Discover and read the best of Twitter Threads about #paws

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📚 Excellent article on #ADSecurity, and more particularly Security Bastions (#PAM) in the context of #ActiveDirectory tiering👍 It is not easy to make it simple on this topic, and it's the case here!
1️⃣ In theory, there should be an instance of a bastion in each Tier
2️⃣ In reality, very few companies have a bastion on #Tier2 💻
3️⃣ First choice is to deploy a bastion on #Tier1 (large number of machines and accounts 👥️️)
4️⃣ #Tier0 can be more simply managed by #VPN + #PAWs (dedicated and hardened admin workstations)
5️⃣ Most importantly is to ensure the #PAM does not interfere with the principles of tiering... you can easily break the silos when you start playing with the functionalities 🌐
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Do you use #CameraTraps for wildlife abundance? Do you feel intimidated by the complex models & codes that statisticians come up with to help design & analyze camera trap data?
If your answer is yes to any of the above, follow this thread with a new resource that is pure gold:
Spatial Capture Recapture (#SCR) co-developer @david_borchers and fellow @indurbach with @statsStAndrews have created a fabulous website with online training material to help get started with spatial capture-recapture (SCR) methods, with a focus on camera traps.
With simple, intuitive navigation, the site has three sections:
1. Software
2. Training videos
3. Other resources
While there are a few books on #SCR, remember the method has undergone rapid development during the last decade, making it daunting to keep pace...
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@DrFulli @lapsyrevoltee I do agree, Dr. Fulli. Response to the drug most certainly is not a diagnosis, & those physicians who conclude an adverse reaction to an #antidepressant is diagnostic of bipolar disorder not only have poor pharmacology knowledge but poor logical skills as well. /1
@DrFulli @lapsyrevoltee Even people with no pre-existing #psychiatric symptoms may have a severe adverse reaction to an #antidepressant or any other psychotropic.

Conversely, any psychotropic might relieve "depression" in someone, eg. amphetamines or opiates. This is another law of psychotropics. /2
@DrFulli @lapsyrevoltee For what it's worth, I have a collection of case studies where people had immediate severe adverse reactions to #antidepressants & even though they quit within a handful of doses, suffered symptoms identical to post-acute withdrawal syndrome #PAWS for months or years. /3
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@psychunseen: "...if the goal of anti-psychiatry is to get #psychiatrists to listen...this is better done within a therapeutic relationship, not in a picket line at the American Psychiatric Association annual meeting or on social media" apparently refers to me personally. /1
I thought it stood out as particularly illogical in his most recent screed…

Who pickets the APA other than Scientology?
Then I recalled I had attended an APA meeting where there were pickets. I did not do any picketing myself, but I was invited to speak outside:

