Explore every episode of PsychEd: educational psychiatry podcast
Dive into the complete episode list for PsychEd: educational psychiatry podcast. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
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28 Oct 2022
PsychEd Episode 48: History of Psychiatry with Dr. David Castle
01:04:29
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode delves into the history of psychiatry with Dr David Castle, the inaugural Scientific Director of the Centre for Complex Interventions at the Centre for Addictions and Mental Health and a Professor in the Department of Psychiatry at the University of Toronto. Prior to migrating to Canada in 2021, he spent 15 years as a Professor of Psychiatry at St Vincent’s Hospital and the University of Melbourne in Australia.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Gain an appreciation for the historical context of the field of psychiatry
Understand how illness categories and treatments have been shaped by this history
Compare and contrast how various past societies viewed and conceptualized mental illness
Apply lessons learned from historical practices to appraise current approaches
Guest: Dr David Castle
Hosts: Dr Alex Raben (Staff Psychiatrist), Gaurav Sharma (PGY4), Nikhita Singhal (PGY4), Andreea Chiorean (CC4)
Castle, D., Bassett, D., King, J., & Gleason, A. (2013).A primer of clinical psychiatry. Elsevier Health Sciences.
de Leon J. DSM-5 and the research domain criteria: 100 years after Jaspers' General psychopathology. Am J Psychiatry. 2014 May;171(5):492-4.https://doi.org/10.1176/appi.ajp.2013.13091218
Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003 Jan;160(1):4-12.https://doi.org/10.1176/appi.ajp.160.1.4
Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970 Jan;126(7):983-7.https://doi.org/10.1176/ajp.126.7.983
Psyched Episode 3 b): Diagnosis of Bipolar Disorder (Depression) with Dr. Ariel Shafro
00:27:08
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of bipolar disorder in ther depressive episodes, and a phenomenon termed "episodes with mixed features", with guest Dr. Ariel Shafro, a staff psychiatrist at Trillium Health Partners.
Bipolar disorder is an illness characterized by manic and depressive episodes; patients in fact spend more time in a depressed state than a manic state. The criteria for diagnosing a bipolar depression is the same as unipolar depression (or major depressive disorder).
When patients present with a depressive episode, it is important to consider bipolar disorder as a possible differential diagnosis. In addition, we discuss certain features that can point to an increased likelihood of bipolarity in a patient presenting with depression: this includes a strong family of bipolar disorder; previous subthreshold mania and cyclothymic features;atypical depression, psychomotor retardation (and/or catatonia), and psychotic features; and atypical reaction to antidepressants.
Lastly, we talk about the phenomenon of "episodes with mixed features", where people can present with simultaneous symptoms of depression and mania. We discuss the relevance of recognizing such episodes, including increased vigilance for features of bipolarity and considerations for treatments that have effect in both unipolar and bipolar depression.
The learning objectives for this episode are as follows. By the end of this episode, the listener will be able to:
Describe criteria for bipolar depression (it's the same as unipolar depression!)
List features suggestive of bipolarity in a presentation of depression
Know the DSM-V criteria of and recognize episodes with mixed features
Describe the relevance of diagnosing episodes with mixed features
Guest Staff Psychiatrist: Dr. Ariel Shafro (Trillium Health Partners, Mississauga)
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
12 Mar 2017
PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn
00:26:48
Welcome to PsychEd, the educational psychiatry podcast for medical learners, by medical learners.
This episode covers the diagnosis of major depressive disorder (MDD), leveraging experience from Dr. Ilana Shawn, Staff Emergency and Outpatient Psychiatrist at St. Michael’s Hospital in Toronto.
In this episode we talk about a hypothetical case of someone presenting for the first time with a depressive illness. Using the metric of DALY (disability-adjusted life-years), we highlight the high global disease burden of depression. We then briefly discuss the purpose and limitations of using a diagnostic manual. We describe in depth the symptoms of depression using the mnemonic MSIGECAPS, including Dr. Shawn’s thoughts on how the they can be elicited more naturally in an assessment. We talk about common challenges in performing a suicide assessment, and the misconception that asking about suicide increases the risk of suicide. Finally, we highlight other medical and psychiatric conditions that can mimic depression.
The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:
Understand the societal impact of depression
Describe the diagnostic criteria of MDD
Describe strategies to elicit depression symptoms
Apply Mental State Exam findings to support or a diagnosis of depression
Understand the limitations of the Diagnostic and Statistical Manual (DSM)
Perform a differential diagnosis of major depression
Guest Staff Psychiatrist: Dr. Ilana Shawn (St. Michael’s Hospital, Toronto)
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
29 May 2019
PsychEd Episode 13: Psychiatric Rehabilitation with Dr. Abraham Rudnick
00:43:02
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Psychiatric Rehabilitation with guest Dr. Abraham Rudnick, who is currently a Professor in the Department of Psychiatry at the University of Dalhousie.
In this episode, Aarti and Alex learn about Psychiatric Rehabilitation, also known as Psychosocial Rehabilitation (PSR), a rarely discussed or taught “4th branch” of mental health intervention. Join our residents as they discover the definition, purpose, history, process, character, and possibilities of psychiatric rehabilitation from a world expert.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to
Define psychiatric rehabilitation (PSR)
Differentiate clinical and personal recovery
Understand how PSR supports personal recovery
Differentiate psychiatric rehabilitation from other mental health interventions
Identify key areas of overlap with psychotherapy
Identify key concepts within the process of PSR: readiness assessment and development, skills, supports, environment of choice, lack of coercion, maintenance of hope
Locate resources to further their own knowledge and skills in PSR*
Guest staff psychiatrist: Dr. Abraham Rudnick, BMedSc, MD, MPsych, PhD, CPRP, FRCPC, CCPE, DFESPCH, FCPA, CSLI, CPRRP
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.comFor more information visit our website:psychedpodcast.org.
18 Oct 2021
PsychEd Episode 39: Electroconvulsive Therapy with Dr. Wei-Yi Song
01:02:35
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers electroconvulsive therapy with Dr. Wei-Yi Song, the Department Head of Psychiatry, Director of Mood Disorder Services, and Director of ECT Services in Victoria, BC, as well as a Clinical Professor at the University of British Columbia, and a past president of the Canadian Psychiatric Association.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Briefly describe the history of ECT from inception to the present.
Debunk common misconceptions about ECT.
Describe the major proposed mechanisms of action of ECT.
Describe the efficacy of ECT for common psychiatric illnesses.
List the indications, contraindications, side effects and risks of ECT.
Understand how the procedure of ECT is performed.
Guest: Dr. Wei-Yi Song
Hosts: Jake Johnston (MS4), Dr. Shaoyuan “Randi” Wang (PGY1), Dr. Arielle Giest (PGY2), Dr. Alex Raben (Staff Psychiatrist)
Baldinger, P., Lotan, A., Frey, R., Kasper, S., Lerer, B., & Lanzenberger, R. (2014). Neurotransmitters and electroconvulsive therapy. The journal of ECT, 30(2), 116–121.https://doi.org/10.1097/YCT.0000000000000138
Francois, D. and DellaCava E. (2018). “10 myths about ECT”. Current Psychiatry. Accessed 2021-06-28 from MDedge.
Kane, J., Rubio, J., Kishimoto, T., Correll, C., Marder, S., and Friedman, M. (2021). Evaluation and management of treatment-resistant schizophrenia. UpToDate. Accessed 2021-07-27.
Kellner, C., Keck, P., and Solomon, D. (2021). Bipolar disorder in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
Kellner, C. and Rasmussen, K. (2015). Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions.Psychiatric Times. Accessed 2021-07-08.
Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Overview of electroconvulsive therapy for adults. UpToDate. Accessed 2021-06-28.
Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
Petrides, G., Malur, C., Braga, R. J., Bailine, S. H., Schooler, N. R., Malhotra, A. K., Kane, J. M., Sanghani, S., Goldberg, T. E., John, M., & Mendelowitz, A. (2015). Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study.The American journal of psychiatry,172(1), 52–58.https://doi.org/10.1176/appi.ajp.2014.13060787
Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology,15(3), 210–221.https://doi.org/10.9758/cpn.2017.15.3.210
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 15: Managing Aggression and Agitation with Dr. Jodi Lofchy
00:56:00
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors and management of aggression in the Psychiatric Emergency context.
Our guest expert is Dr. Jodi Lofchy. She is the Chair of the Canadian Psychiatric Association’s Section of Emergency Psychiatry, and Interim Chief and Medical Program Director for the Department of Psychiatry at St. Joseph’s Health Centre. Dr. Lofchy has presented and published many works on Best Practice in Emergency Psychiatry and has been tremendously involved in Medical Education.
The learning objectives for this episode are as follows:
Identify risk factors for violence in the ER, static and dynamic risks
Know how to take a history for violence, and communicate risk
Describe the indications for non-chemical interventions in the management of the agitated patient
Describe pharmacologic interventions in managing the agitated patient
How to apply legislation regarding risk of violence
Recommended Readings:
Emergency Psychiatry: Clinical and Training Approaches
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
29 May 2024
PsychEd Episode 61: Introduction to Forensic Psychiatry with Dr. Amina Ali
00:50:04
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to forensic psychiatry with Dr. Amina Ali, a forensic psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. Dr. Ali joined the Forensic Division at CAMH in 2018. She is an Assistant Professor in the Department of Psychiatry at the University of Toronto. Prior to joining CAMH, Dr. Ali received her Doctor of Medicine at the American University of the Caribbean, completed her Psychiatry residency at the Icahn School of Medicine at Mount Sinai in New York, and fellowship in Forensic Psychiatry at the Albert Einstein College of Medicine.
Dr. Ali's leadership experience includes serving as Chief resident during her residency, for which she was bestowed a Residency Leadership Award from the Bronx Lebanon Hospital Center. She is a Competence By Design coach to residents and serves on the Psychiatry Competency Committee and as a CaRMS file reviewer for the University of Toronto General Psychiatry Residency Program. She is also a supervisor for forensic residents and sits on the subspecialty resident committees. Within the forensic division, Dr. Ali has contributed to the organization and implementation of the Summer Studentship in Forensic Psychiatry Program and is our Medical Education and Wellness Lead. Internationally, Dr. Ali was appointed to serve on the American Academy of Psychiatry and the Law Education Committee and most recently recruited to Chair their Civil Commitment and Consent to Treatment Working Group.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Describe the role of forensic psychiatry and its relation to the Ontario Review Board.
Outline the criteria for fitness to stand trial.
Describe the function and possible outcomes of a treatment order.
Outline the criteria for not criminally responsible on account of a mental disorder.
Distinguish between the disposition options available under the Ontario Review Board.
Demonstrate an enhanced ability to advocate for and support patients in navigating the forensic psychiatric system.
Guest: Dr. Amina Ali
Hosts: Alexander Simmons (PGY3), Kate Braithwaite (MD), and Rhys Linthorst (PGY5)
Audio editing by: Gaurav Sharma (PGY5)
Show notes by: Alexander Simmons (PGY3)
References:
Crocker, A. G., Nicholls, T. L., Seto, M. C., Charette, Y., Cote, G., Caulet, M. (2015). The National Trajectory Project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: the people behind the label. The Canadian Journal of Psychiatry, 60(3), 106-116.
Prpa, T., Moulden, H. M., Taylor, L., Chaimowitz, G. A. (2018). A review of patient-level factors related to the assessment of fitness to stand trial in Canada. International Journal of Risk and Recovery, 1(2), 16-22.
Carroll, A., McSherry, B., Wood, D., & Yannoulidis, LLB, S. (2008). Drug‐associated psychoses and criminal responsibility. Behavioral sciences & the law, 26(5), 633-653.
Watts, J. (2013). Updating toxic psychosis into 21st-century Canadian: Bouchard-Lebrun v. R. Journal of the American Academy of Psychiatry and the Law Online, 41(3), 374-381.
Crocker, AG, Nicholls, TL, Seto, MC, Cote, G, Charette, Y, Caulet, M. The national trajectory project of individuals found not criminally responsible on account of a mental disorder in Canada, Part 1: Context and methods. Canadian Journal of Psychiatry. 2015;60(3):98-105.
Schneider, RD. Mental health courts. Current Opinion in Psychiatry. 2008;21:510-513.
PsychEd Episode 23: Autism Spectrum Disorder with Dr. Melanie Penner, Dr. Yona Lunsky and Dr. Mitesh Patel
01:07:47
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Autism Spectrum Disorder (ASD) with not one, not two but THREE experts in the field: Dr. Melanie Penner (Developmental Pediatrician at Holland-Bloorview), Dr. Mitesh Patel (Forensic and Child Psychiatrist at CAMH) and Dr. Yona Lunsky (Psychologist at CAMH)
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Have an understanding of the neurobiology and epidemiology of autism
Tailor their diagnostic interview for autism in a way that improves accuracy and is empathic
Have familiarity with the impact of autism on people and their families and the interdisciplinary and biopsychosocial approaches involved in caring for people with autism
Host(s): Dr. Alex Raben (PGY5), Dr. Sabrina Agnihotri (PGY1)
Produced by: Dr. Alex Raben (PGY5), Dr. Sabrina Agnihotri (PGY1), Weam Sieffien (CC3) and Dr. Gurnaam Kasbia
Guest experts: Dr. Melanie Penner, Dr. Mitesh Patel and Dr. Yona Lunsky
Episode infographic by Weam Sieffien (CC3) and Dr. Nikhita Singhal (PGY1)
American Academy of Pediatrics. Management of Children With Autism Spectrum Disorder. Pediatrics. 2007 Nov;120(5):1183-1215.
Bartlo P, Klein PJ. Physical activity benefits and needs in adults with intellectual disabilities: systematic review of the literature.Am J Intellect Dev Disabil. 2011 May. 116(3):220-32.
Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities.Am J Prev Med. 2009 Dec. 37(6 Suppl 1):S201-8.
Lyall, K., Croen, L., Daniels, J., Fallin, M. D., Ladd-Acosta, C., Lee, B. K., ... & Windham, G. C.(2017). The changing epidemiology of autism spectrum disorders. Annual review of public health, 38, 81-102.
Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in developmental disabilities, 32(2), 419-436.
McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami S, Jerome RN, et al. A systematic review of medical treatments for children with autism spectrum disorders.Pediatrics. 2011 May. 127(5):e1312-21.
Rubin IL, Crocker AC.Medical care for children and adults with developmental disabilities. Second edition. Baltimore, MD: Paul H Brookes Publishing Co, Inc; 2006.
Rueda JR, Ballesteros J, Tejada MI. Systematic review of pharmacological treatments in fragile X syndrome.BMC Neurol. 2009 Oct 13. 9:53.
Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), 3623-3629.
Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies.Vaccine,32(29), 3623-3629.
Thapar, A., Cooper, M., & Rutter, M. (2017). Neurodevelopmental disorders. The Lancet Psychiatry, 4(4), 339-346
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.com. For more information visit our website:psychedpodcast.org.
31 Mar 2021
PsychEd Episode 34: Ketamine for Treatment-Resistant Depression with Dr. Sandhya Prashad
00:43:29
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers ketamine for treatment-resistant depression (TRD) with Dr. Sandhya Prashad, apsychiatrist and the founder and medical director of Houston Ketamine Therapeutics. She has extensive expertise using ketamine and is one of the most experienced ketamine psychiatrists in the United States, with her clinical practice focusing on TRD and incorporating transcranial magnetic stimulation (TMS), sometimes in conjunction with ketamine. Dr. Prashad is also a founding member and current president of the American Society of Ketamine Physicians (ASKP), a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy.
We’re also experimenting with something new for this episode — providing a transcript of the entire interview! The transcript can be found atpsychedpodcast.org/transcripts/ketamine. We’d love to hear your feedback as listeners on this as a feature, including whether it’s something you’d be interested in seeing for other episodes moving forward!
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Describe ketamine and how it came to be used in the field of psychiatry.
Develop an appreciation for benefits and potential harms associated with ketamine and how this compares to other treatments for depression.
Understand how ketamine fits into the treatment of depression and suicidality, patient characteristics to consider before initiation, potential mechanisms of action, different models of administration, and incorporation of psychotherapy.
Guest expert: Dr. Sandhya Prashad
Hosts: Jimmy Qian (MS2), Dr. Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3)
Audio editing by: Dr. Chase Thompson
Show notes by: Gray Meckling (MS4)
Interview transcript by: Gray Meckling
00:00 – Introduction
03:00 – Learning objectives
03:30 – History of ketamine
06:20 – Recreational use of ketamine, phenomenology of the ketamine experience
09:45 – Where does ketamine fall in the algorithm for treatment of depression?
11:50 – Ketamine’s use in acute suicidality
13:40 – Ketamine contraindications
14:40 – Ketamine efficacy
19:00 – Combining ketamine with rTMS
21:15 – Limitations to ketamine
24:35 – Ketamine mechanism of action
26:05 – Ketamine formulations, and integrating ketamine into psychotherapy
33:10 – Combining ketamine with traditional antidepressant treatment
Berman, R., Cappiello, A., Anand, A., Oren, D., Heninger, G., Charney, D.. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 47: 351–354.
Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA psychiatry, 76(9), 893-903.
J.W. Murrough, D.V. Iosifescu, L.C. Chang, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two site randomized controlled trial. Am. J. Psychiatry, 2013 (170) (2013), pp. 1134-1142
Kim, J., Farchione, T., Potter, A., Chen, Q., & Temple, R. (2019). Esketamine for treatment-resistant depression-first FDA-approved antidepressant in a new class. N Engl J Med, 381(1), 1-4.
McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S. (2021). Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation.American Journal of Psychiatry, appi-ajp.
Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence [Internet]. 2008 Jun 1;95(3):219–29.
Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405.
Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15.
Williams NR, Heifets BD, Bentzley BS, Blasey C, Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of antidepressant and anti suicidal effects of ketamine by opioid receptor antagonism. Molecular psychiatry. 2019 Dec;24(12):1779-86.
Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63: 856–864.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA).
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is a special episode in a new series — the PsychEd Book Club, a forum where we'll introduce and discuss books of interest to psychiatry learners from a variety of disciplines, moving beyond epidemiology and clinical practice to look at science, history, culture, and more. We'll also invite you to read along and discuss with us as we read!
Our book club episodes will start with a short introductory episode (like this one) sharing the book title and why we picked it. A few months later, we plan to release an episode debriefing our thoughts on the book. If there are specific things you want us to talk about, email us at psychedpodcast@gmail.com or reach out to us on social media and we will try to include them in our debrief!
The first book we'll be covering is Anne Harrington's Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. This is a new history of psychiatry, from the later nineteenth century to the present, with a focus on biological explanations and treatments for mental illness — the way that these approaches have gained and lost ground in the profession over time, clashing and collaborating with other understandings. It offers a wide-ranging overview of many defining figures, discoveries, and shifts within modern mental healthcare, unified by a single narrative which gives the book momentum and makes its portraits memorable, and often stinging. It's a polemical history, which prompts us to reconsider some of the field's most automatic self-conceptions, and to recognize the social, political, and cultural forces that have shaped and reshaped it over time.
Hosts: Drs Kate Braithwaite, Wendy MacMillan-Wang, Alastair Morrison, and Gaurav Sharma
PsychEd Episode 32: Diagnosing Borderline Personality Disorder with Dr. Robert Biskin and Dr. Ronald Fraser
00:50:10
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers the diagnosis of borderline personality disorder with expert guests:
Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as inpatient psychiatrist at the Jewish General Hospital.
Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre.
By the end of this episode, you should be able to…
List the DSM-5 diagnostic criteria of borderline personality disorder.
Recall the epidemiology of borderline personality disorder.
Consider the risk factors and posited causal mechanisms for borderline personality disorder, including developmental and neurobiological mechanisms.
Discuss the clinical presentation of borderline personality in different clinical settings, including the Emergency and Outpatient settings.
Recognize the differential diagnoses for patients presenting with borderline personality disorder.
List the common comorbid psychiatric and general medical conditions with borderline personality disorder.
Discuss the common diagnostic challenges and pitfalls.
Explore the stigma surrounding the diagnosis of borderline personality disorder, and discuss a therapeutic approach to providing psychoeducation to patients with this diagnosis.
Guests: Dr. Robert Biskin and Dr. Ronald Fraser.
Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4).
Audio editing by Audrey Le.
Show notes by Dr. Nima Nahiddi.
