PsychEd: educational psychiatry podcast

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode is an introduction to the use and monitoring of lithium in bipolar disorder. Join Tingting Yan (CC4) and Dr. Alex Raben (staff psychiatrist at CAMH and lecturer at the University of Toronto) for a lively case-based discussion. Learning Objectives The learning objectives for this episode are as follows:   By the end of this episode, the listener will be able to… Describe the indications and process for starting lithium Monitor and interpret serum lithium levels List short and long-term adverse effects of lithium Produced by: Tingting Yan CC4, Dr. Alex Raben (staff psychiatrist)   Hosts: Tingting Yan, Alex Raben   Audio editing by: Alex Raben   Show notes by: Alex Raben   Contents: Learning objectives: 00:44 Lithium background and brief history: 2:48 Women’s health and lithium: 5:28 Underutilization of lithium: 8:02 Baseline blood work for lithium: 11:32 Choosing a lithium starting dose: 14:32 Lithium serum levels: 16:17 Lithium titration: 20:46 Lithium toxicity: 23:48 Lithium side effects: 26:52 Summary: 32:11   References Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet. 1970;2(7668):326-330. doi:10.1016/s0140-6736(70)92870-9 Bauer LA. Chapter 17. Lithium. In: Bauer LA. eds. Applied Clinical Pharmacokinetics, 2e. McGraw Hill; 2008. Accessed March 16, 2023. https://accesspharmacy.mhmedical.com/content.aspx?bookid=510&sectionid=40843106 Chokhawala K, Lee S, Saadabadi A. Lithium. StatPearls. Davis J, Desmond M, Berk M. Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification. BMC nephrology. 2018 Dec;19:1-7. Draaisma D. Lithium: the gripping history of a psychiatric success story. Nature. 2019 Aug 1;572(7769):584-6. Hedya SA, Avula A, Swoboda HD. Lithium toxicity. Malhi GS, Bell E, Outhred T, Berk M. Lithium therapy and its interactions. Australian Prescriber. 2020 Jun;43(3):91. Malhi GS, Gessler D, Outhred T. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. J Affect Disord. 2017;217:266-280. doi:10.1016/j.jad.2017.03.052 McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721-728. doi:10.1016/S0140-6736(11)61516-X Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S. Lithium use in pregnancy and the risk of cardiac malformations. New England Journal of Medicine. 2017 Jun 8;376(23):2245-54. Tondo L, Alda M, Bauer M, Bergink V, Grof P, Hajek T, Lewitka U, Licht RW, Manchia M, Müller-Oerlinghausen B, Nielsen RE. Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders. 2019 Dec;7(1):1-0. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders. 2018 Mar;20(2):97-170.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the “big picture” relationship between violence and severe mental illnesses such as schizophrenia and bipolar spectrum disorders. Our guest experts in this episode are Dr. Robert McMaster, Assistant Professor of Forensic Psychiatry at the University of Toronto and Dr. Ragy R. Girgis, Associate Professor of Clinical Psychiatry at Columbia University in New York. This episode is a good companion to Episode 15: Managing Aggression and Agitation with Dr. Jodi Lofchy, which covers how to identify and manage acute risk of violence in a clinical setting. The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Describe the epidemiology of violence in severe mental illness (rates of perpetration vs. victimization, risk factors, quality of evidence)  Understand and critique how society currently addresses violence in those with severe mental illness  Discuss this topic with patients, caregivers and the public, and address common myths  Guests:  Dr. Robert McMaster - Assistant Professor of Forensic Psychiatry at the University of Toronto Dr. Ragy R. Girgis - Associate Professor of Clinical Psychiatry at Columbia University in New York Hosts: Dr. Alex Raben (Staff Psychiatrist), Dr. Gaurav Sharma (PGY4), Sena Gok(IMG), Josh Benchaya (CC4) Audio editing by: Gaurav Sharma Show notes by: Josh Benchaya, Gaurav Sharma, Sena Gok   Interview Content:   Learning Objectives: 02:29 Perceptions of Violence and Mental Illness: 03:53 Mental illness & Violence Link Evidence: 06:48 Violence Perpetration & Victimisation: 10:10 Risk of Violence Assessment (HCR 20 Model): 17:00 Mass Shootings & Mental Illness & Predictions: 20:30 Violence Risk Prediction: 25:25 Severe Mental Illness & Violence Risk Treatments: 29:40 Society’s approach to Severe Mental Illness & Violence Misperceptions: 38:30 Mental Illness and Violence Stigma: 45:03 Case Vignette & Approach: 46:44 Summary of the episode: 58:00   References:   de Mooij, L.D., Kikkert, M., Lommerse, N.M., Peen, J., Meijwaard, S.C., Theunissen, J., Duurkoop, P.W., Goudriaan, A.E., Van, H.L., Beekman, A.T. and Dekker, J.J., 2015. Victimization in adults with severe mental illness: prevalence and risk factors. The British Journal of Psychiatry, 207(6), pp.515-522. Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community violence perpetration and victimization among adults with mental illnesses. American journal of public health, 104(12), 2342-2349. Metzl, J.M., Piemonte, J. and McKay, T., 2021. Mental illness, mass shootings, and the future of psychiatric research into American gun violence. Harvard review of psychiatry, 29(1), p.81.   Buchanan, A., Sint, K., Swanson, J. and Rosenheck, R., 2019. Correlates of future violence in people being treated for schizophrenia. American Journal of Psychiatry, 176(9), pp.694-701.   Rund, B.R., 2018. A review of factors associated with severe violence in schizophrenia. Nordic journal of psychiatry, 72(8), pp.561-571.   Markowitz FE. Mental illness, crime, and violence: Risk, context, and social control. Aggress Violent Behav. 2011 Jan 1;16(1):36–44.   Pescosolido BA, Manago B, Monahan J. Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences. Health Aff Proj Hope. 2019 Oct;38(10):1735–43.   Ross AM, Morgan AJ, Jorm AF, Reavley NJ. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc Psychiatry Psychiatr Epidemiol. 2019 Jan 1;54(1):11–31.   Srivastava K, Chaudhury S, Bhat PS, Mujawar S. Media and mental health. Ind Psychiatry J. 2018;27(1):1–5.   Stuart H. Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness? CNS Drugs. 2006;20(2):99–106.   Rowaert S, Vandevelde S, Lemmens G, Audenaert K. How family members of mentally ill offenders experience the internment measure and (forensic) psychiatric treatment in Belgium: A qualitative study. Int J Law Psychiatry. 2017;54:76–82.   Bjørn Rishovd Rund (2018) A review of factors associated with severe violence in schizophrenia, Nordic Journal of Psychiatry, 72:8, 561-571, DOI: 10.1080/08039488.2018.1497199  References cited by our experts:   Steadman, H.J., Monahan, J., Pinals, D.A., Vesselinov, R. and Robbins, P.C., 2015. Gun violence and victimization of strangers by persons with a mental illness: data from the MacArthur Violence Risk Assessment Study. Psychiatric services, 66(11), pp.1238-1241. [00:05:26]   Appelbaum PS, Robbins PC, Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry. 2000 Apr;157(4):566-72. doi: 10.1176/appi.ajp.157.4.566. PMID: 10739415. [00:05:26]   Torrey EF, Stanley J, Monahan J, Steadman HJ; MacArthur Study Group. The MacArthur Violence Risk Assessment Study revisited: two views ten years after its initial publication. Psychiatr Serv. 2008 Feb;59(2):147-52. doi: 10.1176/ps.2008.59.2.147. PMID: 18245156. [00:05:26]   Witt, K., Hawton, K. and Fazel, S., 2014. The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophrenia research, 154(1-3), pp.61-67. [00:08:46] Sariaslan, A., Arseneault, L., Larsson, H., Lichtenstein, P., & Fazel, S. (2020). Risk of subjection to violence and perpetration of violence in persons with psychiatric disorders in Sweden. JAMA psychiatry, 77(4), 359-367. [00:11:20] Douglas, K. S., Shaffer, C., Blanchard, A. J. E., Guy, L. S., Reeves, K., & Weir, J. (2014). HCR-20 violence risk assessment scheme: Overview and annotated bibliography. HCR-20 Violence Risk Assessment White Paper Series, #1. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University. [00:18:53] Girgis, R.R., Rogers, R.T., Hesson, H., Lieberman, J.A., Appelbaum, P.S. and Brucato, G., 2022. Mass murders involving firearms and other methods in school, college, and university settings: findings from the Columbia Mass Murder Database. Journal of forensic sciences. [00:25:11]       CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the mental status examination and makes use of practical and fictional examples to delve deeper into the skills and concepts   Learning Objectives:   The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Explain the utility and purpose of the mental status examination in psychiatry Describe the major components of the mental status examination and be familiar with some of the common vocabulary used Incorporate the mental status in a way that respects patients in presentation, documentation and formulation in clinical practice    Topics: 2:37 - Learning objectives 3:10 - Definition of the MSE 6:48 - History of the MSE 9:00 - Limitations of the MSE 15:37 - Strengths of the MSE 21:30 - ASEPTIC Mnemonic 23:04 - Appearance and Behaviour 37:42 - Speech 51:51 - Emotion (mood and affect) 1:03:51 - Perception 1:08:38 - Thought Form and Content 1:17:30 - Insight and Judgement 1:27:40 - Cognition   Hosts: Andreea Chiorean (CC4), Saja Jaberi (IMG), Dr. Weam Seiffien (PGY2), Angad Singh (CC2), Dr. Annie Yu (PGY1), and Dr. Alex Raben, staff psychiatrist.   Guest Experts: Us!   Video clips: Speech:  Mojo Jojo: https://youtu.be/y4qNWPPlYE4?t=48 Family guy video: no longer available   Emotion Eeyore: https://youtu.be/7xPnUe6Xcbw?t=12   Squidward: https://youtu.be/FjrOWnywPok?t=195   Bubbles: https://youtu.be/rAC4W563Ayk?t=339   Perception A Beautiful Mind: https://youtu.be/vNa37tOB4rE   Insight and Judgement Simpsons: no longer available Mr. Magoo: https://youtu.be/eWEnzLFd4P4?t=201   Cognition Still Alice: https://youtu.be/mhiXAJO8kBc?t=67 Resources: MSE template: https://www.therapistaid.com/therapy-worksheet/mental-status-exam Emotion wheel: https://feelingswheel.com/ MSE vocabulary: http://www.columbia.edu/itc/hs/medical/psychmed/1_2004/mental_status_exam.pdf References: Bell, R. (1977). The Mental Status Examination. 16(5).Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198. Donnelly, J., Rosenberg, M., & Fleeson, W. P. (1970). The evolution of the mental status—past and future. American Journal of Psychiatry, 126(7), 997-1002. Norris, D. R., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. 94(8). Norton, J. W., & Corbett, J. J. (2000, February). Visual perceptual abnormalities: hallucinations and illusions. In Seminars in neurology (Vol. 20, No. 01, pp. 0111-0122). Copyright© 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Notes, T. (2020). Comprehensive Medical Reference and Review for the Medical Council of Canada Qualifying Exam (MCCQE) Part I and the United States Medical Licensing Exam (USMLE) Step II 36th ed: Toronto Notes for Medical Students. Recupero, P. R. (2010). The Mental Status Examination in the Age of the Internet. The Journal of the American Academy of Psychiatry and the Law, 38(1). Robinson D. J. (2002). Mental status exam explained (2nd ed.). Rapid Psychler Press. Robinson D. J. (1998). Brain Calipers: a guide to a successful mental status exam. Rapid Psychler Press. Ross, C. A., & Leichner, P. (1988). Residents Performance on the Mental Status Examination. The Canadian Journal of Psychiatry, 33(2), 108–111. https://doi.org/10.1177/070674378803300207 Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Lippincott Williams & Wilkins Publishers. Segal, D. L. (Ed.). (2019). Diagnostic interviewing. Springer. Snyderman, D., & Rovner, B. (2009). Mental status examination in primary care: a review. American family physician, 80(8), 809-814. Spencer, R. J., Noyes, E. T., Bair, J. L., & Ransom, M. T. (2022). Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination. Clinical Gerontologist, 45(3), 454–466. https://doi.org/10.1080/07317115.2022.2032523 The Collected Papers of Adolf Meyer. Volume III: Medical Teaching. (1952) JAMA. 148(17):1544. https://www.statpearls.com/ArticleLibrary/viewarticle/24998 CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we’ll explore a topic that we’re sure many listeners are eager to learn about: The Assessment of Major Neurocognitive Disorder, also known as dementia with Dr. Lesley Wiesenfeld who is a Geriatric Psychiatrist and Psychiatrist-in-Chief at Mount Sinai Hospital in Toronto, where she leads the Geriatric Consult Liaison Psychiatry Service. She is also an Associate Professor in the Department of Psychiatry at the University of Toronto.   The learning objectives for this episode are as follows:   Define Major Neurocognitive Disorder (aka Dementia) as per DSM-5 diagnostic criteria Identify differential diagnoses for cognitive decline and list differentiating clinical features  Outline an approach to the assessment of a patient presenting with cognitive decline, including the role of a comprehensive history, psychometric tools and other investigations [ Relevant PMH/risk factors, ADLs/IADLs to cover on history, psychometric tools such as MMSE, MoCA and tie this back into major cognitive domains when to consider imaging, bloodwork including specialized testing such as ApoE genetic tests]  Classify the major subtypes of Neurocognitive Disorders, their epidemiology, and clinical presentations [ Vascular dementia, Alzheimer’s, Frontotemporal, Lewy Body, Parkinson’s,    Mixed dementia - Early onset dementia]   Guest: Dr. Lesley Wiesenfeld ( Lesley.Wiesenfeld@sinaihealthsystem.ca )   Hosts: Dr. Luke Fraccaro (PGY-3), Dr. Mark Fraccaro (PGY-4), Sena Gok (international medical graduate)   Audio editing by: Sena Gok   Show notes by: Sena Gok   Interview Content: Introduction: 0:13 Learning Objectives: 02:35 Diagnostic criteria of Major Neurocognitive Disorder: 03:20 Difference between Major and Mild Neurocognitive Disorder: 05:20 Red Flags of Cognitive Declines: 06:50 Normal Aging vs Major Neurocognitive Disorder: 10:00 Clinical Vignette – introduction: 11:35 Patient Assessment: 16:50 Past medical/family / Psychosocial history: 21:55 Clinical Vignette - Assessment: 37:45 Physical examination: 43:50 Investigations: 45:53 Role of genetic testing: 53:24 Clinical Vignette – Diagnosis: 57:50   References:   American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).   Sadock, B. J., Sadock, V. A., Ruiz, P., & Kaplan, H. I. (2015). Neurocognitive Disorders. Kaplan and Sadock’s Synopsis of Psychiatry (11th ed.). Wolters Kluwer   DSM-5-TR Fact Sheets (https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets )   Gauthier S, Patterson C, Chertkow H, Gordon M, Herrmann N, Rockwood K, Rosa-Neto P, Soucy JP. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012 Dec;15(4):120-6. doi: 10.5770/cgj.15.49. Epub 2012 Dec 4. PMID: 23259025; PMCID: PMC3516356.   Gauthier S, Chertkow H, Theriault J, Chayer C, Ménard MC, Lacombe G, Rosa-Neto P, Ismail Z. CCCDTD5: research diagnostic criteria for Alzheimer's Disease. Alzheimers Dement (N Y). 2020 Aug 25;6(1):e12036. doi: 10.1002/trc2.12036. Erratum in: Alzheimers Dement (N Y). 2022 Feb 03;6(1):e12088. PMID: 32864413; PMCID: PMC7446944. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode delves into the history of psychiatry with Dr David Castle, the inaugural Scientific Director of the Centre for Complex Interventions at the Centre for Addictions and Mental Health and a Professor in the Department of Psychiatry at the University of Toronto. Prior to migrating to Canada in 2021, he spent 15 years as a Professor of Psychiatry at St Vincent’s Hospital and the University of Melbourne in Australia.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Gain an appreciation for the historical context of the field of psychiatryUnderstand how illness categories and treatments have been shaped by this history Compare and contrast how various past societies viewed and conceptualized mental illnessApply lessons learned from historical practices to appraise current approaches   Guest: Dr David Castle   Hosts: Dr Alex Raben (Staff Psychiatrist), Gaurav Sharma (PGY4), Nikhita Singhal (PGY4), Andreea Chiorean (CC4)   Audio editing by: Dr Alex Raben   Show notes by: Dr Nikhita Singhal   Interview Content:   1:45 - Learning Objectives   3:25 - Ancient Times   14:42 - Middles Ages    23:56 - Renaissance to Enlightenment   34:55 - 19th-20th Centuries   47:55 - 20th-21st Centuries   1:00:48 - Final Thoughts   Resources: Shrinks: The Untold Story of Psychiatry (Jeffrey A Lieberman)   References: The Emotional Foundations of Personality: A Neurobiological and Evolutionary Approach (Kenneth L Davis, Jaak Panksepp) Illustration of Bedlam (William Hogarth) Pinel, médecin en chef de la Salpêtrière en 1795 (Tony Robert-Fleury)Castle, D., Bassett, D., King, J., & Gleason, A. (2013). A primer of clinical psychiatry. Elsevier Health Sciences.de Leon J. DSM-5 and the research domain criteria: 100 years after Jaspers' General psychopathology. Am J Psychiatry. 2014 May;171(5):492-4. https://doi.org/10.1176/appi.ajp.2013.13091218Eisenberg L. Mindlessness and brainlessness in psychiatry. Br J Psychiatry. 1986 May;148:497-508. https://doi.org/10.1192/bjp.148.5.497Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36. https://doi.org/10.1126/science.847460Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003 Jan;160(1):4-12. https://doi.org/10.1176/appi.ajp.160.1.4Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970 Jan;126(7):983-7. https://doi.org/10.1176/ajp.126.7.983Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):250-8. https://doi.org/10.1126/science.179.4070.250Scheff TJ. The labelling theory of mental illness. Am Sociol Rev. 1974 Jun;39(3):444-52. https://doi.org/10.2307/2094300Szasz T. The myth of mental illness: 50 years later. The Psychiatrist. Cambridge University Press; 2011;35(5):179–182. https://doi.org/10.1192/pb.bp.110.031310   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a focused summary of the latest changes in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) with our guest expert — Dr. Michael First, a Professor of Clinical Psychiatry at Columbia University, NY. Dr. First is an internationally recognized expert on psychiatric diagnosis and assessment issues, he is the editor and co-chair of the DSM-5 text revision project (DSM-5-TR), the editorial and coding Consultant for the DSM-5, the chief technical and editorial consultant on the World Health Organization ICD-11 revision project and was an external consultant to the NIMH Research Domain Criteria project (RDOC).   The learning objectives for this episode are as follows: Understand the rationale for undertaking a DSM-5-TR as well as the revision process itself  To become familiar with disorder, text and symptom code additions and modifications to the DSM-5-TR  To understand the purpose and function of the DSM in its current form and be able to contemplate future directions   Guest Expert: Dr. Michael First – staff psychiatrist and professor of clinical psychiatry at Columbia University, USA. Produced and hosted by: Dr. Alex Raben (staff psychiatrist) and Saja Jaberi (international medical graduate) Audio editing by: Dr. Alex Raben Show notes by: Saja Jaberi Interview Content: 2:53 - Learning objectives 3:34 - Brief description of the DSM and its history 4:54 – ICD vs. DSM  7:43 - Rationale behind the new revision 11:11 - Characteristics of the DSM-5-TR revision process and the people behind it 16:54 - Case presentation and Differential Diagnosis 23:07 - Prolonged Greif disorder 27:04 - Most important changes to the terminology used in the manual 39:34 - Pros and cons of the DSM 44:30 - A brief Comparison to the RDOC Framework 49:04 – Future Directions of the DSM   References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Text Revision ed. 2022.  DSM-5-TR Fact Sheets https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a broad overview of antisocial personality disorder and psychopathy with our guest expert - Dr. Donald Lynam. Dr. Lynam is a clinical psychologist by training, and professor at Purdue university, where he heads the Purdue's Developmental Psychopathology, Psychopathy and Personality Lab. While there may be some disagreement in the field, Dr. Lynam and I discuss how ASPD and psychopathy are two diagnostic constructs that are attempting to outline the same psychopathology, with the main difference being the degree of severity - for this reason, we use the terms antisocial and psychopathic interchangeably.    While not necessary, it may be of benefit for listeners to familiarize themselves with the DSM-V criteria for antisocial personality disorder, the psychopathy checklist (PCL), as well as the 5-factor model of personality. References for each are listed below in the references section, however, for a brief overview, one could do a quick google image search for each term (Wikipedia also has a succinct overview of the psychopathy checklist).   The learning objectives for this episode are as follows:   Develop a basic understanding of what is meant by antisocial personality and psychopathy Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors  Describe the theoretical basis for the development of antisocial personalities    Guest Expert: Dr. Donald Lynam - Clinical psychologist, Investigator at Purdue University, Indiana Produced and hosted by: Dr. Chase Thompson (PGY5 in Psychiatry) Episode guidance and feedback: Dr. Gaurav Sharma (PGY4 in Psychiatry)   Interview Content:   0:50 - Learning objectives 1:40 - Dr. Lynam discusses his path to his current research interests 3:40 - Defining the terms antisocial personality disorder, sociopathy, psychopathy 8:30 - Discussing the possibility of antisocial behaviors without an antisocial personality 12:07 - Laying out the core features of antisocial individuals  18:20 - Antisocial personality from the perspective of the Big 5 personality model 22:00 - Discussion of the high-functioning psychopathy  25:06 - Prevalence of psychopathy 30:10 - Factors relevant to the development of psychopathy 39:30 - Prognosis and clinical trajectory  44:30 - Comorbid psychopathology  46:30 - Functions of antagonism or antisocial behaviours  49:30 - Treatment    References   American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R, Lynam DR. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Developmental psychology. 2003 Mar;39(2):222. Babiak P, Hare RD, McLaren T. Snakes in suits: When psychopaths go to work. New York: Harper; 2007 May 8. Hare RD. The psychopathy checklist–Revised. Toronto, ON. 2003;412. Hare RD, Harpur TJ, Hakstian AR, Forth AE, Hart SD, Newman JP. The revised psychopathy checklist: reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Sep;2(3):338. Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of abnormal psychology. 1991 Aug;100(3):391. Jones SE, Miller JD, Lynam DR. Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice. 2011 Jul 1;39(4):329-37. Lynam DR. Early identification of chronic offenders: Who is the fledgling psychopath?. Psychological bulletin. 1996 Sep;120(2):209. Miller JD, Lynam DR. Psychopathy and the five-factor model of personality: A replication and extension. Journal of personality assessment. 2003 Oct 1;81(2):168-78.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of perinatal psychiatryDescribe the key issues that should be addressed in pre-conception psychiatric counselingDiscuss the management approach for prescribing medications during pregnancyRecognize the prevalence of mood disorders during the perinatal periodRecall the diagnostic criteria for postpartum depressionConsider the risk factors and explanatory models for postpartum depressionDiscuss the use of screening tools for postpartum depressionOutline the treatment for postpartum depressionDescribe the clinical presentation of postpartum psychosis and recognize the urgency of this conditionList important risk factors for postpartum psychosisDiscuss the management for postpartum psychosis   Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Produced by: Nima Nahiddi (PGY4), Audrey Le (PGY1), Rebecca Marsh (PGY2) and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00Learning objectives - 00:43Defining the field of perinatal psychiatry - 01:55Key issues to address in preconception counseling - 02:50Management approach for prescribing medications during pregnancy - 07:00Prevalence of mood disorders during the perinatal period - 12:11Diagnostic criteria for postpartum depression - 14:05Differentiating postpartum psychosis from postpartum depression - 16:52Risk factors and explanatory models for postpartum depression - 18:58Screening tools for postpartum depression - 20:15Treatment for postpartum depression - 22:13Pharmacotherapy - 22:20Psychotherapy - 27:34 Clinical presentation of postpartum psychosis - 29:07Risk factors for postpartum psychosis - 30:43Postpartum psychosis prognosis and impacts on attachment- 32:57Management of postpartum psychosis -35:30Closing comments - 38:00   Resources: Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ open, 7(1), e013372. https://doi.org/10.1136/bmjopen-2016-013372Boukhris, T., Sheehy, O., Mottron, L., & Bérard, A. (2016). Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children. Jama Pediatrics, 170(2), 117-24. doi: 10.1001/jamapediatrics.2015.3356.Brown, A. S., Gyllenberg, D., Malm, H., McKeague, I. W., Hinkka-Yli-Salomäki, S., Artama, M., Gissler, M., Cheslack-Postava, K., Weissman, M. M., Gingrich, J. A., & Sourander, A. (2016). Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring. JAMA psychiatry, 73(11), 1163–1170. https://doi.org/10.1001/jamapsychiatry.2016.2594Cohen, J. , Hernández-Díaz, S. , Bateman, B. , Park, Y. , Desai, R. , Gray, K. , Patorno, E. , Mogun, H. & Huybrechts, K. (2017). Placental Complications Associated With Psychostimulant Use in Pregnancy. Obstetrics & Gynecology, 130(6), 1192-1201. doi: 10.1097/AOG.0000000000002362.Huybrechts, K. F., Hernández-Díaz, S., Patorno, E., Desai, R. J., Mogun, H., Dejene, S. Z., Cohen, J. M., Panchaud, A., Cohen, L., & Bateman, B. T. (2016). Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations. JAMA psychiatry, 73(9), 938–946. https://doi.org/10.1001/jamapsychiatry.2016.1520Huybrechts, K. F., Palmsten, K., Avorn, J., Cohen, L. S., Holmes, L. B., Franklin, J. M., Mogun, H., