Some reasons having a psychiatry resident as your doctor on a #COVID19 unit may not be so bad: a #medtwitter thread.
1. A psychiatry resident already completed a medicine internship. They’ve done this before, and they’re supervised by an internal medicine attending.
We are expecting a surge in PTSD from people being in the ICU and from invasive procedures. Psychiatry residents are more likely to work to prevent this, recognize it, and treat it.
Many coronavirus patients will experience delirium: a reversible syndrome in which you forget where you are and may even hallucinate. Psychiatry residents know how to recognize and treat this (it’s often missed).
Some experimental medications like hydroxychloroquine have psychiatric side effects, ranging from psychosis to suicidal ideation. Psychiatrists can recognize and treat and help with a safety assessment of pros and cons of the medication.
It goes without saying, but psychiatry is often consulted to help communicate with patients and families dealing with serious medical illness. They will have extra focus on clear communication and emotional support.
So yes - continue physical distancing and washing your hands. But if you need to be cared for by a redeployed specialist, you’ll be in good hands.
#Trans people who accessed gender-affirming hormones during adolescence had lower odds of adverse mental health outcomes, including suicidality, when compared to those who didn't access hormones until adulthood. (2/6)
All age groups that accessed gender-affirming hormones (during early adolescence, during late adolescence, and during adulthood) had better mental health outcomes than those who desired but weren't able to access gender-affirming hormones. (3/6)
Let’s talk about “complex #PTSD.” Have you learned about it but don’t understand it? That’s because it’s controversial! But a useful construct in my opinion. #medtwitter#psychtwitter 🧵
Classic PTSD can occur after one big life threatening event (think a car crash). Common symptoms include nightmares, flashbacks, startling more easily, and avoiding things that remind you of the trauma.
In 1992, Harvard psychiatrist Dr. Judith Herman proposed the concept of complex PTSD (CPTSD) as a distinct syndrome that can occur when people have repeated prolonged trauma (for example, chronic exposure to domestic violence or childhood abuse)
Rigorous research has shown that #trans antidiscrimination laws result in a decrease in suicidality. States that implemented these laws saw a 39% drop in suicidality among #trans people. pubmed.ncbi.nlm.nih.gov/32374362/
Adolescent suicidality dropped in states that passed marriage equality, likely due to broad societal impact that improved social climates and subsequently mental health pubmed.ncbi.nlm.nih.gov/28241285/
In summary: 13.1% of currently identified #trans people report that they detransitioned at some point in their lives. Most (82.5%) report that detransition was driven by at least one external factor (e.g., harassment, stigma, etc.) #detrans 🧵
A minority (15.9%) reported that detransition was driven by at least one internal factor (e.g., fluctuation in or uncertainty regarding gender identity). Clinicians should be aware of potential factors - internal and external - that may drive detransition. Examples:
The high number of #trans folks reporting a history of detransition highlights that some who detransition will transition again in the future. Folks should also keep in mind that external factors (societal stigma) can drive internal factors (doubt regarding gender identity).
As a @Harvard undergrad, I read an @AnnCoulter book and was struck by this line:
"Liberals can't have #gay marriage and evolution. For that we would need survival of the most fabulous."
Turns out she's wrong, but it took my whole evolutionary bio class to learn why (1/2) #LGBTQ
My favorite reconciliation of male homosexuality & evolution comes from studies suggesting it is an X-linked trait. For XY folks, it makes them gay, but for XX folks it makes them more fecund (i.e. fertile). This results in a stable but low % of gays in the population over time
It turns out there's a lot of homosexuality in nature. But things are complicated. Dolphins have 50% same-sex pairings. Male albatross are promiscuous, so females have lifelong pairings.
A new book about #trans youth from The Wall Street Journal's @AbigailShrier has some truly disturbing recommendations.
Page 215: She recommends parents isolate their trans children by sending them to live on horse farms with no internet, hoping that will make them cisgender.
She asserts that children whose parents isolated them in this way all "desisted" from identifying as #transgender.
If a parent sends their kid to a horse farm with no internet to try to make them cisgender, it's not surprising that the kid's going to go back in the closet.
These practices are cruel gender identity conversion therapies, and they've been labelled unethical & dangerous by The American Medical Association, The American Academy of Pediatrics, The American Psychiatric Association, and The American Academy of Child & Adolescent Psychiatry