Anonymous asked:

Hi I had the question about the apocalypse where the vaccine causes schizophrenia. Would it make sense if the MC found a blue print of some sort that helped her make the meds she needed? Like a list of ingredients and then directions. Or would it make more sense to find someone who's kept a lab going through the apocalypse to help her, like a researcher or scientist.

scriptshrink answered:

Having your character find a still-functioning laboratory with a chemist would be a great idea! I think that’s the ideal solution. @scriptchemist should be able to get you further information about what you’d need!

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scriptchemist

A disclaimer before I start: my organic synthesis experiments were on a relatively small (i.e. not commercial) scale, and I’m assuming your MC and sidekick chemist would be doing the same. I have no experience with medicinal synthesis on a commercial scale.

If your MC wants to synthesize antipsychotics, having a fully-functioning lab and a Real Chemist™ would definitely be beneficial. Unfortunately, I don’t think they solve all the hurdles. Let’s go through them one by one.

1) Procedure

You can find papers detailing the synthesis of various antipsychotics online. As chemists devise new (and hopefully better) ways of performing various syntheses, including ones for antipsychotics, the procedures and results will eventually be published in various reputable journals. Some of them will be locked behind paywalls, but if your MC’s sidekick chemist is working at a fully-functioning (at least before the zombie apocalypse) lab, it’s plausible for the chemist’s employer to pay for access to papers. Even if whatever they get is not the absolute best procedure available in the world, it’s at least a decent starting point.

Your MC would definitely want a chemist’s assistance even with a written procedure, since papers are written for other scientists who know the subject. It’s generally assumed that other chemists know how to safely handle various chemicals and equipment; the average layperson would not know what precautions to take.

2) Equipment and common reagents

At a fully-equipped and fully-functioning lab, I expect your MC and their sidekick to have access to most of the equipment/reagents bench chemists use for organic synthesis.

There may be additional complications if the lab was damaged during the apocalypse, and of course sourcing additional reagents and equipment would be very difficult after the zombies attack.

Does the lab have enough resources in all their forms?

3) Precursors

This is the first major logistical hurdle. I put this in a separate category than 2) because generally precursors refers to a starting material that is pretty specific to the synthesis at hand. 2) will cover your common solvents, reducing/oxidizing agents, acids/bases, TLC stains, glassware, and general equipment that many people and many projects can use. A precursor is a starting material specific to this particular synthesis.

Chemistry is divided into various disciplines, and even those in the same discipline often focus their work/research on their own particular niche. There are a lot of chemicals out there, and if a chemist is spending their career working on the synthesis of an alkaloid from the cockroach plant, it’s very unlikely they’d have the appropriate precursors for clozapine just lying around. (Coworkers within the same company usually have the same general focus, so if the company isn’t making drugs it’s unlikely the right precursors would be available anywhere in the building. Even if they do make drugs, “drugs” is a very broad scope so they still may not have the right precursors.) Some precursors can be made, others can be bought or otherwise acquired, but all of that takes time. So your MC’s sidekick chemist is unlikely to have the correct precursors for the correct antipsychotic (does your MC know which one they need?) on hand unless their job happens to be synthesizing antipsychotics on the regular.

4) Experience

As I mentioned before, chemistry has a lot of sub-disciplines and their day-to-day lives can differ greatly. I have never made a superconductor in my life but it’s something J does regularly. That doesn’t mean a chemist from a different discipline can’t do a synthesis when needed–they understand the principles and lab practices–but you’d expect a bit of a learning curve, or for things to go not so smoothly at first. I’ve bombed the first attempt at a reaction and did fine on the second try using the same procedure. But unless your sidekick chemist is from the exact same niche and regularly makes the required antipsychotic (again, does your MC know which one?), the quality of their results would likely suffer, at least at first–in the midst of a zombie apocalypse, I imagine stress is high and sleep, food, and other life-sustaining necessities are low, which is an environment conducive to mistakes.

Let me be clear: inexperience is not an insurmountable hurdle. But it does take time to overcome, and your product yield and purity may suffer in the meanwhile. Does your MC have that kind of time in the middle of a zombie apocalypse, with presumably limited resources? And did I mention purity is really, really, really important for medicine? It’s hard enough to find the drug cocktail that works for you when said cocktail was prepared correctly; drugs and their dosages aren’t one size fits all. When you add questionable purity and improper storage into the equation, things get considerably more complicated.

