. And I'm on Instagram. I'm occasionally on LinkedIn, but not really. I will be on Clubhouse because I got to find the time Lisa: What the hel

We teased this in the very first episode of That Shit is Poison and now it is finally coming to fruition. Fanatic Indian religious groups, Oregon, beer, sex, a villainous, but BOSS businesswoman and, of course, poison. What more could you want in a story? Join us as Harini takes on the behemoth tale of the Bhagwan Shree Rajneesh and Rajneeshpuram. Pro tip: burn all your maroon clothing before listening.  In this episode: Wild Wild Country (series) on Netflix  Bat Shit Valley by Documentary Now (a spoof on Wild Wild Country) on Netflix If you liked this episode please rate, review and subscribe! Follow us on Instagram: @thatshitispoison Email us your homegrown poison stories at thatshitispoison@gmail.com   See omnystudio.com/listener for privacy information.

Until now, schizophrenia and other psychotic diseases were consistently treated with heavy duty, anti-dopaminergic, anti-psychotic medications. These drugs- both first and second generation- carry serious and sometimes irreversible adverse effects (think: EPS, NMS, etc.) In today's episode, we'll discuss a groundbreaking phase-2 clinical trial exploring the use of a muscarinic agonist in the treatment of schizophrenia. Worried about DUMBBELLS? So were we! But these researchers have designed a truly elegant cholinergic/anti-cholinergic duet. This is an exciting article you don't want to miss out on!

Emergency Medical Education,Falck Salem PodcastDocumentation exercise, Narrative review - ColeEmployee Spotlight: Charles Bishop - BiancaSpotlight Prescription Medication: Insulin - ColeResponding on Emotionally Disturbed Patients EDP'sFocusing on Schizophrenia and RASS Scores, Haldol, Versed, Benadryl and Zyprexa - DustinBasics of Cardiology, Anatomy of the heart, Basics of EKG understanding, Eintovens TriangleSpecial Guest, Blaze Amodei REACH Air and a talk about how Cardiology is so important to EMS - BiancaResiliency in EMS Music provided by https://pixabay.com/music/Artwork supplied by http://www.falck.dk 

Podcast 224 Ask David January 11, 2021 Ask David featuring more challenging and interesting questions. Josh asks: What are the most effective types of psychotherapy homework assignments? Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! And Joe asks: Would you say that the secret to overcoming OCD is willpower? Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain? Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks. Clarity asks: Is it too late to be a beta tester for your app? Simon asks: Is there a podcast that you can recommend for general depression, and how to find out what is wrong? Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt! * * * Josh asks: What are the most effective types of psychotherapy homework assignments? Hi David, thanks for all your work. It has been very helpful. You mention That doing homework is essential to recovery from anxiety and depression. Any homework you recommend? I am going to buy a few of your books and have the worksheets from the Neil Sattin podcast. Anything else that will benefit? Josh Hi Josh, It depends on the type of problem you are working on. I can work up an answer, perhaps, if you want to tell me! I did not hear from Josh, but Rhonda and I summarize the best kids of psychotherapy homework for: depression anxiety relationship problems * * * Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! Hi David, I love your work on the podcast. I have not yet found a copy of any of your books in Lahore (where I live), but I have grown to understand your philosophy through your podcasts. Episode 162 disturbed me a little. I suffer from severe OCD and its cousin, depression. And the "high-speed cure" in the title really attracted me. But I had buyer's remorse. Why? Because it does not work like that for most people. The guest on your show, had a few exposures, and BAM, cured. I have tried exposure many many times, and it very minimally helps in lowering the threat of the obsessions. I feel that this was a Magic Pill kind of account, and at the risk of judging a person's pain, I think your guest had a relatively mild (as compared to me) OCD. I would really love it if you could talk about Pure OCD (the type I have), and how it can be resistant to exposure. The intrusive thoughts/obsessions continue to be extremely, EXTREMELY, painful. This "high speed cure" idea seems dismissive of the seriousness of my condition. Please keep up the great work. And I hope to read your books one day. Thanks Hassam (Therapist in training) Thanks Hassam, sometimes, therapy is much harder, as you say! Good point. I often get slammed when I present patients who recover rapidly, especially patients who have had incapacitating symptoms for years or even decades of failed therapy. This is disappointing to me, as my goal is to bring hope to people that rapid and meaningful change IS possible. To be honest, I don’t like it when I get slammed for presenting cases of rapid recovery. Some people think I am a con artist! Yikes! Of course, everyone is different, and some people will be more challenging to treat. One thing I learned when I was in private practice is that you can never tell ahead of time who will recover rapidly and who will take much more time. I’ve had patients I thought would be super easy to treat who responded much slowly than I predicted, and many who I thought would be nearly impossible to treat who responded almost overnight. You’ve mentioned that exposure has been of limited value for you. I totally agree and saw that early in my treatment of anxiety that exposure alone is often quite ineffective. That’s why I argue so strongly that exposure is not a treatment for OCD or for any form of anxiety. It is just one tool among many I use in the treatment of anxiety. I use four very different treatment models with every anxious patient: The Cognitive Model The Motivational Model The Hidden Emotion Model The Behavioral (Exposure) Model Unless you understand and use all four models, the prognosis might be somewhat guarded, as you’ve discovered. In contrast, when you use all four strategies, your chances for success increase tremendously. For example, prior to using Exposure in the episode you listened to, I spent about 25 minutes with Sara using the motivational and cognitive models, which really helped. Focusing on one method alone will often not be terribly effective, especially if you’re looking rapid, complete, and lasting recovery. However, occasionally one method will work, so therapists and patients alike get focused on some single approach they’ve learned, thinking they’ve found “the answer.” There’s a great deal of information on the treatment of anxiety disorders using these four models on my website, www.feelinggood.com. I often urge listeners to use the search function on my website, and everything will be served up to you immediately. You can learn all about these four powerful models. In addition, if you were looking for more techniques, you might want to take a look at my book, When Panic Attacks, which describes 40 potent anti-anxiety techniques. You can order it from Amazon. My psychotherapy eBook, Tools, Not Schools, of Therapy, might also be helpful for therapists who want to learn more about the treatment of depression and anxiety with TEAM. It is an eBook, and order forms are available on my website, www.feelinggood.com, in the resources tab, and also in my store. Thanks for your excellent question! david And Joe asks: Would you say that the secret to overcoming OCD is willpower? In reply to Joe. I use four treatment models in the treatment of all anxiety disorders, including OCD. Certainly, the willingness to use Exposure is required, but Exposure is only one of many helpful methods for OCD. You can search for anxiety treatment on my website, and you’ll find many good podcasts. Also, there is a free anxiety class on my website. My book, When Panic Attacks, is another great resource with more than 40 techniques to combat all forms of anxiety, including OCD. You can find all my books on AMAZON, or on the books page on my website. david * * * Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain? Hi Dr. Burns, It says in your book, When Panic Attacks, p. 49, 3rd paragraph, you said that there's not a shred of evidence that there's any chemical imbalance for any psychiatric disorder. Does that include schizophrenia or bipolar or OCD?  Haldol works for me for schizoaffective....controls dopamine in brain? Ted Hi Ted, There are likely one or more biological factors that contribute to schizophrenia as well as full blown bipolar disorder (with true manic episodes.) We do not yet know what those causes are. However, the brain is not a hydraulic system of chemical balances and imbalances, or perhaps more like a supercomputer. I am not aware of any neuroscientists who believe in the crude “chemical imbalance” theory. We simply don’t know what the causes are. Meds can definitely help with the symptoms of schizophrenia and mania as well. This tells us nothing about causes. Aspirin can help with a headache, but headaches are not due to an “aspirin deficiency” in the brain. Computers often crash, but I’ve never heard of a computer problem that was caused by a “silicon imbalance” in the chips. Hope that helps. Psychotherapy can definitely help with feelings of depression and anxiety, but is not a cure for schizophrenia or mania. I would hate to have to treat any psychiatric problem with drugs alone! I like to treat humans, not “diagnoses,” but it can helpful to be aware of diagnoses like schizophrenia, or schizoaffective, or bipolar I, for example. Hope that is helpful! And just my thinking, too, not “written in stone.” david * * * Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks. Hi Brian, Thanks! One point is that people are often looking for “formulas” or general solutions to buzzwords like “stress.” The key to TEAM is to focus on one specific moment, and to work with it in an individual way, never using non-specific solutions like exercise, meditation, deep breathing, dietary changes, and so forth. But as you can see, this is tough for many people to grasp. The failure to understand the importance of specificity is one of the big problems in our field, and it is a problem for therapists and patients alike. There are no very good solutions in the clouds of abstraction, because we are all unique. I asked Brian for specific examples, and he wrote: “Work pressure, obnoxious bosses, nagging family members, drug addicted family members, and inability to pay bills are a few.” I responded, Thanks, these are all totally unique with different solutions. Perhaps you can focus on one and provide a couple details. david Brian responded, Thanks. Whichever one you think is best. Stressful thoughts. Also how to change stressful thoughts when they're automatic. Hi Brian, There an infinite variety of "stressful thoughts," and they all have unique, non-overlapping solutions. Could you tell me about one thought you had at one specific moment? david During the podcast, I made some additional comments on dealing with stress using TEAM: Stress is a fairly non-specific word for feeling upset or distressed. I like to use and measure specific emotions in my patients, like depression, anxiety, guilt, shame, inadequacy, hopelessness, frustration, anger, and so forth. But for some people, “stressed” may be more acceptable than words like “depression,” which may carry more stigma. However, there is a somewhat specific meaning to stress, which means overwhelmed by having too much to do and not enough time to do it all. This can sometimes result from taking on too much, and having trouble saying no. Reasons for this difficulty being assertive include: Conflict Phobia Excessive Niceness Submissiveness / Pleasing Others Fear of missing out on something cool and exciting to do NY TV story on “stress” and my ten distortions General tools for dealing with patients who feel “stressed out.” Daily Mood Log Relationship Journal Brief Mood Survey You can take a thought on a DML and do a downward arrow—you will typically come to several common Self-Defeating Beliefs, such as Perfectionism Perceived Perfectionism Approval Addiction Submissiveness Worthlessness schema Conflict Phobia / Anger Phobia Superman / Superwoman Specific Tools Positive Reframing “No” Practice * * * Clarity asks: Is it too late to be a beta tester for your app? Hi Clarity, Thanks! You can sign up at www.feelinggood.com/app * * * Simon asks: I have a question for you. I am very depressed at the moment, and I don't know what is wrong, or I have difficult to find out what thought is giving me the down-feeling ☹ Is there a podcast that you can recommend for general depression, and how to find out what is wrong?Thanks for the sooooo great in inspiration. Thanks Simon. I will include your question in an upcoming Ask David, but here’s a start. Focus on one moment you were upset, and tell me how you were feeling and thinking at that specific moment, and record the information on a Daily Mood Log. If you listen to live therapy on the Feeling Good Podcasts, or read one of my books, like Feeling Good or Feeling Great, you will get a step by step introduction to TEAM therapy. Thanks! d PS There is at least one podcast on how to identify your negative thoughts and generate a Daily Mood Log. You can use the search function on the website to find those or podcasts on any topic, but here’s the link since the search function is not working properly at the moment so I’ll have to fix it. (https://feelinggood.com/2018/03/05/078-five-simple-ways-to-boost-your-happiness-5-you-can-change-the-way-you-feel/) PS PS I want to thank Simon for creating time codes for all 50 techniques on podcasts 93 (https://feelinggood.com/2018/06/18/093-fifty-ways-in-fifty-minutes-part-1/) and 94 (https://feelinggood.com/2018/06/25/094-50-methods-in-50-minutes-part-2/) entitled, “Fifty techniques in fifty minutes.” His time codes allow you to find the description of any techniques of interest. * * * Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt! Hi David, I hope this is the right address to which to send an "Ask David." I am a huge fan of your work and cannot thank you enough for making your therapy techniques so accessible. And thank you for taking audience questions! I am in the process of learning TEAM and notice myself getting more skilled, slowly but surely.  There are times I hear you help patients recover in a single session. So far, I have not found myself able to help patients that quickly. I've felt disappointed about this, and it's led to anxiety and self-doubt ("I need to learn TEAM faster so I can help my patients as quickly as possible," "This should be happening quicker."). I am wondering how logical it is for me to expect myself to help patients recover in a single session. Is it reasonable to assume I may have to practice TEAM for some time and go through several training experiences before I can help patients change that quickly? Thank you again!! Stephanie David and Rhonda discuss ways of improving over time and reducing the pressure on yourself if you are a therapist.