Interview Content:
Introduction – 0:00
Learning objectives – 2:03
DSM-5 definition of personality disorder, and borderline personality disorder (BPD) – 3:00
Other associated features of BPD – 4:36
Distinguishing BPD from other psychiatric and co-morbid conditions – 5:55
Epidemiology of BPD – 13:48
BPD over the lifecycle – 18:05
Explanatory models for the development of BPD – 21:20
Differences in the presentation of BPD – 26:00
Approach to a BPD diagnosis in the emergency department – 31:05
Stigma surrounding BPD diagnosis and disclosure of diagnosis – 33:51
Clinical pearls for screening of BPD – 41:11
Evidenced based screening tools or scales for BPD diagnosis – 46:22
Zanarini, M. C., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised Diagnostic Interview for Borderlines: Discriminating BPD from other Axis II disorders.Journal of Personality Disorders,3(1), 10–18.
American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.). https://doi.org/10.1176/appi.books.9780890425596
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 17: The Psychiatric Interview with Dr. Juveria Zaheer
01:10:48
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode of our miniseries on psychiatric skills, we review the core content areas of a psychiatric assessment and look at techniques to improve interviewing efficiency, accuracy and alliance building. Our expert for this episode is Dr. Juveria Zaheer, a clinician-scientist at the Centre for Addiction and Mental Health, and an assistant professor at the University of Toronto, in Toronto, ON.
Learning Objectives:
By the end of the episode you, the learner, should...
Have a clear understanding of the goals of a complete psychiatric interview and the general structure and content that should be covered
Feel comfortable to begin to use techniques that will help you conduct a professional, compassionate, empathic, efficient, and accurate interview
Be familiar with techniques you can use to facilitate information gathering in more challenging interviews
Episode Timepoints
3:15 - Purpose of the psychiatric interview
6:30 - First content areas of the interview; introduction, ID, RFR, CC, HPI, ROS, Past Psych Hx
19:00 - Techniques and Strategies for Organized and Efficient Psychiatric ROS
26:00 - Details of Past Psychiatric History
29:30 - Past Medical History
31:00 - Substance Use History
33:30 - Medications
34:20 - Family Psych History
36:25 - Personal and Developmental History (Content & Process discussion)
44:00 - Commonly missed areas including Legal/Forensic history
45:00 - Shift from content to process discussion “how to best manage a psychiatric interview”
49:00 - Self-care and monitoring
52:00 - Building rapport, therapeutic alliance, empathy
53:30 - Alex and Lucy reflect on their growth as interviewers over 4 years in residency
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com; For more information visit our website:psychedpodcast.org
02 Jun 2021
PsychEd Episode 36: Understanding Eating Disorders with Dr. Randy Staab
01:15:32
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the first of two episodes covering the topic of eating disorders. In this episode, we explore the diagnosis, etiology, and symptomatology of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. Dr. Staab joins us again for Part 2, which will focus on eating disorder treatment.
By the end of this episode, you should be able to…
Recognize the clinical features of the following eating disorders using DSM-5 diagnostic criteria:
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge Eating Disorder (BED)
Avoidant/Restrictive Food Intake Disorder (ARFID)
Other Specified Feeding or Eating Disorder (OSFED)
Identify predisposing factors for eating disorders using a biopsychosocial framework.
List common comorbid psychiatric conditions associated with eating disorders.
Identify and describe the medical complications of eating disorders.
Guest: Dr. Randolf “Randy” Staab
Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY2), Dr. Vanessa Aversa (PGY3)
Audio editing by: Dr. Nikhita Singhal, Dr. Vanessa Aversa
Show notes by: Dr. Vanessa Aversa
Interview Content:
Introduction - 0:00
Learning objectives - 2:08
DSM-5 definition, clinical features, and associated comorbidities of:
Other Specified Feeding or Eating Disorder (OSFED) - 26:21
Approach to the initial assessment of a patient with an eating disorder - 29:45
Predisposing factors and explanatory models for the development of eating disorders:
Biological factors - 38:10
Psychological factors - 44:00
Sociocultural factors - 48:02
Onset of eating disorders - 49:34
Possible precipitating factors - 51:50
Medical complications of eating disorders:
Cardiovascular - 56:13
Endocrine - 58:09
Musculoskeletal - 1:03:20
Gastrointestinal - 1:05:17
Neurological - 1:08:13
Renal - 1:08:59
Dermatological - 1:09:26
Relevant laboratory investigations - 1:11:27
Overview of refeeding syndrome - 1:12:30
Closing - 1:14:27
Resources:
The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders:https://nedic.ca.
The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment:https://nied.ca.
Body Brave provides accessible eating disorder treatment and support, as well as community training and education:https://bodybrave.ca.
Gaudiani J.Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019.
Mehler PS, Andersen AE.Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017.
McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth.Pediatr Clin North Am. 2016 December; 63(6):1079–1090.https://doi.org/10.1016/j.pcl.2016.07.008
Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women.Int J Eat Disord. 2014 April; 47(3):320–324.https://doi.org/10.1002/eat.22232
PsychEd Episode 65: Psychotherapy in Youth with Dr. Laurence Katz
01:17:33
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers psychotherapy in youth with Dr. Laurence Katz, a professor of child and adolescent psychiatry at the University of Manitoba. Dr. Katz received his medical and adult psychiatric training at the University of Manitoba and his child and adolescent psychiatry training at the Albert Einstein College of Medicine, Bronx N.Y. He is an adjunct scientist at the Manitoba Centre for Health Policy and has published numerous papers using the population health administrative database in mental health outcomes. He has held and been part of numerous grants funded by CIHR, PHAC, and other national funding agencies related to work with First Nations communities. Dr. Katz is widely published in particular in the areas of suicide and suicidal behaviour. His other research interests include Dialectical Behaviour Therapy, pharmacoepidemiology, and implementation of complex interventions.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Outline which psychotherapeutic modalities are commonly used in youth
Identify which youth may benefit/should be referred for psychotherapy
Discuss important considerations in delivering psychotherapy to youth
Guest: Dr. Laurence Katz
Hosts: Wendy MacMillan-Wang, Shaoyuan Wang, Kate Braithwaite, and Sara Abrahamson
Audio editing by: Angad Singh
Show notes by: Kate Braithwaite
Interview content:
Introduction - 0:04
Guest introduction - 00:44
Learning objectives - 05:25
Definitions - 06:00
Types of psychotherapy in youth - 07:44
Evolution of psychotherapy in youth over time - 13:10
Psychotherapy in suicide prevention/risk mitigation - 16:24
Challenges in research: decrease in effect sizes over time - 18:32
Conditions responding best to psychotherapy - 22:01
Youth specific modalities - 26:44
Summary of learning objective 1 - 29:49
Indications and contraindications - 30:23
Consent - 37:31
Group therapy - 39:31
Summary of learning objective 2 - 46:27
Differences in psychotherapy in youth compared to adults in practice - 47:10
Techniques for engagement of youth - 53:32
Family involvement - 58:21
Confidentiality - 1:02:39
Use of mobile apps/internet-based therapies - 1:07:20
Summary of learning objective 3 - 1:11:17
Other considerations - 1:12:35
End credits - 1:16:52
References:
Agostino, H., & Toulany, A. (2023). Considerations for privacy and confidentiality in adolescent health care service delivery. Paediatrics & Child Health, 28(3), 172–183. https://doi.org/10.1093/pch/pxac117
Bailin, A., Cho, E., Sternberg, A., & others. (2023). Principle-guided psychotherapy for children and adolescents (FIRST): Study protocol for a randomized controlled effectiveness trial in outpatient clinics. Trials, 24, Article 682. https://doi.org/10.1186/s13063-023-07717-y
Bhide, A., & Chakraborty, K. (2020). General principles for psychotherapeutic interventions in children and adolescents. Indian Journal of Psychiatry, 62(Suppl 2), S299–S318.
CADDRA - Canadian ADHD Resource Alliance. (2020). Canadian ADHD practice guidelines (4.1 ed.). Toronto, ON: CADDRA.
Christner, R. W., Stewart, J. L., & Mulligan, C. A. (Eds.). (2024). Handbook of cognitive-behavior group therapy with children and adolescents: Specific settings and presenting problems (2nd ed.). Routledge.
Campisi, S. C., Ataullahjan, A., Baxter, J. B., Szatmari, P., & Bhutta, Z. A. (2022). Mental health interventions in adolescence. Current Opinion in Psychology, 48. https://doi.org/10.1016/j.copsyc.2022.101492
Katzman, M. A., Bleau, P., Blier, P., & others. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress, and obsessive-compulsive disorders. BMC Psychiatry, 14(Suppl 1), S1. https://doi.org/10.1186/1471-244X-14-S1-S1
Kendall, P. C., Ney, J. S., Maxwell, C. A., Lehrbach, K. R., Jakubovic, R. J., McKnight, D. S., & Friedman, A. L. (2023). Adapting CBT for youth anxiety: Flexibility within fidelity in different settings. Frontiers in Psychiatry, 14, Article 1067047. https://doi.org/10.3389/fpsyt.2023.1067047
Kernberg, P. F., Ritvo, R., Keable, H., & American Academy of Child an Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2012). Practice Parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child and Adolescent Psychiatry, 51(5), 541–557. https://doi.org/10.1016/j.jaac.2012.02.015
Lam, R. W., Kennedy, S. H., Adams, C., & others. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adults: Réseau canadien pour les traitements de l’humeur et de l’anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry, 69(9), 641–687. https://doi.org/10.1177/07067437241245384
Oetzel, K. B., & Scherer, D. G. (2003). Therapeutic engagement with adolescents in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40(3), 215–225. https://doi.org/10.1037/0033-3204.40.3.215
Wergeland, G. J., Fjermestad, K. W., Marin, C. E., Haugland, B. S., Bjaastad, J. F., Oeding, K., Bjelland, I., Silverman, W. K., Öst, L. G., Havik, Ø. E., & Heiervang, E. R. (2014). An effectiveness study of individual versus group cognitive behavioral therapy for anxiety disorders in youth. Behaviour Research and Therapy, 57, 1–12. https://doi.org/10.1016/j.brat.2014.03.007
Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021). Interventions for self-harm in children and adolescents. Cochrane Database of Systematic Reviews, 3, Article CD013667. https://doi.org/10.1002/14651858.CD013667.pub2
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O'Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., McIntyre, R. S., Kozicky, J., Kanba, S., Lafer, B., Suppes, T., Calabrese, J. R., Vieta, E., Malhi, G., Post, R. M., & Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. https://doi.org/10.1111/bdi.12609
PsychEd Episode 43: Psychedelic-Assisted Psychotherapy with Dr. Emma Hapke and Dr. Daniel Rosenbaum
01:23:18
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychedelic-assisted psychotherapy with Dr Emma Hapke and Dr Daniel Rosenbaum, both of whom are psychiatrists at the University Health Network in Toronto and co-founders of UHN’s Nikean Psychedelic Psychotherapy Research Centre (in addition to being lecturers in the Department of Psychiatry at the University of Toronto).
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Briefly describe the history of psychedelics in psychiatry
List the four classes of psychedelic drugs and their mechanism of action
Summarize the evidence regardingpsychedelic-assisted psychotherapy for various psychiatric disorders
Discuss patient selection considerations for psychedelic-assisted psychotherapy
Describe the safety, tolerability and possible side effects of psychedelic-assisted psychotherapy
Understand how a psychedelic-assisted psychotherapy session is practically carried out
Guests: Dr Emma Hapke and Dr Daniel Rosenbaum
Hosts: Dr Chase Thompson (PGY4), Dr Nikhita Singhal (PGY3), Jake Johnston (CC4), and Annie Yu (CC4)
Audio editing by: Nikhita Singhal
Show notes by:Nikhita Singhal
Interview Content:
Introduction - 0:00
Learning objectives - 02:47
Definitions/categories of psychedelics - 03:24
Classic psychedelics - 04:15
Empathogens (e.g. MDMA) - 07:15
Etymology of the term “psychedelic” - 09:30
Ketamine - 12:24
Iboga - 13:28
Brief history of psychedelic medicine - 17:51
Current evidence and ongoing trials - 27:38
MDMA and PTSD - 29:26
Psilocybin and treatment-resistant depression - 32:24
A word of caution - 34:29
End-of-life care - 38:47
Practical aspects of psychedelic-assisted psychotherapy sessions - 45:45
Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021;384(15):1402-1411.https://doi.org/10.1056/nejmoa2032994
Carhart-Harris R, Nutt D. Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology. 2017;31(9):1091-1120.https://doi.org/10.1177/0269881117725915
Davis AK, Barrett FS, May DG, et al. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(5):481–489.https://doi.org/10.1001/jamapsychiatry.2020.3285
Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. dhttps://dx.doi.org/10.1177%2F0269881116675513
Griffiths RR, Johnson MW, Richards WA, et al. Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. J Psychopharmacol. 2018;32(1):49-69.https://doi.org/10.1177/0269881117731279
Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Ther. 2019;197:83-102.https://doi.org/10.1016/j.pharmthera.2018.11.010
Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033.https://doi.org/10.1038/s41591-021-01336-3
Mithoefer MC, Mithoefer AT, Feduccia AA, et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. 2018;5(6):486-497.https://doi.org/10.1016/s2215-0366(18)30135-4
Nicholas CR, Henriquez KM, Gassman MC, et al. High dose psilocybin is associated with positive subjective effects in healthy volunteers. J Psychopharmacol. 2018;32(7):770-778.https://doi.org/10.1177/0269881118780713
Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol. 2019;26(4):225-226.https://dx.doi.org/10.3747%2Fco.26.5009
Swift TC, Belser AB, Agin-Liebes G, et al. Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress. Journal of Humanistic Psychology. 2017;57(5):488-519.https://doi.org/10.1177/0022167817715966
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 37: Treating Eating Disorders with Dr. Randy Staab
00:52:55
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the second of two episodes covering the topic of eating disorders. In this episode, we explore the treatment of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital.
The learning objectives for the episode are as follows:
By the end of this episode, you should be able to…
Outline the management of eating disorders using a biopsychosocial framework.
Identify the indications for various levels of care (inpatient, residential, day hospital, outpatient, etc).
Understand the ethical and medicolegal dilemmas (i.e. involuntary treatment) that may arise in treatment of eating disorders.
Consider the treatment of special populations (i.e. children and adolescents, older adults, men, LGBTQ+ individuals).
Guest: Dr. Randolf “Randy” Staab
Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY3), Dr. Vanessa Aversa (PGY4)
Audio editing by: Dr. Vanessa Aversa
Show notes by: Dr. Vanessa Aversa, Dr. Nikhita Singhal
Interview Content:
Introduction - 0:00
Learning objectives - 00:39
Biological approaches to treatment:
Nutritional rehabilitation - 03:47
Medications - 06:00
Psychological approaches to treatment -16:35
Treatment of comorbidities - 23:45
Levels of care - 26:00
Ethical dilemmas - 32:40
Special populations:
Children and adolescents - 35:35
Older adults - 36:45
Men - 37:55
LGBTQ+ - 40:23
Novel interventions - 42:48
Closing - 51:47
Resources:
The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders:https://nedic.ca.
The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment:https://nied.ca.
Body Brave provides accessible eating disorder treatment and support, as well as community training and education:https://bodybrave.ca.
Gaudiani J.Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019.
Mehler PS, Andersen AE.Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017.
American Psychiatric Association.Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. 2006.
Geller J, Isserlin L, Seale E, et al. The short treatment allocation tool for eating disorders: current practices in assigning patients to level of care.J Eat Disord. 2018;6(45).https://doi.org/10.1186/s40337-018-0230-2
McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth.Pediatr Clin North Am. 2016 December; 63(6):1079–1090.https://doi.org/10.1016/j.pcl.2016.07.008
Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women.Int J Eat Disord. 2014 April; 47(3):320–324.https://doi.org/10.1002/eat.22232
Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the mental status examination and makes use of practical and fictional examples to delve deeper into the skills and concepts
Learning Objectives:
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Explain the utility and purpose of the mental status examination in psychiatry
Describe the major components of the mental status examination and be familiar with some of the common vocabulary used
Incorporate the mental status in a way that respects patients in presentation, documentation and formulation in clinical practice
Topics:
2:37 - Learning objectives
3:10 - Definition of the MSE
6:48 - History of the MSE
9:00 - Limitations of the MSE
15:37 - Strengths of the MSE
21:30 - ASEPTIC Mnemonic
23:04 - Appearance and Behaviour
37:42 - Speech
51:51 - Emotion (mood and affect)
1:03:51 - Perception
1:08:38 - Thought Form and Content
1:17:30 - Insight and Judgement
1:27:40 - Cognition
Hosts: Andreea Chiorean (CC4), Saja Jaberi (IMG), Dr. Weam Seiffien (PGY2), Angad Singh (CC2), Dr. Annie Yu (PGY1), and Dr. Alex Raben, staff psychiatrist.
Notes, T. (2020). Comprehensive Medical Reference and Review for the Medical Council of Canada Qualifying Exam (MCCQE) Part I and the United States Medical Licensing Exam (USMLE) Step II 36th ed: Toronto Notes for Medical Students.
Recupero, P. R. (2010). The Mental Status Examination in the Age of the Internet. The Journal of the American Academy of Psychiatry and the Law, 38(1).
Robinson D. J. (2002). Mental status exam explained (2nd ed.). Rapid Psychler Press.
Robinson D. J. (1998). Brain Calipers: a guide to a successful mental status exam. Rapid Psychler Press.
Ross, C. A., & Leichner, P. (1988). Residents Performance on the Mental Status Examination. The Canadian Journal of Psychiatry, 33(2), 108–111. https://doi.org/10.1177/070674378803300207
Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Lippincott Williams & Wilkins Publishers.
Spencer, R. J., Noyes, E. T., Bair, J. L., & Ransom, M. T. (2022). Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination. Clinical Gerontologist, 45(3), 454–466. https://doi.org/10.1080/07317115.2022.2032523
The Collected Papers of Adolf Meyer. Volume III: Medical Teaching. (1952) JAMA. 148(17):1544.
PsychEd Episode 41: MAiD and Mental Illness with Dr. Sonu Gaind
01:21:53
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness with our guest expert Dr. Sonu Gaind. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Briefly summarize the history of Medical Assistance in Dying in Canada
Define the present policy on Medical Assistance in Dying and Mental Health in Canada
Evaluate the arguments in support of and against the implementation of Medical Assistance in Dying in Mental Health
Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry
Guest expert: Dr. Sonu Gaind is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Humber River Hospital. Dr. Gaind has testified in front of the Federal External Panel on Options for a Legislative Response to Carter v. Canada, the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the Special Joint Commons/Senate Committee on Physician-Assisted Dying, and the Senate Committee on Legal and Constitutional Affairs on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, and has spoken across the country and internationally on the subject.
Grand Rounds Presenter: Dr. Urvashi Prasad (PGY3)
Produced by: Dr. Urvashi Prasad (PGY3) and Dr. Alex Raben (staff psychiatrist)
Hosts: David Eapen-John (MS2), Dr. Alex Raben (Staff Psychiatrist)
Audio editing by: Dr. Alex Raben (Staff Psychiatrist)
Council of Canadian Academies, 2018.The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition.Ottawa (ON): The Expert Panel Working Group on MAID Where a Mental Disorder Is the Sole Underlying Medical Condition
Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.”Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/.
Tabitha Marshall. “Assisted Suicide in Canada.”The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada.
“Get the Facts: Canada's Medical Assistance in Dying Law.”Dying With Dignity Canada, https://www.dyingwithdignity.ca/get_the_facts_assisted_dying_law_in_canada#mental_illness.
Jones, Roland M, and Alexander I F Simpson. “ Medical Assistance in Dying: Challenges for Psychiatry.”Frontiers in psychiatryvol. 9 678. 10 Dec. 2018, doi:10.3389/fpsyt.2018.00678
Thienpont, Lieve et al. “Euthanasia requests, procedures and outcomes for 100 Belgian patients
suffering from psychiatric disorders: a retrospective, descriptive study.”BMJ openvol. 5,7
Komrad, Mark S. “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients.”Psychiatric Times, 1 June 2021, https://www.psychiatrictimes.com/view/canada-law-provide-not-prevent-suicide.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA).
