In this episode, we will be discussing some of the themes within Fyodor Dostoevsky’s legendary text, Crime and Punishment. It deals with the suffocating guilt and uneasy journey towards redemption of impoverished ex-student, Raskolnikov, who commits a horrific murder of a pawnbroker and tries to justify it, unsuccessfully, with noble purposes. Not only is the novel a stellar thriller, its themes deal with the eternal struggle between good and evil that encapsulates the human condition.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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The underreporting of psychotic symptoms by patients in depression is a significant concern, frequently driven by the fear of consequences like hospitalization or the stigma of embarrassment. 

We'll discuss the history, the differential to consider when thinking of psychotic depression, mechanisms, and treatment. Notably, individuals with psychotic depression face a suicide rate double that of their non-psychotic counterparts. A recent cohort study by Paljärvi in 2023 revealed a stark contrast: deaths due to suicide were 2.6% in the psychotic depression cohort, compared to 1% in the non-psychotic group. Alarmingly, most suicides occurred within the first two years following diagnosis. People who suffer from psychotic depression often do not report their psychotic symptoms, leading to inadequate response to normal depression treatments. With 6-25% of individuals with major depressive disorder (MDD) exhibiting psychotic features, it is imperative to understand and address these unique challenges. Join us as we unravel the complexities of this underrecognized aspect of mental health.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In today’s episode of the podcast, we will be doing a deep dive into duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI). In part one of this two-part series, we will cover the history of SNRIs as well as mechanisms of action, cytochrome P450 issues, side effects, and contraindications to consider when prescribing duloxetine and this class of medications.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In this episode, I am going to build on the therapeutic alliance series to express my thoughts on how understanding emotion, specifically microexpressions, can better help you make connections with your clients. The research is amazing; there are thousands of articles on the subject. I thought I would share a bit about the evolution of my interest in emotion and microexpression in this episode and how I translated it from the forensic world into a psychotherapy setting.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In part 2 if the Big Five series we talk about how medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), psychotherapy, and exercise can make an impact. Trial studies of mindfulness-based cognitive therapy and cognitive behavioral therapy (CBT) have shown promise in the treatment of neuroticism. We also discuss the possible benefits of neuroticism. Studies have shown that neurotic people may outperform their stable counterparts in a work context. This “healthy neuroticism” may exist when the effects of neuroticism and conscientiousness interact. 

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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If you are a medical student or someone studying for a big exam, this episode is for you. We will first discuss the mental roadblocks that prevent students from performing at their top potential for exams. We also break down and outline some effective study strategies, and provide a sample day-by-day study plan for any 2nd year medical student preparing for the USMLE Step 1 exam. Finally, we have also created a 3-step challenge all students can follow.

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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In this episode, Dr. David Puder and Liam Browning delve into the ancient practice of sauna and modern heat exposure therapies, exploring how they influence both physical and mental health. From boosting cardiovascular and cognitive health to potentially alleviating symptoms of depression and chronic diseases, this discussion reveals the science behind heat therapy's therapeutic effects. Discover how cultures worldwide have utilized heat for healing, the physiological benefits it offers, and practical insights into incorporating these practices into daily life. Join us as we uncover the evidence-based benefits and limitations of sauna use, exercise, and other heat therapies.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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In a previous episode of the podcast, we discussed exercise for the brain, reviewing the pathophysiology between exercise and dementia, the pathophysiological mechanisms associated between low skeletal muscle mass and cognitive function, exercise as a treatment, and cardiorespiratory fitness and its relationship to all-cause mortality. In today’s episode, we look at the extensive research available on these subjects.

By listening to this episode, you can earn 2 Psychiatry CME Credits.

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In this week’s episode, we have a conversation with Dr. Matthew Lederman, a board-certified internal medicine physician and CNVC Certified Trainer of Nonviolent Communication, as well as a prominent contributor behind the documentary Forks Over Knives. Dr. Lederman and his wife, Dr. Alona Pulde, recently published a book called, Wellness to Wonderful: 9 Pillars for Living Healthier, Longer, and with Greater Joy, and this conversation today revolves around the topic of nonviolent communication.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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On this week’s episode, Dr. Puder interviews Mary Lynch Barbera, Ph.D., RN, BCBA-D, creator of the approach and book titled Turn Autism Around. Dr. Barbera began her journey in the autism world over 20 years ago, when her first son, Lucas, was diagnosed with autism. Dr. Barbera made the incredible transformation from a confused parent to a doctoral-level behavioral analyst, best-selling author, and a tremendous resource for health professionals and parents of children with autism all over the world.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Eating disorders are often understood through a medical or behavioral lens, focusing on symptom reduction. But what if we’ve overlooked something deeper—something rooted in the complex emotional lives of our patients? In this episode, Dr. Tom Wooldridge, a psychoanalyst and expert in eating disorders, joins Dr. David Puder to explore the psychoanalytic perspective on treating these conditions.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In this episode, Dr. Cummings and I discuss forensic pedophilia and the sexualization of children in our society.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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In this episode, Dr. Puder discusses the importance of dynamic listening with patients in order to alleviate guilt, shame, and self-disgust. Building connection with your patients is a crucial element for mental health professionals, and this episode dives into the best practices that build connection through dynamic listening for the benefit of the patient. 

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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We are joined again by Dr. Neal Christopher, who is currently the Vice Chair and Associate Medical Director of Arrowhead Regional Medical Center and the Psychiatry and Addiction Consultant for the San Bernardino County Department of Public Health. Dr. Christopher has previously appeared on the Psychiatry and Psychotherapy Podcast in episode 063, “Interviewing Well For Psychiatry Residency & Beyond,” and episode 103, “Acceptance and Commitment Therapy with Dr. Steven Hayes.” 

In this week’s episode, Dr. Puder and Dr. Christopher discuss the recent elimination of the X-Waiver and what it means for providers, the mechanism and efficacy of buprenorphine, and practical tips for prescribing buprenorphine and supporting patients on their road to recovery from opioid use disorder.

This episode continues our podcast series on addiction, designed to meet the one-time, 8-hour training requirement introduced by the Consolidated Appropriations Act of 2023. This mandate applies to all providers registered with the Drug Enforcement Administration (DEA), and our series primarily focuses on the treatment and management of patients with substance use disorders.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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In this week’s episode of the podcast, we interview Dr. Kirk Schneider, a psychologist, psychotherapist, and author of, Life-enhancing Anxiety: Key to a Sane World. Dr. Schneider is a practicing psychotherapist and director of the Existential-Humanistic Institute, a psychotherapy training institute. As a former mentee of the great existential psychologist Rollo May and a self-described existential-integrative psychotherapist, he has made significant contributions to the fields of humanistic psychology and existential psychology throughout his career. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In today’s podcast, we discuss the Big Five personality traits, focusing on neuroticism and how it fits into this set. We then explore each of the six domains of neuroticism and the research of how it manifests in other parts of one’s life and affects relationships.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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Therapies of depth, insight, and relationship have been missing from, if not pushed out of, the public conversation on mental health treatment. After decades of attack from multiple fronts, these therapies are misunderstood, undervalued, and overlooked by the general public. In order to address this challenge and change this trajectory, we must start by listening to the public and understand their needs, values, and preferences about therapy. Dr. Linda Michaels and colleagues conducted an extensive research project, leveraging qualitative and quantitative tools and techniques widely used in the corporate world, focused on “listening” to the public and understanding what people want and need from therapy. 

Linda Michaels, PsyD, MBA, is a clinical psychologist in private practice in Chicago. She is also chair and co-founder of the Psychotherapy Action Network (PsiAN), a non-profit that advocates for quality therapy. 

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Inaccurate diagnosis of schizophrenia and/or missed diagnosis of affective disorders can lead to inappropriate and inadequate treatment; worsened outcomes can follow. Because schizophrenia is a complex condition with a broad range of signs and symptoms that also occur in other mental disorders, it can be difficult to differentiate it from other serious mental disorders, especially mood disorders. Notably, these other conditions should actually be ruled out before arriving at a diagnosis of schizophrenia.  In this episode, Danielle Hairston, M.D. and Chantel Fletcher join the podcast to discuss the issue of overdiagnosis of schizophrenia in Black male patients, especially.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Link to The Next 72 Hours Podcast.