From Tics to Tourettes, from rarity to more common place.

More about the girl who was told she was going to be the greatest Canadian actress ever only to find herself on the psychiatric ward of the general hospital. In this episode, Kate is now back in Toronto and has been discharged from hospital with a prescription for Haldol, a anti psychotic medication. It cost over $70 and had to be taken everyday but, Kate had other ideas. She took it when SHE felt like it. Her mom booked a cottage by the beach to stop Kate and her sister arguing and Kate decided to bring a friend. She also took a shine to the boy next door to the cottage and was wanting to see her brother, who lived very near to the cottage. It was all going Kate's way, another plan; until she did not take the medication.

More about the girl who was told she was going to be the greatest Canadian actress ever only to find herself on the psychiatric ward of the general hospital. In this podcast, Kate meets her day nurse and is then sent to have a lesson in bio-energetics, having been told it will be good for her. After that, she goes off to see her phsycocycleist, or at least that's what she thinks he is. Back on the ward, she asses her day and realises she is now being given Haldol, which is commonly know as a 'Chemical Kosh'.

In this episode, we will be talking about Tera's stay in a psych ward and her following the antichrist. True story...true, true story!!!! Come join us on this epic adventure where we get to see how crazy Tera was growing up. Along with Dawn's traumatic past experience with a psych ward as well. Was Dawn a patient as well or was she a visitor??? Well, you'll just have to listen in to find out! --- Send in a voice message: https://podcasters.spotify.com/pod/show/crazy-lady-chronicles/message Support this podcast: https://podcasters.spotify.com/pod/show/crazy-lady-chronicles/support

Episode 12: Got the Hiccups! The sun rises over the San Joaquin Valley, California, today is May 15, 2020. It’s 85 degrees today, Bakersfield is finally warming up! Some people are excited, but some may not be so thrilled, because Bakersfield’s heat in mid-summer is no joke. Would COVID 19 fade out with these warmer temperatures? We don’t know, but that’s our hope. Our program director, Carol Stewart, had a double celebration last week because of her birthday on “Cinco de Mayo” (which is May 5th), and also as a mother of three children, three dogs and hundreds of “adopted” children residents and medical students. Happy Birthday, Dr Stewart, thanks for your example of dedication, wisdom, and good sense humor; and Happy Mother’s Day to all our mother listeners. ______________________ Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere. The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “When one teaches, two learn” —Robert Heinlein Teaching is the best way to know that you know something. Dear residents, what knowledge is the most important for you? Go and learn those things good enough to be able to teach them. Remember, when one teaches, two learn. Today we are here to learn from Dr Yunior Martinez. He is on the last weeks of his training, and I’m happy for having him here today, in front of our microphones. Dr Martinez is one of our chief residents, welcome, Dr Martinez. 1. Question number 1: Who are you? My name is Yunior Martinez Duenas, PGY-3 at Rio Bravo Family Medicine Residency Program also one of the chief resident for the past 2 years. I am from Cuba, came to America in 2012 after working 5 years as a family physician in Venezuela. I am married, and a father of 2 teens and a dog. 2. Question number 2: What did you learn this week? I was in the hospital for the last 4 weeks, an interesting case arrived at our ER. He was a 45 year old Male complaining of HICCUPS for 3 days. The patient was being discharge after improvement of his symptoms, treated with Reglan®, however, his vital signs were significant for tachycardia, and fever as the patient was heading out the door. So, labs were performed including a swab for COVID-19. The patient was admitted because his oxygen saturation was also going down to the low 90s. Next day the COVID-19 test came back as POSITIVE. After 10 days in our service and appropriate treatment, which included azithromycin, hydroxychloroquine and finally convalescent plasma, patient was discharged fully recovered. The take home message: Hiccups is usually benign and self-limited, but it may be persistent and a sign of serious underlying illness. Hiccups affect almost everyone during their lifetime. Also known as a “hiccough”, from the Latin singult, meaning gasp or SOB. While brief hiccups episodes lasting less than 48 hours are common, little is known about the overall incidence and prevalence of prolonged hiccups in the general population. However, among patients with advanced cancer, 1 to 9 percent had persistent or intractable hiccups. Also, hiccups has a higher prevalence in people who are taller and male, mostly elders. No racial, geographic or socioeconomic variation in hiccups has been documented. Definition of hiccups A hiccup occurs due to an involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles causing a sudden inspiration that ends with abrupt closure of the glottis, generating the “hic” sound. Transient vs Persistent Hiccups The pathogenesis of hiccups lasting more than 48 hours is uncertain. Transient hiccups (usually due to gastric distention) is cause by excessive laughter or tickling, aerophagia, tobacco abuse, overindulgence in food or alcohol, GERD, change in gastric temperature due to movement into hot or cold environment, and ingestion of hot or cold foods. Recurrent or persistent hiccups lasting over 48 hours are caused by: 1. Reflex stimulation due to alcohol abuse, anxiety disorder. 2. Neurological disorders such as encephalitis, meningitis, vertebrobasilar ischemia, intracranial hemorrhage, intracranial tumor, uremia, dementia, cardiac pacemaker stimulating diaphragm. 3. Mediastinal disorders: aortic dissection, phrenic nerve trauma, TB, malignant neoplasm, pulmonary fibrosis, sarcoidosis, adherent pericardium, MI, pneumonia with pleural irritation (our patient hiccups’ etiology). 4. Abdominal disorders: diaphragmatic hernia, GERD, subphrenic abscess and peritonitis, liver disease, pancreatitis, post OP, splenic infarct. 5. Medications: steroids, benzodiazepines, chemotherapy, dopamine agonists 6. Related to tympanic membrane foreign body, anesthesia, also psychogenic and idiopathic. Workup In order to rule out any serious etiology, you should order a serum creatinine, liver chemistry test, CXR, CT or MRI of the head, Chest and abdomen, Echocardiography and upper endoscopy. Tailor your work up after examining Treatment 1. For transient hiccups, folk remedies include: breath holding, tongue traction, breathing into a paper bag, suddenly frightened, gargling ice water, drinking water for a side glass and occlude ears; Stimulate pharyngeal mucosa, swallow a teaspoon of vinegar, pickle juice or dry granulated sugar; Stimulate Gag reflex with tongue depressor (avoid it if recent food intake due to aspiration risk). 2. For intractable hiccups: • First line are central agents: o Chlorpromazine which is the best studied of all agents used for hiccups. Monitor for hypotension, QT prolongation. o Gabapentin or baclofen for up to 7-10 days o Other Agents: Diphenylhydantoin, Haldol, Orphenadrine, Ketamine • Peripheral agents: Reglan is the most effective. Other agents include quinidine, atropine, amphetamine, and amyl nitrate. 3. Question number 3: Why is that knowledge important for you and your patients? Hiccups can decrease quality of life by interrupting eating, drinking, sleeping, and conversation; exacerbate pain; cause insomnia, fatigue, and mental stress; or adversely affect mood. When prolonged, hiccups can have serious adverse health impacts including malnutrition, weight loss, and dehydration. Hiccups may have other sequelae; for example, a case report described a patient with pharyngitis who developed hiccups and bouts of convulsive syncope. 4. Question number 4: How did you get that knowledge? I learned it from my patients. Every patient is a learning opportunity and I take the time everyday to review an interesting topic, usually related to my patients. I also learn from our faculty, after discussion of every case in the clinic or the hospital. 5. Question number 5: Where did that knowledge come from? The sources I use are: Up to date, FP notebook, Quick medical Diagnosis and Treatment. See details in our website. ________________________ Speaking Medical (Medical word of the Week): EXOSTOSIS by Dr Golriz Asefi Exostosis refers to benign bone growth on top of normal bone. Another name for exostosis is bone spur. Depending on the location and shape of the exostosis, it may cause chronic pain ranging from mild to severe, and even disabling. When needed, treatment of exostosis is surgical. This week I saw a patient with buccal exostosis or tori. Buccal exostosis needs to be monitored by a dentist annually and treated if it causes pain, inflammation or for cosmetic reasons. Another location for exostosis is the external auditory canal, which commonly occurs in individuals who are repeatedly exposed to cold water. Exostosis may need surgical removal if it occludes the EAC and interferes with hearing. ________________________ Espanish Por Favor (Spanish Word of the Week): DOLOR by Dr Anuradha Rao Hi, guys, this is Dr Rao with our section Espanish Por Favor. Today we are going to talk about the word Dolor. Knowing this word can be very useful in performing your history and physical exam. Dolor means pain or ache in Spanish. This the most common complaint among Spanish-speaking patients. Dolor is easy to use because you can add an anatomical location to the phrase “Dolor de” and find out where the pain is. For example: Dolor de cabeza is headache, Dolor de cuerpo is body ache, Dolor de estómago is stomachache, and so on. Now you know the Spanish word of the week, dolor, see you next week! ______________________ For your Sanity This week, we just want you to breath. Inhale and exhale slowly for one minute. Repeat this exercise as frequently as you want. [Ocean waves] ______________________ Now we conclude our episode 12, “Got the Hiccups!”, remember that hiccups should last no longer than 48 hours. If hiccups are persistent or recurrent, think about other conditions such as neurologic disorder, intraabdominal problems and infections… including the feared COVID-19. If there is a Spanish word you need to know, it is dolor, which means pain. Just add a body part to “dolor de” and voilà, you are set to start your H&P. This week we didn’t have a joke for you, but breathing exercises are also good for your sanity. See you next week. This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team for this week was Hector Arreaza, Yunior Martinez, Anuradha Rao, and Golriz Asefi, Audio edition: Suraj Amrutia. See you soon! References 1) Hiccups, Anthony J Lembo, MDD, UpToDate, https://www.uptodate.com/contents/hiccups?search=hiccups%20treatment§ionRank=1&usage_type=default&anchor=H12&source=machineLearning&selectedTitle=1~150&display_rank=1#H12, accessed May 11, 2020. 2) Hiccups, Quick Medical Diagnosis & Treatment App, McGraw Hill Education. 3) Hiccup, Family Practice Notebook, https://fpnotebook.com/GI/Sx/Hcp.htm, accessed on May 10, 2020. 4) Medical Student Conducts History & Physical with Spanish-Speaking Patient Using Only the Word ‘Dolor’, by Dr Pablo Pistola, January 2016, https://gomerblog.com/2016/01/spanish-speaking-patient/