PsychEd Episode 10: Treatment of Schizophrenia Part II with Dr. Albert Wong
01:00:31
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode is part II in the treatment of schizophrenia series with our expert Dr. Albert Wong, a psychiatrist and research scientist who is an expert in schizophrenia at the Centre for Addiction and Mental Health (CAMH) and professor at the University of Toronto.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Conceptualize antipsychotic drugs categories in in different and clinically relevant ways
Have an approach for choosing an antipsychotic medication for a patient and be able to consent them by going over the benefits and limitations of the medications
Understand the limitations of our understanding of schizophrenia and our current treatments and some of the problems that remain to be solved in this area of psychiatry
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Robinson, D. J. (1997). Brain calipers: A guide to a successful mental status exam. Fort Gratiot, Mich., USA: Rapid Psychler Press.
Kuipers, E., Yesufu-Udechuku, A., Taylor, C., & Kendall, T. (2014). Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ: British Medical Journal (Online), 348.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website:psychedpodcast.org.
25 Oct 2019
PsychEd Episode 21: Motivational Interviewing with Dr. Wiplove Lamba
01:01:45
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Motivational Interviewing (MI) with Dr. Wiplove Lamba (staff psychiatrist), Dr. Anees Bahji (PGY5 resident), and Dr. Marlon Danilewitz (PGY5 resident) who we caught up with after their workshop on MI at the CPA annual conference in Quebec City. In addition to learning the basics about MI, Alex also volunteered to do a real-play with Dr. Lamba to demonstrate some MI techniques (and all in one take!).
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define MI and its utility
Appreciate some of the techniques that are used in MI to increase motivation
Start to use some of these techniques with your patients
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.com. For more information visit our website:psychedpodcast.org.
28 Mar 2022
PsychEd Episode 42: Interpersonal Psychotherapy (IPT) with Dr. Paula Ravitz
01:18:08
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers interpersonal psychotherapy (IPT) with Dr. Paula Ravitz, an Associate Professor of Psychiatry at the University of Toronto and Senior Clinician-Scientist at the Lunenfeld-Tanenbaum Research Institute of Mt Sinai Hospital. Dr. Ravitz held the Morgan Firestone Psychotherapy Chair at the Mount Sinai Hospital from 2011 to 2021 and is a past president of the International Society of Interpersonal Psychotherapy.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define interpersonal psychotherapy
Describe the core principles and phases of IPT
Become familiarized with some psychological theories underpinning IPT
List some patient selection considerations for IPT
Describe the efficacy and evidence base for IPT
Understand how IPT is practically carried out
Briefly compare and contrast IPT to other common psychotherapies
Guest: Dr. Paula Ravitz (paula.ravitz@sinaihealthsystem.ca)
The International Society of Interpersonal Psychotherapy (ISIPT) has a helpful overview of IPT and helpful resources for finding more information and IPT training opportunities:https://interpersonalpsychotherapy.org/
The online IPT curriculum is now available as a University of Toronto, Faculty of Medicine-sponsored open-access online course through Coursera, that is free for learners to audit - https://www.coursera.org/learn/learn-ipt
References:
Bernecker, S. L., Coyne, A. E., Constantino, M. J., & Ravitz, P. (2017). For whom does interpersonal psychotherapy work? A systematic review.Clinical psychology review, 56, 82–93.https://doi.org/10.1016/j.cpr.2017.07.001
Chaimowitz, G., Weerasekera, P., & Ravitz, P. (2021). Psychotherapy in Psychiatry.The Canadian Journal of Psychiatry,66(11), 999–1004.https://doi.org/10.1177/07067437211040958
Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis.The American journal of psychiatry,173(7), 680–687.https://doi.org/10.1176/appi.ajp.2015.15091141
Dennis, C. L., Grigoriadis, S., Zupancic, J., Kiss, A., & Ravitz, P. (2020). Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial.The British journal of psychiatry : the journal of mental science,216(4), 189–196.https://doi.org/10.1192/bjp.2019.275
Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., & Docherty, J. P. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.Archives of general psychiatry,46(11), 971–983.https://doi.org/10.1001/archpsyc.1989.01810110013002
Klerman, G. L., Dimascio, A., Weissman, M., Prusoff, B., & Paykel, E. S. (1974). Treatment of depression by drugs and psychotherapy.The American journal of psychiatry,131(2), 186–191.https://doi.org/10.1176/ajp.131.2.186
MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly.Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 588–603.https://doi.org/10.1177/0706743716659276
Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., Velyvis, V., Kennedy, S. H., Lam, R. W., MacQueen, G. M., Milev, R. V., Ravindran, A. V., Uher, R., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments.Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 524–539.https://doi.org/10.1177/0706743716659418
Ravitz, P., Watson, P., Lawson, A., Constantino, M. J., Bernecker, S., Park, J., & Swartz, H. A. (2019). Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974-2017).Harvard review of psychiatry,27(3), 165–180.https://doi.org/10.1097/HRP.0000000000000219
Swartz, H. (2021). Interpersonal Psychotherapy (IPT) for depressed adults: Indications, theoretical foundation, general concepts, and efficacy.UpToDate. Accessed 2021-10-12.
PsychEd Episode 19: Applying Mental Health Legislation with Kendra Naidoo
00:56:00
Welcome to PsychEd, the psychiatry podcast by medical learners, for medical learners. In this episode from our EPA mini-series on clinical skills we review the Ontario mental health act.
Our guest expert is Kendra Naidoo, legal counsel at the Center for Addiction and Mental Health (CAMH) in Toronto.
The learning objectives for this episode are as follows:
Review some of the history behind mental health legislation in Ontario.
Discuss involuntary hospitalization, including criteria and relevant documentation.
Understand capacity assessments and processes for substitute decision making.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more Psyched, follow us on Twitter and Facebook @PsychEdPodcast. You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website: psychedpodcast.org.
31 Oct 2020
PsychEd Episode 28: Newcomer mental health with Dr. Lisa Andermann, Dr. Clare Pain, and Norma Hannant
00:44:56
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Immigrant and Refugee mental health with not one, not two but three experts in the field: Dr. Lisa Andermann, Dr. Clare Pain, and Norma Hannant.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to:
Explore the social, political and legal context of refugees and immigrants presenting with mental health concerns:
Appreciate the specific mental health needs of refugee and immigrant populations in Canada.
Describe the clinical approach to providing mental health care for this population:
Produced and Hosted by: Dr. Sarah Hanafi (PGY 3), Weam Sieffien (CC3), and Shaoyuan (Randi) Wang (CC3)
Produced by: Dr. Sarah Hanafi (PGY 3), Weam Sieffien (CC3), and Shaoyuan (Randi) Wang (CC3)
Guest experts: Dr. Lisa Andermann, Dr. Clare Pain, Norma Hannant
Robert, A. & Gilkinson, T. (2012). Mental health and well-being of recent immigrants in Canada: Evidence from the Longitudinal Survey of Immigrants to Canada.Citizenship and Immigration Canada.Retrieved 2020-06-16 fromhttps://novascotia.cmha.ca/wp-content/uploads/2020/01/mental-health.pdf
Blair AH, Schneeberg A. Changes in the ‘healthy migrant effect’ in Canada: are recent immigrants healthier than they were a decade ago?. Journal of immigrant and minority health. 2014 Feb 1;16(1):136-42
Vang Z, Sigouin J, Flenon A, Gagnon A. The healthy immigrant effect in Canada: A systematic review. Population Change and Lifecourse Strategic Knowledge Cluster Discussion Paper Series/Un Réseau stratégique de connaissances Changements de population et parcours de vie Document de travail. 2015;3(1):4.
Close C, Kouvonen A, Bosqui T, Patel K, O’Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Globalization and health. 2016 Dec;12(1):47.
Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, Hassan G, Rousseau C, Pottie K. Common mental health problems in immigrants and refugees: general approach in primary care. Cmaj. 2011 Sep 6;183(12):E959-67
Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care.Public Health Reports, 118,293-302.
Harris, M. & Fallot, R.D. (2001). Envisioning a Trauma-informed service system: A vital paradigm shift.New Directions in Mental Health Services, 89,3-22.
Chen AW, Kazanjian A, Wong H. Why do Chinese Canadians not consult mental health services: health status, language or culture?. Transcultural psychiatry. 2009 Dec;46(4):623-41.
Durbin A, Lin E, Moineddin R, Steele LS, Glazier RH. Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada. Open Medicine. 2014;8(4):e136.
Paniagua, F. (2014). Assessing and Treating Culturally DiverseClients: A Practical Guide. Thousand Oaks, California: Sage
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.com. For more information visit our website:psychedpodcast.org.
23 Nov 2021
PsychEd Episode 40: Suicide Epidemiology and Prevention with Dr. Juveria Zaheer
00:54:39
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer,a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populations
Incorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches
Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours
Guest expert: Dr. Juveria Zaheer
Hosts: Dr. Chase Thompson (PGY4)
Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson
Audio editing: Dr. Chase Thompson
Show notes: Dr. Chase Thompson
00:00 – Introduction
01:14 – Learning objectives
04:00 – Overview of suicide rates across populations
07:20 - Sex and gender differences in suicide
08:50 - Suicide following discharge from hospital
14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors
20:50 - Meeting patients and families where they are at
23:30 - Suicide safety plans
28:30 - Evidence-based approaches to suicide prevention
32:30 - Commentary on strength of evidence for interventions in suicide prevention
38:40 - Addressing suicidality in borderline personality disorder
47:00 - Ethics of involuntary hospitalization for suicidality
50:00 - Future of suicide prevention
References:
Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients.The American Journal of Bioethics,19(10), 71-83.
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis.Bmj,346.
Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation.BMJ open,9(3), e023883.
Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis.JAMA psychiatry,74(7), 694-702.
Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies.Social psychiatry and psychiatric epidemiology,54(12), 1459-1470.
Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward.Molecular psychiatry,25(1), 168-179.
Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review.Jama,294(16), 2064-2074.
Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study.JAMA psychiatry,74(6), 563-570.
Sakinofsky, I. (2014). Preventing suicide among inpatients.The Canadian journal of psychiatry,59(3), 131-140.
Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department.JAMA psychiatry,75(9), 894-900.
Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders.Schizophrenia research,202, 347-353.
Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders.Psychiatric Clinics of North America,31(3), 527-543.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA).
PsychEd Episode 51: Mental Illness and Violence with Dr. Robert McMaster and Dr. Ragy Girgis
01:02:47
Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the “big picture” relationship between violence and severe mental illnesses such as schizophrenia and bipolar spectrum disorders. Our guest experts in this episode are Dr. Robert McMaster, Assistant Professor of Forensic Psychiatry at the University of Toronto and Dr. Ragy R. Girgis, Associate Professor of Clinical Psychiatry at Columbia University in New York.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Describe the epidemiology of violence in severe mental illness (rates of perpetration vs. victimization, risk factors, quality of evidence)
Understand and critique how society currently addresses violence in those with severe mental illness
Discuss this topic with patients, caregivers and the public, and address common myths
Guests:
Dr. Robert McMaster - Assistant Professor of Forensic Psychiatry at the University of Toronto
Dr. Ragy R. Girgis - Associate Professor of Clinical Psychiatry at Columbia University in New York
Hosts: Dr. Alex Raben (Staff Psychiatrist), Dr. Gaurav Sharma (PGY4), Sena Gok(IMG), Josh Benchaya (CC4)
Audio editing by: Gaurav Sharma
Show notes by: Josh Benchaya, Gaurav Sharma, Sena Gok
Interview Content:
Learning Objectives: 02:29
Perceptions of Violence and Mental Illness: 03:53
Mental illness & Violence Link Evidence: 06:48
Violence Perpetration & Victimisation: 10:10
Risk of Violence Assessment (HCR 20 Model): 17:00
Mass Shootings & Mental Illness & Predictions: 20:30
Violence Risk Prediction: 25:25
Severe Mental Illness & Violence Risk Treatments: 29:40
Society’s approach to Severe Mental Illness & Violence Misperceptions: 38:30
Mental Illness and Violence Stigma: 45:03
Case Vignette & Approach: 46:44
Summary of the episode: 58:00
References:
de Mooij, L.D., Kikkert, M., Lommerse, N.M., Peen, J., Meijwaard, S.C., Theunissen, J., Duurkoop, P.W., Goudriaan, A.E., Van, H.L., Beekman, A.T. and Dekker, J.J., 2015. Victimization in adults with severe mental illness: prevalence and risk factors. The British Journal of Psychiatry, 207(6), pp.515-522.
Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community violence perpetration and victimization among adults with mental illnesses. American journal of public health, 104(12), 2342-2349.
Metzl, J.M., Piemonte, J. and McKay, T., 2021. Mental illness, mass shootings, and the future of psychiatric research into American gun violence. Harvard review of psychiatry, 29(1), p.81.
Buchanan, A., Sint, K., Swanson, J. and Rosenheck, R., 2019. Correlates of future violence in people being treated for schizophrenia. American Journal of Psychiatry, 176(9), pp.694-701.
Rund, B.R., 2018. A review of factors associated with severe violence in schizophrenia. Nordic journal of psychiatry, 72(8), pp.561-571.
Markowitz FE. Mental illness, crime, and violence: Risk, context, and social control. Aggress Violent Behav. 2011 Jan 1;16(1):36–44.
Pescosolido BA, Manago B, Monahan J. Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences. Health Aff Proj Hope. 2019 Oct;38(10):1735–43.
Ross AM, Morgan AJ, Jorm AF, Reavley NJ. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc Psychiatry Psychiatr Epidemiol. 2019 Jan 1;54(1):11–31.
Srivastava K, Chaudhury S, Bhat PS, Mujawar S. Media and mental health. Ind Psychiatry J. 2018;27(1):1–5.
Stuart H. Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness? CNS Drugs. 2006;20(2):99–106.
Rowaert S, Vandevelde S, Lemmens G, Audenaert K. How family members of mentally ill offenders experience the internment measure and (forensic) psychiatric treatment in Belgium: A qualitative study. Int J Law Psychiatry. 2017;54:76–82.
Bjørn Rishovd Rund (2018) A review of factors associated with severe violence in schizophrenia, Nordic Journal of Psychiatry, 72:8, 561-571, DOI: 10.1080/08039488.2018.1497199
References cited by our experts:
Steadman, H.J., Monahan, J., Pinals, D.A., Vesselinov, R. and Robbins, P.C., 2015. Gun violence and victimization of strangers by persons with a mental illness: data from the MacArthur Violence Risk Assessment Study. Psychiatric services, 66(11), pp.1238-1241. [00:05:26]
Appelbaum PS, Robbins PC, Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry. 2000 Apr;157(4):566-72. doi: 10.1176/appi.ajp.157.4.566. PMID: 10739415. [00:05:26]
Torrey EF, Stanley J, Monahan J, Steadman HJ; MacArthur Study Group. The MacArthur Violence Risk Assessment Study revisited: two views ten years after its initial publication. Psychiatr Serv. 2008 Feb;59(2):147-52. doi: 10.1176/ps.2008.59.2.147. PMID: 18245156. [00:05:26]
Witt, K., Hawton, K. and Fazel, S., 2014. The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophrenia research, 154(1-3), pp.61-67. [00:08:46]
Sariaslan, A., Arseneault, L., Larsson, H., Lichtenstein, P., & Fazel, S. (2020). Risk of subjection to violence and perpetration of violence in persons with psychiatric disorders in Sweden. JAMA psychiatry, 77(4), 359-367. [00:11:20]
Douglas, K. S., Shaffer, C., Blanchard, A. J. E., Guy, L. S., Reeves, K., & Weir, J. (2014). HCR-20 violence risk assessment scheme: Overview and annotated bibliography. HCR-20 Violence Risk Assessment White Paper Series, #1. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University. [00:18:53]
Girgis, R.R., Rogers, R.T., Hesson, H., Lieberman, J.A., Appelbaum, P.S. and Brucato, G., 2022. Mass murders involving firearms and other methods in school, college, and university settings: findings from the Columbia Mass Murder Database. Journal of forensic sciences. [00:25:11]
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 59: Critical Psychiatry with Dr. Elia Abi-Jaoude and Lucy Costa
01:03:55
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the field of critical psychiatry with Dr. Elia Abi-Jaoude and Lucy Costa. Dr. Abi-Jaoude is a staff psychiatrist at The Hospital for Sick Children and Assistant Professor and Clinician Investigator in the Department of Psychiatry at the University of Toronto in Toronto, Canada. Lucy Costa is Deputy Executive Director of the Empowerment Council, a voice for clients of mental health and addiction services primarily at the Centre for Addiction and Mental Health in Toronto.
While this topic could be very philosophical and expansive, we are going to focus our discussion by considering the practical implications of this field on psychiatric practice. What do you need to know about critical psychiatry as a trainee, and how might it impact your clinical practice?
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Define the term critical psychiatry and describe how the field has evolved over time
Review core principles of critical psychiatry and apply them to a clinical situation
Understand the potential benefits and harms of critical psychiatry and where the field is headed
Guests: Dr. Eila Abi-Jaoude and Lucy Costa
Hosts: Dr. Gaurav Sharma (PGY5), Dr. Nikhita Singhal (PGY5), Dr. Monisha Basu (PGY2), and Saja Jaberi (IMG)
Audio editing by: Gaurav Sharma
Show notes by: Gaurav Sharma and Nikhita Singhal
Conflicts of interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic.
Interview content:
Introduction - 00:13
Learning objectives - 02:35
Defining critical psychiatry - 03:33
How our experts got involved in critical psychiatry and incorporate it into their work - 04:50
What are some of the questions critical psychiatry tries to answer? - 15:07
Why care about critical psychiatry and “holding truths lightly”? - 23:55
Principles of critical psychiatry - 24:55
Applying critical psychiatry principles to a case - 32:40
Potential benefits and harms of a critical psychiatry approach - 41:49
Future directions for critical psychiatry - 58:29
Review of learning objectives and summary - 1:01:30
Barkil-Oteo A. Collaborative care for depression in primary care: how psychiatry could "troubleshoot" current treatments and practices. Yale J Biol Med. 2013 Jun 13;86(2):139-46.
Craddock N, Mynors-Wallis L. Psychiatric diagnosis: impersonal, imperfect and important. The British Journal of Psychiatry. 2014;204(2):93-95. doi:10.1192/bjp.bp.113.133090
Kirsch I. The emperor's new drugs: medication and placebo in the treatment of depression. Handb Exp Pharmacol. 2014;225:291-303. doi:10.1007/978-3-662-44519-8_16
Middleton H, Moncrieff J. Critical psychiatry: a brief overview. BJPsych Advances. 2019;25(1):47-54. doi:10.1192/bja.2018.38
O'Donoghue T, Crossley J. A critical narrative analysis of psychiatrists' engagement with psychosis as a contentious area. Int J Soc Psychiatry. 2020 Nov;66(7):724-730. doi: 10.1177/0020764020934516
Samara MT, Dold M, Gianatsi M, et al. Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia: A Network Meta-analysis. JAMA Psychiatry. 2016;73(3):199–210. doi:10.1001/jamapsychiatry.2015.2955
Important figures in the history of anti-psychiatry and critical psychiatry (discussion edited from episode for length):
PsychEd Episode 4: Treatment of Bipolar Disorder with Dr. Roger McIntyre
01:01:02
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers treatment of bipolar disorder with Dr. Roger McIntyre, Professor of Psychiatry and Pharmacology at University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, Canada.
In this episode, we follow the case of Devon, a 28 year old male who presents to the ER with acute mania and is diagnosed with bipolar disorder. Our team of psychiatry residents from University of Toronto guide you through Devon’s trajectory with reference to CANMAT guidelines and expertise from Dr. McIntyre. We discuss how to manage acute mania and acute depression and what management looks like for outpatients (pharmacological and non-pharmacological). Special topics include treating severe agitation on the inpatient ward and things to consider for lithium treatment.
