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Tyler Black, MD

@tylerblack32

4 Feb

A parable on relative rates:

A man processes fruit. Each hour, he is presented with 100 oranges and apples each to package. He does this for years. He loves his job, and comes to expect the steady bags of similar oranges and apples.

100 apples. 100 oranges.
/1

The inspectors come to see the man work.
The suppliers come to take the bags of fruit.
The patrons of the markets buy apples and oranges.

They all see the balance between oranges and apples.

100 apples. 100 oranges.

/2

One day, conditions change, and the fruit is impacted. There are fewer apples and oranges, but for whatever reason, oranges are less impacted. Now, every hour, it's 60 less apples and 20 less oranges.

The man arrives to work and starts his first hour.

40 apples. 80 oranges.

/3

Read 8 tweets

Tyler Black, MD

@tylerblack32

4 Feb

Have suicides increased in the pandemic?
(also a comment on kids below)

We have data for BC, AB, and SK... so far, and so far, so good. There have been fewer suicides in 2020 than in 2019.

Thank you everyone for the feedback, I've made this a lot cleaner and simpler now!

/1

For people who saw this yesterday, I've changed things to become more confident.

For Alberta, this meant removing November #'s (they seem VERY low in 2020 and I will wait for confirmation). This raised Alberta's rate.

It doesn't change the message.

AB suicides are down.

/2

The other major change is giving a guess for how much the Saskatchewan number for 2020 may increase. In previous reports, a result reported the next year increases by ~20 suicides when the final count is done.

It doesn't change the message.

SK suicides are down. (by 25-36%)

/3

Read 14 tweets

Tyler Black, MD

@tylerblack32

4 Feb

jamanetwork.com/journals/jamap…

From the suicide perspective, a great but nuanced study. It shows that presentations for suicide attempts overall dropped in the US (5300/week prior to the pandemic starting to 4944/week after the pandemic started).

/1

This figure here shows this... you can see the number (in thousands, take a sharp drop during covid and gradually restore (albeit not above pre-pandemic levels).

/2

However, in terms of relativity to other presentations to the ER, that drop was much less, so the Rate (suicide attempts per 100,000 ER visits) increased.

/3

Read 4 tweets

Tyler Black, MD

@tylerblack32

3 Feb

1/ Suicidology 🧵, "why rates matter"

A news article in Bengaluru (Bangalore), India, shows that suicides have increased and "Experts blame COVID."

2,081 in 2019
2,162 in 2020
(up 3.8%)

The headline (with a disturbing "toe tag" graphic, not shared), is that suicides are up.

2/ However, Bengaluru has had an incredible population explosion, with an average yearly increase of 3.6-4% per year for over decade now.

The net result: the suicide rate is essentially unchanged. 17.5 per 100k (up about 0.16%)

3/ So while the headline is a toe tag graphic with a chilling statement about increasing rates, the actual news for the year is "suicides increased proportionally to the population growth, such that the rate is unchanged."

**Expertise matters to tell the right story**

Read 6 tweets

Tyler Black, MD

@tylerblack32

1 Feb

Starting my day off with a bit of cleanup in Internet drama Aisle 9.

1) I do not support the public doxxing of anyone. In fact I call it out. It's wrong.

2) I do support someone, feeling harrassed, privately doing what they can to deal with it officially.

3) there are really really good reasons to be anonymous on the internet, for example, people who might be marginalized or victimized because of who they are can gain strength in anonymity. I support anonymity.

4) anonymity does not give someone a shield to violate rules

5) old man internet beard here: If you are anonymous, there is no way to hold you accountable for your words or phrases or identity and history is rife with faked siblings, stories, identities, genders, and even races. Anonymity comes at the cost of credibility.

Read 9 tweets

Tyler Black, MD

@tylerblack32

30 Jan

https://twitter.com/AllenFrancesMD/status/1355287463812448257

Because it's actually much more likely to be transient, and its severity usually wanes, I would prefer to see this diagnosis termed not as a personality disorder at all. It is no more stable in prognosis than depression.

"Trait and Transient Emotional Instability"

https://twitter.com/AllenFrancesMD/status/1355287463812448257

Ten year longitudinal
psycnet.apa.org/record/2018-31…

In adolescents/young adults
journals.sagepub.com/doi/abs/10.117…

Which symptoms may be more stable
journals.lww.com/jonmd/Fulltext…

If we as clinicians can see depression and anxiety -- both which can progress into chronic but usually attenuated conditions -- as episodic, we can damn we'll see "bpd" as episodic

Read 4 tweets

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