This week on the Psychiatry and Psychotherapy Podcast, I am joined by Dr. Mark Ard, a chief resident physician at Loma Linda University’s Psychiatry program, to talk about holds and capacity evaluations as it relates to medicine and psychiatry.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In this episode, we continue our Big Five Personality Traits series by doing a deep dive into Conscientiousness. We'll look into studies that show how low conscientiousness increases mortality rate as well as positive aspects of high conscientiousness. We also explore the 6 domains, genetic factors, and different life stages of conscientiousness. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In this episode of the Psychiatry & Psychotherapy Podcast, Dr. David Puder is joined by Mark Ruffalo to dive deep into the complexities of borderline personality disorder (BPD). Together, they unpack Donald Burnham’s influential 1966 paper on splitting and identity diffusion, exploring themes of self-concept, relational dynamics, and the therapeutic challenges posed by BPD patients.

Learn how splitting impacts interpersonal relationships and therapeutic teams, the historical evolution of BPD from "pseudoneurotic schizophrenia" to a recognized DSM diagnosis, and the significance of psychodynamic and mentalization-based therapies in treatment.

Key topics include:

• The history of BPD diagnosis and theory
• Splitting and its effects on therapy teams and relationships
• Identity diffusion and its manifestations in gender, sexuality, and self-worth
• The role of childhood trauma, attachment, and genetic factors in BPD
• Practical insights for clinicians working with complex personality dynamics

Whether you’re a mental health professional, a student of psychiatry, or someone seeking a deeper understanding of BPD, this episode offers rich insights and evidence-based approaches for navigating this challenging and often misunderstood condition.

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

 Link to blog.

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Explore the transformative potential of the ketogenic diet for mental health with expert Dr. Matt Bernstein, a pioneer in metabolic psychiatry. Learn how targeting metabolic dysfunction can profoundly improve psychiatric outcomes in bipolar disorder, schizophrenia, depression, and epilepsy, with fewer side effects than traditional treatments. Discover actionable insights on diet, metabolism, and brain health backed by the latest scientific research.

Tune in to revolutionize your understanding of nutrition's role in mental wellness!

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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As the economy continues to shut down during COVID-19, people are growing more concerned about work and finances. Even if the virus is miraculously contained in the next few months, the economy will still be reeling from the damage of the lockdown. 

As psychiatrists, we are concerned about the increases in mental illness from the lack of employment and a potential increase in suicides. In this episode, we begin to look at past studies on the links between economic disaster and the subsequent rates of depression and suicide, and what we might be able to do to help.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In this episode, we will be discussing some themes observed in Meditations, a collection of notebooks written by the 16th Roman emperor, Marcus Aurelius, during the last years of his reign. His writings are still relevant to us and resonate within us, as the emperor himself struggled with some core questions that anyone who is living this thing called life might ponder.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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In this episode, Dr. David Puder interviews Dr. Frank Yeomans, a leading expert in Transference-Focused Psychotherapy (TFP) and personality disorders, to explore the treatment of Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD). They discuss object relations theory, identity diffusion, splitting, and the therapeutic relationship in TFP. Dr. Yeomans shares clinical insights on working with paranoid, devaluing, and omnipotent transferences, highlighting how therapists can navigate idealization, devaluation, and therapeutic neutrality. They also compare TFP with other psychodynamic approaches and discuss the role of aggression in mentalization and personality integration.

• Learn how TFP helps patients develop a stable identity
• Understand the differences between BPD and NPD treatment
• Explore the role of transference in psychotherapy

Tune in for a deep dive into psychodynamic therapy with one of the field’s top experts!

By listening to this episode, you can earn 2.0 Psychiatry CME Credits.

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In today’s episode of the podcast, we are joined by Dr. Michael Cummings to discuss the most recent and popular diagnosis wave of individuals believing they may have autism, which has become a recent TikTok phenomenon.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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This is the second episode in our Free will series. In this episode, we will describe some definitions of free will, explore determinism (the opposite of free will), cover some quotes by famous authors on the topic, and break down some statistics, and studies about it. 

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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In this episode of the podcast, I speak with Dorothy Kaufman, a marriage and family therapist who was married to the late Daniel Wile. We discuss the book that they both co-authored together called, Solving the Moment: A Collaborative Couple Therapy Manual. Dan is a well-known marriage and family therapist, the creator of Collaborative Couple Therapy, and spoken very highly of by Dr. Gottman.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Stress and anxiety are going to be very common during this time. In one study of Wang et al, 2020 they found that in China, 53.8% of the respondents to a survey rated their psychological impact as moderate-to-severe and 28.8% had moderate to severe anxiety, 16.5% had moderate to severe depressive symptoms, 8.1% had moderate to severe stress levels.

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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In today's episode post, we embark on an in-depth exploration of adverse childhood experiences (ACEs) and their profound impact on adult mental and physical health. The CDC defines ACEs as, “potentially traumatic events that occur in childhood.” ACEs include (but are not limited to) physical, emotional, sexual abuse, neglect, household dysfunction, such as domestic violence or parental substance abuse. We'll investigate how these early negative events are critical predictors of adult psychiatric diagnoses, including substance use disorders (SUDs), depression, anxiety, PTSD, psychosis, and personality disorders. Our analysis extends to the intricate ways ACEs affect an individual's physiology and psychology. This episode will be the first of a mini-series of several episodes surrounding the impact of ACEs and how we can treat patients who experienced trauma.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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In this episode, David Puder, M.D., and Victoria Agee discuss possible links between marijuana use and psychosis. There a multiple studies which reveal links in genetics and marijuana potency that can lead to an increase in schizophrenia and psychosis. 

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Dr. Mark Solms, author of,  The Hidden Spring, gives us a guided tour of a journey into different aspects of consciousness, how Freud can be updated with the work of Jaak Pankseep and affective neuroscience, as well as some of the more fundamental principles and groundbreaking work in which he comes to the conclusion that the why, how and where of consciousness centers on our “in the moment” experience of emotions and feelings.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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Over the last several years, Dr. Puder has worked as the medical director for Loma Linda University Health’s MEND program, a hospital-based intensive outpatient program (IOP) and partial program that works with patients who have chronic illness and their families. Jesse has been a lead therapist instrumental to the program’s success and Brian Distelberg oversees the MEND program and acts as the Director of Research for the program. During this episode, they come together to discuss the MEND program. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Esketamine is the first non-monoaminergic based medication which is FDA approved and indicated for treatment refractory depression. A longer duration of undertreated depression is associated with poor longitudinal functional outcomes. Instead of cycling patients through monoaminergic antidepressant trials and cognitive behavioral therapy approaches, according to Dr. Kitay, providers should consider treatments like esketamine much sooner in the treatment course.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Join Dr. David Puder and renowned psychopharmacologist Dr. Michael Cummings as they dive deep into the complex relationship between psychiatric medications and weight gain. In this episode, they explore the metabolic challenges posed by antipsychotic medications, focusing on cutting-edge solutions like GLP-1 agonists. Whether you're a mental health professional or someone impacted by these medications, this conversation offers practical insights on how to manage medication-induced weight gain through diet, exercise, and pharmacological interventions. Learn how to tackle this growing issue in mental health care with a thoughtful, science-backed approach.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Psilocybin has been increasingly part of western consciousness. As the scientific community explores its therapeutic use and safety in controlled settings, there are a lot of people outside of that community who are passionate advocates for its recreational use. If we are to be knowledgeable about this subject, it is useful to know the sources that our patients are getting their information from, the history of its use, and what we currently know about its safety.

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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From childhood, Russell experienced intense social anxiety to the point that, on more than one occasion, he discontinued certain extracurricular activities and socially normal gatherings to avoid it. Red Face is a narrative of his struggles with this social anxiety, the accompanying idiopathic craniofacial erythema (uncontrollable blushing), and the many successful and unsuccessful coping mechanisms he has attempted over the years. 