The Learning Objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Treat acute mania and depression in bipolar disorder
Prevent relapse in bipolar disorder through maintenance pharmacotherapy
Prevent relapse through nonpharmacological interventions
Obtain informed consent for and initiate lithium treatment
Guest staff psychiatrist: Dr. Roger McIntyre (University Health Network, Toronto)
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
01 Sep 2023
PsychEd Episode 57: HIV psychiatry with Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel
00:57:03
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers HIV/AIDS psychiatry with special guests from two international settings to provide complementary perspectives on HIV psychiatry. Dr. Adriana Carvalhal, HIV Psychiatrist and Staff Psychiatrist at Scarborough Health Network in Canada and Dr. Leigh Van Den Heuvel, Psychiatrist and Associate Professor in the Department of Psychiatry, at Stellenbosch University in South Africa.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health
Identify HIV-specific mental health disorders and how to screen for these conditions
Outline the overall approach to treatment for HIV patients with mental health disorders
Guests: Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel
Produced by: Saja Jaberi (MD), Kate Braithwaite (MD) and Gaurav Sharma (PGY5)
Hosts: Kate Braithwaite (MD) and Gaurav Sharma (PGY5)
Audio editing by: Gaurav Sharma (PGY5)
Show notes by: Saja Jaberi (MD) and Gaurav Sharma (PGY5)
Conflicts of Interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Generic names are used for all medications referenced.
Contents:
Introduction - 0:19
Learning objectives - 3:52
The bidirectional relationship between HIV and psychiatric illness - 4:24
Prevalence of psychiatric illness in HIV - 9:56
Screening for psychiatric illness in HIV populations - 12:11
HIV Associated Neurocognitive Disorder (HAND) - 19:27
Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.
Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.
Awori V, Mativo P, Yonga G, Shah R. The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus. South Afr J HIV Med. 2018 Apr 12;19(1):674. doi: 10.4102/sajhivmed.v19i1.674. PMID: 29707383; PMCID: PMC5913780.
Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19. PMID: 27325690; PMCID: PMC4981762.
Clinical Care Guidelines for Adults and Adolescents living with HIV in Ontario, Canada. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)
Core Concepts - Screening for Mental Health Conditions - Basic HIV Primary Care - National HIV Curriculum (uw.edu)
Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci. 2021;50:271-298. doi: 10.1007/7854_2019_116. PMID: 31559600.
EACS Guidelines version 11.1, October 2022.
Joska JA, Witten J, Thomas KG, Robertson C, Casson-Crook M, Roosa H et al. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS and behavior. 2016 Aug 1;20(8):1621-1631. doi: 10.1007/s10461-016-1316-y
Kolakowska A, Maresca AF, Collins IJ, Cailhol J. Update on Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options Infect Dis. 2019;11(4):372-387. doi: 10.1007/s40506-019-00203-7. Epub 2019 Nov 16. PMID: 33380904; PMCID: PMC7758219.
Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci. 2021;50:429-478. doi: 10.1007/7854_2019_117. PMID: 32677005.
Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci. 2021;50:175-191. doi: 10.1007/7854_2019_101. PMID: 31396894.
Southern African HIV Clinicians Society. Management of mental health disorders in HIV-positive patients. S Afr J HIV Med 2013; 14(4): 155 - 165
Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Erratum in: Clin Infect Dis. 2021 Dec 08;: Erratum in: Clin Infect Dis. 2022 Nov 30;75(11):2052. PMID: 33225349.
Turjanski, N., & Lloyd, G. (2005). Psychiatric side-effects of medications: Recent developments. Advances in Psychiatric Treatment, 11(1), 58-70. doi:10.1192/apt.11.1.58
Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, Lu L, Bao Y. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurology. 2020 Nov 10;95(19):e2610-e2621. doi: 10.1212/WNL.0000000000010752. Epub 2020 Sep 4. PMID: 32887786.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 9: Treatment of Schizophrenia Part 1 with Dr. Jason Joannou and Dr. Andrew Lustig
00:47:21
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of schizophrenia with Dr. Jason Joannou and Dr. Andrew Lustig, two inpatient staff psychiatrists at the Centre for Addiction and Mental Health (CAMH) and assistant professors at the University of Toronto.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Articulate the basic psychopharmacology of antipsychotics
Create a basic treatment presenting with a first episode of schizophrenia, based on the 2017 Guidelines for the Pharmacotherapy of Schizophrenia in Adults
Summarize principles of longitudinal treatment, which includes treatment-resistant schizophrenia and psychosocial approaches to the illness.
Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $230 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change!
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.com.For more information visit our website:psychedpodcast.org.
27 Dec 2020
PsychEd Episode 30: Anti-black Racism and Mental Health with Dr. Kwame McKenzie
01:04:36
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers anti-black racism and mental health with Dr. Kwame McKenzie. Dr. McKenzie is an international expert on the social causes of illness, suicide and the development of effective, equitable health systems. He is a Professor of Psychiatry at University of Toronto and a staff psychiatrist and Director of Health Equity at the Centre of Addiction and Mental Health.
The learning objectives:
By the end of this episode, you should be able to…
Understand the history and legacy of racism and mental health in the black community
Understand the current state of racism towards black people and the impacts on their mental health.
Explore how healthcare workers can be anti-racist in providing mental health care and how the system can change to improve the mental health of black people.
Host(s): Anita Corsini (social worker), Dr. Alex Raben (staff psychiatrist), and Rebecca Marsh (CC4)
Produced by: Anita Corsini, Rebecca Marsh, Randi Wang (CC4), and Dr. Alex Raben
Guest experts: Dr. Kwame McKenzie, staff psychiatrist
Adelman, J. (2003). Study in Blue and Grey, Police Interventions with People with Mental Illness: A Review of Challenges and Responses [Ebook]. Canadian Mental Health Association. Retrieved 7 October 2020, from https://cmha.bc.ca/wp-content/uploads/2016/07/policereport.pdf.
Bailey, R. K., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: current perspectives. Neuropsychiatric disease and treatment, 15, 603–609. https://doi.org/10.2147/NDT.S128584
Bor, J., Venkataramani, A., Williams, D., & Tsai, A. (2018). Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. The Lancet, 392(10144), 302-310. https://doi.org/10.1016/s0140-6736(18)31130-9
Bresnahan, M., Begg, M., Brown, A., Schaefer, C., Sohler, N., & Insel, B. et al. (2007). Race and risk of schizophrenia in a US birth cohort: another example of health disparity?. International Journal Of Epidemiology, 36(4), 751-758. https://doi.org/10.1093/ije/dym041
Chakraborty, A., McKenzie, K., & King, M. (2009). Discrimination, ethnicity and psychosis — a qualitative study. Ethnicity And Inequalities In Health And Social Care, 2(1), 18-29. https://doi.org/10.1108/17570980200900004
Fernando, S. (2014). Racism in psychiatry. In R. Moodley & M. Ocampo (Eds.), Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando in Clinical Practice (pp. 22-32). Taylor & Francis.
Kirkmayer, L. J. (2014). Critical psychiatry in Canada. In R. Moodley & M. Ocampo (Eds.), Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando in Clinical Practice (pp. 170-181). Taylor & Francis.
Kuper, A. (2018). Cultural Safety & Equity [Lecture PDF]. Retrieved from University of Toronto Faculty of Medicine.
Maynard, R. (2017). Policing Black Lives: State Violence in Canada from Slavery to the Present. Fernwood.
McKenzie, K. (2002). Does racial discrimination cause mental illness?. European Psychiatry, 17, 84. https://doi.org/10.1016/s0924-9338(02)80385-6
McKenzie, K., & Bhui, K. (2007). Institutional racism in mental health care. BMJ, 334(7595), 649-650. https://doi.org/10.1136/bmj.39163.395972.80
Richardson, L. (2019). Diversity and Advocacy [Lecture PDF]. Retrieved from University of Toronto Faculty of Medicine.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website: psychedpodcast.org.
07 Jul 2017
Psyched Episode 3 a): Diagnosis of Bipolar Disorder (Mania) with Dr. Mark Sinyor
00:49:06
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers the diagnosis of Bipolar Disorder (Type 1 and 2), with insights from guest Dr. Mark Sinyor, Staff Psychiatrist at Sunnybrook Health Sciences Centre.
Bipolar disorder is characterized by depressive and manic episodes. This episode focuses on the diagnostic criteria and assessment in mania, and presents a fictional case of a patient with a first manic episode. We discuss the epidemiology of bipolar disorder, and a plain-English description of manic episodes. We then explore the DSM-5 diagnostic criteria for manic episodes using the mnemonic GSTPAID. Relating the criteria back to the case, we will talk with Dr. Sinyor about practical methods and tips for assessing a person who presents with manic symptoms. Some common mental status exam terms and findings in mania will be explained. We then discuss common differential diagnoses for bipolar disorder, including schizoaffective disorder, schizophrenia, borderline personality disorder, and substance intoxication/substance-induced mania.
Lastly, we will differentiate between mania and hypomania, and Bipolar Disorder Type 1 and Type 2. Through the examination of the concept of “bipolar spectrum”, we will discuss some challenges and limitations of the DSM-5 and the current understanding of Bipolar Disorder. The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:
Cite the prevalence and incidence rates of bipolar affective disorder
Describe the natural history of bipolar disorder including its cyclical nature, and relative ratio of times in mania vs depression
Know the DSM-V criteria for mania, hypomania
Suggested mnemonic GSTPAID
Perform an effective diagnostic interview for manic symptoms
Perform a differential diagnosis for bipolar disorder including borderline personality disorder and psychotic disorders
Guest Staff Psychiatrist: Dr. Mark Sinyor (Sunnybrook Health Sciences Centre, Toronto)
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
30 Jun 2019
PsychEd Episode 14: Diagnosis and Treatment of PTSD with Dr. Dana Ross
00:57:01
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we comprehensively review the diagnosis and treatment of PTSD, and explore the psychological and physiological underpinnings of trauma.
Our guest expert is Dr. Dana Ross. She is a psychiatrist in the Trauma Therapy Program at Women’s College Hospital in Toronto, Canada. She is also a founder of Trauma Education Essentials Inc. which provides trauma-focused educational webinars, online courses, and workshops to health professionals and organizations
The learning objectives for this episode are as follows:
Know the prevalence and incidence rates of Posttraumatic Stress Disorder (PTSD)
Recognize the clinical features of PTSD using DSM-5 diagnostic criteria
List 5 common risk factors for the development of PTSD
Describe evidence-based pharmacological and psychological treatments for
Recommended Readings by Dr. Ross:
The Body Keeps the Score by Bessel Van der Kolk, MD
Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care by Clark, Classen, Fourt, & Shetty
Trauma and Recovery by Judith Herman, MD
The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris, MD
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website:psychedpodcast.org.
23 Jul 2018
UPDATE: Research Survey, Feedback and New Episodes
00:02:20
Please take our 5-minute RESEARCH SURVEY. (more details below)
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. We apologize that we don't have a new episode for you this month but we are working hard behind the scenes both on new episodes and on medical education research into podcasting. Don't fear, new episodes are on the way!
In the meantime, we have a favour to ask. We have started a research project to improve PsychEd and to better understand how medical learners use podcasts. We are asking for our listeners help in completing this brief 5-minute RESEARCH SURVEY.
Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $250 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change!
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
06 Jun 2020
PsychEd Episode 25: Understanding Attachment with Dr. Diane Philipp
00:55:43
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
In this episode, we explore Attachment Theory, a key foundational framework in psychiatry which concerns relationships and the ways in which infants seek proximity to caregivers in development.
Our guest expert is Dr. Diane Philipp, a child and adolescent psychiatrist at the Sick kids Center for Community Mental Health in Toronto and Assistant Professor at the University of Toronto. She has developed a family therapy method called Reflective Family Play, a model of therapy which aims to improve parent-child dynamics, and more specifically attachment. She currently practices reflective family play and also teaches this method locally and internationally.
Produced and Hosted by Dr. Chase Thompson (PGY2) and Dr. Lucy Chen (PGY5)
Audio Editing by Dr. Alex Raben (PGY5)
The learning objectives for this episode are as follows:
Define attachment theory
Review the history of attachment theory and how the field developed
Briefly review the evolutionary basis, and functional role of attachment in infants
Briefly review the neurobiological perspectives of attachment
Outline and describe different types of attachment and attachment disorders
Learn how infant attachment is assessed in contemporary psychiatry/psychology
Learn how attachment disorders impact adult relationships and child rearing
Some sources for further reading:
Ainsworth, Mary S. “Infant-mother attachment” American psychologist 34.10 (1979): 932
Bowlby, J. "Lecture 2: The origins of attachment theory." A secure base (1988): 20-38.
Cicchetti, Dante, Fred A. Rogosch, and Sheree L. Toth. "Fostering secure attachment in infants in maltreating families through preventive interventions." Development and psychopathology 18.3 (2006): 623-649.
Cohen, Nancy J., et al. "Watch, wait, and wonder: Testing the effectiveness of a new approach to mother–infant psychotherapy." Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health 20.4 (1999): 429-451.
Collins, Nancy L. "Working models of attachment: Implications for explanation, emotion, and behavior." Journal of personality and social psychology 71.4 (1996): 810.
Feeney, Judith A., and Patricia Noller. "Attachment style as a predictor of adult romantic relationships." Journal of personality and Social Psychology 58.2 (1990): 281.
George, Carol, Nancy Kaplan, and Mary Main. "Adult attachment interview." (1996).
Insel, Thomas R., and Larry J. Young. “The neurobiology of attachment.” Nature Reviews Neuroscience 2.2 (2001):129
Main, Mary. "Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment." Journal of consulting and clinical psychology 64.2 (1996): 237.
Simpson, Jeffry A., et al. "Attachment and the experience and expression of emotions in romantic relationships: A developmental perspective." Journal of personality and social psychology 92.2 (2007): 355.
Sroufe, L. Alan, et al. "Implications of attachment theory for developmental psychopathology." Development and psychopathology 11.1 (1999): 1-13.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodast@gmail.comFor more information visit our website:psychedpodcast.org.
23 Mar 2018
PsychEd Episode 6: Diagnosing Generalized Anxiety Disorder with Dr. Jared Peck
00:37:29
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto.
In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) sit down with Dr. Peck to help them understand the clinical construct of generalized anxiety disorder (GAD). In addition to understanding how to make the diagnosis they also cover the epidemiology natural course, differential diagnosis and routine investigations for GAD.
By the end of this episode, the listener will be able to…
Recognize the clinical features of GAD using DSM-5 diagnostic criteria
Appreciate the differential diagnosis and how to conduct assessments to help clinical judgment
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
15 Apr 2019
PsychEd Episode 12: Treatment of Schizophrenia Part IV Advanced Principles of Schizophrenia Treatment with Dr. Gary Remington
00:57:41
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode is our fourth and final episode in our mini-series on schizophrenia. In this episode, we take an advanced look at the clinical management of schizophrenia, including a discussion of treatment-resistant schizophrenia and clozapine.Warning: this content in this episode is a little bit more advanced than usual, but also ultra interesting.
Our guest expert is Dr. Gary Remington. He is a researcher, psychiatrist, Chief of the Schizophrenia Division at CAMH and an author of the 2017 Canadian schizophrenia guidelines
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Have an approach to treating a first episode psychosis of schizophrenia
Understand the important components of maintenance treatment in schizophrenia
Understand the concept of treatment-resistant schizophrenia (TRS)
Know when to initiate clozapine
List some of the psychosocial interventions involved in treating schizophrenia
Kapur, S., Remington, G., Jones, C., & Wilson, A. (1996). High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study.The American journal of psychiatry,153(7), 948.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.comFor more information visit our website:psychedpodcast.org.
07 Mar 2019
PsychEd Episode 11: Treatment of Schizophrenia Part III CTOs and ACTT with Dr. Arash Nakhost
00:42:17
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers community treatment orders (CTOs) and assertive community treatment (ACT) teams in the context of schizophrenia treatment with Dr. Arash Nakhost a staff psychiatrist who works on the FOCUS ACT team at St. Michael’s Hospital.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Provide a brief description of the history of ACT teams and CTOs, as well as the challenges in establishing evidence for their use
Compare and contrast ACT teams with intensive case management teams in terms of their composition, methods, and respective strengths and weaknesses
Describe the array of services that an ACT team can help provide to its clients as well as some of the challenges and drawbacks of ACT teams
Outline the major reasons someone might be put on a community treatment order and describe how a CTO is applied and enforced
Outline the major challenges in using CTOs as a treatment tool
Guest staff psychiatrist: Dr. Arash Nakhost (St. Michael’s Hospital, Toronto)
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
17 Jan 2018
PsychEd Episode 5: Diagnosing Schizophrenia with Dr. Andrew Lustig and Dr. Jason Joannou
00:43:03
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Schizophrenia, which guest speakers Dr. Jason Joannou and Dr. Andy Lustig from the CAMH inpatient psychiatry unit.
In this episode we discuss schizophrenia, with the following objectives:
1. The DSM V diagnostic criteria of schizophrenia
2. The impact of the disease and its trajectory
3. The differential diagnosis of schizophrenia
4. Clinical approach to patients with schizophrenia
5. The Mental Health Act and involuntary admission
By the end of this episode, the listener will be able to…
1. Know the DSM V diagnostic criteria of schizophrenia and specific manifestations of the disease
2. Know some of the epidemiology, triggers and impact of the disease
3. Know the differential diagnosis of schizophrenia and its subtypes
4. Know how to elicit a good history and how to approach patients with schizophrenia
5. Know the Mental Health Act and the legalities around forming a patient with schizophrenia.
The perspectives we have elicited in this episode are from inpatient psychiatrists who generally tend to see more severe cases of schizophrenia.
CPA Note: The content of this podcast are created for medical Learners by medical learners. The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
29 Jun 2022
PsychEd Episode 45: Perinatal Psychiatry with Dr. Tuong Vi Nguyen
00:40:17
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define the field of perinatal psychiatry
Describe the key issues that should be addressed in pre-conception psychiatric counseling
Discuss the management approach for prescribing medications during pregnancy
Recognize the prevalence of mood disorders during the perinatal period
Recall the diagnostic criteria for postpartum depression
Consider the risk factors and explanatory models for postpartum depression
Discuss the use of screening tools for postpartum depression
Outline the treatment for postpartum depression
Describe the clinical presentation of postpartum psychosis and recognize the urgency of this condition
List important risk factors for postpartum psychosis
Discuss the management for postpartum psychosis
Guest: Dr. Tuong Vi Nguyen
Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)
Produced by:Nima Nahiddi (PGY4), Audrey Le (PGY1), Rebecca Marsh (PGY2) and Arielle Geist (PGY2)
Audio editing by: Audrey Le
Show notes by: Arielle Geist
Interview content:
Introduction - 00:00
Learning objectives - 00:43
Defining the field of perinatal psychiatry - 01:55
Key issues to address in preconception counseling - 02:50
Management approach for prescribing medications during pregnancy - 07:00
Prevalence of mood disorders during the perinatal period - 12:11
Diagnostic criteria for postpartum depression - 14:05
Differentiating postpartum psychosis from postpartum depression - 16:52
Risk factors and explanatory models for postpartum depression - 18:58
Screening tools for postpartum depression - 20:15
Treatment for postpartum depression - 22:13
Pharmacotherapy - 22:20
Psychotherapy - 27:34
Clinical presentation of postpartum psychosis - 29:07
Risk factors for postpartum psychosis - 30:43
Postpartum psychosis prognosis and impacts on attachment- 32:57
Management of postpartum psychosis -35:30
Closing comments - 38:00
Resources:
Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort.BMJ open, 7(1), e013372. https://doi.org/10.1136/bmjopen-2016-013372
Boukhris, T., Sheehy, O., Mottron, L., & Bérard, A. (2016). Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children.Jama Pediatrics, 170(2), 117-24. doi: 10.1001/jamapediatrics.2015.3356.
Brown, A. S., Gyllenberg, D., Malm, H., McKeague, I. W., Hinkka-Yli-Salomäki, S., Artama, M., Gissler, M., Cheslack-Postava, K., Weissman, M. M., Gingrich, J. A., & Sourander, A. (2016). Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring.JAMA psychiatry, 73(11), 1163–1170. https://doi.org/10.1001/jamapsychiatry.2016.2594
Cohen, J. , Hernández-Díaz, S. , Bateman, B. , Park, Y. , Desai, R. , Gray, K. , Patorno, E. , Mogun, H. & Huybrechts, K. (2017). Placental Complications Associated With Psychostimulant Use in Pregnancy.Obstetrics & Gynecology, 130(6), 1192-1201. doi: 10.1097/AOG.0000000000002362.