In this episode, we discuss the use of droperidol for the treatment of agitation in the ER setting. Please remember to subscribe to our podcast and leave us a comment! References:Knott JC, et al. Randomized clinical trial comparing intravenous midazolam and droperidol for sedation of the acutely agitated patient in the emergency department. Ann Emerg Med. 2006; 47: 61-67Isbister GK, et al. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med. 2010; 56: 392-401Chan EW, et al. Intravenous droperidol or olanzapine as adjunct to midazolam for the acutely agitated patient: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Ann Emerg Med. 2013; 61: 72-81Taylor, DM, et al. Midazolam-droperidol, droperidol, or olanzapine for acute agitation: a randomized clinical trial. Ann Emerge Med. 2017; 69(3): 318-326Olanzapine (Zyprexa) [prescribing information]. Princeton, NJ: Sandoz; 2019

Deutschlands Lieblingsvollidiot und ursympathischer Reichsbürger Xavier Naidoo hatte ja vor kurzem mal wieder eine der ihm aus unerfindlichen Gründen immer wieder eingeräumten Chancen vertan und aus Versehen sein wahres, rechtes Gesicht gezeigt. Diesertage ist sein Gesicht wieder zu sehen und zwar aufgedunsen und mit dicken Tränen überströmt auf dem YouTube Kanal irgendeines dahergelaufenen Verschwörungsschwurbelkloppis. Worum es geht kann man dem Gewimmere garnich so richtig entnehmen aber bestimmt is er da einem ganz großen Unrecht auf der Spur mal wieder! Oder, eher meine Theorie, der alte Schmierlappen befindet sich auf direktem Wege in den Abgrund einer amtlichen, sich seit Jahrzehnten anbahnenden Psychose. Ich bin ja sehr sehr ungern missgünstig oder zynisch aber ein bisschen wünsche ich mir schon, ihn in den RTL News komplett durchballern zu sehn. Wenn er dann noch alle seine Anhänger mit in den Irrsinn reisst, können die bis dahin hoffentlich geleerten Corona Krankenhäuser ja als geschlossene Stationen dienen, wo den ganzen Assis die Rübe bis zum Rand mit Haldol zugespritzt wird und sie bis zur Heilung sabbernd im Raucherraum rumhängen können. Allen voran ihr Messias mit dem Goldkehlchen, der gute Xavier..

Contributor: Sam Killian, MD Educational Pearls: Agitation can be due to a number of causes, but regardless of the cause, sedation often plays a key role in patient and provider safety. But what is the best sedative agent? A study looked at control of agitation with intramuscular medication. Specifically, 5 different IM sedative agents were compared to see which one best provides “adequate” sedation in 15 minutes or less. Haldol 5mg, Haldol 10mg, Versed 5mg, Zyprexa 10mg, and Geodon 20mg were all compared, and by far Versed provided the best sedative results. All medications had approximately the same amount of adverse effects. There are so many sedative options, but time and time again large dose benzodiazepines have demonstrated great effectiveness in treating acute agitation References 1) Klein, Lauren R. et al. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department. Annals of Emergency Medicine. 2018. 72(4), 374 - 385   Summarized by Jackson Roos, MS3 | Edited by Erik Verzemnieks, MD

Haloperidol (Haldol) is a traditional antipsychotic with some very distinct guidelines that could show up on your next exam or with your next combative, delirious patient.  In this podcast episode, I’ll talk you through: What Haldol is used for in the clinical settingThe multiple ways Haldol can be given (and how we’re going to give it for acute agitation in the hospital)THE most important thing you need to know before you give Haldol and what to monitor afterwards.The very dangerous thing that could happen to your patient with Haldol administrationMonitoring parametersCommon side effects of Haldol Plus, I’m sharing a sneak peak into my Pharmacology course and an acronym that can help you focus your studying when learning new medications.  Want to learn more about the QT interval? (https://www.straightanursingstudent.com/qt-interval/) Want to see how I remember drug side effects? (https://www.straightanursingstudent.com/psychopharmacology-podcast/) Want to “bulletproof” your medication administration? (https://straightanursing.ck.page/fc69f2501b) Looking for your new BFFs? Join the Thriving Nursing Students Facebook group! (https://www.facebook.com/groups/thrivingnursingstudents/) Episode notes here: (https://www.straightanursingstudent.com/haldol/)

This week, Kat & Andrea talk about mythical meth trailers, human combustion, pop culture, and more!