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@sandysteingard @awaisaftab Clarifying: Across psychotropics, withdrawal syndrome is not "time-bound" except by arbitrary distinction between acute & post-acute withdrawal syndrome #PAWS, which can last years & is often conflated with "relapse". Lerner & Klein, M. (2019).…
@sandysteingard @awaisaftab Presentation from a Merck scientist that lays out tolerance, withdrawal, protracted withdrawal #PAWS: Markgraf, C. G. (2012, October). Introduction to Physical Dependence and Withdrawal. 12th Annual Meeting. Safety Pharmacology Society, Phoenix, Arizona.…
@sandysteingard @awaisaftab Only wishful thinking & fixation on dangers of addiction have given #antidepressants, etc. a free pass from psychotropic adaptation, dependence, tolerance, withdrawal, & #PAWS. With very few exceptions, all regularly taken psychotropics cause withdrawal & #PAWS.
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@DrFulli @AllenFrancesMD Yes, we know. I've got 6,000 naturalistic case histories of adverse effects of psychotropics right here. I know more about adverse effects of psychotropics than I ever cared to. Being prescribed isn't a shield for a drug.…
@DrFulli @AllenFrancesMD Not joining handwaving over esketamine because it's so dangerous, though I abhor the dishonesty & hype. I counsel people with akathisia, movement disorders, suicidality induced by prescribed #psychiatric drugs every damn day. A psychotropic is a psychotropic. They all ruin lives.
@DrFulli @AllenFrancesMD I just had to review and document the suicides of 2 of my site members who could not stand their post-acute withdrawal syndrome #PAWS from #antidepressants any more. One was a woman with PSSD sexual dysfunction for 38 months. She was 21. Started sertraline at age 17. /1
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"I tapered down to 3mg [Lexapro] and I couldn't stand the way I felt, so on April 15 I just stopped....I went through many horrible feelings, the zaps when moving eyes side to side, I have the constant tinnitus & electrical showers in my head."… /1
Off Lexapro April 15, 2020: "I went through periods of feeling like I was slurring my words, as if I was drunk. Some days I feel like someone unplugged me & I have zero life force, my body is heavy like lead. Then the extreme dizziness & nausea started. /2…
Textbook case: Off Lexapro April 15, 2020, she is moving from ~12 weeks of acute withdrawal symptoms to post-acute withdrawal syndrome #PAWS. "I think I am getting better because some of the symptoms went away, but then new symptoms take their place." /3…
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I'm in a particularly bad mood about the delusions of #psychiatry having spent the last week analyzing the case histories of 70 people with #antidepressant post-acute withdrawal syndrome #PAWS: duration 5-166 months, median 29.5 months. Lots of #psychiatrists involved. /1
5/70 reported recovered, 2 reported suicides. One suicide, better after 69 months of #PAWS, had an adverse reaction to an antibiotic that threw her back into the depths of withdrawal. The other, a 21-year-old woman, because of 38 months of post-SSRI sexual dysfunction #PSSD. /2
The 63 for whom I do not have reports of recovery from antidepressant post-acute withdrawal syndrome #PAWS or suicide have mostly been lost to follow-up. After years of reporting grueling symptoms, they didn't come back to tell us how they were doing. I hope they did recover.
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Nevada woman: "spring 2002-summer 2008 - in chronological order: Effexor CT'd, Lexapro, possibly Luvox & Zoloft?, Prozac (brand name), Paxil, Geodon, & Prozac summer 2009-summer 2012 Prozac (up to 80 mg but settled at 60 mg) & Wellbutrin (300 mg)...." /1…
"....fall 2012-fall 2016 Prozac (60 mg) & Wellbutrin (300 mg) - also tried Anafranil close to the beginning of this period (unsure of dosage) fall 2016-fall 2017...." /2…
"....FT'd Wellbutrin to 0mg & Prozac to 10 mg (had FT'd both, reinstated at 300mg & 60mg, then FT'd again - very bad for my CNS) fall 2017-October 2018 Prozac (10 mg) FT'd to switch to Anafranil...." (FT means "fast taper")… /3
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@DBDouble @f_hieronymus @awaisaftab @rcpsych I took it as "contend" but @f_hieronymus does not seem to be aware that while #antidepressant withdrawal problems are well-documented, this awareness has not translated to clinical practice for 60 years. What is the nature of the barrier? This is the epistemiological question.
@DBDouble @f_hieronymus @awaisaftab @rcpsych First, late '80s-early '90s, new #antidepressants were held not to have a withdrawal syndrome (despite known pharmacological principles of psychotropics & appearance in clinical trials).

Then, starting with Schatzberg et al., 1997, withdrawal syndrome was held to be trivial /1
@DBDouble @f_hieronymus @awaisaftab @rcpsych Schatzberg et al., 1997 claimed #antidepressants "discontinuation" symptoms were mild, transitory, lasting only a few weeks, barely needing tapering. This held sway to the present day (despite decades of many, many patient complaints of more severe problems). /2
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"I was eventually convinced by a psychologist (and my wife) to try Zoloft because I was one of those people that was either born with a chemical imbalance or I acquired one due to my childhood traumas. Well...those 3 days were...pure hell on earth."…
After 2 years on #antidepressants: Diagnosed Paroxysmal Supra Ventricular Tachycardia "24 years of my life chasing this, never not once did any medical or other professional suggest I go see a cardiologist but they were all too willing to take my money.."…
"I was very very ill about a week after I started Pristiq & I told my GP numerous times but she just said to "keep going" as it takes about 6-8 weeks to kick in and start was obvious she was in too far over her head..."…
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At age 33: "I ran into a situation that required me to confront someone. As that time approached, I became increasingly anxious about my ability to handle the situation....I went to my doctor for help. He immediately threw 20 mg of Prozac at me...."…
"I left my GP & sought out the top Psychiatrist in my city...By this time, I was such a mess due to the effects of the Prozac, I was diagnosed with GAD Generalized Anxiety Disorder....We tried several other types of antidepressants...."…
"we tried several other types of antidepressants over the following months....Each one effecting me the same way....Over the last 20 years I ran into a few occasions that required the medication to be increased....Again, I would lose my mind!"…
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I started playing #guitar in college. Some of my friends back home played, so I thought I'd learn. It's been years since I kept up with it. With no job and an empty house, I had time. Plus, I could crank up my amp. Ava would have hated it. All the more reason to do it.
Strumming a few chords or playing a riff through a loud amp usually makes me feel better. It's more of a distraction this time. My amp is a little old. Even a #ragpicker might pass on it. "If you're not going to play it, sell it," Ava nagged. Life always got in the way.
Or I got in the way. Not even ten years ago I kept getting sick all the time. Painful stomach cramps would radiate weakness throughout my body. I learned how to wash it away like healing #rainwater. That's when I really started to figure out who I was and what I could do.
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