[THREAD] I saw a few of us saying that their 2021 resolution was to improve their mental health. So I decided to write this guide in terms of what steps we can take to improve our mental health for 2021 and beyond. The most important step is to start some form of treatment.

[THREAD] memory loss and mental health. It is something that we don’t often put together. However, it is a very common issue for many individuals whose mental health is not doing well. So why do we get that memory loss? Is it permanent? Are there ways to cope with that?

The reason why memory loss happens is not because our brains are not working well or somehow not registering events but because we are so tuned in to our thoughts and emotions that we are not paying attention to our environment.

Given that we are not paying attention to what is going on around us, we are less likely to remember them. Also, issues such as depression and anxiety affect the way we sleep and sleep has been proven to be the time when short term memories are transferred into long term memory.

When we can’t sleep well, that process is disturbed and we may lose some memories during that process shift. Also, we may feel as unable to access our childhood or even recent memories when our mental health is not doing well and we may be scared that it is permanent.

However, in this situation, it is not so much that we have lost our memories. It is more a problem of retrieval. The memories are still there in our big library, but we just can’t find them. Furthermore, memories are highly dependent on our mood.

[THREAD] In our last thread, we talked about the physical symptoms of mental health. Let's focus this one on the psychological symptoms, mainly intrusive and racing thoughts. Why do they happen? What are the solutions for them?

While physical symptoms can be very hard to deal with, psychological ones are not easy. Intrusive thoughts are some of the most troubling to deal with. It is important to note that every single person on this planet gets intrusive thoughts. No exceptions!

Why do they seem to impact some more than others? That's because in someone who does not have anxiety, they will simply overlook these thoughts. They know they are thoughts that they won't act on. However, in someone who is suffering from anxiety, those thoughts will stick.

That's because the intrusive thought(s) will induce a lot of anxiety, and the more emotion we attach to a thought, the more likely it is to be saved in our memory and come back often. Therefore, a thought that should have left right away stays for a long time.

The reason why intrusive thoughts are scary to begin with is because they are often of sexual, violent, and dark thoughts. Therefore, we get scared that we may lose control and act on these thoughts or turn into a bad person. However, the fact that they are scary means a lot.

[THREAD] I want to revisit a topic I get asked about almost everyday. Physical symptoms in mental health. They are so scary and can be so hard to believe that something like anxiety can cause such devastating symptoms. Let’s break it down and see how that happens.

Generally speaking, mental health symptoms are divided into 3 distinct categories: physical, psychological and social. Psychological would be racing thoughts, intrusive thoughts. Social is withdrawal from loved ones and other social symptoms.

Physical symptoms are definitely those that feel that we notice the most because they can look like potentially dangerous illnesses. Usually, we experience those symptoms, go to the emergency room, and the doctors can’t find anything.

It leaves us feeling puzzled and wondering what’s happening. What happens is that our mind identifies some type of danger. After that, it is time for the endocrine system to start working. It releases hormones that send signals to our body.

These hormones (cortisone, adrenaline) tell our body to prepare to fight or run away. Blood goes to our muscles, meaning our brain doesn’t have enough blood pumping. That’s why we feel that brain fog, racing thoughts, tunnel vision and we get that burst of energy.

TW: Abuse

[THREAD] Let's talk about recognizing signs of emotional abuse. For a lot of people, it can be hard to recognize those signs, especially early on, or we may not realize what they were until we have suffered under them and it affected our mental health.

For the most part, people who engage in a lot of emotional abuse won't show it at the very beginning. They need feelings to develop or an attachment to happen in order to be able to show those signs when it is harder for the other person to leave. It can also be progressive.

However, there are some ways to recognize those signs early on. One of the main ones is how these people talk about others they shared a relationship with in the past. If every ex was a bad person or every friendship has issues, then it is generally a bad sign.

This is especially true for men who may badmouth women they have been it by calling them names that are not worth typing. That's a big red flag because it means that this man is likely to be the bad person here. They may be volatile even in their friendships.

They seemingly seem to lose friends quickly and get new ones quickly. This is because these friends may recognize the toxic tendencies of the person and leave them, and they constantly have to integrate with new people that they want to use for one purpose or another.