This episode is from the vault and was first released November 20, 2017. Dr. Newton wants to educate people on how medications can cause dementia. Also, how to avoid these medications. The only thing worse than having dementia is taking care of a loved one with dementia. Many people do not realize that many medications can cause dementia. Dr. Camille Newton is a home visiting physician. You may also know it as a traveling doctor or mobile doctor. It is such an important service for seniors that are not able to travel for the doctor’s appointments. She focuses on minimizing medications. Especially psychotropic pharmaceuticals, to help senior brains stay healthier longer. Medications get tested by the FDA to see if they are safe. But those medications are not really tested to see if they cause brain failure. While performing house calls, she has seen the effect psychotropic medications have on people who take them for a long period. Some examples of psychotropic drugs are: * Antipsychotics including Risperdal or Haldol * Sedatives especially the benzodiazepines such as Ativan, Xanax, or Valium * Anti-depressants * Antihistamines These are some staggering and scary statistics! According to Dr. Newton, using Benzodiazepine increases the risk of Dementia. Nearly tripling risk within 3 years. Quitting reduces risk over time, to only 10% increase in risk 3 years after quitting. Benzodiazepine use quadruples the risk of suicide in the elderly. In one study, Benzodiazepines and hypnotics increased suicide risk by 14 times. Antihistamines can have an anticholinergic effect. This means some of them block a certain neurotransmitter called acetylcholine. This can have a detrimental effect on the brain over a long period. This includes Benadryl. In monkeys, laboratory rats, and humans, antipsychotics such as Haldol showed a huge measurable shrinking of the brain within 8 weeks of use. A person goes to the drugstore and they have allergy symptoms. They could choose Claritin or Allegra (which are not anticholinergic). Also, they could choose Benadryl or Coricidin and end up with dementia within a few years. Maybe less is more? Dr. Newton tells a fascinating story about “Pam” who has a rare case of dementia reversed by getting her off of her medications. Although she has had only a few cases of ‘total cure’, she's had many patients improve when taken off from anticholinergics. These medications are so dangerous to our brains, and yet there is no warning label.  Many of them are over the counter. A lot of people ask Dr. Newton, “What Can I take?” Her response is, don't look for something to take when you are having a problem. Don't look for a pill to solve your problem and question every medication given. *Please note: Neither the Rock Your Retirement Show nor the host, Kathe Kline provides medical advice.  Please consult your own practitioner about any healthcare issues that you have. About Our Co-Host Dr. Newton cares for complicated elderly patients in their homes through her medical practice, Home Excel Physician’s Group. She is also the founder and former president of Pure Wick Corporation. It's a manufacturer of non-invasive, external urinary catheters for women. (Pure Wick was recently sold to C.R. Bard). An Attending Physician for Camp Pendleton Naval Hospital Residents in Family Medicine. Also, for Kaplan University School of Nursing. She is board-certified in family medicine. A Member of the American Academy of Home Care Physicians, and a Gulf War Veteran. She is also an Athena Pinnacle Award winner. This is an honor given to exemplary female executives in San Diego–for ‘Women who Champion Women’. She studied Genetics at U.C. Davis, where she graduated with honors. She completed her medical education at Saint Louis University and Residency at U.C. Irvine.

Celebrating the release of the 2019 PEN America Prison Writing Awards Anthology, PEN America and The Poetry Project present an evening of exceptional work from currently incarcerated writers, staged by a series of dynamic authors, actors and activists. Part 1 of 2 Cortney Lamar Charleston reads Self Portrait As State Property by P.M. Dunne (00:20) Margo Jefferson reads “Thorazine, Haldol & Coffee: My Life in a Prison Mental Health Ward,” by Michael Kaiser (03:58) T Kira Madden reads “My Co-Worker,” Edward Ji (14:50) Shaun Leonardo reads "Geode" by David A. Pickett (15:33) Rachel Eliza Griffiths reads “Time Reversal Invariance" by David Pickett (26:55) Kevin Boone, Tamika Graham, Milton Jones, Paul Kim, and Edwin Santan perform “Never 2 Late” by John Benjamin (29:00) T Kira Madden reads "Under the Bridge" by Christiana Justice (42:15) Robert Pollock reads "Monologue" by Sean Thomas Dunne (45:41)

On this episode of The Sofa King Podcast, we look at one of the most interesting cults we’ve ever covered: The Rajneeshees. Let me give you a teaser. Their story involves the bombing of a hotel by a radical Islamic group, a bio weapon attack involving poisoned salads, an assassination attempt of a prominent politician, a lot of capitalistic sex, a war against Nike, the attempt to take over a town in Oregon, an army of hoboes who were knowingly high on Haldol, and a plot to poison the water supply with an army of beavers. Yes. That’s all true. It sure seems like a lot when you string it all together. So, who are the Rajneeshees, and what did they believe? They started as the followers of Bhagwan Shree Rajneesh (also known as Osho), a public speaker from India who specialized in meditation seminars. He got backing by some wealthy folks in India, and he quickly rose in prominence, securing a whopping 100,000 followers in just a few years. They lived in an ashram in India but spread throughout the globe. They started to be a group that was somewhat hedonistic, celebrating things that made you feel good, from material possession to sex. Lots of sex. Eventually, they settled on a plot of land in rural Oregon, and there, they went to war with one of the co-founders of Nike to claim dominance over the area. This battle got intense, and eventually led to the group doing all they could to win local elections and stay in power (this is where the bio attack, army of hoboes, an assassination plot, and poisonous beavers come on the scene). So, what was up with Rajneesh’s 93 Rolls Royce cars? How much sex did this sex cult have? How big was their militia? What did the Rajneeshees secretary do to take power, and where did she end up? What happened to the army of hoboes? Why did the cult try to cultivate live AIDS cultures? Listen, laugh, learn. List of Crazy Crimes from the Cult: https://www.thedailybeast.com/wild-wild-country-the-most-shocking-reveals-from-the-sex-cults-fbi-informant

One of the stress points when a patient taking chronic opioids presents with acute pain is that we feel we have little to offer them. Are more opioids the answer? That's often what happens, but might not be the best next step. In this episode, Reuben Strayer presents the argument in favor of haloperidol for analgesia and why more opioids can do more harm than good.    Episode Guide In the introduction, preview of a project we're working on for Essentials of Emergency Medicine (May 15-17). Opioid induced hyperalgesia: compared to those not taking opioids, patients on chronic opioids may have a more unpleasant experience when exposed to painful stimuli. In other words, they are more sensitive pain. The meds used to treat pain, actually worsen pain. A patient who uses chronic opioids will have marginal gains in analgesia with escalating doses while getting closer to potentially lethal adverse effects. Haloperidol is an analgesic option for patients taking chronic opioids. Reuben's strategy for using haloperidol for analgesia in chronic opioid patients: 10 mg IM haloperidol if there is no IV,  5 mg IV if they have a line. If they don't fall asleep shortly after (or have improvement of pain) he repeats the dose.  If that doesn’t work, he uses analgesic dose ketamine. For analgesic dose ketamine in these patients, Reuben uses 30 mg IV. This may cross over into the 'recreational' or 'partial dissociation' dose where the patient can have disturbing psycho-perceptual effects. He has found that the pretreatment with haloperidol leads to less distress from these psycho-perceptual effects. For more information on ketamine dosing, see Reuben's post on the Ketamine Brain Continuum. Haloperidol and the prolonged QTc: Butyrophenones (of which haloperidol is one) are known to prolong the QTc. Should we get an EKG prior to giving haloperidol to see if the QTc is already prolonged? Reuben feels that the negative effects of butyrophenone QTc prolongation are overblown and does not routinely get an EKG prior to giving haloperidol. This includes initial and subsequent doses.  Take that with a grain of salt because there are many docs who do get an EKG before the first or second dose of haloperidol, especially if there is a known QTc prolonging drug on the patient's med list (like methadone). Some hospitals even have policies that before a second dose is given, there is a hard stop for EKG and QTc check. Check out Reuben's blog Emergency Medicine Updates and follow him on Twitter   References Opioid Hyperalgesia Marion Lee, M., et al. "A comprehensive review of opioid-induced hyperalgesia." Pain physician 14 (2011): 145-161 Full text link. PMID: 21412369  Hooten, W. Michael, et al. "Associations between heat pain perception and opioid dose among patients with chronic pain undergoing opioid tapering." Pain Medicine 11.11 (2010): 1587-1598 Full text link.  PMID: 21029354 Droperidol for analgesia Richards, John R., et al. "Droperidol analgesia for opioid-tolerant patients." Journal of Emergency Medicine 41.4 (2011): 389-396.  PMID: 20832967 Amery, W. K., et al. "Peroral management of chronic pain by means of bezitramide (R 4845), a long-acting analgesic, and droperidol (R 4749), a neuroleptic. A multicentric pilot-study." Arzneimittel-Forschung 21.6 (1971): 868. PMID: 5109279 Admiraal, P. V., H. Knape, and C. Zegveld. "EXPERIENCE WITH BEZITRAMIDE AND DROPERIDOL EN THE TREATMENT OF SEVERE CHRONIC PAIN." British journal of anaesthesia 44.11 (1972): 1191-1196. PMID: 4119073 Early studies on Haloperidol for analgesia Maltbie, A. A., et al. "Analgesia and haloperidol: a hypothesis." The Journal of clinical psychiatry 40.7 (1979): 323-326. PMID: 222741 Cavenar, Jo, and A. A. Maltbie. "The analgesic properties of haloperidol." US Navy Med 67 (1976): 10. Cavenar, Jesse O., and Allan A. Maltebie. "Another indication for haloperidol." Psychosomatics 17.3 (1976): 128-130. Haloperidol for pain Seidel, Stefan, et al. "Antipsychotics for acute and chronic pain in adults." Cochrane Database Syst Rev 4 (2008). PMID: 18843669 Ramirez, R., et al. “Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department.” The American journal of emergency medicine (2017). PMID:28320545 Reviewed in this ERCast episode Salpeter, Shelley R., Jacob S. Buckley, and Eduardo Bruera. "The use of very-low-dose methadone for palliative pain control and the prevention of opioid hyperalgesia." Journal of palliative medicine 16.6 (2013): 616-622. PMID: 23556990 Afzalimoghaddam, Mohammad, et al. "Midazolam Plus Haloperidol as Adjuvant Analgesics to Morphine in Opium Dependent Patients: A Randomized Clinical Trial." Current drug abuse reviews 9.2 (2016): 142-147. PMID: 28059034

The agitated patient can be very challenging to evaluate in the ED. This episode of EMGuideWire's Core Concepts will address options to help evaluate these patients while keeping the patient and the staff safe.