In today's episode, Russell shares his experience with social anxiety, which started at a young age and continued into adulthood. He will share what he does to overcome the often debilitating fear. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Special guest Dr. Joseph F. Goldberg is a psychiatrist and clinician researcher with over 180 publications and 3 books. This episode focuses on his newest book, written with Dr. Stephen M. Stahl,  Practical Psychopharmacology: Translating Findings From Evidence-Based Trials into Real-World Clinical Practice. In this episode, we discuss psychopharmacology and his approach to psychiatry. 

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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I am thrilled to continue our podcast series on addiction, designed to meet the one-time, 8-hour training requirement introduced by the Consolidated Appropriations Act of 2023. This mandate applies to all practitioners registered with the Drug Enforcement Administration (DEA), and our series primarily focuses on the treatment and management of patients with substance use disorders.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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Physical activity has been shown to reduce stress reactivity and reduce all cause mortality. Physical activity also results in decreased psychosocial stress. In this episode, Dr. Puder speaks with Dr. Stephen Seiler about the connection between mental health and physical activity.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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In this episode, Dr. David Puder sits down with Dr. Stijn Vanheule, professor of clinical psychology and psychoanalysis, to challenge misconceptions about psychosis and explore paths to understanding and recovery. They discuss psychosis as more than a clinical label, delving into its connection to existential struggles and creative expression.

Dr. Vanheule explains primary-process thinking, how traumatic events can disrupt the mind's coherence, and the importance of empathic listening in therapy. Drawing on examples like Carl Jung's Red Book and Annie Rogers' creative processes, the conversation highlights the therapeutic potential of integrating psychoanalysis, creativity, and supportive environments.

Whether you’re a mental health professional, caregiver, or curious listener, this episode provides insights into how psychotic experiences can be understood, respected, and addressed through innovative approaches.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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PANS/PANDAS is the hypothesis that there are certain types of obsessive compulsive symptoms, tic symptoms or restrictive eating symptoms that are caused by an infection and the immune response to an infection. Kyle Williams, MD, PHD and Sarah O'Dor, PhD join the podcast to discuss their research and diagnoses of PANS/PANDAS. 

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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In this episode, we will be going over a book every therapist and psychiatrist should read, Viktor Frankl’s “Man’s Search for Meaning.” Being in the trenches with our patients, we see so much pain and suffering and potentially undergo vicarious trauma ourselves through their suffering. The question, “What is the meaning of life?” often comes up in such a context.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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Violence and aggression are often used interchangeably, with subtle distinctions differentiating the two. Aggression is an umbrella term that encompasses violence and is defined as actions that lead to harm towards self, others, or objects, while violence is defined as actions that lead to harm, specifically toward other individuals (Newman, 2012). Aggression, according to the 3-factor approach initially detailed by investigators from the New York State Hospital system, is categorized into three types of assault: impulsive, predatory/organized, and psychotic. Impulsive aggression was the most common type at 54%, with predatory/organized type (29%) and psychotic type (17%) trailing behind (Quanbeck CD, 2007; Meyer et al., 2016). This episode aims to explore the management of agitation, aggression, and violence in the inpatient setting.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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On this episode of the Psychiatry and Psychotherapy Podcast, we continue our conversation with geriatric psychiatrist, Dr. Osorio, to talk about retirement—specifically, how to retire well and happy.  She recently published a book for people in this transition: Stop Freaking Out About Retirement

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Can cold exposure improve your mental health? In this episode, we explore the science behind cold therapy methods like ice baths, cryotherapy, cold-water swimming, and cold showers. Backed by research, we dive into the physiological and psychological effects of cold exposure, including its impact on mood, anxiety, dopamine, norepinephrine, and stress resilience.

We discuss historical practices, benefits for mental and physical health, and common misconceptions around claims like immune boosting and inflammation reduction. Learn practical tips, safety precautions, and how cold immersion could fit into your mental health or wellness routine.

Whether you’re curious about the Wim Hof Method, the dopamine-boosting effects of cold plunges, or the latest studies on cold exposure’s antidepressant potential, this episode offers insights you won’t want to miss.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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On this episode of the Psychiatry and Psychotherapy Podcast, we talk about meaning, and how it relates to suicide. 

This is part 3 of a series of podcasts on suicide. If you haven’t listened to the first two episodes, they are here: 

Suicide Epidemiology, Risk Factors, and Treatments

Genetics and Environmental Factors in Suicide

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In today’s episode of the podcast, I interview Dr. Sue Johnson, founder of Emotionally Focused Therapy, an intervention for relationships aimed at resolving distress by helping clients become attuned within a secure attachment bond. She has also written countless books and articles, a personal favorite being Hold Me Tight. She was the first person to teach me about the still face experiment in 2013. I, myself, have had the personal benefit of being in EFT with my wife for the past year. I remember watching a video of Sue doing therapy, and I thought, there is some sort of symphony happening here, and I really want to learn how to play the notes. I wanted this session to pull out as many practical pearls as possible from Dr. Johnson, more of the “how” of the process of helping people reconnect.

By listening to this episode, you can earn 1.5 Psychiatry CME Credits.

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In this episode, we are joined by a panel of experts to discuss treatment of psychosis. Experiences of psychosis are common. When these experiences lead to interference in achieving life goals and/or distress, individuals can benefit from seeking evidenced-based care. The earlier individuals experiencing psychosis come to treatment, the better the outcomes. We are all allies in connecting these young people to care and services. Recovery is possible—people living with psychosis experiences can lead full, meaningful, and fulfilling lives. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Malingering is the conscious misrepresentation of psychiatric symptoms for a secondary gain (such as hospitalization, obtaining disability benefits, avoiding criminal responsibility, proceedings or sentencing, or avoiding military service). In today’s episode of the podcast, we are joined by Dr. Phillip Resnick and Dr. Alex Scott as we discuss the topic of malingering.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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The purpose of this episode is to provide a clear and simple guide for clinicians on the diagnosis of complex PTSD (C-PTSD) and how it differs from post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). It is intended to complement and add to recent episodes on attachment and trauma: 213: Reflective Functioning, 203 and 204 on adverse childhood experiences. 

In today’s episode of the podcast, we are joined by Dr. Adam Borecky. Dr. Borecky is a psychiatrist and therapist who helped author the Connection Index and is part of Dr. Puder’s core team. His practice utilizes a holistic approach towards therapy and medication management.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In this episode, Dr. Cummings joins the podcast to discuss and give tips on overcoming social anxiety disorder. Individuals with social anxiety disorder tend to avoid important events and activities, such as classes, meetings, or public speaking. The disorder is essentially the fear of rejection by a group one would like to be part of. This is different from shyness because of the intensity and pervasiveness of the symptoms.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Schema therapy is a model of psychotherapy that was originally designed for chronic mental health problems. It comes from the Cognitive Behavioral Therapy (CBT) tradition, but also integrates different arms of psychotherapy, such as elements from the Gestalt tradition, and also aspects of object relations theory. In this episode, we have an in-depth discussion about schema therapy, which has proven to be effective in treating borderline personality disorder (BPD), with Australian schema therapist, Andrew Phipps.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Amidst the rise of dating apps and websites lurks a new form of deviance: online romance scams. In this episode, we interview Dr. Annabel Kuhn on the subject of online catfishing relationship scams. We discuss with Dr. Kuhn how to identify an online scammer, the personality types of both the scammer and the scammed, and how providers can help patients who have fallen victim to such a scam.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In today’s episode of the podcast, we are joined by psychiatrist and neuropharmacologist Dr. Ken Gillman who is the founder and convener of the International MAOI (monoamine oxidase inhibitor) Expert Group and widely recognized as a world expert in serotonin toxicity. 

Serotonin toxicity (syndrome) is a rare as well as potentially lethal form of toxicity that results from excess serotonin within neuronal synapses. There are numerous poorly written/controlled case reports that have perpetuated misinformation about drugs that can cause serotonin toxicity. While the word “syndrome” is often used, toxicity is a more accurate description given that toxicity represents a spectrum of severity rather than a defined set of symptoms. In today’s podcast, we will discuss the pathophysiology, causes, clinical presentation, criteria, controversies, and medical management of serotonin toxicity. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Exercise is an integral contributor to brain health. Physical activity has been proven to slow the rate of cognitive decline. In this episode, Dr. Puder invites four guests to discuss the importance of incorporating exercise into mental health routines. 