Huybrechts, K. F., Hernández-Díaz, S., Patorno, E., Desai, R. J., Mogun, H., Dejene, S. Z., Cohen, J. M., Panchaud, A., Cohen, L., & Bateman, B. T. (2016). Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations.JAMA psychiatry, 73(9), 938–946. https://doi.org/10.1001/jamapsychiatry.2016.1520
Huybrechts, K. F., Palmsten, K., Avorn, J., Cohen, L. S., Holmes, L. B., Franklin, J. M., Mogun, H., Levin, R., Kowal, M., Setoguchi, S., & Hernández-Díaz, S. (2014). Antidepressant use in pregnancy and the risk of cardiac defects.The New England Journal of Medicine, 370(25), 2397–2407.https://doi.org/10.1056/NEJMoa1312828
Imaz, M. L., Oriolo, G., Torra, M., Soy, D., García-Esteve, L., & Martin-Santos, R. (2018). Clozapine Use During Pregnancy and Lactation: A Case-Series Report.Frontiers in Pharmacology, 9,264. https://doi.org/10.3389/fphar.2018.00264
Nörby, U., Forsberg, L., Wide, K., Sjörs, G., Winbladh, B., & Källén, K. (2016). Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy.Pediatrics, 138(5), e20160181. https://doi.org/10.1542/peds.2016-0181
Nörby, U., Winbladh, B., & Källén, K. (2017). Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy.Pediatrics, 140(6), e20170747. https://doi.org/10.1542/peds.2017-0747
Reis, M., & Källén, B. (2013). Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A registered study.BMJ Open, 3, e002166. doi:10.1136/bmjopen-2012-002166
Sundram S. (2006). Cannabis and neurodevelopment: implications for psychiatric disorders.Human psychopharmacology, 21(4), 245–254. https://doi.org/10.1002/hup.762
References:
Boland, R., Verduin, M., & Ruiz, P. (2021). Psychopharmacology. InKaplan & Sadock's synopsis of psychiatry(Twelfth edition.). Philadelphia: Wolters Kluwer.
Jones, I., Chandra, P.S., Dazzan, P., & Howard, L.K. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period.Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2.
Nieldson, D., Videbech, P., Hedegaard, M., Dalby, J., & Secher, N.J. (2005). Postpartum depression: identification of women at risk.An International Journal of Obstetrics and Gynaecology, 107(10), 1210-1217. https://doi-org.myaccess.library.utoronto.ca/10.1111/j.1471-0528.2000.tb11609.x
Schiller, C.E., Meltzer-Brody, S., & Rubinow, D.R. (2015). The role of reproductive hormones in postpartum depression.CNS Spectrums, 20(1), 48-59. doi: 10.1017/S1092852914000480
Viguera, A. (2021). Mild to moderate postpartum unipolar major depression: Treatment.UpToDate.Accessed 2021-01-18.
Wisner, K.L., Sit, D.K.Y., & McShea, M.C. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.JAMA Psychiatry,70(5), 490-498. doi:10.1001/jamapsychiatry.2013.87
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode is an introduction to the use and monitoring of lithium in bipolar disorder. Join Tingting Yan (CC4) and Dr. Alex Raben (staff psychiatrist at CAMH and lecturer at the University of Toronto) for a lively case-based discussion.
Learning Objectives
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Describe the indications and process for starting lithium
Monitor and interpret serum lithium levels
List short and long-term adverse effects of lithium
Produced by: Tingting Yan CC4, Dr. Alex Raben (staff psychiatrist)
Hosts: Tingting Yan, Alex Raben
Audio editing by: Alex Raben
Show notes by: Alex Raben
Contents:
Learning objectives: 00:44
Lithium background and brief history: 2:48
Women’s health and lithium: 5:28
Underutilization of lithium: 8:02
Baseline blood work for lithium: 11:32
Choosing a lithium starting dose: 14:32
Lithium serum levels: 16:17
Lithium titration: 20:46
Lithium toxicity: 23:48
Lithium side effects: 26:52
Summary: 32:11
References
Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet. 1970;2(7668):326-330. doi:10.1016/s0140-6736(70)92870-9
Chokhawala K, Lee S, Saadabadi A. Lithium. StatPearls.
Davis J, Desmond M, Berk M. Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification. BMC nephrology. 2018 Dec;19:1-7.
Draaisma D. Lithium: the gripping history of a psychiatric success story. Nature. 2019 Aug 1;572(7769):584-6.
Hedya SA, Avula A, Swoboda HD. Lithium toxicity.
Malhi GS, Bell E, Outhred T, Berk M. Lithium therapy and its interactions. Australian Prescriber. 2020 Jun;43(3):91.
Malhi GS, Gessler D, Outhred T. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. J Affect Disord. 2017;217:266-280. doi:10.1016/j.jad.2017.03.052
McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721-728. doi:10.1016/S0140-6736(11)61516-X
Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S. Lithium use in pregnancy and the risk of cardiac malformations. New England Journal of Medicine. 2017 Jun 8;376(23):2245-54.
Tondo L, Alda M, Bauer M, Bergink V, Grof P, Hajek T, Lewitka U, Licht RW, Manchia M, Müller-Oerlinghausen B, Nielsen RE. Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders. 2019 Dec;7(1):1-0.
Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders. 2018 Mar;20(2):97-170.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 62: Antipsychotic Side Effects with Dr. Alex Raben
00:58:57
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Antipsychotic Side Effects with our very own expert Dr Alex Raben, a staff psychiatrist in chronic care at the Centre for Addiction and Mental Health in Toronto.
Dr. Raben graduated from medical school and completed residency at the University of Toronto. His academic interests include teaching and medical education scholarship with a particular interest in novel modalities of knowledge translation within the field of psychiatry. He is a founding member and Executive Director of PsychEd, this educational psychiatry podcast which aims to empower medical learners to seek out current knowledge from mental health experts to share with their colleagues around the world.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Outline the side effects of antipsychotics and their known/potential mechanisms
Discuss management options for the different side effects
Identify which antipsychotics are more likely to cause certain side effects
Guest: Dr Alex Raben
Hosts: Angad Singh and Kate Braithwaite
Audio editing by: Angad Singh
Show notes by: Angad Singh and Kate Braithwaite
Interview Content:
Introduction - 0:00
Primer on antipsychotics - 1:54
Anti-dopamine side effects - 5:04
Drug potency as it relates to side effects - 38:46
Anticholinergic side effects - 41:37
Antiadrenergic side effects - 47:30
Metabolic side effects - 50:29
Sedation - 56:46
Please note that this episode does not include a discussion of the life threatening side effects of antipsychotics. These include neuroleptic malignant syndrome, torsades de pointes, laryngospasm, and seizure.
de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC psychiatry. 2016;16:1-0.
Migirov A, Datta AR. Physiology, Anticholinergic Reaction. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546589/
Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3-7. PMID: 16001094; PMCID: PMC487011.
Roerig JL, Steffen KJ, Mitchell JE. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS drugs. 2011;25:1035-59.
Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press; 2021.
Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-56.
PsychEd Episode 58: Depression in Children and Adolescents with Dr. Darren Courtney
00:57:16
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto.
Dr. Courtney earned his MD in 2004 at Queen’s University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth.
Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Outline the prevalence and risk factors for depression in children and adolescents
Explain how children and adolescents with depression present in clinical practice
Discuss the use of screening tools for depression in this population
Describe an approach to the management of depression in children and adolescents
Outline the management of an adolescent with suicidal thoughts or behaviours
Guest: Dr. Darren Courtney
Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5)
Audio editing by: Nikhita Singhal
Show notes by: Kate Braithwaite and Nikhita Singhal
Interview Content:
Introduction - 0:00
Learning objectives - 02:11
Prevalence of depression in youth - 03:11
Risk factors for depression in youth - 06:25
Diagnosing depression in youth - 08:30
Screening tools - 14:24
Approach to taking a history from youth - 19:45
Management of depression in youth - 30:12
Psychotherapies - 33:20
Medications - 37:37
Assessing and managing suicidality in youth - 44:00
Includes links to various tools for health care providers, researchers, youth, and other stakeholders (such as teachers and family members) informed by research evidence
References:
Bennett K, Courtney D, Duda S, Henderson J, Szatmari P. An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth. Depress Anxiety. 2018 Jun;35(6):530-540. https://doi.org/10.1002/da.22752
Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry. 2020 Aug;14(4):486-494. https://doi.org/10.1111/eip.12918
Georgiades K, Duncan L, Wang L, Comeau J, Boyle MH; 2014 Ontario Child Health Study Team. Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Can J Psychiatry. 2019 Apr;64(4):246-255. https://doi.org/10.1177%2F0706743719830024
Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess. 2017 Mar;21(12):1-94. https://doi.org/10.3310/hta21120
Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. https://doi.org/10.1002/14651858.CD013674.pub2
MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016 Sep;61(9):588-603. https://doi.org/10.1177%2F0706743716659276
National Institute for Health and Care Excellence. Depression in children and young people: Identification and management NG134 [Internet]. London: NICE; 2019 Jun 25 [cited 2023 Sep 22]. Available from: https://www.nice.org.uk/guidance/ng134.
Parikh A, Fristad MA, Axelson D, Krishna R. Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2020 Oct;29(4):587-599. https://doi.org/10.1016/j.chc.2020.06.001
Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):479-502. https://doi.org/10.1016/j.jaac.2022.10.001
Wiens K, Bhattarai A, Pedram P, Dores A, Williams J, Bulloch A, Patten S. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr Sci. 2020 Apr 17;29:e115. https://doi.org/10.1017%2FS2045796020000281
PsychEd Episode 7: Treatment of Generalized Anxiety Disorder with Dr. Jared Peck
00:40:31
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto.
In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) reunite with Dr. Peck to talk about the bio-psycho-social management of GAD. They cover recommended lifestyle changes for people with GAD, evidence-based pharmacotherapies, including SSRIs, SNRIs, Pregabalin, Quetiapine, TCAs and benzodiazepines, and how to choose between them, and psychotherapeutic treatments with a focus on CBT and a quick overview of some of the third wave cognitive models.
By the end of this episode, the listener will be able to…
List the lifestyle changes recommended for people with GAD
Describe the first line and second line medication therapies for GAD and the rationale supporting each agent's place in the treatment hierarchy
Appreciate the key elements of CBT that make it effective for the treatment of GAD
Please Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association or the University of Toronto and are not meant to replace formal clinical education or judgment.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
01 May 2021
PsychEd Episode 35: Pain Psychiatry with Dr. Leon Tourian
01:06:22
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers the psychiatric aspects of chronic pain with expert guest:
Dr. Leon Tourian, Associate Professor in the Department of Psychiatry at McGill University, and psychiatrist at the MUHC Alan Edwards Pain Management Unit.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to
Explore the role of psychiatry in the management of pain
Discuss the epidemiology of psychiatric comorbidities in pain disorders.
Outline the pathophysiology of pain and its relationship to psychiatric disorders.
Outline the role of non-pharmacological management/treatment of pain including psychotherapy and central neuromodulation
Discuss a general psychopharmacology approach in the management of pain relief and psychiatric comorbidities with chronic pain (including SNRI, TCAs, anticonvulsants, antipsychotics and cannabinoids).
Discuss the intersection of pain medicine with somatic symptom and related disorders
Guest: Dr. Leon Tourian
Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4)
Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic medicine, 64(5), 773–786. https://doi.org/10.1097/01.psy.0000024232.11538.54
Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(4), 160–167. https://doi.org/10.1177/070674371506000402
O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. The Cochrane database of systematic reviews, 4(4), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5
Ratcliffe, G. E., Enns, M. W., Belik, S. L., & Sareen, J. (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. The Clinical journal of pain, 24(3), 204–210. https://doi.org/10.1097/AJP.0b013e31815ca2a3
Tunks, E. R., Crook, J., & Weir, R. (2008). Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 53(4), 224–234. https://doi.org/10.1177/070674370805300403
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 26: Nutritional Psychiatry with Dr. Laura LaChance
00:52:23
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers nutritional psychiatry with expert guest Dr. Laura LaChance, Staff Psychiatrist and Director of Outpatient Psychiatry at St. Mary’s Hospital Centre in Montreal, Quebec and Faculty Lecturer in the Department of Psychiatry at McGill University.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
1) Define nutritional psychiatry
2) Understand the mechanisms, common misconceptions, challenges, and current evidence supporting the role for nutrition in mental health
3) Apply this understanding to clinical cases in psychiatry
Guest: Dr. Laura LaChance
Hosts: Dr. Sarah Hanafi (PGY2), Dr. Nima Nahiddi (PGY2), Gray Meckling (CC3)
Audio editing by Dr. Alex Raben (PGY5)
Show notes by Gray Meckling
Interview Content:
· Introduction and learning objectives – 0:35
· Dr. Laura LaChance’s professional background – 1:50
· Definition of nutritional psychiatry and history of the field – 3:35
· Putative mechanisms through which nutrition is implicated in mental health – 7:00
· Common misconceptions surrounding the role for nutrition in mental health – 11:45
· Current evidence supporting the role for nutrition in the management of psychiatric illness – 16:00
· Case-based examples of nutrition in clinical psychiatry – 23:35
· Challenges to capitalizing on this mode of intervention in psychiatry – 32:30
· Taking a dietary history in the context of mental health – 34:50
· Future directions in the field of nutritional psychiatry – 41:20
· The gut-microbiome – 43:00
· Tips for those interested and how to get involved – 48:00
· Adan, R. A., van der Beek, E. M., Buitelaar, J. K., Cryan, J. F., Hebebrand, J., Higgs, S., ... & Dickson, S. L. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology.
· Auction, Monique & LaChance, Laura & Cooley, Kieran & Kidd, Sean. (2019). Diet and Psychosis: A Scoping Review. Advances in Integrative Medicine. 6. S101. 10.1016/j.aimed.2019.03.292.
· Firth J, Veronese N, Cotter J, Shivappa N, Hebert J, Ee C, Smith L, Stubbs B, Jackson S, Sarris J. What is the role of dietary inflammation in severe mental illness? a review of observational and experimental findings. Frontiers in psychiatry. 2019;10:350.
· Firth, J., Carney, R., Stubbs, B., Teasdale, S. B., Vancampfort, D., Ward, P. B., ... & Sarris, J. (2018). Nutritional deficiencies and clinical correlates in first-episode psychosis: a systematic review and meta-analysis. Schizophrenia bulletin, 44(6), 1275-1292.
· Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. A brief diet intervention can reduce symptoms of depression in young adults–A randomised controlled trial. PloS one. 2019;14(10).
· Guu TW, Mischoulon D, Sarris J, Hibbeln J, McNamara RK, Hamazaki K, Freeman MP, Maes M, Matsuoka YJ, Belmaker RH, Jacka F. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder. Psychotherapy and psychosomatics. 2019;88(5):263-73.
· Jacka, F. N. (2017). Nutritional psychiatry: where to next?. EBioMedicine, 17, 24-29.
· Jacka F, O’Neil A, Opie R, et al. A randomized controlled trial of dietary improvement for adults with major depression (the SMILES trial). BMC Med. 2017; 15:23.
· LaChance, L. R., & Ramsey, D. (2018). Antidepressant foods: An evidence-based nutrient profiling system for depression. World journal of psychiatry, 8(3), 97–104. https://doi.org/10.5498/wjp.v8.i3.97
· Lachance, L., & Ramsey, D. (2015). Food, mood, and brain health: Implications for the modern clinician. Missouri medicine, 112(2), 111.
· Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proc Nutr Soc. 2017;76: 427-436.
· Lakhan, S. E., & Vieira, K. F. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition journal, 9(1), 42.
· Mörkl S, Butler MI, Holl A, Cyran JF, Dinan TG. Probiotics and the Microbiota-Gut-Brain Axis: Focus on Psychiatry. Current Nutrition Reports. 2020 May 13.
· Mörkl, S., Wagner-Skacel, J., Lahousen, T., Lackner, S., Holasek, S. J., Bengesser, S. A., ... & Reininghaus, E. (2020). The role of nutrition and the gut-brain axis in psychiatry: a review of the literature. Neuropsychobiology, 79(1-2), 80-88.
· Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsenga T, Blunden S, Meyer B, Segal L. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutritional neuroscience. 2019 Jul 3;22(7):474-87.
· Sarris J, Logan AC, Akbaraly TN, et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2: 271-274.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 54: Cannabis and Psychosis with Dr. Nitin Chopra
01:08:36
Welcome to PsychEd - the psychiatry podcast for medical learners, by medical learners. This episode covers the relationship between cannabis and psychotic disorders, as well as the potential impact of cannabis legalization in Canada, with our special guest Dr. Nitin Chopra. This episode was originated by Dr. Luke Fraccaro for his Grand Rounds.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Briefly summarize the effects of cannabis on mental health and cognition, with a focus on psychosis.
Appreciate the evidence for cannabis use as a potential cause of persistent psychotic disorders.
Discuss the possible impact that recent cannabis legislation may have had on cannabis use and psychosis in Canada.
Guest Expert Dr. Nitin Chopra is an addictions psychiatrist at the Centre for Addiction and Mental Health (CAMH) and is an Assistant Professor in the Department of Psychiatry at the University of Toronto. He has an interest in concurrent disorders and is a staff psychiatrist on the Concurrent Addictions Inpatient Treatment Service and Concurrent Outpatient Medical and Psychosocial Addiction Support Service. Through his work on the Psychiatry Addictions Capacity Building and Consultation Service (PACCS) at CAMH and the Addiction Medicine and Psychosocial Addictions ECHO program, he is evolving into a leader in capacity building and education for addictions treatment. Furthermore, Dr. Chopra also works on the Early Psychosis Unit at CAMH and has extensive clinical experience working with patients experiencing psychosis, often with comorbid cannabis and other substance use.
Grand Rounds Presenter: Dr. Luke Fraccaro (PGY3)
Produced by: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)
Hosts: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)
Audio Editing by: Dr. Luke Fraccaro (PGY3)
Show notes by: Dr. Luke Fraccaro (PGY3)
Conflicts of Interest: There are no known conflict of interests to report
Topics:
0:00 - Introduction
2:50 - Objectives
3:55 - Case example
7:25 - Overview of cannabis effects of mental health
10:45 - Differentiating clinically between cannabis-induced psychosis and a primary psychotic disorder
13:11 - Cannabis causing acute psychotic symptoms
14:15 - Back to the case
16:05 - Overlapping risk factors for cannabis use and psychotic disorders
18:14 - Cannabis use as a potential cause of persistent psychotic disorders (Reviewing the evidence)
30:14 - Summary of the relationship between cannabis and psychosis and how to apply it clinically
35:20 - Cannabis legalization in Canada
39:45 - Canadian studies on potential impact of cannabis legalization on psychosis
44:33 - Brief review of American studies on potential impact of cannabis legalization on psychosis.
46:35 - Summary of potential impact of legalization
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Arlington, VA: American Psychiatric Association, 2022.
Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. Can J Psychiatry. 2022 Jun 16:7067437221099769. doi: 10.1177/07067437221099769. Epub ahead of print. PMID: 35711159.
Xue S, Husain MI, Zhao H, Ravindran AV. Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies. Can J Psychiatry. 2021 Feb;66(2):126-138. doi: 10.1177/0706743720952251. Epub 2020 Sep 10. PMID: 32909828; PMCID: PMC7918873.
Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N. Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 2016 Apr 1;79(7):557-67. doi: 10.1016/j.biopsych.2015.12.002. Epub 2015 Dec 8. PMID: 26858214.
Wilkinson ST, Radhakrishnan R, D'Souza DC. Impact of Cannabis Use on the Development of Psychotic Disorders. Curr Addict Rep. 2014 Jun 1;1(2):115-128. doi: 10.1007/s40429-014-0018-7. PMID: 25767748; PMCID: PMC4352721.
Hindley G, Beck K, Borgan F, Ginestet CE, McCutcheon R, Kleinloog D, Ganesh S, Radhakrishnan R, D'Souza DC, Howes OD. Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis. Lancet Psychiatry. 2020 Apr;7(4):344-353. doi: 10.1016/S2215-0366(20)30074-2. Epub 2020 Mar 17. PMID: 32197092; PMCID: PMC7738353.
Ksir, C., Hart, C.L. Cannabis and Psychosis: a Critical Overview of the Relationship. Curr Psychiatry Rep 18, 12 (2016).
Ganesh S, D'Souza DC. Cannabis and Psychosis: Recent Epidemiological Findings Continuing the "Causality Debate". Am J Psychiatry. 2022 Jan;179(1):8-10. doi: 10.1176/appi.ajp.2021.21111126. PMID: 34974754.