Listen NowIn early February the Human Rights Watch (HRW) published, "'They Want Docile': How Nursing Homes in the US Over-medicate People with Dementia."  The inappropriate or misuse of antipsychotics, e.g., Haldol, Seroquel and Risperdal, in nursing facilities to chemically restrain nursing home patients, moreover frail and elderly seniors, has been practiced for decades.  The HRW report found in 2016-2017 "massive use" or abuse, i.e., the report estimated in an average week over 179,000 long-stay nursing facility patients were administered antipsychotic drugs without a diagnosis for which the drugs are indicated or approved.  Despite efforts to reduce the abuse of these medications, in part via a CMS voluntary initiative (a link to which his provided below), the practice persists, in part, because the federal government has nominally enforced regulations and enforcement measures to remedy the problem.  The use of these drugs can and does cause serious patient harm.  In testimony before the Congress in 2007, the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year form the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work."  Listeners may recall I initially discussed this topic in December 2012 with Diana Zuckerman.   During this 36 minute discussion Ms. Flamm explains what prompted the HRW study, the study's methodology, how widespread is the practice of misuse of antipsychotics in nursing facilities, how and why they are used inappropriately, that includes the the failure to obtain free and informed consent, the federal government's inadequate enforcement of federal laws and regulations to police the problem and how this practice violates not just US laws but international human rights agreements. Ms. Hannah Flamm is currently an immigration lawyer at The Door's Legal Services Center in New York. In 2016-2017, Ms. Flamm was New York University's School of Law Fellow at Human Rights Watch where she researched and wrote, "They Want Docile."  She interned with the Southern Poverty Law Center, South Brooklyn Legal Services and Schonbrun DeSimone, an international human rights and civil rights firm.  She is a graduate of NYU's School of Law and the Harvard University Kennedy School of Government.  As a student she participated in NYU's Family Defense Clinic and the Harvard International Human Rights Clinic.  Prior to attending law school, Ms. Flamm worked for the International Rescue Committee in Haiti. The Human Rights Watch report is at: https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia.Two related 2012 and 2011 DHHS Office of the Inspector General reports are at: https://oig.hhs.gov/oei/reports/oei-07-08-00151.pdf and https://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf.Information on CMS' "National Partnership to Improve Dementia Care in Nursing Homes" is at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Dr. Newton wants to educate people on how medications can cause dementia and how to avoid these medications. The only thing worse than having Dementia is taking care of a loved one with Dementia. Many people do not realize that a large number of medications can cause dementia. Dr. Camille Newton is a home visiting physician. You may also know it has a traveling doctor or mobile doctor. It is such an important service for seniors that are not able to travel for doctor’s appointments. She focuses on minimizing medications, especially psychotropic pharmaceuticals to help senior’s brains stay healthier longer. When medications are tested by the FDA to see if they are safe, they are not really tested to see if they cause brain failure. While performing house calls she has seen the effect psychotropic medications have on people who take them for a long period of time. Some examples of psychotropic drugs are: * Antipsychotics including Risperdal  or Haldol * Sedatives especially the benzodiazepines such as Ativan, Xanax, or Valium * Anti-depressants * Antihistamines These are some pretty staggering and scary statistics! According to Dr. Newton, Benzodiazepine use is associated with an increased risk of Dementia. Nearly tripling risk within 3 years. Quitting reduces risk over time, to only 10% increase in risk 3 years after quitting. Benzodiazepine use quadruples the risk of suicide in the elderly. In one study, Benzodiazepines and hypnotics increased suicide risk by 14 times. Antihistamines can have the anticholinergic effect. This means some of them block a certain neurotransmitter called acetylcholine. This can have a detrimental effect on the brain over a long period of time. This includes Benadryl. in monkeys, laboratory rats, and humans, the antipsychotics such as Haldol, showed a huge measurable shrinking of the brain within 8 weeks of use. A person goes to the drug store and they have allergy symptoms. They could choose Claritin or Allegra (which are not anticholinergic) or they could choose Benadryl or Coricidin and end up with dementia within a few years. Maybe Less is more? Dr. Newton tells a fascinating story about “Pam” who is a rare case of dementia reversed by getting her off of her medications. Although she has had only a few cases of ‘total cure’, she's had numerous patients improve dramatically when their anticholinergics were stopped.  These medications are so dangerous to our brains, and yet there is no warning label.  Many of them are over the counter. A lot of people ask Dr. Newton,”what CAN I take.” Her response is, don't look for something to take when you are having a problem. Don't look for a pill to solve your problem and question every medication you are given. *Please note:  Neither the Rock Your Retirement Show nor the host, Kathe Kline provide medical advice.  Please consult your own practitioner about any healthcare issues that you have. If you would like to reach out to Dr. Newton, her email is docnewton@att.net Today's Freebie, Medications that can cause Dementia, Can be found at http://rockyourretirement.com/Medications Did you know medications can cause dementia? Are you or someone you love taking any of these? Tell us your story below in the comments This post about retirement and Retirement Lifestyle first appeared on http://RockYourRetirement.com Image already added

This episode covers Chapter 104 (or 94 in the 9th Edition) of Rosen's Emergency Medicine. If you can't get delirium versus dementia straight in your head, then this is the podcast for you! Core questions: List the four key diagnostic criteria for delirium List six strong predisposing or precipitating factors for delirium List 15 causes of delirium Describe how to use a screening tool for delirium: MMSE List 3 potential medications used for chemical restraint List 2 potential side effects of Haldol administration Compare delirium with dementia List important diagnostic studies for the workup of delirium List four diagnostic criteria for dementia List 10 specific causes of reversible dementia List 10 causes of non-reversible dementia Wisecracks: Explain how you differentiate between psychosis, delirium and dementia. How does Aricept work? Describe the pathophysiology of Alzheimer’s dz and list RFs for its development What is the triad of normal pressure hydrocephalus?

This episode covers Chapter 104 (or 94 in the 9th Edition) of Rosen's Emergency Medicine. If you can't get delirium versus dementia straight in your head, then this is the podcast for you! Core questions: List the four key diagnostic criteria for delirium List six strong predisposing or precipitating factors for delirium List 15 causes of delirium Describe how to use a screening tool for delirium: MMSE List 3 potential medications used for chemical restraint List 2 potential side effects of Haldol administration Compare delirium with dementia List important diagnostic studies for the workup of delirium List four diagnostic criteria for dementia List 10 specific causes of reversible dementia List 10 causes of non-reversible dementia Wisecracks: Explain how you differentiate between psychosis, delirium and dementia. How does Aricept work? Describe the pathophysiology of Alzheimer’s dz and list RFs for its development What is the triad of normal pressure hydrocephalus?

Guest: Melody Moezzi Charlie talks to author Melody Moezzi about the experiences that led her to write the book Haldol and Hyacinths. Host: Charlie Bennett

Generic Name haloperidol Trade Name Haldol Indication Schizophrenia, mania, aggressive and agitated patient Action Alters the effect of dopamine Therapeutic Class Antipsychotic Pharmacologic Class butyrophenones Nursing Considerations extrapyramidal symptoms, tardive dyskinesia use caution in QT prolongation may cause seizures, constipation,… The post Haloperidol: Haldol (Antipsychotic) appeared first on NURSING.com.

It failed as a painkiller, but Haldol rapidly became an essential medicine for schizophrenia. Raychelle Burks explains more

Photo by Kittenlive - CC BY-SA 3.0 In this episode we were extremely lucky to get Kenneth Reitz on the show to discuss his experiences when he had a mental health event that resulted in a stay in the hospital and some major life changes as a result. Normally we’re a comedy podcast that focusses on technology, but issues surrounding mental health are very important to us. We’re extremely grateful that Kenneth came on and was very open about what happened to him. We hope you enjoy what was a great, open, freewheeling discussion about how the symptoms of some mental illnesses appear beneficial from the outside. Do these things! Check out our sponsors Backup Pro, Roave and WonderNetwork Get 50% off Backup Pro’s services by using the promo code ‘devhell’ Buy stickers at devhell.info/shop Follow us on Twitter here Rate us on iTunes here Listen Download now (MP3, 97.2MB, 1:43:49) Links and Notes Kenneth on Twitter Requests Python HTTP library Heroku Kenneth’s post about his mental health event Bipolar Disorder Haldol Lithium (not the framework) The Hypomanic Edge Kanye West car accident 2016 Mental Health in Tech Survey Python support on Heroku David Zuelke Prison Architect SimCity franchise Football Manager Dungeon Keeper II Bejwelled Skylines Tiny Bird Louisville Arcade Expo Gold farming Video of Bo Jackson from Tecmo Bowl MAME cabinets Kenneth Reitz’s Music

Chris intentionally flips out in the psych ward to get put into a 5 point restraint... and receive an injection of Ativan and Haldol. Also, he is treated by Bob Forrest and Dr. Drew.