[THREAD] I want to talk a little bit about how people who are struggling with their mental health may appear to the outside world and why some things contribute to stigma even when we are not aware of them. I often complaints from families or partners.

They would say this person no longer listens, is absent, always on their own and may take it personally. Let’s go through why that happens and what explanations we have for these shifts. First of all, social withdrawal is one of the main symptoms of many forms of psych issues.

Social situations (yes that includes family and loved ones) takes a lot of energy. We don’t notice that for the most part when we are doing well but when we start struggling, every word, listening to conversations, etc...takes so much energy and can be hard to maintain.

This is why they may get irritated and lash out. It is because the energy is gone and they can no longer keep up the mask of normalcy. It is important to respect their space and boundaries while they are going through this hard time. Don’t force them to do things they don’t want.

Also, if you talk to someone who is struggling with their mental health, they may seem absent or like they are not caring at all. Well, from the perspective of the person who is struggling, their concentration is on their thoughts, their bodies, checking for panic attacks.

The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some

Want to include the menstrual cycle in your scientific work, but aren't sure how to do it? My lab (@katjaschmalen) have just published an article on best practices for observational studies of the cycle! Thread below! 🧵

Despite decades of research on the menstrual cycle, empirical studies have not adopted consistent methods for operationalizing the menstrual cycle, resulting in confusion in the literature and limited possibilities to conduct systematic reviews and meta-analyses.

Below, I summarize this "how to" article, and relay some of the key points!

PARTICIPANTS: All participants should be naturally-cycling people with ovaries (remember that they are not necessarily "women"! 🏳️‍⚧️ ⚧).

We provide a Reproductive Status Questionnaire with rules for identifying naturally-cycling people (current function of the sexual organs and hormonal/other medications that stop the cycle).

It's Monday AM post-@ASCO #GU21 & clinic starts in a couple of hours! Lots to process - I'll try to tackle optimal 1L tx for #kidneycancer. I'll make a case for cabo/nivo, leaning on the beautiful (& timely) tables below from @lalaniMD, @SoaresAndrey & @brian_rini (1/15)

What about IO/IO? We have long f/u w #CM214 data w nivo/ipi, no doubt (@AlbigesL et al in @myESMO Open). And treatment-free interval discussed by McDermott @BIDMChealth is no doubt impt. But we've known data not as impressive for favorable risk (2/15)

And furthermore, as @ERPlimackMD points out in another tweet, impt to look at primary PD rates (seen in @lalaniMD's table) - nivo/ipi at 19%!!! CR rate used to be something we highlighted w nivo/ipi, but now comparable across studies (3/15)

Okay now to the really tough stuff - comparing TKI/IO regimens. Something interesting I will add to @brian_rini @uromigos table above is the HR for PFS by INVESTIGATOR review. If the diff in HR for PFS by IND review caught your eye, this is even more striking (4/15)

I think INV-assessed PFS is impt, but if you're a skeptic, forget that argument. Turn instead to #QOL with axi/pembro. Kudos to @brian_rini @tompowles1 @ERPlimackMD et al for advocating for QOL in KN-426. @crisbergerot et al have taughts us the importance of these metrics. (5/15)

is ADHD a mental illness ?

a thread

ADHD is a neurodevelopmental disorder - people with it are born with it and it cannot be altered because it's part of their brain structure and is seen on brain scans. ADHD is also linked to premature births and hypothyroidism during pregnancy, among other things

from the WHO website: "neurodevelopmental disorders are disabilities in the functioning of the brain that can affect behaviour, memory and/or ability to learn."

neurodevelopmental disorders are not caused by external/environmental factors. you cannot *develop* these conditions

mental illness is a general term for a health problem that significantly affects how someone feels/thinks/behaves. mental illnesses cause suffering to those who experience them, as well as often their loved ones. ADHD does not directly cause suffering.

neurodevelopmental disorders are not mental illnesses. ADHD however, does make it more likely for a person to experience mental illness. ADHD can cause dysfunction and stress, but more often than not this comes from lack of accommodation rather than the symptoms themselves.