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In this episode, Dr. David Puder, Dr. Kristin Lasseter, and medical student Cara Jacobson discuss treatment of psychiatric illness in the peripartum period.

Dr. Kristin Yeung Lasseter is a renowned reproductive psychiatrist who has dedicated her career to the intersection of mental health and reproductive medicine. 

As the founder of Reproductive Psychiatry and Counseling, Dr. Lasseter has been instrumental in expanding access to reproductive psychiatry services in Texas but also worldwide through her teaching and online presence. Through her steadfast devotion to comprehending the singular hurdles faced by individuals as they navigate the reproductive journey, she has garnered immense respect within the field.

Dr. Kristin Yeung Lasseter's profound contributions to advancing women's mental health in Central Texas have been recognized through the prestigious Association of Women Psychiatrists Symonds Fellowship in 2018. Through her expertise, compassion, and advocacy, she is transforming lives and dismantling the stigma associated with perinatal mental health.

Of note, this episode, and the article below is for information purposes only and we recommend talking with a specialist doctor when considering what is the risk and benefits of particular medications in an individual's specific situation. 

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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In a podcast episode with award-winning author and screenwriter Norman Ohler, Dr. Puder and Dr. Borecky discussed Ohler’s recent book, Blitzed, about how the Third Reich used drugs to optimize performance during World War II and how it may have changed the course of history.

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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On this episode, we are joined by psychiatrist, psychopharmacologist, and author, Dr. Jonathan Meyer, to talk about using antipsychotic plasma levels to assess treatment response, safety, and oral medication adherence. He is a clinical professor of psychiatry at the University of California, San Diego. He recently published a book with Dr. Stephen Stahl for clinicians to utilize called, The Clinical Use of Antipsychotic Plasma Levels: Stahl's Handbooks.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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In today’s episode of the podcast, I interview Dr. Rocio Salas-Whalen, owner of New York Endocrinology on Park Avenue. Dr. Salas-Whalen has deep expertise in diabetes, metabolism, obesity, thyroid abnormalities and other endocrine disorders. She completed her internal medicine residency at Albert Einstein College of Medicine and her endocrinology fellowship at the University of Maryland School of Medicine in Baltimore. Additionally, she was a research fellow at Johns Hopkins University School of Medicine and is board certified in Obesity Medicine.

We will be discussing obesity and weight loss. The definition of obesity has changed significantly in the last few years. In 1942, WHO classified obesity as a chronic disease. In 2013, the American Medical Association accepted it as a chronic metabolic and multifactorial disease.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In this episode of the podcast, we sit down with Dr. Cummings to discuss the benefits, progress, and fears related to electroconvulsive therapy. For years the efficacy of electroconvulsive therapy has been debated, but we’ve learned that it still remains an essential part of psychiatric treatment in patients with severe mental health disorders.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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On this week’s episode of the podcast, I interview Dr. Drew Ramsey, a nutritional psychiatrist. When I was a resident, I saw him give a lecture on diet and how it affects our mood, and I’ve been wanting to interview him for a long time. He is the author of several books about diet and health.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In this first episode, I talk about my approach to seeing a new patient for the first time.  I go over the importance of empathy and psychological safety in the first interview.  I then go into how to do some of the components of a psychiatric history.  I go into details on what parts are important and why.  Please see my resource page for a full PDF of my notes and also the PDF of the document I give to patients prior to their first appointment with me. 

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Editor: Arvy Wuysang

*This podcast is for informational purposes only and is the opinions of the people on this episode.  For full disclaimer go here.  

This week we discussed cognitive distortions with Adam Borechy. Usually cognitive behavioral therapists deal with cognitive distortions by helping their clients identify habitual negative thoughts and and putting those thoughts on trial. We don’t have to accept every thought that passes through our brains as truth. When we have distressing thoughts, it can be helpful to consider if we might be telling ourselves the full truth about a situation.

We refer to common cognitive distortions—depression, anxiety, feelings of failure, negative thoughts when interacting with people, social anxiety—and we see how they are applying to our thought process.

For a PDF of the cognitive distortions and a 8 days journal task towards better identifying them in your life, please see my resource page. In this 8 day journey you will better identify your own troubling thoughts and move towards gratitude.

Here are a list of the cognitive distortions:

All or nothing thinking: things are black and white, completely without shades of gray.  For example, you may think, “If I am not perfect, I should not try at all, because then I would fail completely.” Or you might think, “My significant other is completely evil.” And then the next day, “My significant other is perfect.”  

Overgeneralization: generalizations are made without context, experience or evidence.  “I am always alone.”  Or “Everyone hates me.”  “I never win.” Always? Never?  Everyone? It happens absolutely all the time, without exceptions? In the moment, it can feel like that, but those statements are actually rarely true. Speaking truth to yourself in this case might look like: I am sometimes alone, several people are upset at me, I win sometimes, even if I didn’t this time.

Mental Filter: focusing on the negative rather than the whole picture. After receiving multiple positive statements and one negative statement, all you focus on is the negative statement.  

Disqualifying the positive: When you do something good like get a compliment or award, you instantly find ways to make less of it! For example, if someone says, “You are looking good today,” but instantly you assume that person is giving you a false compliment.  

Jumping to conclusions (without evidence): reaching conclusions (usually negative) without little evidence.

ind reading: assuming you know what the person is thinking about you.  Connection occurs from accurately knowing another, and with mindreading you blind yourself without evidence.

Fortune telling: predicting negative things in the future.  For example you think “I am going to fail this test even if I study,” so you don’t try, don’t study, and don’t even show up.

Magnification or Minimization: you make some weakness of yours much larger than it is or a strength much less than it really is. For example you see your friends as beautiful whereas you see your own beauty as very average.

Emotional Reasoning: believe that your feelings reflect reality. For example, “I feel stupid, therefore I am.” or “I feel fearful of flying in planes therefore they must be dangerous,” or “I feel ugly therefore I am ugly despite what others tell me.”  

Shoulding: a thing that you believe you should or should not do, often created to try to maintain an image of yourself which is more in line with social pressures. For example, “I should be perfect,” “I should never cry,” “I should always win,” “I should be able to do this on the first try.”

Personalization: blaming oneself for a bad event without looking at external factors that contributed to the bad event. Attributing personal responsibility to things that you have no control over, or when you do not see all the things that caused something. For example, a friend is upset so you think it is something you caused or are responsible for.  

Error Messages: thoughts that are like obsessive compulsive disorder due to having thoughts that are repetitive, intrusive and not meaningful. 

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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Co-host: Adam Borecky

Editor: Trent Jones

*This podcast is for informational purposes only and is the opinions of the people on this episode.  For full disclaimer go here.  

In this episode, Dr. Cummings and I discuss psychopathy: the fearless, empathyless people, who see others as objects, and have the inability to attach within relationships. Dr. Michael Cummings recently contributed to a book called “Violence in Psychiatry,” detailing the biological aspects of psychopathy, edited by Stephen Stahl. Dr. Cummings works at Patton State Hospital, one of the biggest forensic hospitals in the world. He is the Yoda of the psychiatric world, with many other psychiatrists bringing him their most complex and difficult cases.   

In this episode we cover:

History of psychopathy

Influence of early life traumas

Prosocial careers of psychopaths

Biological components in psychopathy

The emotion psychopaths fail to see

BDNF (brain-derived neurotrophic factor)

Prefrontal area (the parent of the brain that warns us “that is not a good idea”)

Amygdala

Why psychopathy has not been bred out of existence

Advice when you are in a relationship with a psychopath

What drugs make someone look psychopathic

Effect of alcohol andmethamphetamines on the brain

Influence of cocaine on the brain

Why more men are violent psychopaths

And treatment of this group of people (clozapine’s influence on glutamate)

The Story of Phineas Gage

We also wrestle with how to increase the percentage of psychopaths that end up helping society vs percentage that become criminals.

