aprox at the min 24:25

Just noticed something near the middle of the episode, just before the detox – there’s a big clue that what follows (House detoxing) is a hallucination – he tells us:

House: Go suckle the little bastard child if it makes you feel better
Cuddy: Screw you..
House: I’m hallucinating

As we find out next episode, right after she says screw you, the hallucination starts. So yeah, we’re told this isn’t real, we just don’t realise it. Thoughts?

Hallucinations on opioids are more common than you think. Meperidine (Demerol) is an opioid that can cause hallucinations simply because of its similarity in structure to atropine.

Of course, even bringing up ECT is for dramatic effect. There are these newfangled things these days called “antipsychotics” that any doctor who isn’t a nutjob would use first. (Sure, House can be a nutjob, but Wilson?) And, of course, bringing up schizophrenia is also for dramatic effect seeing as how it’s an involved disorder with more than one symptom, and the criteria specifically state that you must exclude drugs first. And it has to be for 6 months, but I can give the show a pass because 6 months is about two and a half House days. I was also pretty disappointed with the “if you’re mentally ill you can’t practice medicine” baloney. Maybe if it’s untreated, but (unbeknownst to some) treatment has come a long way in the past century.

On the bright side, maybe enough people will come here and get educated to cancel out the effect of other viewers’ negative beliefs being reinforced. I mean, it was because of that stupid bone marrow transplant episode that I actually learned about bone marrow transplants and signed up for the Bone Marrow Registry. Maybe it will save someone’s life someday.

Also, another good point was made above, which is that for a show that centers around opiate use, it’s absolutely ludicrous that House is depicted popping Vicodin pills numerous times daily. Even the Vicodin with the lowest acetaminophen dose would cause serious liver complications with the frequency of use depicted.

It’s even more ridiculous that they show him popping Vicodin & drinking alcohol. The combination of acetaminophen & alcohol is particularly damaging to the liver, and potential respiratory depression can be serious. In my opinion, I really don’t even think it’s all right for a popular TV show to be depicting alcohol + Vicodin use… without any really bad consequences. It may lead some to think that taking opiates & drinking alcohol together is OK, when, it’s really not & can lead to death!

The show producers are treating hydrocodone as if it were LSD or PCP, and this is clearly ridiculous. The pharmacodynamics simply do not work in that manner.

There have been no documented cases to my knowledge of “Vicodin Psychosis”.

In addition, and person in the level of chronic pain that House endures would have been put on a non-compounded drug long ago. That is, one without acetaminophen such as Oxycontin or Dilaudid.

The tablets he takes on the show are Vicodin 5/500 tablets, which are weak and would quickly induce liver failure at the number of tablets that he is taking.

The show is playing very fast and loose with their understanding of narcotic pain medication, and this is a shame given that it is a focal point of the plot.

I was hospitalized for depression about 5 years back. I received a 12 round treatment of ECT, three times a week for four weeks. This appeared to be a common regimen. I didn’t end up drooling or incapacitated in any way. I did feel pretty wrung out of about 12 hours following each session.

I found the anesthesia and succinylcholine effects to be the most disturbing. I didn’t appear to suffer any of the worst side effects of the ECT itself. Then again, it didn’t really make a huge change in my depression, either.

That said, I did see some of my fellow patients make significant progress when nothing else helped them.

As far as treatment for schizophrenia is concerned, I suspect that ECT is probably reserved , as it is for depression, for the more resistant cases and not the first course of treatment.