Hasan A, von Keller R, Friemel CM, Hall W, Schneider M, Koethe D, Leweke FM, Strube W, Hoch E. Cannabis use and psychosis: a review of reviews. Eur Arch Psychiatry Clin Neurosci. 2020 Jun;270(4):403-412. doi: 10.1007/s00406-019-01068-z. Epub 2019 Sep 28. PMID: 31563981.
Petrilli K, Ofori S, Hines L, Taylor G, Adams S, Freeman TP. Association of cannabis potency with mental ill health and addiction: a systematic review. Lancet Psychiatry. 2022 Sep;9(9):736-750. doi: 10.1016/S2215-0366(22)00161-4. Epub 2022 Jul 25. PMID: 35901795.
Buchy L, Perkins D, Woods SW, Liu L, Addington J. Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophr Res. 2014 Jul;156(2-3):277-80. doi: 10.1016/j.schres.2014.04.021. Epub 2014 May 14. PMID: 24837058; PMCID: PMC4082820.
Gillespie NA, Kendler KS. Use of Genetically Informed Methods to Clarify the Nature of the Association Between Cannabis Use and Risk for Schizophrenia. JAMA Psychiatry. 2021 May 1;78(5):467-468. doi: 10.1001/jamapsychiatry.2020.3564. PMID: 33146687.
Johnson EC, Hatoum AS, Deak JD, Polimanti R, Murray RM, Edenberg HJ, Gelernter J, Di Forti M, Agrawal A. The relationship between cannabis and schizophrenia: a genetically informed perspective. Addiction. 2021 Nov;116(11):3227-3234. doi: 10.1111/add.15534. Epub 2021 May 19. PMID: 33950550; PMCID: PMC8492483.
Fischer, B., Lee, A., Robinson, T. et al. An overview of select cannabis use and supply indicators pre- and post-legalization in Canada. Subst Abuse Treat Prev Policy 16, 77 (2021). https://doi.org/10.1186/s13011-021-00405-7
Myran DT, Imtiaz S, Konikoff L, Douglas L, Elton-Marshall T. Changes in health harms due to cannabis following legalisation of non-medical cannabis in Canada in context of cannabis commercialisation: A scoping review. Drug Alcohol Rev. 2023 Feb;42(2):277-298. doi: 10.1111/dar.13546. Epub 2022 Sep 27. PMID: 36165188.
Vignault C, Massé A, Gouron D, Quintin J, Asli KD, Semaan W. The Potential Impact of Recreational Cannabis Legalization on the Prevalence of Cannabis Use Disorder and Psychotic Disorders: A Retrospective Observational Study. Can J Psychiatry. 2021 Dec;66(12):1069-1076. doi: 10.1177/0706743720984684. Epub 2021 Feb 11. PMID: 33567893; PMCID: PMC8689454.
Callaghan RC, Sanches M, Murray RM, Konefal S, Maloney-Hall B, Kish SJ. Associations Between Canada's Cannabis Legalization and Emergency Department Presentations for Transient Cannabis-Induced Psychosis and Schizophrenia Conditions: Ontario and Alberta, 2015-2019. Can J Psychiatry. 2022 Aug;67(8):616-625. doi: 10.1177/07067437211070650. Epub 2022 Jan 12. PMID: 35019734; PMCID: PMC9301152.
D'Souza DC, DiForti M, Ganesh S, George TP, Hall W, Hjorthøj C, Howes O, Keshavan M, Murray RM, Nguyen TB, Pearlson GD, Ranganathan M, Selloni A, Solowij N, Spinazzola E. Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis. World J Biol Psychiatry. 2022 Dec;23(10):719-742. doi: 10.1080/15622975.2022.2038797. Epub 2022 Mar 22. PMID: 35315315.
Wang, G. S., Buttorff, C., Wilks, A., Schwam, D., Tung, G., & Pacula, R. L. (2022). Impact of cannabis legalization on healthcare utilization for psychosis and schizophrenia in Colorado. International Journal of Drug Policy, 104, 103685.
Kim, H. S., & Monte, A. A. (2016). Colorado Cannabis Legalization and Its Effect on Emergency Care. Annals of emergency medicine, 68(1), 71–75. https://doi-org.proxy3.library.mcgill.ca/10.1016/j.annemergmed.2016.01.004
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.
24 Apr 2023
PsychEd Episode 53: Insomnia with Dr. Michael Mak
01:12:41
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the Journey Through Stages of Sleep with Dr. Michael Mak, Assistant Professor in the Department of Psychiatry at the University of Toronto, and an Adjunct Research Professor at Western University.
The learning objectives for this episode are as follows:
Understand the basics of sleep physiology, including the stages of sleep
Recognize the clinical features of insomnia disorder using the ICSD-3 and DSM-5-TR criteria
Develop an approach to the assessment of insomnia
Identify the pharmacological and non-pharmacological treatments for insomnia disorder
Guest: Dr. Michael Mak (Staff Psychiatrist)
Hosts: Dr. Vanessa Aversa (PGY4), Andreea Chiorean (CC4), Sena Gok (IMG)
Audio editing by: Sena Gok
Show notes by: Sena Gok
Contents:
Introduction: 0:16
Learning Objectives: 01:49
Definition and Clinical features of insomnia (ICSD-3 and DSM-5-TR criteria): 02:39
Insomnia prevalence, cost effects: 05:25
Sleep physiology: 10:05
Stages of Sleep: 11:37
Changes in Sleep stages during Insomnia: 14:35
Melatonin/Orexin systems: 15:45
Assessment and diagnosis of Insomnia: 21:00
Risk Factors of Insomnia: 30:12
CBT for Insomnia (CBT-I): 31:35
Relaxation-based techniques: 40:25
Contraindication for Insomnia: 42:15
Pharmacological treatments of insomnia: 45:15
Summary: 1:11:10
Resources:
1. Wainberg M, Jones SE, Beaupre LM, Hill SL, Felsky D, Rivas MA, et al. Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank. PLOS Med. 2021 Oct 12;18(10):e1003782.
2. Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial. JAMA. 2009 May 20;301(19):2005–15. :
3. Crescenzo FD, D’Alò GL, Ostinelli EG, Ciabattini M, Franco VD, Watanabe N, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. The Lancet. 2022 Jul 16;400(10347):170–84.
4. Watanabe Y, Kuroki T, Ichikawa D, Ozone M, Uchimura N, Ueno T. Effect of smartphone-based cognitive behavioral therapy app on insomnia: a randomized, double-blind study. Sleep. 2023 Mar 1;46(3):zsac270.
5. Erland LAE, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 13(02):275–81.
6. Sweetman A, McEvoy RD, Smith S, Catcheside PG, Antic NA, Chai-Coetzer CL, et al. The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial. Sleep. 2020 Jul 13;43(7):zsaa002.
7. Origins of Sleep Medicine: Dr. Nathaniel Kleitman,, Dr. Mark Mahowald, Dr. Carlos Schenck
PsychEd Episode 66: ADHD in Youth with Dr. Daniel Gorman
01:12:32
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers ADHD in youth with Dr. Daniel Gorman, an Associate Professor in the Department of Psychiatry at the University of Toronto and a Staff Psychiatrist at The Hospital for Sick Children. Dr Gorman’s clinical and academic interests include ADHD, Tourette syndrome, obsessive-compulsive disorder, child psychopharmacology, psychiatric education, and narrative medicine. He is highly involved in resident teaching and clinical supervision, and from 2014 to 2022 he was the Program Director for the Child and Adolescent Psychiatry subspecialty program at the University of Toronto.
Dr. Gorman has given over 85 invited presentations and authored or co-authored over 35 peer-reviewed articles and book chapters, mainly related to childhood neuropsychiatric disorders and their pharmacological management. He also contributed to several Canadian guidelines, including guidelines on cardiac risk assessment before the use of stimulants, management of tic disorders, pharmacotherapy for childhood disruptive and aggressive behaviour, and pharmacogenetic testing for children treated with psychiatric medications.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Review diagnostic criteria for ADHD
Describe important considerations in making the diagnosis of ADHD
Describe psychosocial aspects of management of ADHD
Outline the pharmacological management of ADHD
Guest: Dr. Daniel Gorman
Hosts: Dr. Kate Braithwaite, Dr. Shaoyuan Wang (PGY-4), Matthew Cho (MS-4)
Biederman, J., DiSalvo, M., Fried, R., Woodworth, K. Y., Biederman, I., & Faraone, S. V. (2019). Quantifying the protective effects of stimulants on functional outcomes in attention-deficit/hyperactivity disorder: A focus on number needed to treat statistic and sex effects. Journal of Adolescent Health, 65(6), 784–789. https://doi.org/10.1016/j.jadohealth.2019.06.016
Peterson, B. S., Trampush, J., Brown, M., Maglione, M., Bolshakova, M., Rozelle, M., Miles, J., Pakdaman, S., Yagyu, S., Motala, A., & Hempel, S. (2024). Tools for the diagnosis of ADHD in children and adolescents: A systematic review. Pediatrics, 153(4), e2024065854. https://doi.org/10.1542/peds.2024-065854
Canadian Pediatric Society. (2022). Mental health: Screening tools and rating scales. Canadian Pediatric Society. Retrieved January 31, 2025, from https://cps.ca/mental-health-screening-tools
PsychEd Episode 20: Understanding rTMS with Dr. Jonathan Downar
00:31:33
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers repetitive transcranial magnetic stimulation (rTMS) with Dr. Jonathan Downar, a world expert and leading researcher on rTMS, and clinical fellow Dr. Jean-Phillippe Miron. In addition to learning the basics about rTMS, you will also be listening to Henry Barron’s first-hand experience with non-therapeutic rTMS treatment to help bring some of the learning principles to life.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Understand generally how rTMS is conducted and some of the theory behind how it works
Understand where rTMS fits in the treatment algorithm for depression and what kind of patient characteristics should be considered before initiating rTMS
Appreciate the benefits, side effects and drawbacks of rTMS and how it compares to other depression treatments
Guest staff psychiatrist: Dr. Jonathan Downar, Associate Professor at the University of Toronto andCo-Director of the MRI-Guided rTMS Clinic at University Health Network.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email atpsychedpodcast@gmail.comFor more information visit our website:psychedpodcast.org.
31 Jul 2023
PsychEd Episode 56: Understanding Trauma and Addictions with Dr. Gabor Maté
01:02:43
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers trauma and addictions with Dr. Gabor Maté, a retired physician who, after 20 years of family practice and palliative care experience, worked for over a decade in Vancouver’s Downtown East Side with patients challenged by drug addiction and mental illness. The bestselling author of five books published in thirty languages, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Maté is an internationally renowned speaker highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. For his groundbreaking medical work and writing he has been awarded the Order of Canada, his country’s highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver. His fifth book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture was released on September 13, 2022.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Understand the connection between trauma and the development of addictions and other mental illnesses
Critically reflect on current diagnostic and treatment paradigms
Apply principles of trauma-informed care to psychiatric assessment and the provision of mental health services
Guest: Dr Gabor Maté
Hosts: Sena Gok, Rhys Linthorst, Angad Singh, Nikhita Singhal, and Alex Raben
Brown, T., Berman, S., McDaniel, K., Radford, C., Mehta, P., Potter, J., & Hirsh, D. A. (2021). Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Academic medicine: journal of the Association of American Medical Colleges, 96(5), 661–667. https://doi.org/10.1097/ACM.0000000000003587
Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/
Colon-Rivera Hector, A., Aoun, E. & Vaezazizi, L. M. (2023). Addiction Psychiatric Medicine: A Comprehensive Board Review. Elsevier.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Michaels, T. I., Stone, E., Singal, S., Novakovic, V., Barkin, R. L., & Barkin, S. (2021). Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World journal of psychiatry, 11(6), 222–231. https://doi.org/10.5498/wjp.v11.i6.222
Olsen Y. (2022). What Is Addiction? History, Terminology, and Core Concepts. The medical clinics of North America, 106(1), 1–12. https://doi.org/10.1016/j.mcna.2021.08.001
Panksepp J. (2011). The basic emotional circuits of mammalian brains: do animals have affective lives? Neuroscience and biobehavioral reviews, 35(9), 1791–1804. https://doi.org/10.1016/j.neubiorev.2011.08.003
Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of anxiety disorders, 88, 102558. https://doi.org/10.1016/j.janxdis.2022.102558
Shonkoff, J. P., Richter, L., van der Gaag, J., & Bhutta, Z. A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), e460–e472. https://doi.org/10.1542/peds.2011-0366
Volkow, N. D., & Li, T. K. (2004). Drug addiction: the neurobiology of behaviour gone awry. Nature reviews. Neuroscience, 5(12), 963–970. https://doi.org/10.1038/nrn1539
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 29: Cultural Psychiatry with Dr. Eric Jarvis
01:02:05
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the topic of cultural psychiatry with expert guest Dr. Eric Jarvis, Staff Psychiatrist and Director of the Cultural Consultation Service and the First Episode Psychosis Program at the Jewish General Hospital in Montreal, Quebec and Associate Professor in the Department of Psychiatry at McGill University.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define culture
Describe how culture affects psychiatric care
Outline the goal and structure of a Cultural Formulation Interview
Evaluate clinical scenarios to determine whether to employ the Cultural Formulation Interview or seek a cultural consultation
Define the three types of cultural concepts of distress, and compare these with DSM-5 nosology
Discuss the concept of cultural competency
Explore the role of advocacy in psychiatric practice
Guest expert: Dr. Eric Jarvis
Hosts: Dr. Sarah Hanafi (PGY3), Audrey Le (CC4)
Audio editing by Dr. Sarah Hanafi (PGY3)
Show notes by Dr. Sarah Hanafi (PGY3)
Interview Content:
Introductions: 0:28
Learning objectives: 3:01
Definition of cultural psychiatry: 3:52
Definition of culture: 6:50
Disparities in mental health outcomes 12:48
The Cultural Formulation Interview (CFI) 15:59
Cultural concepts of distress 34:28
Cultural competency 40:46
Role of advocacy in psychiatry 48:04
Tips for those interested and training opportunities 51:26
Cultural Formulation. (2017). InDiagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.
Kirmayer, L. J., Fung, K., Rousseau, C., Lo, H. T., Menzies, P., Guzder, J., . . . Mckenzie, K. (2020). Guidelines for Training in Cultural Psychiatry.The Canadian Journal of Psychiatry,070674372090750. doi:10.1177/0706743720907505
Kirmayer, L. J., Kronick, R., & Rousseau, C. (2018). Advocacy as Key to Structural Competency in Psychiatry.JAMA Psychiatry,75(2), 119. doi:10.1001/jamapsychiatry.2017.3897
Kirmayer, L.J., Rousseau, C., Jarvis, G.E. and Guzder, J. (2008). The Cultural Context of Clinical Assessment. In Psychiatry (eds A. Tasman, J. Kay, J.A. Lieberman, M.B. First and M. Maj). doi:10.1002/9780470515167.ch4
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 16: Biopsychosocial Formulation with Dr. Erin Carter
01:04:27
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we discuss the biopsychosocial formulation--what it is and how we do it . Our guest expert is Dr. Erin Carter, an in-patient psychiatrist at St. Joseph's Healthcare Centre in Toronto, Canada.
The learning objectives for this episode are as follows:
1. Understand the components of a biopsychosocial formulation 2. Develop an approach to organizing and eliciting salient information to aid in formulation 3. Distinguish between summary and synthesis of information 4. Understand how to communicate a formulation effectively 5. Use the biopsychosocial formulation to inform a management plan
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
26 Jan 2020
PsychEd Episode 22: Psycho-Oncology Assessments with Dr. Elie Isenberg-Grzeda
01:15:24
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode is an introduction to the subspeciality of psychosocial oncology, focusing on 10 key content areas that you want to supplement your general psychiatric interview with. Along the way, we discuss the history of the field, contemporary controversies and useful interviewing techniques that can help with history collection, therapeutic alliance, and formulation.
Learning objectives:
Gain familiarity with unique content areas to include in the assessment of patients with cancer
Learn interview techniques to facilitate accurate and efficient history taking in this patient population
Increase knowledge around the concept of cancer-related distress and how it informs patient formulation, intervention, and DSM-5 Diagnosis
Host: Dr. Jordan Bawks, PGY4 in Psychiatry at the University of Toronto
Guest: Dr. Elie Isenberg-Grzeda, Psychiatrist at Sunnybrook Health Sciences Centre and Assistant Professor at the University of Toronto
Timestamps for Content:
4-11minutes - History of Psycho-Oncology
11- 14minutes –Distress Screening
14- 16minutes – Overview of specific content areas in psychosocial oncology assessments
15:50 – Cancer history
20:10- Beliefs about illness
24:00- Physical symptoms
26:00- Body Image
33:55- Coping
38:30- Family Supports &
41:00- Counseling on Cancer Disclosure to Family Members
49:30- Work Disruption
52:00- Religion & Spirituality
57:30- Death, Dying, Prognosis
1:04:45- Diagnostic dilemmas
1:10:30- Closing thoughts
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website:psychedpodcast.org.
17 Jul 2019
PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer
00:56:18
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors for self-harm and suicide and components of risk assessment.
Our guest expert is Dr. Juveria Zaheer. She is a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Emergency Department at CAMH. Her research focuses on suicide, gender and culture, and she is the lead author of the Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention.
The learning objectives for this episode are as follows:
Be familiar with the risk factors and predictors of suicide, as well as protective factor
Be familiar with the components of a Suicide Risk assessment
Be familiar with how to comprehensively document and communicate the risk assessment
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
Credits note: Alex Raben provided audio-editing for this episode.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website:psychedpodcast.org.
22 Sep 2020
PsychEd Episode 27: Serotonin Pharmacology: From SSRIs to Psychedelics with Dr. Robin Carhart-Harris
01:14:37
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
In this episode, we begin to explore the neurobiology of the serotonin system — along with key pharmacological agents (SSRIs and classical psychedelics) that act on this system — with guest expert Dr. Robin Carhart-Harris, a neuroscientist andhead of the Centre for Psychedelic Research at Imperial College London.
Our discussion is more theoretical than directly clinically relevant, striving to provide a mechanistic understanding of how serotonin functions within the brain and how serotonin-modulating drugs influence this system. The episode was inspired by a review published by our guest expert and Dr. David Nutt called “Serotonin and brain function: a tale of two receptors” (cited below). If you are interested in the topic, you might consider reading this review in full! Please note that the figures referenced during this episode can be accessed at https://journals.sagepub.com/doi/figure/10.1177/0269881117725915.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Understand the general anatomy and function of the serotonin system, with a focus on the purported activity of the more common serotonin receptors and transporters.
Describe the effects of serotonin reuptake inhibitors and how they lead to symptom improvement in mood and anxiety disorders, in addition to the mechanism of action of other serotonergic medications.
Consider the two-pronged serotonin system conceptualized by Dr. Carhart-Harris, and understand how serotonergic agents (including SSRIs and classic psychedelics) and the concepts of active and passive coping fit within this theory.
Guest: Dr. Robin Carhart-Harris, a neuroscientist andhead of the Centre for Psychedelic Research at Imperial College London.
Produced and hosted by: Dr. Chase Thompson (PGY3), Dr. Lucy Chen (Psychiatrist), Dr. Nikhita Singhal (PGY2)
Audio editing by: Dr. Chase Thompson
Infographicby: Dr Chase Thompson, Dr Nikhita Singhal
Interview Content:
00:18 - Introductions
3:00 - Learning objectives
4:10 - Introduction to serotonin
10:30 - 5HT1A receptors
24:30 - 5HT2A receptors
30:20 - Serotonin system operation under normal conditions
35:00 - Introduction of bipartite model / two divergent methods for addressing depression
42:20 - Parallels between psychological destabilization (through therapy) and the psychedelic effect
46:20 - Who shouldnothave a psychedelic experience? Are psychedelics intrinsically psychotherapeutic or facilitative in nature?
50:20 - Brief discussion of the neuroimaging correlates of psychotherapeutic benefits from psychedelic experiences
58:40 - Discussion of why 2A agonists cause psychedelic effects but high serotonin release does not
Resources:
Carhart-Harris RL, Nutt DJ. Serotonin and brain function: a tale of two receptors.J Psychopharmacol. 2017;31(9):1091-1120.https://doi.org/10.1177/0269881117725915
Artigas F, Nutt DJ, Shelton R. Mechanism of action of antidepressants.Psychopharmacol Bull. 2002;36 Suppl 2:123-132.