Warburton, K and Stahl S (Editors).  Violence in Psychiatry.  The Neurobiology of Psychopathy. Cambridge University Press 2016), pp. 200-05

CV of Dr. Michael A. Cummings

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Editor: Trent Jones

*This podcast is for informational purposes only and is the opinions of the people on this episode.  For full disclaimer go here.  

In this episode I will be interviewing William Britt, PhD level clinical psychologist, an expert in cognitive behavioral therapy, object relations therapy, EMDR and a board certified neuropsychologist. He runs cognitive rehabilitation groups and neuropsychological assessments, and supervises neuropsychological fellows and interns. He also works closely with the psychiatric residents teaching about suicide.  

In this episode, Dr. William Britt explores his experiences running an inpatient psychiatric group for 5 to 13 year olds who are being treated for violence or attempted suicide, using uses a method based on Irving Yalom’s inpatient group psychotherapy technique.

We discuss how the trend of teen suicide has increased over the years and the typical causes of depression. We also cover common bullying tactics and how cyber bullying has changed society.  We then discuss how to use the group's support to help each other move away from being suicidal. We explore how the Netflix TV series “Thirteen Reasons Why” has influenced young minds and the new terms the patients are using.

In the end, Dr. Britt and Dr. Puder answers how we adapt and recover from trauma, and how we find meaning and value within stress.  

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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CV of Dr. Britt

This week David Puder, M.D., has a discussion with Randy Stinnett, Psy.D, regarding his journey to become an excellent therapist.  Randy shares aspects of his journey and insights.  His enthusiasm is contagious.  He discusses formative influences including Habib Davanloo, Donald Kalsched, and Todd Burley.  Please follow the link to the website for Randy Stinnett's list of 5 recommendations for someone aspiring to be an excellent therapist.

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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Sensorium is the total brain capacity for focusing, processing, and interpreting. It is not a static state—it can fluctuate throughout the day.  

It can be influenced by sleep, food, stress, exercise, drugs, medications, and long term, through epigenetic phenomenon.  

If there is damage to the structure of the brain, it can permanently lowered.

It is a slope, which we all move up and down on, based on our baseline, but then also influenced by many factors.  

In your 20s and 30s you are very far on the left side of the line. If you get stressed, sleep deprived, starving, maybe have a small infection, you may still be able to think, but just less clearly. If you did those same things to an elderly person, they would be sent into a full delirium, hallucinating, throwing things, yelling, seeing spiders on the wall, and looking psychotic.  In this way it is common for an elderly person with dementia, they can be more confused in the evening then in the morning, they call this “sundowning”.  

We all have a baseline level of brain function, and this can be optimized by several factors like good sleep, good amounts of exercise, good mental functions (like reading), meaningful relationships, good spiritual practice, and meaningful work.  

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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This week I had a discussion with Dr. Darcy Trenkle on the difficulty of providers to get psychiatric treatment, using ourselves as the examples.  In a recent article nearly 40% of physicians surveyed said they would be reluctant to seek formal medical care for treatment of a mental health problem because of concern that this may put their medical license in jeopardy.  Physicians have three times the national average for suicide and have unique stressors and often a culture not conducive to seeking help.  We discussed difficulties we had in contemplating getting care for different issues we faced.  Hopefully, this will open a discussion regarding the conflicts providers have in engaging needed help.  Dr. Trenkle is a psychiatrist in Southern California and is affiliated with Loma Linda University Health.  She received her Medical Degree from Loma Linda University School of Medicine. She completed her residency training at Loma Linda University in 2015. She is the Medical Director for Electroconvulsive Therapy as well as Program Development for the Behavioral Medical Center at Loma Linda University.  If you are a Medical Student, Resident or Attending listening to this and need help, please reach out to a local provider.  We are open to receive emails if you are local, our names are searchable in the Loma Linda email system.  

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In this episode, Dr. Puder addresses the fascinating realm of schizophrenia with Dr. Cummings, a previous guest in the show. Dr. Cummings is a psychiatrist with a wealth of experience from working at Patton State Hospital in California, one of the biggest forensic hospitals in the world.

-Defining Schizophrenia

-Living with Schizophrenia and Perception of Reality

-Are Negative Symptoms in Schizophrenia Precipitated by Medications?

-Emil Kraepelin, and the Early Studies on Schizophrenia

-The Pathology, Biology, and Genetics of Schizophrenia

-Cannabis Use and Risk For Schizophrenia

-The Loss of Brain in Schizophrenia

-Counter-arguments Against Robert Whitaker’s “Anatomy of an Epidemic”        

-Schizophrenia Prevention in High Risk Population

-Australian Study on Children of Schizophrenic Parents

-Crime, Violence, Mass Shootings and Schizophrenia

-Medical Management of Schizophrenia

-1st Break Psychosis

-Long-acting Injectable Antipsychotics in Early Illness

-Medication Adherence

-Exercise, Lifestyle, Diet Optimization

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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CV of Dr. Michael A. Cummings

Assistant Producer: Arvy Wuysang

Editor: Trent Jones

What are the best diets for the brain and cognitive function?  

How much does diet influence our sensorium?

What particular foods are important?  

How do we change our genes to optimize our brain?

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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For PDF with citations and detailed notes go to: My Resource Page

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Western society faces is the most unhealthy we’ve ever been. It’s reached epidemic proportions: depression, anxiety, poor focus and sensorium issues, chronic stress, and diseases of chronic stress (like diabetes). The solution is simple—exercise and healthy eating.

In this episode, I will be going through 17 studies on how exercise influences and improves these factors. I will cover how it works, and how to develop an exercise program from the perspective of a doctor, not just for body sculpting.  

Some things I am covering:

Strength training decreases depression

Strength training increases cognitive function

Fitness decreases risk of dementia

Exercise increases BDNF

Strength training and exercise in treatment for diabetes

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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For PDF with citations: https://psychiatrypodcast.com/my-resources

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Starting Strength Online Coaching

Learn:

Why to optimize medical issues like hypertension and diabetes

Change psychiatric and non-psychiatric medications to optimize brain function

Optimize sleep to obtain rest and increase brain function

How drugs influence the brain short and long term to change sensorium

How viewing yourself without "free will" influences brain function

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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For PDF with citations and full notes go to: https://psychiatrypodcast.com/resources

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Our bodies are “wired” to perform. Learning how to consciously modulate your internal sympathetic state is the key to unlocking optimal performance. The autonomic nervous system (ANS) facilitates survival by generating the fight-or-flight response and promotes recovery following activation (the ability to relax). The ANS achieves this by balancing two complementary systems: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). For example, your ANS is currently adjusting your pupillary diameter, respiratory rate, blood pressure, heart rate, skin conductance, sweat production, sphincter tone and postural muscles (just to name a few) to allow you to focus your eyes to read this information without passing out, falling over, overheating or urinating on yourself.

For PDF with full notes on our discussion and breathing: https://psychiatrypodcast.com/resources

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Overcoming Postpartum Depression

Link to show on: iTunes, Google Play, Stitcher, Overcast, PlayerFM, PodBean, TuneIn, Podtail, Blubrry, Podfanatic

This week on the podcast, I joined with Dr. Pereau to talk about postpartum depression, both from a personal level and as those who treat it in our patients.

Dr. Pereau is incredibly honest and vulnerable in this emotional episode as she shares her story. Throughout it, she talks about the symptoms of her postpartum depression, including:

• Intrusive thoughts

• Emotional disconnection from her baby

• Sleep deprivation

• Hopelessness

• Problems with concentration

• Disconnection from passion and joy

• Panic attacks and anxiety

• Poor self care

It had never occurred to Dr. Pereau that she would struggle with postpartum depression, though she had treated many people with it, and could easily recognize symptoms in others. Often, when we are experiencing these kinds of things, it’s hard to identify the symptoms within ourselves. We understand the need for someone with a recognizable disorder, such as bipolar or schizophrenia, to get help. But depression can be a slippery, indefinable problem when it comes to labeling ourselves.