Antipsykotiska läkemedel ges allt oftare till barn men vilka är riskerna? Kaliber om tunga mediciner, läkare som inte följer riktlinjerna och Claudio som höll på att mista livet när han medicinerades Jag brukar kolla på matcherna på Champions League. Jag kollar mycket på fotboll. Jag gillar det och har spelat själv. Det här är Claudio. Han visar runt i sitt rum. Han gillar träning och fotboll. Här är din medicinlåda. Ja, förut fick jag ta mer. Det är glest i medicinfacken. Men så har det inte alltid sett ut. När Claudio var 15 blev han sjuk.  Vi har alltid sett honom som frisk. Men Claudio blev sjuk. Från en dag till en annan, säger Claudios föräldrar Claudio och Angela. Han hade svårt att sova mellan natten söndag till måndag. Han hade svårt att sova. Vi hade lagt oss och klockan var fyra. - Han vaknar och gråter och skriker. Det var som någon slags kramp i kroppen som han fick. Jag tänkte att kan det vara någon sorts förkylning, vi tar tempen på honom, ger honom en Alvedon och sen blir det bra, säger Claudios mamma. Allt hände så fort. Claudio hade inte haft några psykiska problem innan. Och helt plötsligt blev han sjuk, han inbillade sig saker - till exempel att han just vaknat ur ett koma. Han var rädd och förvirrad. Efter besök på vårdcentralen och sen sjukhuset blir han inlagd på barn- och ungdomspsykiatriska kliniken, BUP, i Stockholm.  När han kom dit, den där läkaren, jag kommer aldrig glömma det, hon började proppa honom med mediciner, säger Claudios pappa.Vad sa läkaren då till er om de här medicinerna? Läkaren sa att det här var det bästa. Hon visste vad hon höll på med. Hon hade mycket erfarenhet. Hon kunde allting, säger Claudios mamma. Vi trodde på medicinerna. Vi trodde de skulle hjälpa, men vi visste inget om sådana starka mediciner. Vi har inte hört de där namnen på medicinerna förut, säger Claudios pappa.   Claudios pappa häller ut medicinerna på köksbordet.-  Haldol, 20 mg Zuprexa, Oxascan, Olanzapin, läser föräldrarna upp.Medicinerna på bordet är de flesta neuroleptika. Mediciner som används för att behandla allvarliga psykoser och schizofreni. På kliniken försöker man lista ut vad som är fel, samtidigt som man försöker stötta föräldrarna. I journalen kan man se att de olika läkarna engagerat sig för att hjälpa honom. Men för Claudio blev inläggningen på BUP en början på ett långt töcken, när han kommer ut från kliniken fem månader senare har han gått igenom 20 tvångsinjiceringar, 24 elchocksbehandlingar, 12 fastspänningar i bältessäng och flera attacker där han förlorat medvetandet. - Till sist trodde vi att Claudio kommer att dö här. Ja det trodde vi, berättar föräldrarna. Det här är den andra delen i Kalibers granskning av barn- och ungdomspsykiatrin, BUP. Idag handlar det om neuroleptika - medicin som används - ofta framgångsrikt - mot allvarliga psykoser och schizofreni. Men det är också en medicin som kan ge allvarliga biverkningar - speciellt för barn.På BUP har förskrivningen av neuroleptika ökat mycket. Det visar nya siffror som Kaliber har låtit Socialstyrelsen ta fram. 2009 förskrev BUP:s läkare i Sverige 10 000 recept med neuroleptika till barn och ungdomar. Förra året hade den siffran ökat till nästan 16 000. Alltså en ökning med nästan 60 procent. Ökningen är störst hos de yngre barnen. Förra året skrev BUP:s läkare ut mer än tre gånger fler recept med neuroleptika - till barn mellan fem och nio år - än vad man gjorde 2009.   - Jag ser ett väldigt stort problem. Det finns all anledning att ta det på oerhört stort allvar, säger Åsa Nilsonne är psykiatriker och professor i medicinsk psykologi vid Karolinska Institutet.- Vi har ju också det problemet att många av de här preparaten vet vi inte vilka långtidseffekterna kan vara - särskilt när vi ger dem till barn.   Åsa Nilsonne säger att neuroleptika är ett värdefullt preparat för dem som verkligen är i behov av det, men menar att det samtidigt finns en övertro på neuroleptika bland många läkare: Hon säger att läkemedlen skrivs ut för slarvigt, med tanke på de biverkningar som finns.- Det är fruktansvärda biverkningar och som vi borde ha väldigt mycket respekt för.  Håkan Jarbin är chefsöverläkare på BUP i Halland. Han ingår även i Läkemedelsverkets expertgrupp som just nu håller på att skärpa de riktlinjer som finns när det gäller förskrivning av neuroleptika. Han blir bekymrad när han ser hur mycket förskrivningen av neuroleptika till barn har ökat. Biverkningarna är många och flera av dem är allvarliga.- De lömska biverkningarna som är mer under huden, om man säger så, inte i hjärnan utan mer under huden är att man får ökad aptit. Man går upp i vikt. Får metabola biverkningar. Med fettrubbningar och glukosrubbningar som kan leda till diabetes av ålderstyp. Det kan leda till högt blodtryck och övervikt. Sen endokrina biverkningar som påverkar prolaktinet i som är ett sexhormon som gör att man får problem både med mens och sexuella funktioner, men också med en del av benbildningen, man får klenare skelett till exempel. Andra allvarliga biverkningar är motoriska och kallas extrapyramidala symtom. Det förkortas EPS. EPS innefattar kramp i muskler, stelhet, skakningar, rastlöshet, motorisk oro och ofrivilliga muskelspänningar.    - Det ser ut som man har Parkinsons sjukdom, man blir stel och orörlig och går sakta och skakar, säger Håkan Jarbin.Enligt Håkan Jarbin så är det inte ökningen av neuroleptika i sig som är problemet. Oftast fungerar medicinen bra utan allvarliga biverkningar. Problemet handlar snarare om att inte alla läkare följer upp medicineringen ordentligt, med kontroller av till exempel vikt, blodfetter och för att se att det inte har uppstått biverkningar som till exempel extrapyramidala symtom. Om allvarliga biverkningar uppstår måste man sänka dosen eller upphöra med medicineringen. - Man vet ju också att riskerna ökar när man exponerar fler. Jag tror att kontrollerna sköts inte så bra som de bör skötas, säger Håkan Jarbin.15-åriga Claudio är en av dem som upplevt de allvarligare biverkningarna man kan få av neuroleptika. Den 18 september för tre år sen läggs han in på BUP-kliniken i Stockholm. Enligt hans föräldrar har han inte haft psykiska problem tidigare. Han var inte suicidal som många andra patienter, och förvirring som han upplevde var något nytt. Men Claudio hade haft problem. I skolan och på fotbollsträningen. Några killar hade under en lång tid hackat på och trakasserat honom. Till en början misstänker man att Claudio insjuknat i en psykos. Men det är osäkert. Det framgår av Claudios journal. Senare gör läkaren bedömningen att han är bipolär. Hans föräldrar får ett eget rum så de kan vara med sin son. - Vi bodde där tillsammans med Claudio, säger hans föräldrar.Ni bodde där båda två?- Vi skulle aldrig lämna Claudio.Claudio får snart flera neuroleptika. Som förstamedicin sätts Olanzapin in. Vi visar Claudios journal för Håkan Jarbin på BUP i Halland. Han har ingen möjlighet att gå igenom hela journalen, men han upptäcker ändå snabbt ett problem.- Ja nu ser jag här att Han hade Olanzapin den här patienten ser jag. Olanzapin är inget försthandsmedel för det är det som ger värst av alla metabola biverkningar. Det bör man inte börja med, säger Håkan Jarbin.Men här har man ju fortsatt med den.  - När man fortsätter med den så känns det inte bra, den är ju tredjehandsmedel i så fall. Riskerna är ju så pass stora. Det tycker jag är bekymmersamt.Enligt Läkemedelsverkets riktlinjer och även i BUP Stockholms egna riktlinjer ska inte Olanzapin användas som förstahandsmedel, utan ska mer användas som komplement - eftersom medicinen ger så pass kraftiga bivekningar. Enligt journalen har alltså läkaren brutit med de interna riktlinjerna. - Och jag vet att om det är akut så är den väldigt bra, säger Håkan Jarbin. Men då är det ju risken att man inte bara använder den de tre första dagarna utan man rullar på sen. Men om man fortsätter mer än tre dagar börjar nackdelarna torna upp sig om man säger sig.Medicinen kommer Claudio ha stående - alltså att han får den dagligen - under hela tiden han är på BUP. Vi träffar verksamhetschefen på kliniken, Per-Olof Björck. - Ja, jag tycker överhuvudtaget att man ska vara väldigt försiktig med farmaka när det gäller växande individer, säger Per-Olof Björck. Moderna neuroleptika har biverkningar som är ganska allvarliga. Det finns ju risker beskrivna och det vet vi ju om.När Claudio vårdades på kliniken hade verksamhetschefen Per-Olof Björck inte börjat än. Han säger att han inte vill kommentera enskilda ärenden. Men vi visar honom den fullmakt som Claudio och hans föräldrar har skrivit under - vilket ger honom rätt att fritt prata om vården, trots sekretessen. Men verksamhetschefen vill ändå inte svara på våra frågor om Claudios vård.    - Det blir bara fånigt. Jag kommenterar inte ett enskilt fall, säger Per-Olof Björck.Förra veckan i Kaliber granskade vi BUP-kliniken i Stockholm och fallet Amanda. Hon som bältades 44 gånger på tre och en halv månader. Då fick vi höra personal berätta om hur man ibland använde tvångsåtgärder - alltså bältningar och avskiljningar - som straff på kliniken. En av skötarna som var med och berättade minns Claudio som han fick bra kontakt med. Men han märkte att Claudio blev mer och uppskruvad och förvirrad. Skötaren vill vara anonym, så vi har bytt ut hans röst. - Det förvärrades under veckorna som gick, och det blev mer och mer och mer. Jag försökte prata med honom men det gick inte. Han blev bara sämre och sämre. Jag såg ingen förbättring. Skötaren berättar att Claudio flera gånger förväxlade personalen med de mobbande killarna från skolan, och att Claudio mest var rädd.- Han var uppvarvad och orolig, sen var han livrädd, säger skötaren. De tre första veckorna får Claudio två typer av neuroleptika. Men trots medicinerna så blir han inte bättre. Kaliber får kontakt med den psykiatriker som hjälpt Claudios föräldrar att göra en anmälan till Inspektionen för vård och omsorg, Ivo. Det har än så länge inte kommit något beslut. Psykiatrikern menar att det begåtts flera fel i vården av Claudio. Den psykiatriska världen är liten och läkaren är rädd för att öppet kritisera vården och tror att det kan påverka hans framtida arbete. Vi har därför bytt ut hans röst. - De första tre veckorna efter inläggningen var väl inte så dramatiska egentligen.Men det blev dramatiskt sen. Man började medicinera honom väldigt frikostigt. Den där medicineringen tog en väldig fart, säger psykiatrikern. I Läkemedelsverkets rekommendationer står det att barn och ungdomar är mer känsliga för biverkningar av neuroleptika än vuxna. Framförallt gäller det de motoriska biverkningarna - alltså de extrapyramidala symtomen, EPS. Claudio ges nu maxdosen för vuxna av Olanzapin. Han får också ett annat neuroleptika - Levomepromazin. Det dröjer inte länge förrän han har fem stående mediciner. Det framgår av Claudios journal. - Så fort man sysslar med någon sorts läkemedelscocktail, då vet man inte vad man håller på med riktigt, säger psykiatrikern.Både i landstingets egna interna rekommendationer och i Läkemedelsverkets riktlinjer för neuroleptika, står det att är viktigt att polyfarmaci undviks, alltså att man inte ska använda flera läkemedel samtidigt, eftersom man inte vet hur medicinerna interagerar med varandra. Enligt journalen så följer man alltså inte de interna rekommendationerna. I journalen kan man också läsa att Claudio blir alltmer uppvarvad och agiterad. Skötaren som vi har kontakt med beskriver att Claudio i takt med den ökande medicineringen så försvinner han allt mer mentalt.- Det var inte riktigt den Claudio jag mötte första gången. Som var lite rädd och traumatiserad. Det var en annan person. Det fortsatte bara att ge honom mer och mer mediciner och det blev bara sämre och sämre, säger skötaren.Claudios föräldrar blir förtvivlade, men trodde ändå att medicinerna skulle hjälpa. Men de började snart tvivla på behandlingen.- För han luktade när jag kramade honom. Han luktade bara medicin, säger pappan.Han luktade medicin?