Antidepressants. In: Stahl SM.Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 4th ed. Cambridge University Press; 2013:284-369.
Carhart-Harris RL, Bolstridge M, Rucker J, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study.Lancet Psychiatry. 2016;3(7):619-627.https://doi.org/10.1016/S2215-0366(16)30065-7
Carhart-Harris RL, Leech R, Hellyer PJ, et al. The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs.Front Hum Neurosci. 2014;8:20.https://doi.org/10.3389/fnhum.2014.00020
Carhart-Harris RL, Friston KJ. REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics.Pharmacol Rev. 2019;71(3):316-344.https://doi.org/10.1124/pr.118.017160
Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.J Psychopharmacol. 2016;30(12):1181-1197.https://doi.org/10.1177/0269881116675513
Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance.Psychopharmacology (Berl). 2006;187(3):268-292.https://doi.org/10.1007/s00213-006-0457-5
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 47: Understanding the DSM-V-TR with Dr. Michael First
00:52:19
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a focused summary of the latest changes in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) with our guest expert — Dr. Michael First, a Professor of Clinical Psychiatry at Columbia University, NY. Dr. First is an internationally recognized expert on psychiatric diagnosis and assessment issues, he is the editor and co-chair of the DSM-5 text revision project (DSM-5-TR), the editorial and coding Consultant for the DSM-5, the chief technical and editorial consultant on the World Health Organization ICD-11 revision project and was an external consultant to the NIMH Research Domain Criteria project (RDOC).
The learning objectives for this episode are as follows:
Understand the rationale for undertaking a DSM-5-TR as well as the revision process itself
To become familiar with disorder, text and symptom code additions and modifications to the DSM-5-TR
To understand the purpose and function of the DSM in its current form and be able to contemplate future directions
Guest Expert: Dr. Michael First – staff psychiatrist and professor of clinical psychiatry at Columbia University, USA.
Produced and hosted by: Dr. Alex Raben (staff psychiatrist) and Saja Jaberi (international medical graduate)
Audio editing by: Dr. Alex Raben
Show notes by: Saja Jaberi
Interview Content:
2:53 - Learning objectives
3:34 - Brief description of the DSM and its history
4:54 – ICD vs. DSM
7:43 - Rationale behind the new revision
11:11 - Characteristics of the DSM-5-TR revision process and the people behind it
16:54 - Case presentation and Differential Diagnosis
23:07 - Prolonged Greif disorder
27:04 - Most important changes to the terminology used in the manual
39:34 - Pros and cons of the DSM
44:30 - A brief Comparison to the RDOC Framework
49:04 – Future Directions of the DSM
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Text Revision ed. 2022.
PsychEd Episode 38: Clinical High Risk for Psychosis with Dr. Thomas Raedler
00:52:30
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Clinical High Risk for Psychosis with Dr. Thomas Raedler, Psychiatrist and associate professor at the University of Calgary and one of the authors of the Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Recognize a patient who may be clinically high-risk for psychosis and provide a differential diagnosis
Understand the importance, utility and prognosis of these risk categories
Have an approach to initial management and the array of treatment options for a patient with
Hosts: Dr. Luke Fraccaro (PGY-2), Dr. Rebecca Marsh (PGY-1), Dr. Alex Raben
Episode lead: Dr. Luke Fraccaro
Audio-engineered by: Dr. Rebecca Marsh
Guest experts: Dr. Thomas Raedler
Show Notes by: Dr. Luke Fraccaro
Resources:
Addington, J., Francey, S., Morrison, A. (2006). Working with People at High Risk of Developing Psychosis: A Treatment Handbook
McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: handbook for diagnosis and follow-up. Oxford University Press.
References :
Addington, J., Addington, D., Abidi, S., Raedler, T., & Remington, G. (2017). Canadian treatment guidelines for individuals at clinical high risk of psychosis. The Canadian Journal of Psychiatry, 62(9), 656-661.
Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., ... & Heinssen, R. (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry, 168(8), 800-805.
Addington, J., & Heinssen, R. (2012). Prediction and prevention of psychosis in youth at clinical high risk. Annual review of clinical psychology, 8, 269–289.
Carrión, R. E., McLaughlin, D., Goldberg, T. E., Auther, A. M., Olsen, R. H., Olvet, D. M., Correll, C. U., & Cornblatt, B. A. (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA psychiatry, 70(11), 1133–1142. https://doi.org/10.1001/jamapsychiatry.2013.1909
Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., Barale, F., Caverzasi, E., & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220–229.
Fusar-Poli P, Salazar de Pablo G, Correll CU, et al. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. 2020;77(7):755–765. doi:10.1001/jamapsychiatry.2019.4779
Fusar-Poli, P., Schultze-Lutter, F., Cappucciati, M., Rutigliano, G., Bonoldi, I., Stahl, D., Borgwardt, S., Riecher-Rössler, A., Addington, J., Perkins, D. O., Woods, S. W., McGlashan, T., Lee, J., Klosterkötter, J., Yung, A. R., & McGuire, P. (2016). The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophrenia bulletin, 42(3), 732–743.
Kuharic, D. B., Kekin, I., Hew, J., Kuzman, M. R., & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews, (11).
Nelson, B., Amminger, G. P., Bechdolf, A., French, P., Malla, A., Morrison, A. P., ... & Wood, S. J. (2020). Evidence for preventive treatments in young patients at clinical high risk of psychosis: the need for context. The lancet. Psychiatry, 7(5), 378.
Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., ... & Morrison, A. (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European psychiatry, 30(3), 388-404.
Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., ... & Buckby, J. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11-12), 964-971.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website: psychedpodcast.org.
29 Jan 2021
PsychEd Episode 31: Understanding Psychodynamic Therapy with Dr. Rex Kay
01:11:29
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychodynamic psychotherapy with Dr. Rex Kay. Dr. Kay is a staff psychiatrist at Mount Sinai Hospital, assistant professor and modality lead for dynamic psychotherapy at the University of Toronto, as well as a faculty member at the Toronto Institute for Contemporary Psychoanalysis.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define psychodynamic psychotherapy.
Describe the core concepts of psychodynamic therapy.
Determine who may be an appropriate patient for psychodynamic psychotherapy.
Describe the evidence base for psychodynamic psychotherapy.
Compare and contrast psychodynamic therapy to other psychotherapies.
Guest: Dr. Rex Kay
Produced and Hosted by: Jordan Bawks and Anita Corsini
Audio editing by: Anita Corsini
Resources:
Ars Medica: A Journal of Medicine, the Arts, and Humanities
Black, M. & Mitchell, S. (2016).Freud and beyond: A history of modern psychoanalytic thought. Basic Books.
Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2017).Psychodynamic psychotherapy: A clinical manual. Wiley.
Driessen, E., Hegelmaier, L. M., Abbass, A. A., Barber, J. P., Dekker, J. J., Van, H. L., Jansma, E. P., & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update.Clinical Psychology Review,42, 1-15. doi: 10.1016/j.cpr.2015.07.004
Eppel, A. (2018).Short-term psychodynamic psychotherapy. Springer.
Karen, R. (1994).Becoming attached: First relationships and how they shape our capacity to love. Oxford.
Safran, J. D. (2012).Psychoanalysis and Psychoanalytic Therapies. American Psychological Association.
Summers, R. F. & Barber, J. P. (2010).Psychodynamic Therapy: A Guide to Evidence-Based Practice. Guilford.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 63: Balancing Perspectives on Safety and Involuntary Hospitalization with Jesse Mangan and Dr. Jim McQuaid
01:44:35
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we discuss the practice of involuntary hospitalization (also referred to as involuntary commitment or certification) with two special guests and fellow podcast creators — Jesse Mangan and Dr. Jim McQuaid. Their podcast, Committable, focuses on the topic of involuntary commitment and features stories from people with lived experience as a window into complex conversations with attorneys, physicians, psychologists, and more. Jesse Mangan is the producer of Committable and someone who has experienced involuntary hospitalization. Dr. Jim McQuaid is an Associate Professor of Sociology at Framingham University.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Appreciate the individual and societal functions of involuntary hospitalization
Understand the potential benefits and risks associated with involuntary hospitalization from the perspective of health care professionals as well as service users and the community at large
Describe actions you can take as a practitioner (who has the power to certify) that may better serve your community and those you care for
Identify meaningful ways to continue the conversation about these issues in medical education or training and beyond
*This episode was recorded in 2021. Through a saga involving lost and recovered audio files, we’re thrilled to finally be able to release it, and believe that the topic is just as timely and relevant as ever!
Guests: Jesse Mangan and Dr. Jim McQuaid
Hosts: Anita Corsini, Nikhita Singhal, Gray Meckling, and Alex Raben
Audio editing by: Nikhita Singhal
Show notes by: Nikhita Singhal
Interview content:
Introduction - 00:34
Committable podcast trailer - 01:52
Guest introductions - 04:26
Learning objectives - 07:22
Defining terms and setting the context - 08:11
Jesse’s experience - 12:03
Exploring the functions of involuntary hospitalization - 23:06
Power differentials and the importance of humility - 41:05
Training considerations - 45:18
False divide between patients and providers - 51:39
Jaeger S, Hüther F, Steinert T. Refusing medication therapy in involuntary inpatient treatment—a multiperspective qualitative study. Front Psychiatry. 2019 May 9;10:295. https://doi.org/10.3389%2Ffpsyt.2019.00295
Johansson IM, Lundman B. Patients' experience of involuntary psychiatric care: good opportunities and great losses. J Psychiatr Ment Health Nurs. 2002 Dec;9(6):639-47. https://doi.org/10.1046/j.1365-2850.2002.00547.x
McGuinness D, Murphy K, Bainbridge E, Brosnan L, Keys M, Felzmann H, Hallahan B, McDonald C, Higgins A. Individuals' experiences of involuntary admissions and preserving control: qualitative study. BJPsych Open. 2018 Nov 16;4(6):501-509. https://doi.org/10.1192%2Fbjo.2018.59
Sposini FM. Confinement and certificates: consensus, stigma and disability rights. CMAJ. 2020 Nov 30;192(48):E1642-E1643. https://doi.org/10.1503/cmaj.201750
PsychEd Episode 49: Dementia Assessment with Dr. Lesley Wiesenfeld
01:22:19
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we’ll explore a topic that we’re sure many listeners are eager to learn about: The Assessment of Major Neurocognitive Disorder, also known as dementia with Dr. Lesley Wiesenfeld who is a Geriatric Psychiatrist and Psychiatrist-in-Chief at Mount Sinai Hospital in Toronto, where she leads the Geriatric Consult Liaison Psychiatry Service. She is also an Associate Professor in the Department of Psychiatry at the University of Toronto.
The learning objectives for this episode are as follows:
Define Major Neurocognitive Disorder (aka Dementia) as per DSM-5 diagnostic criteria
Identify differential diagnoses for cognitive decline and list differentiating clinical features
Outline an approach to the assessment of a patient presenting with cognitive decline, including the role of a comprehensive history, psychometric tools and other investigations [ Relevant PMH/risk factors, ADLs/IADLs to cover on history, psychometric tools such as MMSE, MoCA and tie this back into major cognitive domains when to consider imaging, bloodwork including specialized testing such as ApoE genetic tests]
Classify the major subtypes of Neurocognitive Disorders, their epidemiology, and clinical presentations [ Vascular dementia, Alzheimer’s, Frontotemporal, Lewy Body, Parkinson’s, Mixed dementia - Early onset dementia]
Hosts: Dr. Luke Fraccaro (PGY-3), Dr. Mark Fraccaro (PGY-4), Sena Gok (international medical graduate)
Audio editing by: Sena Gok
Show notes by: Sena Gok
Interview Content:
Introduction: 0:13
Learning Objectives: 02:35
Diagnostic criteria of Major Neurocognitive Disorder: 03:20
Difference between Major and Mild Neurocognitive Disorder: 05:20
Red Flags of Cognitive Declines: 06:50
Normal Aging vs Major Neurocognitive Disorder: 10:00
Clinical Vignette – introduction: 11:35
Patient Assessment: 16:50
Past medical/family / Psychosocial history: 21:55
Clinical Vignette - Assessment: 37:45
Physical examination: 43:50
Investigations: 45:53
Role of genetic testing: 53:24
Clinical Vignette – Diagnosis: 57:50
References:
American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Sadock, B. J., Sadock, V. A., Ruiz, P., & Kaplan, H. I. (2015). Neurocognitive Disorders. Kaplan and Sadock’s Synopsis of Psychiatry (11th ed.). Wolters Kluwer
Gauthier S, Patterson C, Chertkow H, Gordon M, Herrmann N, Rockwood K, Rosa-Neto P, Soucy JP. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012 Dec;15(4):120-6. doi: 10.5770/cgj.15.49. Epub 2012 Dec 4. PMID: 23259025; PMCID: PMC3516356.
Gauthier S, Chertkow H, Theriault J, Chayer C, Ménard MC, Lacombe G, Rosa-Neto P, Ismail Z. CCCDTD5: research diagnostic criteria for Alzheimer's Disease. Alzheimers Dement (N Y). 2020 Aug 25;6(1):e12036. doi: 10.1002/trc2.12036. Erratum in: Alzheimers Dement (N Y). 2022 Feb 03;6(1):e12088. PMID: 32864413; PMCID: PMC7446944.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 24: COVID-19 and Medical Learner Wellness with Dr. Deanna Chaukos
01:13:09
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers medical trainee wellness during the COVID-19 pandemic with expert guest Dr. Deanna Chaukos, Staff Psychiatrist at Mount Sinai Hospital in Toronto and Wellness Lead for the Psychiatry Residency program at the University of Toronto.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define wellness and burnout and their importance in medical education/psychiatry
Understand strategies on how to maintain our own wellness and prevent burnout
Understand strategies to help others maintain their wellness and deal with burnout
*All through the lens of the COVID-19 pandemic
Hosts: Dr. Alex Raben (PGY5), Gray Meckling (CC3), Shaoyuan (Randi) Wang (CC3), Weam Sieffien (CC3)
Guest Staff Psychiatrist: Dr. Deanna Chaukos (Sinai Health Systems, Toronto)
Resources
COVID-19 Resources for Residents, infographic prepared by residents at the University of Toronto, including team member of PsychEd Nikhita Singhal
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence.The Lancet.
Eckleberry-Hunt, J., Van Dyke, A., Lick, D., & Tucciarone, J. (2009). Changing the conversation from burnout to wellness: physician well-being in residency training programs.Journal of Graduate Medical Education,1(2), 225-230.
Eckleberry-Hunt, J., Lick, D., Boura, J., Hunt, R., Balasubramaniam, M., Mulhem, E., & Fisher, C. (2009). An exploratory study of resident burnout and wellness.Academic Medicine,84(2), 269-277.
Dewey, C., Hingle, S., Goelz, E., & Linzer, M. (2020). Supporting clinicians during the COVID-19 pandemic.Annals of Internal Medicine.
Drolet, B. C., & Rodgers, S. (2010). A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine.Academic Medicine,85(1), 103-110.
Dyrbye, L. N., Burke, S. E., Hardeman, R. R., Herrin, J., Wittlin, N. M., Yeazel, M., ... & Satele, D. V. (2018). Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians.Jama,320(11), 1114-1130.
Kealy, D., Halli, P., Ogrodniczuk, J. S., & Hadjipavlou, G. (2016). Burnout among Canadian psychiatry residents: a national survey.The Canadian Journal of Psychiatry,61(11), 732-736.
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., ... & Tan, H. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.JAMA network open,3(3), e203976-e203976.
Lebensohn, P., Dodds, S., Benn, R., Brooks, A. J., & Birch, M. (2013). Resident wellness behaviors.Fam. Med,45, 541-549.
Santarone, K., McKenney, M., & Elkbuli, A. (2020). Preserving mental health and resilience in frontline healthcare workers during COVID-19.The American Journal of Emergency Medicine.
Shiralkar, M. T., Harris, T. B., Eddins-Folensbee, F. F., & Coverdale, J. H. (2013). A systematic review of stress-management programs for medical students.Academic Psychiatry,37(3), 158-164.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email atpsychedpodcast@gmail.com.For more information visit our website atpsychedpodcast.org.
01 Aug 2022
PsychEd Episode 46: Antisocial Personality Disorder and Psychopathy with Dr. Donald Lynam
00:53:30
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a broad overview of antisocial personality disorder and psychopathy with our guest expert - Dr. Donald Lynam. Dr. Lynam is a clinical psychologist by training, and professor at Purdue university, where he heads the Purdue's Developmental Psychopathology, Psychopathy and Personality Lab. While there may be some disagreement in the field, Dr. Lynam and I discuss how ASPD and psychopathy are two diagnostic constructs that are attempting to outline the same psychopathology, with the main difference being the degree of severity - for this reason, we use the terms antisocial and psychopathic interchangeably.
While not necessary, it may be of benefit for listeners to familiarize themselves with the DSM-V criteria for antisocial personality disorder, the psychopathy checklist (PCL), as well as the 5-factor model of personality. References for each are listed below in the references section, however, for a brief overview, one could do a quick google image search for each term (Wikipedia also has a succinct overview of the psychopathy checklist).
The learning objectives for this episode are as follows:
Develop a basic understanding of what is meant by antisocial personality and psychopathy
Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors
Describe the theoretical basis for the development of antisocial personalities
Guest Expert: Dr. Donald Lynam - Clinical psychologist, Investigator at Purdue University, Indiana
Produced and hosted by: Dr. Chase Thompson (PGY5 in Psychiatry)
Episode guidance and feedback: Dr. Gaurav Sharma (PGY4 in Psychiatry)
Interview Content:
0:50 - Learning objectives
1:40 - Dr. Lynam discusses his path to his current research interests
3:40 - Defining the terms antisocial personality disorder, sociopathy, psychopathy
8:30 - Discussing the possibility of antisocial behaviors without an antisocial personality
12:07 - Laying out the core features of antisocial individuals
18:20 - Antisocial personality from the perspective of the Big 5 personality model
22:00 - Discussion of the high-functioning psychopathy
25:06 - Prevalence of psychopathy
30:10 - Factors relevant to the development of psychopathy
39:30 - Prognosis and clinical trajectory
44:30 - Comorbid psychopathology
46:30 - Functions of antagonism or antisocial behaviours
49:30 - Treatment
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.
Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R, Lynam DR. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Developmental psychology. 2003 Mar;39(2):222.
Babiak P, Hare RD, McLaren T. Snakes in suits: When psychopaths go to work. New York: Harper; 2007 May 8.
Hare RD. The psychopathy checklist–Revised. Toronto, ON. 2003;412.
Hare RD, Harpur TJ, Hakstian AR, Forth AE, Hart SD, Newman JP. The revised psychopathy checklist: reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Sep;2(3):338.
Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of abnormal psychology. 1991 Aug;100(3):391.
Jones SE, Miller JD, Lynam DR. Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice. 2011 Jul 1;39(4):329-37.
Lynam DR. Early identification of chronic offenders: Who is the fledgling psychopath?. Psychological bulletin. 1996 Sep;120(2):209.
Miller JD, Lynam DR. Psychopathy and the five-factor model of personality: A replication and extension. Journal of personality assessment. 2003 Oct 1;81(2):168-78.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 60: Metabolic Psychiatry with Dr. Cindy Calkin
00:44:32
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode introduces the field of metabolic psychiatry, with a focus on patients with severe mental illness and metabolic syndrome. Our guest is Dr. Cindy Calkin, an Associate Professor in the Department of Psychiatry and Department of Neuroscience at Dalhousie University in Nova Scotia. Dr. Calkin has been a pioneer in the field of metabolic and neuroendocrine disorders in patients with bipolar disorder. Her research interests include examining the effects of obesity, insulin resistance and type II diabetes on the clinical course and outcomes in bipolar disorder.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Describe the burden of metabolic syndrome in the population with severe mental illnesses
Explain reasons for the comorbidity between metabolic syndrome and severe mental illness
Identify biopsychosocial strategies to prevent or treat metabolic conditions in this population
Guest: Dr. Cindy Calkin
Hosts: Angad Singh, Gaurav Sharma, and Sara Abrahamson
Audio editing by: Gaurav Sharma
Show notes by: Sara Abrahamson & Gaurav Sharma
Conflicts of interest: Neither our guest nor hosts for this episode have declared any conflicts of interest related to this topic.
Interview content:
0:00 - Introduction
00:54 - Learning objectives
01:37 - Dr. Calkin’s career trajectory
9:45 - Describing the burden of metabolic syndrome in severe mental illness
14:16 - What is the relationship between metabolic syndrome and severe mental illness
25:23 - Why is metabolic syndrome underdiagnosed in severe mental illness
27:56 - How to measure and monitor insulin resistance in clinical practice
32:44 - How stigma impacts treatment of metabolic syndrome in the mentally ill
34:02 - Lifestyle interventions for metabolic syndrome in the mentally ill
37:06 - Medication interventions for metabolic syndrome in the mentally ill
39:44 - Directions for future research in the metabolic psychiatry
41:48 - Episode summary
References:
Bai, Y.-M., Li, C.-T., Tsai, S.-J., Tu, P.-C., Chen, M.-H., & Su, T.-P. (2016). Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry, 16(1), 448–448. https://doi.org/10.1186/s12888-016-1143-8
Calkin, C., Kamintsky, L., & Friedman, A. (2022). Reversal of insulin resistance is associated with repair of blood-brain barrier dysfunction and remission in a patient with treatment-resistant bipolar depression. Bipolar Disorders, 24(5), 553-555. https://doi.org/10.1111/bdi.13199
Calkin, C. V., Ruzickova, M., Uher, R., Hajek, T., Slaney, C. M., Garnham, J. S., ... & Alda, M. (2015). Insulin resistance and outcome in bipolar disorder. The British Journal of Psychiatry, 206(1), 52-57. https://doi.org/10.1192/bjp.bp.114.152850
Giménez-Palomo, A., Gomes-da-Costa, S., Dodd, S., Pachiarotti, I., Verdolini, N., Vieta, E., & Berk, M. (2022). Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review. Neuroscience and Biobehavioral Reviews, 132, 142–153. https://doi.org/10.1016/j.neubiorev.2021.11.026
Ho, C. S., Zhang, M. W., Mak, A., & Ho, R. C. (2014). Metabolic syndrome in psychiatry: advances in understanding and management. Advances in psychiatric treatment, 20(2), 101-112. https://doi.org/10.1192/apt.bp.113.011619
Leboyer, M., Godin, O., Llorca, P. M., Aubin, V., Bellivier, F., Belzeaux, R., Courtet, P., Costagliola, D., Dubertret, C., M’Bailara, K., Haffen, E., Henry, C., Laouamri, H., Passerieux, C., Pelletier, A., Polosan, M., Roux, P., Schwan, R., Samalin, L., … Etain, B. (2022). Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort. Journal of Affective Disorders, 307, 149–156. https://doi.org/10.1016/j.jad.2022.03.053
Stogios, N., Humber, B., Agarwal, S. M., & Hahn, M. (2023). Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Current Psychiatry Reports, 25(11), 707-721. https://doi.org/10.1007/s11920-023-01458-0
Vancampfort, D., Vansteelandt, K., Correll, C. U., Mitchell, A. J., De Herdt, A., Sienaert, P., Probst, M., & De Hert, M. (2013). Metabolic Syndrome and Metabolic Abnormalities in Bipolar Disorder: A Meta-Analysis of Prevalence Rates and Moderators. The American Journal of Psychiatry, 170(3), 265–274. https://doi.org/10.1176/appi.ajp.2012.12050620
Ventriglio, A., Gentile, A., Stella, E., & Bellomo, A. (2015). Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management. Frontiers in Neuroscience, 9, 297–297. https://doi.org/10.3389/fnins.2015.00297
PsychEd Episode 44: Reproductive Psychiatry with Dr. Tuong Vi Nguyen
00:33:25
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Define the field of reproductive psychiatry
Discuss the possible neurobiological pathways impacting mood and cognition during the reproductive cycle of women.
Discuss the influence of sociocultural gender roles on psychopathology.
List the DSM-V diagnostic criteria of premenstrual dysphoric disorder.
Recall the epidemiology of premenstrual dysphoric disorder.
Describe the steps in the diagnostic evaluation for premenstrual dysphoric disorder.
List lifestyle and psychopharmacologic interventions for premenstrual dysphoric disorder.
Discuss common mental health concerns during the perimenopausal period.
Guest: Dr. Tuong Vi Nguyen
Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)
Audio editing by: Audrey Le
Show notes by: Arielle Geist
Interview content:
Introduction - 00:00
Learning objectives - 01:00
Defining the field of perinatal psychiatry - 01:50
Discussing neurobiological pathways impacting mood and cognition during the reproductive cycle - 02:47
The influence of sociocultural gender roles on psychopathology -05:28
DSM-V criteria of premenstrual dysphoric disorder - 11:18
Epidemiology of premenstrual dysphoric disorder - 13:40
Diagnostic evaluation of premenstrual dysphoric disorder - 14:38
Management of premenstrual dysphoric disorder
Pharmacologic - 17:45
Lifestyle - 24:15
Perimenopausal period - 24:45
Closing comments - 31:39
Resources:
Brzezinski, A., Brzezinski-Sinai, N.A., & Seeman, M.V. (2017). Treating schizophrenia during menopause.Menopause, 24(5), 582-588. doi: 10.1097/GME.0000000000000772.
Epperson, C.N., Steiner, M., Hartlage, A., Eriksson, E., Schmidt, P.J., Jones, I., & Yonkers, K.A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5.The American Journal of Psychiatry, 169(5), 465-475. DOI: 10.1176/appi.ajp.2012.11081302
Marsh, W.K., Gershenson, B., & Rothschild, A.J. (2015). Symptom severity of bipolar disorder during the menopausal transition.International Journal of Bipolar Disorders, 3(1), 35. DOI: 10.1186/s40345-015-0035-z
Soares, C.N., Almeida, O.P., Joffe, H., & Cohen, L.S. (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women a double-blind, randomized, placebo-controlled trial.Archives of General Psychiatry, 58(6), 529-534. doi:10.1001/archpsyc.58.6.529
Weber, M.T., Maki, P.M., & McDermott, M.P. (2013). Cognition and mood in perimenopause: A systematic review and meta-analysis.The Journal of Steroid Biochemistry and Molecular Biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001
References:
Kornstein S.G., & Clayton, A.H. (2004). Sex differenes in neuroendocrine and neurotransmitter systems. InWomen’s mental health: A comprehensive textbook (pp.3-30).Guilford Press.
Chrisler, J. C., & Johnston-Robledo, I. (2002). Raging hormones?: Feminist perspectives on premenstrual syndrome and postpartum depression. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 174–197). Guilford Press.
American Psychiatric Association. (2013). Depressive disorders. InDiagnostic and statistical manual of mental disorders(5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 55: MAiD and Mental Illness Part II with Dr. Sonu Gaind and Dr. Jeffrey Kirby
01:41:12
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness as a sequel to our previous episode on MAiD with our guest experts, Dr. Sonu Gaind and Dr. Jeffrey Kirby. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Gain an understanding of the current state of Medical Assistance in Dying for primarily mental illness in Canada
Evaluate the arguments in support of and against implementation of Medical Assistance in Dying for primarily Mental Illness
Understand next steps and future directions of Medical Assistance in Dying for primarily mental illness in Canada
Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry
Guest Experts:
Dr. Sonu Gaind who is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Sunnybrook Health Sciences Centre, and clinically works as a psycho-oncology consultant. As Medical Assistance in Dying (MAiD) policies have been evolving in Canada, Dr. Gaind has testified in front of numerous expert, parliamentary and senate committees on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, was retained by the former Attorney General of Canada as an expert in the Truchon and Lamb cases, and chaired his former hospitals MAiD team. He has spoken across the country and internationally on the subject.
Dr. Jeffrey Kirby is a (retired) Professor in the Department of Bioethics, Faculty of Medicine, Dalhousie University. He has an educational background and professional experience in medicine, philosophy and health care ethics. Dr. Kirby has published a set of academic papers in high-impact, international, bioethics journals on a variety of MAID-related topics including: assisted dying for suffering arising from mental health conditions, morally-relevant distinctions between paradigm and non-paradigm MAID circumstances, meso- and macro-level (MAID-related) health policy development, and organ donation after MAID and institutional conscientious objection to MAID. He made several, virtual and written, Bill C-7 related submissions to the Senate Committee on Legal and Constitutional Affairs regarding matters/issues of relevance to the potential consideration of mental health disorders as sole-qualifying conditions for MAID in Canada. He is a former member of the Expert Panel on MAiD and Mental Illness.
Grand Rounds Presenter: Dr. Urvashi Prasad (PGY4)
Produced by: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben (staff psychiatrist)
Hosts: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben (Staff Psychiatrist)
Peer Reviewer: David Eapen-John (MS4)
Audio editing by: Dr. Urvashi Prasad (PGY4)
Show notes by: Dr. Urvashi Prasad (PGY4)
Resources:
Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.
References:
Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.” Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/.
Tabitha Marshall. “Assisted Suicide in Canada.” The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada.
Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.
Canada, Health. “Final Report of the Expert Panel on MAiD and Mental Illness” Canada.ca, / Gouvernement Du Canada, 13 May 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html#exe.
“Medical Assistance in Dying: An Update - Cpa-Apc.org.” Position Statement, https://www.cpa-apc.org/wp-content/uploads/2021-CPA-Position-Statement-MAID-Update-EN-web-Final.pdf.
APA Official Actions Position Statement on Medical Euthanasia. 2016, https://odbapa.org/wp-content/uploads/2022/02/Position-2016-Medical-Euthanasia.pdf.
The Fifth Estate. “Is It Too Easy to Die in Canada? Surprising Approvals for Medically Assisted Death -the Fifth Estate.” YouTube, 19 Jan. 2023, www.youtube.com/watch?v=plinQAHZRvk&ab_channel=TheFifthEstate.
Wiebe K, Mullin A. “Choosing death in unjust conditions: hope, autonomy and harm reduction.” J Med Ethics. 2023 Apr 26:jme-2022-108871. doi: 10.1136/jme-2022-108871. Epub ahead of print. PMID: 37100589.
Gaind, KS. “What does “irremediability” in mental illness mean?” Canadian Journal of Psychiatry. Online first May 22, 2020. pp 1‐3. doi: 10.1177/0706743720928656
Kirby, J. (2022) Interpreting Irremediability When a Mental Health Disorder is the sole-Qualifying Medical Condition for MAiD. Peer-reviewed critical commentary. Canadian Journal of Bioethics 5(4): 83-88.
Kirby, J. (2021) Reconceptualizing ‘Psychiatric Futility’: Could Harm Reduction, Palliative Psychiatry, and Assisted Death Constitute a Three-Component Spectrum of Appropriate Practices? American Journal of Bioethics 21(7): 65-67.
Kirby, J. (2018) Balancing Competing Interests and Obligations in Mental Health-Care Practice and Policy. Bioethics 33(6): 699-707.
Kirby, J. (2017) Medical Assistance in Dying for Suffering Arising from Mental Health Disorders: Could augmented safeguards enhance its ethical acceptability? Journal of Ethics in Mental Health 10: 1-17.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
PsychEd Episode 8: Diagnosing and Treating Obsessive-Compulsive Disorder with Dr. Nik Grujich
00:42:51
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis and treatment of Obsessive Compulsive Disorder (OCD) with Dr. Nik Grujich, a staff psychiatrist at Sunnybrook Hospital, associate of the Frederick W. Thompson Anxiety Disorders Centre and award-winning educator at the University of Toronto.
In this episode, Jordan Bawks (PGY2 resident) and Aarti Rana (PGY1 resident) sit down with Dr. Grujich to talk about OCD. Together, they discuss the phenomenology of OCD (with a focus on differentiating it from Obsessive Compulsive Personality Disorder, OCPD), the epidemiology and natural course of the disorder, the DSM-5 diagnostic criteria, interview techniques to elicit and differentiate OCD from other psychiatric disorders and the pharmacological and psychological treatments for the disorder.
By the end of this episode, the listener will be able to…
Recognize the clinical features of OCD using DSM-5 criteria
Appreciate the differential diagnosis and how to use specific interviewing questions and the mental status to aid clinical judgment
Describe the evidence-based pharmacological and psychological treatments for OCD and their relative efficacy
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
30 Aug 2024
PsychEd Episode 64: Introduction to Consultation-Liaison Psychiatry with Dr. Raed Hawa and Dr. Alan Wai
01:15:24
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to consultation-liaison psychiatry with Dr. Raed Hawa and Dr. Alan Wai, both from the University of Toronto.
Dr. Raed Hawa is an esteemed CL psychiatrist and educator. Dr Hawa's interests are in the areas of undergraduate, postgraduate, and continuing medical education. He also practices general sleep medicine with particular clinical interest in the areas of insomnia, co-morbid psychiatric and medical illnesses, and sleep-related movement disorders. He currently serves as the President of the Canadian Academy of Consultation-Liaison Psychiatry (CACLP) and holds the position of Professor at the Faculty of Medicine, University of Toronto. Additionally, Dr. Hawa is the Deputy Psychiatrist-in-Chief at the Centre for Mental Health, University Health Network. Dr. Hawa has earned American Board Certification in Psychiatry, with subspecialty certifications in Sleep Medicine and Psychosomatic Medicine (Consultation-Liaison Psychiatry). His expertise and contributions to the field have been recognized through his designation as a Distinguished Fellow of both the American Psychiatric Association (APA) and the Canadian Psychiatric Association (CPA).
Dr. Alan Wai is a psychiatrist at the University Health Network in Toronto and an Assistant Professor in the Department of Psychiatry at the University of Toronto. He provides inpatient CL psychiatry care and mental health and psychiatric care embedded in the Immunodeficiency Clinic at Toronto General Hospital, where he sees both persons living with and at risk of HIV.He received his medical degree from the University of British Columbia and completed his psychiatric residency training at the University of Toronto.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Outline the history and evolution of CL psychiatry
Define the role and scope of CL psychiatrists in diverse medical settings
Identify and assess common psychiatric disorders in CL settings
Provide differential diagnoses and a general approach to a CL patient through a sample case
Guests: Dr. Raed Hawa and Dr. Alan Wai
Hosts: Annie Yu (PGY3), Sena Gok (MD), and Matthew Cho (CC3)
Audio editing by: Sena Gok
Show notes by: Sena Gok
Interview content:
Introduction - 00:13
Learning objectives - 01:09
First guest introduction - 01:36
History of CL psychiatry - 03:18
Subspecialties within CL psychiatry - 10:33
Collaborative care of CL psychiatry - 14:00
Preparation for CL Rotation - 20:03
Bariatric clinic and CL psychiatry - 22:32
Future of CL psychiatry, AFC Certification - 27:45
Beran, C., & Sowa, N. A. (2021). Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision. Journal of the Academy of Consultation-Liaison Psychiatry, 62(2), 186–192. https://pubmed.ncbi.nlm.nih.gov/33288272
Lipowski, Z. J. (1974). Consultation-Liaison Psychiatry: An Overview. American Journal of Psychiatry, 131(6), 623–630. https://doi.org/10.1176/ajp.131.6.623
Swenson, J. R., Abbey, S., & Stewart, D. E. (1993). Consultation-liaison psychiatry as a subspecialty. A Canadian survey. General Hospital Psychiatry, 15(6), 386–391. https://doi.org/10.1016/0163-8343(93)90007-b
Taylor, G., & Doody, K. (1979). Psychiatric Consultations in a Canadian General Hospital. The Canadian Journal of Psychiatry, 24(8), 717–723. https://doi.org/10.1177/070674377902400803
PsychEd Episode 33: Treating Borderline Personality Disorder with Dr. Robert Biskin and Dr. Ronald Fraser
00:54:00
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.
This episode covers the treatment of borderline personality disorder with expert guests:
Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, and inpatient psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as the inpatient psychiatrist at the Jewish General Hospital.
Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, and head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Understand the frame and principles of care for the treatment of individuals with borderline personality disorder.
Explore the approach to the treatment of individuals with borderline personality disorder:
On presentation in crisis to the emergency department.
During an inpatient psychiatric admission.
In the context of psychiatric outpatient care.
Understand the use of psychotherapy in the treatment of individuals with borderline personality disorder.
Understand the use of pharmacotherapy in the treatment of individuals with borderline personality disorder
Guest: Dr. Robert Biskin and Dr. Ronald Fraser
Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4)
Audio editing by Audrey Le
Show notes by Dr. Nima Nahiddi
Interview Content:
Introduction – 0:00
Learning objectives – 0:35
Principles of care for treatment of BPD – 1:16
The therapeutic frame – 5:40
Approach to the management of emergency department presentations – 9:10
Dialectical behaviour therapy (DBT) – 16:15
Suicidality and self-harm in BPD diagnosis – 21:05
Cristea I.A., Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. (2017) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry.74(4):319–328. doi:10.1001/jamapsychiatry.2016.4287
Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H J. (2010) Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials.Clin Psychiatry. 71(1):14.
PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy
01:02:34
Welcome to PsychED, the educational psychiatry podcast for medical learners, by medical learners.
This episode covers the approach to treating Major Depressive Disorder, as described by the CANMAT (Canadian Network for Mood and Anxiety Treatments) Guidelines. We discuss with Dr. Sid Kennedy, the founding chair of CANMAT, the past president of International Society for Affective Disorders, as well as a staff psychiatrist and scientist at Toronto Western and St. Michael’s Hospitals in Toronto.
In this episode, Dr. Kennedy discusses the origins of the CANMAT and how the guidelines are structured and constructed. We talk briefly about consideration of specifiers and symptoms in tailoring treatment. We then approach psychotherapy, pharmacotherapy, electrostimulation, and complementary and alternative therapies as treatment options, using the case from the previous episode on the diagnosis of depression.
Evidence-based psychotherapies for depression include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). We explain briefly the theoretical underpinnings of each. Patient suitability and availability of quality therapy are considered. Some evidence demonstrate a superiority of combining psychotherapy with pharmacotherapy (Cuijpers 2009).
The first-line pharmacotherapy includes antidepressant classes SSRI (selective serotonin reuptake inhibitor), SNRI (serotonin and norepinephrine reuptake inhibitor), NDRI (norepinephrine and dopamine reuptake inhibitor), and NaSSA (norepinephrine and specific serotonergic antidepressant). We discuss side effects with a focus on SSRIs, and understanding them from serotonin receptor profiles. We talk about the delayed onset of antidepressants, using validated tools to measure improvement, and strategies to optimize dosage, or using adjuncts with partial responses. We explore results from STAR*D (Trivedi et al, 2006) regarding response rates to medications.We touch briefly on antidepressant selection and the limited evidence of superiority of one medication/class over another (Cipriani et al 2009).
Brain stimulation includes electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and Deep Brain Stimulation (DBS). Dr. Kennedy discusses the cultural origins of misconceptions around ECT and explores the current practice of ECT today, which includes general anesthesia for the comfort of patients. We explain briefly the practice of rTMS and DBS.
Complementary and alternative therapies are briefly explored, including light therapy which has increasing evidence not only for seasonal patterns of depression. Dr. Kennedy discusses the limited evidence available to support any complementary therapies including nutraceuticals and exercise.
The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:
Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features
Apply the CANMAT Guidelines in discussing treatment options for MDD
Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD
Psychotherapy
Identify CBT, IPT, and MBCT as evidence-based psychotherapies for depression
Explain factors for choosing psychotherapy versus pharmacotherapy as first-line treatment
Describe the efficacy of psychotherapy in relation to pharmacotherapy
Pharmacotherapy
Identify SSRI, SNRI, NDRI, and NaSSA as classes of antidepressants that are first-line for depression
Explain the time of onset and side effect profile of SSRIs
Apply the guideline to either optimize, switch, or add adjunctive therapies with limited or partial responses to medication
Identify some factors to consider in choice of antidepressants
Brain Stimulation
Identify ECT, rTMS, and DBS as brain stimulation treatments for depression
Criticize the cultural origins of stigma around ECT
Describe the current practice of ECT, rTMS, and DBS
Complementary and Alternative Therapies
Describe Light Therapy as the only evidence-based complementary treatment strategy
Recognize the limited data in support of other therapies including nutraceuticals and exercise
Guest Staff Psychiatrist: Dr. Sid Kennedy (Toronto Western Hospital and St. Michael’s Hospital, Toronto)
For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
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