If you are dealing with postpartum depression, know that it can be treated, and there absolutely hope to work through it. Here are some things that can help:

• Breastfeeding to stimulate connection and positive hormone production

• SSRI treatment (medications prescribed by a doctor)

• Talk therapy

• A good support system

If you’ve been experiencing the symptoms we discuss in this podcast, there are plenty of resources, plenty of people who can help you during this time.

The Edinburgh Postnatal Depression Scale is a simple questionnaire that can tell you if you are experiencing postpartum depression.

For a list of local support groups in the region, www.postpartumprogress.com is a wonderful resource.

Postpartum Support International is another great resource for online support groups and educational materials. www.postpartum.org  

2020 Mom is an online advocacy group for maternal mental health. It includes blogs, educational materials and legal support. www.2020mom.org

Below is a touching excerpt from her story:

“My mother always said that when I had a child, I would know true love in a way I could never conceptualize. It had been a very long path to finally getting the child, and when he finally came I felt nothing. Actually, I felt worse than nothing. For the first couple months, all I can remember is darkness. I felt alone to my core. I felt like I was drifting, disconnected and lost. In my mind, my life was over. It was forfeit. The child wasn’t a beaming ray of sunshine, filling me with hope and life and love. When I looked at him I felt nothing. The guilt of this overwhelmed me.

I found myself wrestling through the options, fantasizing about packing a bag and running away in the middle of the night, or giving the baby up for adoption, or crashing my car off the edge of the mountain on my way home from work, or throwing myself off our cabin’s third floor balcony. The images whirled through my mind and I would clench my teeth and force them away. It was all so dark. I didn’t want him. I didn’t want my life. I believed I knew these things for certain. I believed these were my thoughts.

I mentioned to my husband Bryan about having a dream where I  jumped off the balcony, but then I quickly minimized it. I filled out the Edinburgh Scale in the OBGYN office with just enough depression items to be flagged but not enough to get hospitalized. We use the term, “A cry for help,” and generally refer to something gamey or indicative of less severe illness. I can see how it looks that way. But I now know without any doubt what a cry for help really is. It was the weak, thready voice of the last piece of me left in my mind, the last flicker of light not darkened by postpartum depression. It was the last bit of me that was not pinned down under the weight of illness. Those weak cries were the best I was capable of. The illness was too great. My mind did not belong to me. My thoughts did not belong to me. I just didn’t realize it.

As a society, we believe that depression is something that can be willed away if a person is strong enough. If they just try hard enough. And yet nobody tells a schizophrenic to just try to not hallucinate. We don’t tell a person with bipolar disorder to just try to not cash out their retirement to finish that half built bomb shelter in their back yard they’ve been building the last few weeks. Even conditions like alcoholism have been embraced within a medical model. We don’t tell the alcoholic to just try to stop drinking anymore. We recognize this to be a medical illness deserving of care and treatment. And yet we tell the depressed person to try to be positive. Try to be happy. And I think I know why.  As humans on the planet, each of us suffer, faces grief, loss, and even hopelessness. And we find ways to survive, often becoming stronger because of it. We assume our experiences with emotional pain are similar to what a person with depression goes through. I know I thought that, and I’ve faced considerable loss throughout my life.

Unfortunately, depression isn’t anything like that. It’s disease. It’s organic. It’s neuro chemical. It is an illness where your very thoughts become twisted and distorted, your perception of the world around you becomes altered. You lose who you are and generally have no idea that it’s even happening. We have to stop assuming that depression is something like the subjective painful experiences we all encounter in life. It’s a biological illness of the brain. In the past decade completed suicide rates in the United States have increased 20%, taking the lives of 121 people a day. Attempting to will away depression cost me 11 months of my life, where each month that passed took me deeper into a hole I couldn't claw out of.

Postpartum depression affects the lives of over half a million women a year. It destroys families and severs the connection between a mother and child. It is a deadly disease which cannot be combatted through willpower. I believe a new approach is needed to proactively educate and better screen our patients. I don’t begin to have all of the answers, but I can say that the culture around mental illness must change. There is no room for judgment. Maybe it starts with a simple, “I’m worried about you. I think you’re hurting.” Maybe it starts with spending the time to paint a clear biologic picture for the family surrounding a mother to heighten monitoring. All I know is that “holding it together” is no way to live, work, or raise a child.

I chose to accept help. I chose to take medications to treat postpartum depression, nearly a year later. Eleven months after my son was born, I remember a pivotal moment. It was 3 in the morning and he had just fallen back to sleep, there in my arms. As I looked down at his beautiful face, there in the darkness, I whispered to him, “I would choose you.” It was like it was the first time I had ever seen him. The Joy that normally present in my everyday life came back. My thoughts became my own again, no longer twisted and distorted. I have firsthand knowledge of what it looks like to be overcome by an illness of brain, of the mind. It’s chemical. It’s biological. And it’s one of the most terrifying illnesses I can imagine.  And help exists. I know Sharing this helps to dispel shame, despite this being...a bit overwhelming. But it’s seriously about life and death, and if hearing my story helps you to better understand what 1 in 7 women who have had a child is experiencing, then this is worth it to me.”

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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New research on hormonal contraceptives, “the pill”, and how it influences mental health. Dr. David Puder and Dr. Mona Mojtahedzadeh explore:

Claims about the mental health consequences of hormonal contraception

Unique Influences of progesterone and estrogen on the brain

How ovulation changes attraction and desire

Discuss the controversy around recent studies that show that hormonal contraception increases the risk of depression

Critique of those studies and counters to those critiques

Kelly Brogan and other contrasting views and their influence on this field

By listening to this episode, you can earn 0.5 Psychiatry CME Credits.

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Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face.

In this episode we describe the science of microexpressions, emotion and how to use it to connect with others.

For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face.

In this episode, we describe the science of the microexpressions of fear, disgust, and surprise and how to use it to connect with others.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources

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In the third and final installment on microexpressions, Ariana Cunningham and Dr. David Puder talk about how learning microexpressions can help you build empathy and connect with other people.

As Paul Eckman demonstrated in his research, they can be potent glimpses into someone’s emotional experience.

In this episode we talk about:

How emotions come into play in our dreams and other unconscious ways.

How to use what we learn from them carefully and with curiosity, rather than with a know-it-all attitude.

How we create psychological defense to cope with reality

How we might experience problematic relationship patterns through a theory called object relations.

How our emotions happen out of our awareness.

Preventing emotional overload and empathic exhaustion.

Emotional transference and how to stop it.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Can strength training help alleviate depression? In this episode, Dr. David Puder is joined by Trent Jones, a Starting Strength athlete, to discuss how systematic strength training can significantly impact mental health. From boosting confidence and assertiveness to reducing symptoms of depression, we explore the science and personal stories behind this powerful intervention.

Key topics include:

• The transformative mental health benefits of resistance training.
• Insights from research studies showing the link between strength training and reduced depressive symptoms.
• How strength training fosters assertiveness, confidence, and resilience.
• Practical tips to start your own strength training journey, even if you’re a beginner.

Whether you’re a clinician looking for holistic treatments for depression or someone seeking new tools for personal growth, this episode offers actionable insights and inspiration.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In the latest episode of the Psychiatry and Psychotherapy Podcast, Dr. Puder interviews Dr. Cummings, a psychopharmacologist. They discuss the way medicine works in our bodies, and if medicine or therapy is more effective for treating different disorders. They also talk about the different factors that affect absorption rates, such as gastrointestinal surgeries, liver health and actual dosage.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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In the latest podcast, Dr. Cummings and I talked about antipsychotics, the particular branch of psychopharmacology that deals with medicines that treat psychotic experiences and other mental disorders, such as:

Schizophrenia

Severe depression

Severe anxiety

Bipolar disorder

Psychosis exhibiting hallucinations and delusions

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Do you ever feel out of touch with your emotions? Or have you ever felt like you had to hide your real emotions? When people do that—emotionally detach—they develop what therapists call “incongruence.”

Most therapy is actually centered around getting patients back in touch with their emotions. On this week's podcast, Ginger Simonton and I talk about the different methods we use to help our patients develop and maintain healthy emotional congruence.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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What is procrastination?

Procrastination is the act of avoiding something through delay or postponement.

You might be procrastinating when:

There is a gap between your intention and action

You feel like avoiding something

You find yourself easily distracted

You feel overwhelmed by tasks at the last minute

You always feel rushed to complete a project

You’re hesitant to truthfully update someone on your progress

It usually brings about feelings of:

Shame

Guilty

Anxiety

Regret

Anger

Inauthenticity

Why do we procrastinate?

We procrastinate because our brains receive a reward for avoidance. Avoidance brings immediate relief from the distress associated with the task. Although we may experience discomfort in the final moments before a task is due, we rarely think about the past or future when procrastinating.

This creates a problematic cycle, one that erodes at our self-confidence. It also causes us to keep up a steady stream of “I should be…” in our subconscious minds.

The ingredients for procrastination
Personal & System Based Factors of Procrastination

There are fixed factors related to procrastination, things that are innate to each of our different psychological experiences. For example, someone with ADHD is more likely to procrastinate.

The fixed personal factors are:

Higher Impulsivity

Lower conscientiousness—lower drive to be organized and accomplish.

Limited attention-span

Boredom / Low Interest

The variable personal factors are:

Willpower

Distress tolerance

Willingness to ask for help

Task-focused vs value-focused

Self-consciousness & anxiety

The variable task or system-based factors are:

Unclear goals & expectations

Unrealistic goals & expectations

Distractions

Lack of accountability or mentors

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Polyvagal theory by Stephen Porges explains three different parts of our nervous system, and their responses to stressful situations. Once we understand those three parts, we can understand our emotional reactions to trauma or high amounts of stress.

Why is polyvagal theory important?

For therapists, and pop-psychology enthusiast alike, understanding polyvagal theory can help with:

Understanding trauma and PTSD

Understanding the dance of attack and withdrawal in relationships

Understanding how extreme stress leads to dissociation or shutting down

Understanding how to read body language

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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In this week’s episode of the podcast, Dr. Michael Cummings and I talk about the history of antidepressants, and their use in overcoming depression and anxiety disorders.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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In this episode we discuss:

The history of bipolar illness, mood stabilizers, common treatments, psychopharmacology, psychotherapy goals, and more.

For paraphrased transcription and blog: go here

For more detailed notes by Dr. Cummings, go to my resource page.  

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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What are boundaries?

When we refer to boundaries, we are talking about emotional walls that are healthy. Boundaries are meant to keep us in relationship with the people that we love.

Think of them as your property lines around your house. You know where your lines are, where your property ends and your neighbors begins. Therefore you know what you are supposed to take care of and what your neighbor is supposed to take care of.

A boundary defines our self. Within ourselves, our “property” consists of our physical body, our desires, our intellect, and our ability to make decisions. It gives us a sense of defining what is “me” and what is “not me.”

We are not supposed to take on too much of other people’s emotional experiences. When I was a newly practicing psychiatrist, I didn’t know that, and I felt depressed after meeting with a depressed patient. It is possible to have an understanding of what is happening in someone’s emotional world, but not take it on yourself.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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What is trauma?

Emotional trauma comes from stress that is overwhelms a person’s neurological system. Some stress can be good and formative, or it can be bad and get stuck in the brain, causing someone deep emotional pain.

Think of climbing Mount Everest. Some people choose to do that, and it’s easily one of the most stressful situations you can put yourself in on purpose. That’s good stress if you have trained for years and are ready for it. If someone forced you to climb Mount Everest, it would register in the brain as a trauma.

Trauma is too big for the mind, brain, and nervous system to assimilate. It’s a memory, or experience, that gets stuck because the person believed it would result in their death, or at least serious injury.

The brain has several mechanisms to keep something stuck so that the person will remember it, and try to avoid getting hurt in the same way in the future. It is a survival instinct.

People commonly demonstrate symptoms of trauma when they’ve:

Experienced a sexual violation

Seen violence

Experienced violence or abuse

Been neglected—experienced the absence of something that they should have had.

Been in near death experiences like car accidents or war

People who have PTSD, or post traumatic stress disorder, have experienced a soul-level of brokenness, and even talking about the event, or having a memory of it, can bring it back with the same force that occured in the actual accident. They often have recurring nightmares, or repetitive symptoms that continue long after the event.

Typical PTSD symptoms alternate between chronic shut down and fight and flight

Fight and flight symptoms are:

Sweating, nightmares, flashbacks, anger, rage, panic, hypervigilance, tense muscles, painful knotted gut

Shut down symptoms are:

Dissociation, freezing, emotional detachment, voice trembling, difficulty getting words out, numbness, apathy, fear, helplessness, dizzy, empty, nausea

Moments in connection mode look like:

curiosity, exploration, relaxed and full breathing, feeling grounded, true smiles

By listening to this episode, you can earn 1.25 Psychiatry CME Credits.

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What is a therapeutic alliance?

The therapeutic alliance is a collaborative relationship between the physician and the patient. Together, you jointly establish goals, desires, and expectations of your working partnership.

Every interview with a patient, whether it’s for diagnostic, intake, evaluative, or psychopharmacology purposes, has therapeutic potential. The treatment starts from your first greeting—how you listen, empathize, and even how you say goodbye.

It’s built from a partnership and dialogue, like any other relationship. It’s not built from medical interrogation. It’s not about pulling medical information to be able to make a diagnosis. We have to make it a positive experience for patient, so they can begin to talk about what's negative in their lives.

The therapeutic alliance is full of meaning, and it uses every emotional transaction therapeutically. If they get angry, sad, or have fear you will abandon them, as a therapist, it’s our job to figure out how to help them through that feeling within the relationship. The doctor can express desire for the patient to share, in real time, how the patient is feeling, even about his or her relationship with the doctor.

Why do we care?

We all know that some talk therapists have better outcomes than other talk therapists. What’s interesting though, is that some some psychiatrists’ placebos worked better than other psychiatrists’ active drugs. One study of NIMH data of 112 depressed patients treated by 9 psychiatrists with placebo or imipramine, found that variance in BDI score (a score that measures depression) due to medication, was 3.4% and variance due to psychiatrist was 9.1%. One-third of psychiatrists had better outcomes with the placebo than one-third had with imipramine.

Another book argues that the therapist is more important to outcome than theory or technique. Many other studies have shown that therapeutic alliance directly correlates to success rates.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Timothy Lee has talked to thousands of medical students about how to applying for residency programs, and here, he gives us a few tips on how to make it through the gauntlet, and how to have your best chance at landing the program you want.

Here is what Timothy Lee says:

Stay calm

Many students have been fine tuning their personal statements, and trying to get their resume just right, or hurrying to press the faculty to write letters of recommendation. It can be very stressful.

It’s okay to turn in information a little bit later, in order to have all of the paperwork you need. It’s even okay to review your statement after you’ve already turned it in. No one will lower their opinion based on that. You will need to have applied for the majority of the programs you are interested in by early or mid-October, otherwise the program director might wonder if you’re applying to them later as a backup plan.

What matters in a personal statement?

Every program director will have different opinions on what you write, and every program director will be looking for different things from your personal statement. For some people, it’s a chance to get to know the applicant a little bit. For others, it doesn’t really matter that much.

As long as your grammar and syntax are competent, you should be fine. Some people don’t worry about the format, and others are more particular. To be on the safe side, if you have access to a good mentor, run it by them. Also, don’t be too wordy—stick to a page and a half.

Do step scores matter?

Step scores are a very convenient screening tool for what matters, but there are studies that show that step scores are not directly correlated to success in residency performance. They are helpful, but are not the end-all-be-all. It’s only one part of the picture of an applicant. However, if you are going for a highly-competitive residency, you might need to worry about step scores a bit more.

Apply to the right number of programs

The number of programs is not the only way to increase your chance of success of getting in. Pay attention to the types of programs you are applying to as well. If you are applying for a good number of programs, make sure at least half of them are are ones you are a solid and potentially attractive candidate for.

Keep a good perspective

Ultimately, you are more than your CV, step score, or personal statement. If patients like you, that’s going to go a long ways. Your patients won’t know your scores, or where you graduated from medical school. They will know if you were competent, caring and connected. That is ultimately what matters.