- Bara medicin. Jag blev helt chockad för att han luktade medicin.Som något kemiskt?Ja. Precis.Men ifrågasatte ni inte läkaren, varför han skulle få så mycket mediciner?- Jo, vi frågade henne. Men hon sa, vi måste prova vilken medicin som kan passa till honom. Det var det svaret som vi fick. Hon testade, säger mamman.Senare under vårdtiden ges Claudio också neuroleptikan Haldol. Ett preparat som tillhör den gamla generationens neuroleptika. Preparat som Haldol håller på att fasas ut på grund av de svåra biverkningarna. Haldol har extrapyramidala symtom som signifikant vanlig biverkning, enligt de studier som har gjorts. Håkan Jarbin som arbetar med att ta fram nya riktlinjer till Läkemedelsverket vad det gäller förskrivningen av neuroleptika blir överraskad över att Haldol används på BUP i Stockholm.  - Det förvånar mig. Det kan jag säga för unga får ju väldigt mycket av de motoriska biverkningarna på Haldol. De får det i 100 procent av fallen i stort sett. Och det är risk att man får kroniska smackningar, tuggningar, felaktiga rörelsemönster som bara rullar på hela tiden när man slutar med Haldolet sen så det ska man undvika till unga.   I journalen framgår det att Claudio gång på gång försöker vägra att ta medicinerna.- Och när han inte ville ta sina mediciner kom de och sprutade medicinerna. De var fyra stycken, berättar Claudios föräldrar.Under tiden på kliniken tvångsinjicerades Claudio sammanlagt 20 gånger. Ofta med Olanzapin.- De höll fast honom. Vi såg det.Enligt psykiatrikern som har gått igenom journalen börjar nu Claudio få de extrapyramidala symtomen, EPS.- Han får skakningar, stelhet, ordentlig parkinsonism, vadont, fradga i munnen. Nu får han stående det här motgiftet. Biperiden. Stående. Det är medicin som om den ges stående också kan ge biverkningar. Och för varje dag ökar biverkningarna, men man sänker inte medicinerna. Man tar inte bort dem. Och nu börjar det bli riktigt läskigt.Men är det självklart att de här biverkningarna beror på medicinerna?- Ja. för det här var inget han hade i början av inläggningen.Men det kan inte vara så att ni bara gör olika bedömningar? - Ja, men riktlinjen är ju - ser man extrapyramidala symtom ska man antingen sänka medicinen eller sätta ut den. Eller byta till något annat och det har man inte gjort.Här ser du att man har brutit mot riktlinjerna? - Här har man brutit mot riktlinjen.  Är det så att man alltid ska följa riktlinjerna? - Ja det ska man göra.Man kan inte få bryta dem? - Då ska man motivera det i så fall.Men är det motiverat? - Nej, det tycker jag inte. För dagen därpå den 23 oktober då står det i journalen att han är stel, går som en gammal man, skakar i händerna, parkinsonaktigt. Det här är en 15-årig pojke! Krypningar i benen, periodvis hotfull. Dagen därpå. Dreglar, skakiga händer, släpande gång, svårt att hålla ett glas mjölk. En pojke som har fungerat, aldrig varit i kontakt med BUP för en dryg månad sen överhuvudtaget, säger psykiatrikern.- 25 oktober, sväljningssvårigheter. Han är stel i underarmarna, vinglig gång, stel i händerna, släpig gång, står och går runt hela tiden. Det är klassisk akatesi när man inte kan vara stilla.  Och det får man av?- Neuroleptika. Biverkningar. Klassisk biverkningar eller extrapyramidala symtom. Nu har han haft maxdos av Olanzapin i 17 dagar i sträck och under sex dagar har han haft Levomepromazin i sex dagar, som är ett tungt neuroleptika, men man gör ändå ingenting åt medicineringen.Men varför reagerar man inte när man ser de här symptomen?- Det förstår inte jag, att ansvarig överläkare inte reagerar.Vi ber om att få en intervju med BUP-klinikens chefsöverläkare. Hur ser man på neuroleptika på kliniken? Hur viktigt är att följa de rekommendationer som finns? Varför har man använt Haldol? Är det här något som har diskuteras läkare emellan? Men den pressansvarige svarar i ett mail att ingen på kliniken har den överblick som vi efterfrågar - och att de därför inte vill ge några intervjuer.Enligt psykiatrikern hade ett alternativ till medicinerna kunnat vara att arbeta i lugn och ro. Att reda ut det som hade hänt i skolan. Och att man samtidigt hade haft mycket personal som kunde vara där och stötta.I en journalanteckning framgår det att en sjuksköterska vid ett tillfälle sitter och lyssnar på Claudio, och håller om honom. Det är en av gångerna då han är lugn. Trots biverkningarna sänker den ansvariga läkaren inte dosen neuroleptika, enligt journalen.- Nu håller Claudios kropp på att kollapsa, säger psykiatrikern. På natten kissar han på sig när han står upp och han fortsätter att kissa på sig de närmsta dagarna. Den 27 till 28 oktober får han ännu mer extrapyramidala symtom. Han blir stel i rygg och nacke och då är han på väg att få den här sprättbågen, man kan inte böja huvudet. Oerhört otäckt. Han dreglar extensivt. Han har dålig balans. Han lutar åt ena sidan och han har fått förstoppning. Klassiska symtom. Biverkningar.   Claudio har nu medicinerats i 42 dagar med stark dos av neuroleptika. Läkaren på BUP tar nu beslut om flytta Claudio till den vuxenpsykiatriska intensivvårdsavedelningen, PIVA där han ska genomgå elbehandling ECT - alltså elchocker.- Han får sex behandlingar med ECT, 31 oktober till den 12 november, säger psykiatrikern.Men vad hade hänt om han inte hade fått de här elchockerna?- Då hade nog kroppen lagt av.Och det skulle innebära?- Jag tror det hade varit en stor risk att han hade dött.Men Claudio blir bättre av elbehandlingen och han får komma tillbaka till kliniken. Nu har man också satt in den fjärde neuroleptikan - Haldol. Det gamla preparatet som håller på att fasas ut. Känd för att ge extrapyramidala biverkningar särskilt hos barn. Det dröjer inte länge innan Claudio kollapsar igen. Claudios föräldrar har åkt hem en natt för att få sova. Men de blir väckta av telefonen på morgonen. Det är läkaren på kliniken som säger att Claudios hälsotillstånd är allvarligt och att de misstänker att han har fått en stroke.- Så vi rusar iväg, berättar mamman. Och de hade redan tagit Claudio till Södersjukhuset. De hade honom där. Och när vi kommer tillbaka till avdelningen, vi ser att Claudio kan inte gå. Hans hand hade dragit upp sig så här. Och benen också. Och han dreglade. Halva sidan var förlamad. Ansiktet var förlamat. Alltså hela halva kroppen var förlamad.Claudio sitter nu i rullstol och kan inte gå. Hans pappa hjälper honom att duscha, klä på sig och borsta tänderna. Enligt psykiatrikern - som gått igenom journalen - är det mycket som tyder på att Claudio nu håller på att få malignt neuroleptikasyndrom - ett livshotande tillstånd. Det är den allvarligaste formen av extrapyramidala symtom. Tillståndet är sällsynt, men risken är större för patienter som Claudio, enligt psykiatrikern.- Och risken för att få det är mycket högre om man är ung, mycket högre om man är av manligt kön. Det visar sig att han har väldigt många riskfaktorer för att få det här. Och det är lättare att barn får det. Och det har en dödlighet som är högre för barn. Det är ett fullständigt livsfarligt tillstånd. Men det tänker man inte på. Nu man kan börja tänka, nu är han på väg att få det här. Det första stadiet i malignt neuroleptikasyndrom är extrapyramidala symptom. Det är därför man ska sätta ut medicinen eller minska den eller byta ut den så fort man ser sådana symtom. Det har man inte gjort här.I journalen den 16 november gör en ny läkare en anteckning. Han ifrågasätter att man ger Claudio Haldol. Han skriver att den ska tas bort för att undvika extrapyramidala biverkningar. Den 17 november görs ännu en anteckning i journalen - den här gången av ännu en ny läkare - en barnneurolog. I journalen ställer han frågan: Skulle det kunna handla om malignt neuroleptikasyndrom. Och nu sänker man faktiskt dosen Olanzapin.Men samma kväll är Claudio och agiterar, spottar och fräser och biter i sin hand. Strax före klockan nio på kvällen tar en jourläkare beslut om att Claudio ska tvångsinterneras med Olanzapin. 18 minuter senare blir Claudio okontaktbar. I journalen står det att han ligger helt utan tonus i kroppen - alltså att han är helt slapp i musklerna - tillståndet varar i 30 minuter. Och det här kommer hända fler gånger. I journalen kallar man det för frånvaroattacker.  - Ja det är ett tecken på att kroppen håller på att kollapsa ännu en gång. Han börjar närma sig slutet. Kroppen orkar inte med, den håller på att ge upp, säger psykiatrikern.De kommande dagarna får Claudio flera frånvaroattacker. Nu sätter man återigen in Haldol - det som man tidigare tog bort för att lindra biverkningarna. Claudio är i riktigt dåligt skick.  I journalen framgår det att han flera gånger har dödsångest och pendlar mellan gråt och uppgivenhet. Han ber personalen om hjälp att dö. Dagen efter är skicket så pass dåligt att han återigen skickas till Piva för att få fler elbehandlingar.- Vi trodde att Claudio skulle dö, berättar föräldrarna. Till sist trodde vi att Claudio kommer att dö här.Men elbehandlingen ger effekt. Så man fortsätter. Och efter ett tag kan Claudio skrivas ut från BUP och han kan flytta hem igen. Då har han varit på kliniken i nästan fem månader. Räknar man i journalen kan man se att under vårdtiden blev Claudio tvångsinjicerad 20 gånger.  Sammanlagt har han medicinerats med fyra olika neuroleptika. Fem gånger har han drabbats av det man i journalen beskriver som frånvaroattacker. 12 gånger har han spänts fast i bältessäng och sammanlagt har han genomgått 24 elbehandlingar.Utifrån journalen gör psykiatrikern bedömningen att Claudio inte alls är bipolär. Istället tror han att har ADHD och lidit av posttraumatisk stress av mobbningen. Att det var det som utlöste allt från början.   Hade han fått adekvat behandling, hade man tagit reda på mer om hans bakgrund, med mobbningen, hur det var i skolan, och inte gett honom en massa mediciner utan lyssnat på familjen. Då hade han varit utskriven inom någon månad tror jag. Han ligger två år efter när vad gäller skolgång nu. Han har fortfarande problem när han springer med sin arm som han sen tidigare hållit vikt in till kroppen. Jag tycker det är jätteallvarligt och jag tycker det visar på ett stort problem inte bara inom BUP utan inom psykiatrin överhuvudtaget att man använder neuroleptika för frikostigt och inte heller tar på allvar de här biverkningarna.Håkan Jarbin chefsöverläkare på BUP i Halland har med andra kollegor inom kåren legat på Läkemedelsverket om att införa nya riktlinjer vid förskrivning av neuroleptika till barn och ungdomar. Det de har sett är att det har slarvats med uppföljande kontroller. Den mest utsatta gruppen patienter, säger han, är de som flyttas runt mellan olika behandlingshem med täta läkarbyten. Här är det lätt att de viktiga uppföljande kontrollerna inte görs.    Det är en mycket viktig fråga. För det är rätt att de här barn- och unga som är omhändertagna får mer mediciner än andra barn, och det är ju helt rimligt eftersom de ofta har psykiska problem. Men den sköts nog mindre noga än andra barns medicinering och det är verkligen inte okej.I vinter börjar Läkemedelsverkets expertgrupp, där Håkan Jarbin ingår, arbetet med att ta fram de nya riktlinjerna. Det har tagit form, och tagit fart, och det är bra att det kommer från en myndighet, för det talar mer till verksamhetschefer och landstingsledning, och sen gäller det också att implementera dessa så att det verkligen kommer barnen till godo.  Kalibers siffror visar på en stor ökning av förskrivningen av neuroleptika till barn på BUP. Störst är ökningen hos barn mellan fem och nio år. Claudio var nära att dö när han vårdades på BUP. Nu är han tillbaka skolan. Nu bryr han sig inte om killarna som brukade vara taskiga. Och han är också börjat med fotbollen igen. Jag var inte så mycket medveten om vad som hände där på BUP, säger Claudio.Du har glömt mycket, eller? Alltså jag vet inte så mycket om det där. Pappa har berättat lite för jag vet inte så mycket. Sen ville jag inte veta mer. Jag vill inte veta mer.Reporter: Mikael FunkeResearch: Emilia MellbergProducent: Andreas LindahlKontakt: kaliber@sverigesradio.se