5) Dosages

I mentioned this twice above, but it bears repeating: does your MC know which antipsychotic to make? Schizophrenia can be treated with more than one drug (unless medicine in your universe works very differently than medicine in our world, in which case this entire ask is probably moot). And even if your MC knows which drug, do they know how much to administer to the patient? (If, if, IF your chosen sidekick chemist is one who synthesizes antipsychotics on the regular maybe MAYBE they have some general idea of the drug required and a common dose, but chemists are not psychiatrists and their word shouldn’t be taken as gospel. Chemists do not, and should not, prescribe drugs.)

6) Excipients

Excipients are the non-active ingredients of a drug: the fillers, bulking agents, etc. But they also play important roles in medicine. A bulked up pill is easier to transport than 10 mg of drug, which may only be a few grains that’d flutter away at the slightest breeze. Excipients can facilitate drug absorption, increase stability/shelf life, enhance solubility, control the rate of drug release, etc. I have no idea what would happen if one takes a dose of antipsychotics without excipients to control the drug delivery, but I imagine it wouldn’t be good.

And if your MC and their sidekick chemist want to formulate the entire drug, excipients and all, that’s a whole other array of reagents and mixing and formulating for your characters to figure out. The excipients of choice vary by drug, by dose, and by various other factors. By the way, the published papers don’t usually have much information on excipients–that’s firmly in the territory of pharmaceutical manufacturing, whereas journal publications focus on the science of creation (in novel ways).

Some antipsychotics are administered as injections instead of pills; similar principles will apply when formulating the drug. Injections would also carry other considerations such as where to find needles, possibility of infection, etc.

7) Time

Preparation, reaction, working up, purifying, setting up the next reaction, formulating your final drug…all of that takes time. A lot of time. Some reactions take minutes or hours. Some take days. Some take months (not joking). And unless your MC has access to the perfect precursors that just happens to be lying around, this will take several reactions, and a lot lot lot of time.

Does your MC have that kind of time? Can they afford to make mistakes?

To summarize, here’s what your MC will need in order to pull this synthesis off:

A clear understanding of which drug they’d need and the dose
A functioning lab and a competent chemist (ideally one who makes drugs on the regular)
Access to journals or other publications that detail methodology
The appropriate precursors, reagents, and equipment
Access to appropriate excipients and their formulations
Time. A lot of time. A lot of time. Also some very stellar luck
Incredibly stupid zombies (admittedly they’re usually not a bright bunch) because your lab will be a really obvious target if it’s up and running in the middle of an apocalypse

Points 3-6 may be simplified if the sidekick chemist makes drugs regularly.

To be honest, it’s a much more practical idea for your MC to raid a pharmacy or hospital (or several), because already-manufactured medicine has already passed the quality control checks for all the points I mention above. One could probably conduct a successful raid in 15-30 minutes if your MC is well-prepared. In a nice, non-apocalyptic environment 5-10 minutes is about the time I’d take to set up my reaction and get my notes all written down. It’s also very likely this synthetic procedure will be sequential–multiple reactions, each with its own time frame (several hours? A few days?), working up, purifying, analysis, characterize, set up following reaction…and in the meanwhile, the lab’s very existence is a giant target…

As a literature aside, in the novel The Time Traveler’s Wife the MC attempts to memorize the structure of risperidone in the future and then have a chemist synthesize it in the present, before the drug was actually developed. It goes about as well as you’d expect–which is to say, not well at all. Drug development, manufacture, and prescription are not arbitrary for very, very good reasons.

Disclaimer

#reblog #scriptchemist #atypical antipsychotics #antipsychotics #medication #hypothetical #post apocalyptic #guest post #schizophrenia

scriptshrink

Anonymous asked:

This may be a little out of your field? But I was wondering - does having a narrator who has delusions or schizophrenia or anything that makes them experience/percieve things that aren't real, automatically make them unreliable, or does it more depend on the intentions of the narrator? Ty!

This answer comes courtesy of @scriptstructure!

I’d say there’s a few different factors to consider.

First off, are the delusional elements ‘untrue’ in the sense that they are misleading about the experiences that the character is trying to convey?

I’d say that a character having a 'different’ view of reality due to a mental illness or condition doesn’t necessarily make them unreliable, so long as the story’s focus is on their perception of reality - it isn’t unreliable if they’re honestly conveying their perception of events.

That said, there are a few different types of unreliable narrators largely divided into two groups; unreliable narrators who are trying to deceive the audience for some reason, and unreliable narrators who are lying to themselves.

So like, the narrator in Agatha Christie’s The Murder of Roger Ackroyd is the murderer, but he’s keeping that from the reader by misdirecting their attention and misleading them. Likewise, Humbert Humbert from Lolita is an example - he’s narrating the story of what he did in such a way to attempt to persuade the jury of his murder trial that he’s an innocent victim of circumstance.

On the other hand, there are narrators who for whatever reason can’t face the ‘truth’ of a situation. A subtle example would be John Watson in The Study in Scarlet, where there’s a discrepancy between his description of himself as a feckless layabout, and the facts of his military service and career (ie he seems like a dude with depression/ PTSD who’s self image has taken a nosedive after a traumatic experience. When he talks about stuff he’s done as not impressive, it’s misleading, but it does make Sherlock Holmes, who he admires very much, appear a lot more able and vibrant and interesting through his narrative choices).

The third kind would possibly be narrators who are unreliable because they don’t have all the information at the time, and have to work on assumptions.

In terms of delusional or mentally ill characters, I’d probably say that the second or third kind of unreliable narrator would be more likely. However, if the character’s delusions are paranoid in nature, the character might 'test’ the reader or mislead them until they feel that they can give more or correct information.

There’s a chapter in House Of Leaves that does this - the narrator fabricates a chapter where he goes to therapy and starts medication and seems to be getting over the influence of the House, only to reveal to the reader at the end of the episode that actually he’s been living on the floor of his apartment the whole time, still obsessing.

Another good example is 'The Moth Diaries.’ The diarist is a teenage girl who may be succumbing to some form of mental illness, or may be watching her best friend be subsumed by a vampire. The book is ambiguous as to a 'true’ reading of it, but either way, the narrator isn’t unreliable because she’s reporting the facts as she sees them. This girl at school IS a vampire, and IS preying on her friend, and the struggle goes between trying to save a friend who doesn’t want her help, trying to get anyone to believe her that there’s something wrong with the new girl, and struggling herself with her own mind and feelings. She’s not an unreliable narrator, because she’s laying everything out as she witnesses it, and without the expectation of an audience (it’s her private diary), or else with the only intended audience being herself for the purpose of self reflection but there’s definite ambiguity in the text stemming in part from the narrator’s mental state.

I feel like the unreliability of the narrator is relative to the narratorial intent. Whether or not a character should be considered an unreliable narrator depends on the nature of the story, the character, the nature of the character’s mental illness, and the narrator’s relationship to the implied reader.

Thanks again to @scriptstructure!

#Anonymous #asks #scriptstructure #guest post #narrator #unreliable narrator #meta #this is not psychological or medical advice #this is writing advice

scriptshrink

Anonymous asked:

Do you have any info on how a 72-hour health and welfare hold would work for a 13-year-old kidnapping victim MC who has been arrested for a crime and whose mother is several hours away? (Story takes place in CA) I assume he would go to the nearest children's hospital. Any thoughts on how things would proceed from there? Would an officer stay with him? Would he be immediately examined without a parent present? What sort of room would he wait for his mother in? Thanks for your help.

This answer comes courtesy of @gnomer-denois :

[I worked as a] Patient Assist Care Team (PACT) Security Guard where I would watch mental health holds in hospitals, usually ERs but sometimes on the floors if there was a need for inpatient medical care, and on a few occasions on mental health wards/in mental health hospitals.

If it works like CO, the child would probably be taken to a hospital, possibly children’s hospital, but the only one of those I worked at was connected to a regular hospital and I watched teenagers in regular hospitals as well. They would have a one-on-one security, probably a security guard trained just for those holds, but it could be a medic or CNA depending on the laws and who’s available. They would be checked by medical staff for physical trauma, labs, anything under their purview would be addressed first. Once they are signed off as physically ok (and if there needs to be surgery or anything, it can be over 72 hours, but any time they aren’t in the OR or recovery, they will have the on-on-one observation), then the nurse that is in charge of their case at that time will call for a mental evaluation. There is usually one or two groups that provide these per county, though more populated areas might have more (I was in Denver, and there were a couple different ones for the metro area, usually one government funded agency for a county and then one or two private groups, I think, I didn’t get a lot of information about the agencies, just occasionally heard which agency the evaluator was from).

It can take hours for the evaluator to arrive, depending on their case load. They go on first call first serve basis, except, if there are more than one at a hospital they will evaluate all the ones at that hospital before moving on rather than drive back and forth if they can help it. Some hospitals will offer “telepsych” where the evaluation is done over a video phone conference, but they probably wouldn’t offer that to a minor. The evaluators are usually Master’s level therapists, I believe. I know they aren’t MDs or PhDs. I don’t know what they ask, because I was one of the guards, and we would step out of the room during evaluation, close enough to help if there was a problem, but giving privacy. The evaluation includes determining if they would be compliant with outpatient services if they are needed, if any follow up psych care is needed (probably in this case). They will tell the patient, and probably the patient’s parent/guardian, what the plan going forward will be and give lists of resources.

If it’s determined that additional evaluation is needed, or that they would be non-compliant with outpatient visits, then they will be referred for inpatient care. The nurse in charge of the case at the hospital will call around to find a bed available on a mental health ward or in a mental health specific hospital. Once one is found (again, this can take hours, if not days) the patient is moved there for a 72 hour hold and will be evaluated by a psychologist or psychiatrist to determine what additional care may be needed. On the ward, they would generally not have one-on-one observation unless they were non-compliant in some way (actively suicidal, having a condition that impact impulse control to the point where they might do things like pull down their pants in the middle of the common area, etc). They’ll go through group meetings, do quiet activities, which they can usually opt in or out of, watch tv, read, but they aren’t allowed to touch other patients.

#Anonymous #asks #denois #hospitals #health and welfare hold #this is not psychological or medical advice #this is writing advice #guest post

scriptshrink

RE: OCD, Anxiety, & Depression

Y’all may remember that @phoenixtcm asked about what a combination of OCD, Anxiety, and Depression would look like. She had some more specific questions that @scentlessangel was able to answer!

@phoenixtcm :

"I guess my most specific question (not very specific) but how the different things mesh? Because depression makes you want to do nothing, anxiety makes you want to do everything, and ocd makes you stressed about not doing anything So would you do nothing because the depression wins out? Or would you do everything because of the ocd and cry because depression? Or would you worry about everything (anxiety) and not do anything (depression) and eventually stress yourself out because you're doing nothing (ocd)

@scentlessangel answered:

More so the last one! Do nothing because of the depression, with inconsistent swings in motivation followed quickly by it ending. So doing nothing causes anxiety, anxiety kicks up the symptom of my OCD.. like the BFRB, rituals, cleaning, picking everything apart. The depression is always the one in charge, but ultimately the OCD is most destructive (and can also just cause ruminating thoughts, thoughts you can't let go of and that you repeat over and over in your head almost ritualistically)

Aaaand then depression comes back around the bend, because you feel shameful for having given in to certain compulsions (especially because picking at your skin can cause permanent scarring)

The idea is that the OCD causes what looks like productivity, like cleaning, but in reality you're avoiding what you should really be doing and wasting a ton of energy on this task you now can't stop (for example- I lay in bed all morning, get anxious thinking about everything I need to do for the day... then spend 45 min picking my own hairs out because once I pick out one I need to keep going and going....and then I look down and see dust on the floor so I sweep up my entire bedroom, then I notice that the fan is dirty....) etc etc until hours are wasted.

[Thank you so much for sharing your experiences! - Shrink]

#scriptshrink #text #ocd #anxiety #depression #comorbid disorders #personal experiences #phoenixtcm #scentlessangel #this is not psychological or medical advice #this is writing advice #guest post

scriptshrink reblogged

scriptshrink

betweenmayandjuly-deactivated20 asked:

I'm not sure if I should ask you or scriptmedic about this, but what are the do's and don't's of calming someone who's having a panic/anxiety attack?

scriptshrink answered:

Courtesy of @scriptautistic:

Things not to do:

Don’t : Yell at them. Especially not to calm down. This is the exact opposite of helpful.
Don’t : Tell them to stop crying/shaking/hyperventilating. They can’t help it.
Don’t : Start panicking as well (if possible).
Don’t : Touch them or move them without permission.
Don’t : Ask too many questions without giving them time to answer. Ask open questions which require lot of reflection or open answers.
Don’t: Force them to do anything they don’t want to do.
Don’t : Leave them alone before they have calmed down completely and told you so. If it’s not their first attack, they probably know how they behave.

Things to do:

Do: Speak as calmly as possible. Have calm gestures. Try to appear as non-threatening, calm, collected and reassuring as possible.
Do : Ask if you can do anything specific to help. Ask if they have medication and if they want to take it. Ask if they want help getting away from a stressor. Once these basics are covered, you can offer them something cold/warm to drink and a hug if you’re comfortable with giving them one.
Do : Try and help them breathe more regularly if they are hyperventilating. You can help them by saying “breathe in…breathe out” in a regular, slow rhythm, or, while hugging them or with their hand on your chest, by telling them to follow your rhythm.
Do : Reassure them if they apologize, feel guilty or are ashamed to be seen like this.
Do: Gently but firmly keep them from hurting themselves.
Do : Once they have calmed down a bit, try to distract them to stop them from getting back into the attack or having another one. You can chat with them, tell them about your day, offer them to play a game, have a walk together, or do anything nice, soothing, and that they like. Comfort food is nice. Warm blankets are nice.
Do: Give them a way to keep in touch with you if you have to go shortly afterwards, or a way to contact someone else/ a hotline which can help.

Followers who’ve had panic attacks - what helps you calm down? What doesn’t help?

scriptshrink

@pomrania added:

SO TRUE.

Telling someone “calm down” is pretty much NEVER a good idea. If they’re able to, they’ll do it anyways (unless you’ve annoyed them too much by saying stupid things like that); if they’re not, it’s pointless.

I’d add the advice of “stay out of arm’s reach”, because when I’m freaking the hell out, I might mindlessly strike out at anyone who gets too close; and then someone calls security and/or the police and the whole day is ruined. (True story.)

Also, it really does not feel good having people talk about me like I’m not there, even if I’m too busy crying to respond. To me, if you have to call for assistance, move out of earshot. Don’t stop to gawk. I understand curiosity – it’s one of my driving forces – but be discreet about it.

I think of myself as essentially a frightened animal when I’m freaking out that badly, although other people have said that’s not a good comparison to ever say. (Joke’s on you, I’m posting it anyways.)

To me, only time can help; even if the original thing is no longer a problem, everything needs to work its way out of my system. Absolute best-case scenario for me has no unpleasant distractions, and a big fuzzy dog to hug; the more reasonable best-case scenario would be no idiots nearby, and a rhythmic sound to help with my breathing.

@subtletyislost added:

Personally one of the big things for me when I have a panic attack is finding or being handed my inhaler. I also have asthma and when I panic I hyperventilate, which can cause me to breathe in dust or pollen or something else that triggers my asthma, which just makes me panic more. Being given my inhaler and using it forces me to have to focus on something familiar (the steps to using it).

Another thing that helps me is if my teddy bear is around, being handed it can help. I have a strong attachment to the bear, more than some of my human friends, and as long as I have the bear I know even when I panic that nothing imagined/in my head/not physical can hurt me. That calms me a lot. Having my phone helps too, even if i can’t use it, my phone being there gives me the sense that my (long distance) friends are there too.

The only thing (other than the ones already said) that’s ever made it worse for me/not helped me, was people trying to talk to me. To be clear I mean multiple people. If there’s more than one person when someone is panicking, try to remember that for some characters multiple people talking will just make it worse. Try to only have one character talk to the panicked character at a time, preferentially a character they trust.

An Anon added:

You asked for some advice to calm down from panic attacks so here’s a few of my tips. If a person is in a group when they have a panic attack then see if they want to be away from the group (personally I like to be completely alone during an attack and need comfort afterwards bc even one person stresses me out) Also there’s one breathing technique I have is where I tap my finger and count like “1 2 3 4” each gets a tap and that’s when I inhale and the 5,6,7,8 is when I exhale (like dance counts)

Thanks to all three of you for adding to this post! - Shrink

#reblog #betweenmayandjuly #asks #scriptautistic #panic attacks #panic disorder #what do #this is not psychological or medical advice #this is writing advice #guest post #scriptshrink #pomrania #subtletyislost #personal experiences #submissions #addition

scriptshrink

betweenmayandjuly-deactivated20 asked:

I'm not sure if I should ask you or scriptmedic about this, but what are the do's and don't's of calming someone who's having a panic/anxiety attack?

Courtesy of @scriptautistic:

Things not to do:

Don’t : Yell at them. Especially not to calm down. This is the exact opposite of helpful.
Don’t : Tell them to stop crying/shaking/hyperventilating. They can’t help it.
Don’t : Start panicking as well (if possible).
Don’t : Touch them or move them without permission.
Don’t : Ask too many questions without giving them time to answer. Ask open questions which require lot of reflection or open answers.
Don’t: Force them to do anything they don’t want to do.
Don’t : Leave them alone before they have calmed down completely and told you so. If it’s not their first attack, they probably know how they behave.

Things to do:

Do: Speak as calmly as possible. Have calm gestures. Try to appear as non-threatening, calm, collected and reassuring as possible.
Do : Ask if you can do anything specific to help. Ask if they have medication and if they want to take it. Ask if they want help getting away from a stressor. Once these basics are covered, you can offer them something cold/warm to drink and a hug if you’re comfortable with giving them one.
Do : Try and help them breathe more regularly if they are hyperventilating. You can help them by saying “breathe in…breathe out” in a regular, slow rhythm, or, while hugging them or with their hand on your chest, by telling them to follow your rhythm.
Do : Reassure them if they apologize, feel guilty or are ashamed to be seen like this.
Do: Gently but firmly keep them from hurting themselves.
Do : Once they have calmed down a bit, try to distract them to stop them from getting back into the attack or having another one. You can chat with them, tell them about your day, offer them to play a game, have a walk together, or do anything nice, soothing, and that they like. Comfort food is nice. Warm blankets are nice.
Do: Give them a way to keep in touch with you if you have to go shortly afterwards, or a way to contact someone else/ a hotline which can help.

Followers who’ve had panic attacks - what helps you calm down? What doesn’t help?

#betweenmayandjuly #asks #scriptautistic #panic attacks #panic disorder #what do #this is not psychological or medical advice #this is writing advice #guest post

scriptshrink

Anonymous asked:

I'm the DID anon! First, thank you and ciel-inwonderland for your answers, so very much. Second, a character I have has DID. Do you think is it plausible for her to work as a medic/nurse? I know it can be very stressful and it can trigger her disorder, but I'd like a more professional opinion.

This answer comes courtesy of @dinosaursindisarray, who runs a blog about DID!

My answer would be definitely, but it depends. Like, the person would have had to done trauma therapy and have good communication with other alters. They’d have to be able to understand and cope with their triggers, either through switching or cocoon help or grounding techniques.People that have DID are also CEOs of multi-million dollar companies, which is very stressful. My therapist treats someone like that. And they function well enough to do their job.

It’s like any other mental illness really: do the symptoms prevent the character from doing what needs to be done for the job?Depending on the system, it might be easier to have DID because of the irregular schedule and stress, because different alters can handle different aspects of the job.

If they plan to write a dramatic, broken character who’s every bit of functioning is effected by DID, it probably won’t work. Like, they’d have to be as capable as any other person to do the tasks needed. But with DID, a new alter (or alters) could form who handles the aspect of the job and learning the medical stuff and research and treating patients, because that’s what’s needed. Then the person could seemingly be extremely put together on the clock, but still struggles with their own personal trauma because that put together part doesn’t know how to help their own pain.

So basically, depending on what else they do with the character and how they’re developed, what traumas they went through and how much they’ve processed them, the character might be very helped by the presence of alters, or hindered. Either because they work well with their system, or their brain is still doing everything needed to help them survive ie splitting.No job is immediately off limits or unlikely for someone with DID. It’s meant to be hidden no matter what, even from the person who has it. Add in more stressful job and that’s more reason for it to stay under wraps.

I’m really glad we can help, DID anon! It’s awesome that you’re dedicated to fully researching your character.

#dinosaursindisarray #consult #DID #Dissociative Identity Disorder #stress #alters #Anonymous #asks #this is not psychological or medical advice #this is writing advice #guest post