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On this week’s episode of the podcast, I interviewed Allison Maxwell, a social worker and PhD student of clinical social work. I refer patients to her regularly for psychoanalysis, and she has had a wonderful impact on their mental health journey.

What is psychodynamic theory?

Psychodynamic therapy is a form of talk therapy where the practitioner work focuses on the patient’s emotion, fantasies, dreams, unconscious drives and wishes, early and current life relationships, and the relationship that is forming between the patient and therapist.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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On this week’s episode of the podcast, I interview Dr. Cummings, a reputable psychopharmacologist, about ketamine. We talk about psychedelics, the research behind it, both the positives and the negatives. We will look at how it is or is not helpful in psychiatric treatments.

(Disclaimer: There are no conflicts of interest to report. Neither Dr. Puder or Cummings is affiliated with any companies in favor of ketamine and other drug companies.)

Ketamine

Although ketamine has recently become a medication of great interest in psychiatry, it actually is a fairly old medication. It was first synthesized in 1962 and began human trials for anesthesia in 1964. It was finally approved by the FDA as a dissociative anesthetic in 1970.

What has piqued interest in psychiatry is that infusion of a smaller dose of ketamine produces a rapid response in terms of reversal of depressed mood, suicidality, and some treatment-resistant depressed patients.

The literature is rich (in one sense) as the most recent consensus statement (Sanacora, 2017) looked at seven randomized controlled trials, all of which support a robust antidepressant response and anti-suicide response. The difficulty with those trials is the majority of them lasted only one week. A few of the later trials lasted two to three weeks with two to three infusions per week. So, what’s lacking at this point is adequate data regarding long term treatment response and data about transitions to more traditional antidepressant treatments.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Delirium is an acute change in a person’s sensorium (the perception of one’s environment or understanding of one’s situation). It can include confusion about their orientation, cognition or mental thinking.

With hyperactive delirium, a patient can become aggressive, violent and agitated with those around them. A patient experiencing delirium can have hallucinations and hear things, they can become paranoid, and they are overall confused. A family or non-psychiatric medical staff might be concerned that the patient is experiencing something like schizophrenia.

Hyperactive delirium symptoms in patients:

Waxing and waning —it comes and goes

Issues with concentration

Pulling out medical lines

Yelling profanities

Throwing things

Agitated

Responding to things in the room that aren’t there

Not acting like themselves

Hypoactive delirium is much more common than hyperactive delirium (based on research studies), but it is often missed because the presentation is much less dramatic. People with hypoactive delirium are confused and disoriented, but they are not expressing their confusion verbally or physically.

Hypoactive delirium symptoms:

Slower movement

Softer speech

Slower responses

Withdrawn

Not eating as much

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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Episode CME activity objectives:

In the context of a therapeutic alliance, apply the information given in this episode to help draw out meaning in others.

Identify who Viktor Frankl was and how his work and legacy have shaped how we understand and utilize meaning in psychiatry.

Define psychic determinism.

Recognize that meaning is idiosyncratic and unique to each individual.

Recognize the multitude of ways people can find meaning in their lives and the various ways they can express and convey this.

Summarize the various studies listed in this episode that have shown how meaning and the creation of meaning can have a positive impact.

David Puder, M.D. has no conflicts of interest to report.

In the celebrated book Man’s Search for Meaning, author Viktor Frankl wrote about his intimate and horrific Holocaust experience. He found that meaning often came from the prisoners’ small choices—to maintain belief in human dignity in the midst of being tortured and starved and bravely face these hardships together.

“The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal.” - Viktor Frankl

“We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” - Viktor Frankl

Frankl argued that the ultimate human drive is the “will to meaning,” which could be described as the meaning to be found in the present and in the future. For example, I have had patients who are suicidal, yet they would not kill themselves, despite part of them desiring death, because they would not get to see their grandkids grow up. The meaning of the future moments and being able to help their grandkids in some small way empowers them to keep going to treatment.

People’s meaning keeps them going, even when other drives, like sex or desire for power, are completely gone. In this way, Frankl noted, “Focus on the future, that is on the meaning to be fulfilled by the patient in his future…I speak of a will to meaning in contrast to the pleasure principle (or, as we could speak also term it, the will to pleasure) on which Freudian psychoanalysis is centered, as well as in contrast to the will to power on which Adlerian psychology, using the term ‘striving for superiority,’ is focused.”

This idea led to the beginning of a new type of therapy—logotherapy.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

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For many, motherhood is a beautiful, unique, and meaningful experience. The mother-child bond is a relationship that has the potential to be a deeply loving and positive experience for both the mother and child. However, motherhood can be distressing, which is why it is imperative that we, as providers, understand the unique psychiatric issues that are associated with this time period in a woman’s life.

Perinatal mood and anxiety disorders, or PMAD for short, is the term used to describe mood and anxiety disorders that affect women during the perinatal period, which is the timeframe from pregnancy to 12 months postpartum. PMAD encompasses a variety of disorders, such as anxiety, depression, obsessive-compulsive disorder, bipolar mood disorder, psychosis, and PTSD.

Details on connecting with Kelly Rivinius through social media or about her free support group:here

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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What is placebo?

The original meaning of the word placebo is, “I will please.” That statement comes from a time when doctors didn’t have our modern code of ethics, and they would prescribe whatever would make the person feel better. They probably had the best intentions, but they also would have known that whatever they were prescribing might not have been a real medication for the symptoms the patient was experiencing.

Doctors, even then, knew that suggestion was powerful, sometimes more powerful than the medicine they were prescribing.

Laypeople who hear the word “placebo” automatically think of sugar pills. They may think only that it’s something a doctor gives to placate and make people feel better when they aren’t getting the active medication. Placebos have long been used as a comparison arm for clinical trials. Usually it is in the form of an inert sugar pill or sham-procedure. Researchers can observe a psychobiological response known as the placebo effect.

But when thinking about the word “placebo,” we must think of the entire effect of it, and it is perhaps better termed “the meaning effect.” As I discussed in last week’s episode of the podcast, the meaning we give something creates belief, and belief is a potent change mechanism, even when it comes to our physical health. It is especially potent when it comes to mental health.

The placebo effect encompasses the therapeutic alliance, expectations, natural healing of the body and mind, and the environment of therapy. It involves the power of suggestion, mood, and the beliefs behind even one positive or negative interaction with a doctor. It also, as we will see, involves studies involving heavy-hitting medication.

When there is an increased ritual, there is an increased placebo effect. During a hospital stay, the surgery preparation, meetings with doctors, nurses and therapists can have an incredibly therapeutic effect on a patient. It is possible to see biological mechanisms triggered by psychosocial context and attribute it to a placebo effect.

What is the power of suggestion, the meaning effect, placebo effect, and how do we use it or avoid it in our practices and when testing new medical treatments?

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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People who truly have ADHD typically experience inattentive and hyper symptoms across all areas of their life. For example, if they are in a job that requires periods of attention to complete or organize a project, it will be inherently more difficult for people with ADHD.

One of the things that’s important in diagnosing people (particularly younger people) is their collateral history. People around the person with suspected ADHD are often more aware of the person’s deficits than the person themselves. When they reach adulthood, the problems might be made more obvious when they integrate into normal society and notice they struggle with symptoms of ADHD (compared to other people).

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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Empathy is the ability to understand another’s state of mind or emotions. It is also is being able to feel, understand and share with someone else in what they are saying, their meaning of life, their motivations and values.

In research there are 3 types of empathy that are commonly described: cognitive, affective, and compassionate.

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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The words “aggression” and “violence” are sometimes used synonymously, but in reality, aggression can be physical or non-physical, and directed either against others or oneself. Violence is more of a use of force with an intent to inflict damage.

One study looked at the principle types of aggression and violence that occur in psychiatric patients, and broke it down into three categories:

Impulsive violence (the most common category)

Predatory violence (purposeful and planned violence)

Psychotically-driven violence (least common)

By listening to this episode, you can earn 1 Psychiatry CME Credits.

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