has battled mental illness for over 20 years. She shares her journey as an Iranian-American-Muslim activist coping with her bipolar disorder with host Stacey Gualandi, and says she's been able to help a lot of people see that they are not alone with mental illness. Because she feels she was misdiagnosed for years, she says it's important for the medical community to be more proactive. Melody discusses her manic episodes, the undying support she got from her husband, and the importance of treating it early. She believes that people stay sick because they stay silent.  About The Women's Eye Radio: with host Stacey Gualandi is a show from , an Online Magazine which features news and interviews with women who want to make the world a better place. From newsmakers, changemakers, entrepreneurs, best-selling authors, cancer survivors, adventurers, and experts on leadership, stress and health, to kids helping kids, global grandmothers improving children's lives, and women who fight for equal rights,"It's the world as we see it." The Women's Eye Radio Show broadcasts on in Phoenix, live-streams on 1480KPHX.com, and is available as on-demand talk radio on iTunes and at . Learn more about The Women's Eye at

Kay Redfield Jamison, in her class book about depression, The Unquiet Mind, says that "manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it, an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering."  But imagine if no one knows what your illness is, or if it is mistreated by the medical community.  How much worse is it, when treatment is possible, but it is prevented or delayed  by ignorance.That's the story that Melody Moezzi tells in Haldol and Hyacinths: A Bipolar LifeMy conversation with Melody Moezzi:

Seroquel (generic: quetiapine fumarate) is manufactured by the drug company AstraZeneca. Seroquel is a neuroleptic and is part of a newer class of antipsychotic medications called "atypical antipsychotics." These newer medications have been marketed as being as effective but as having fewer side effects than their older counterparts (i.e. Haldol). However, Seroquel and other drugs in its class are linked with a higher risk of diabetes and other blood sugar disorders than the older antipsychotics. Did you or a family member take Seroquel and suffer from diabetes or another blood sugar disorder? If so, you have legal rights and are encouraged to contact Mark & Associates, P.C. Call 1-866-50-RIGHTS (1-866-507-4448) to speak with a lawyer today, or fill out our case review form on youhaverights.com and someone will contact you.

Seroquel (generic: quetiapine fumarate) is manufactured by the drug company AstraZeneca. Seroquel is a neuroleptic and is part of a newer class of antipsychotic medications called "atypical antipsychotics." These newer medications have been marketed as being as effective but as having fewer side effects than their older counterparts (i.e. Haldol). However, Seroquel and other drugs in its class are linked with a higher risk of diabetes and other blood sugar disorders than the older antipsychotics. Did you or a family member take Seroquel and suffer from diabetes or another blood sugar disorder? If so, you have legal rights and are encouraged to contact Mark & Associates, P.C. Call 1-866-50-RIGHTS (1-866-507-4448) to speak with a lawyer today, or fill out our case review form on youhaverights.com and someone will contact you.