2,036 karma · joined August 31, 2015
But I didnt mention this to deter people from fasting, just to be careful. If that fiasco didnt happen to me I'd still be fasting as I felt amazing while fasting. My dad is still doing it for more than a year after I recommended it to him
And it’s not necessarily an absolute deficiency in electrolytes, it’s that when you break a fast with a carb rich meal, it drives the electrolytes into the cells so there is deficiency of electrolytes in the blood even if total body amount is normal.
The exciting research I care about is more along the lines of < https://www.ncbi.nlm.nih.gov/pubmed/30696271 > where we observe neural dynamics, hypothesize causality, intervene with TMS or other focal neuromodulatory tech, and see if in fact region A is causally linked to outcome B, or if neural dynamical state A is causally linked to outcome B.
I also meant that the DSM is biologically unreliable because it is only symptom clusters, and we cannot intervene at the level of symptoms, you have to intervene at the level of pathology. Symptoms are not pathology. It's the brain that is experiencing some pathology, so we need to ascertain the brain pathology and intervene at that level, and DSM, as noted by brain imaging studies, does not seem to reliably map onto that biology.
Aside, are you involved in software engineering? What brings you to HN?
When someone has psychosis (eg hearing voices), maybe it was caused by a severe trauma or maybe it was mostly genetic. In either case the person is suffering from psychosis and is unable to normally function in society (if severe enough). In both cases, in principle, we should be able to detect the problem at the level of the brain in structure and function, and should be able to intervene at the level of the brain.
The intervention required depends on the nature of the brain change. We can change brain function in many cases by intensive therapy. In some cases sensory inputs alone (via talk therapy) are insufficient to change the brain to rectify an issue. That’s when we have to consider direct intervention on the brain itself either via medications or neuromodulation technology.
I don’t think lay people understand how profoundly mentally ill some people are and that they can really have dramatic improvements with treatment. Lay people think of psychiatrists just peddling drugs to mildly depressed patients or people who are mildly oddly behaved. That’s just not the case. I’m working with people who sometimes literally stop eating because they think their food is poisoned, or attempt to kill themselves with minor frustrations, etc. And many patients, mostly not that sick, come in voluntarily because they feel they can’t handle some problem on their own. You’re right that much I mental illness is caused by psychosocial stressors, but some people have just intractably messed up life situations and they’ve just spiraled downward as a result and wouldn’t be able to get on a better path without treatment.
We use them more as a communication tool to give a rough picture of a patient’s symptoms to other providers than as a map onto biology. We simply don’t understand the underlying biology well enough yet to do any better. But there’s a lot of exciting research cracking this area open and we may very well be able to diagnose and prognose based on objective data such as brain imaging, genetics and blood tests.
Psych resident
There's a long history of using differential equation models to model high-level brain function (see also neural mass models and neural field models) but I think there are advantages to using discrete time approximations such as neural networks in an RL setting to investigate how the dynamics (e.g. attractor states, etc) map onto behavior.
Moreover, ending the reliance on unsustainable fossil fuels is an end in itself. It would reshape global geopolitics and of course there’s a ton of destruction that happens from oil spills and oil extraction. Going full electric has many benefits beyond just reducing greenhouse gases.
https://www.sciencedirect.com/science/article/pii/S106474811...
Moreover, there is no incentive for psychiatrists to be admitting people inappropriately. Psychiatrists are physicians and want to feel like they're actually doing something useful like everyone else. I have no interest in admitting a patient that doesn't have a treatable illness. There are plenty of patients with real illnesses to treat.
Patient's are typically brought into a surgical suite, put to sleep and given paralytics as if they were having a surgery. The brain is shocked for like 10 seconds, the patient is asleep and paralyzed, no convulsions happen, no discomfort to the patient. The anesthetics wear off in a couple minutes, the patient wakes up and is able to go home, just as if it were some minor outpatient surgery.
Psychiatrists have no interest in detaining people, quite the opposite. Most of the time I'm dealing with patients who are feigning symptoms e.g. pretending to be suicidal to get admitted because they're homeless, and so we have to admit them lest we get sued, despite the fact there is good evidence many times an admission would be counter-productive. You have people who will sue psychiatrists if they don't admit someone and that person ends up killing themselves, and you have people who think psychiatrists are wantonly admitting too many people.
Also there's nothing dubiously ethical about ECT. It's one of the safest procedures in psychiatrist and the most effective. Many many patients consent to do ECT voluntarily.
As a resident psychiatrist, I can tell you that most of the time I'm not conflicted about involuntarily admitting a patient, at my institution it happens rarely, almost all patients sign in voluntarily and can request to leave, in fact most of the time we deal with patients who actually want to get admitted and will feign symptoms to do so, forcing us to admit them. The times we involuntarily admit patients are when they are so symptomatic that they would very likely die without treatment (e.g. they refuse to eat because they think their food is poisoned).
Every field has its history of controversies, that doesn't mean the field as a whole is inherently bad.
Medical schools admit a variable number of students each year although they aim to have a specific number. It’s difficult to switch medical schools because Med school curricula are very different from program to program. And also there’s just no standard mechanism for switching, you’d just have to schmooze some of the higher up administrators. Med schools don’t really get any advantage by taking in transfers unless they had a mass exodus of students and needed the money. So there’s little incentive for administrators to even bother with transfers. In residency you want all your positions filled so you can keep the funding and have enough staffing so if a position opens you want to fill it ASAP.
However, you are mostly rated on how much you know, how confident you are and your social skills. So if you did really well in the pre clinical years and are not socially inept then you’ll probably get good evaluations.
But it’s a marathon. It’s an unbelievable amount of information you have to memorize and in the beginning it’s hard to stay motivated when you can’t see it’s direct relevance.
So overall I’d say it’s fairly meritocratic. If you can memorize things well and are social then you’ll do well barring any exceptional circumstances.
So I’d only recommend going to medical school if you’re a top student who can get scholarships (so you don’t have much debt) and so you have some control over where you go (because you’ll be competitive for most programs). But even so, I went to a top Med school which was my first choice and I still ended up hating it. You’ll never know what program/city you’ll like until you try it but once you start it’s very difficult to change Med schools or residency programs in general.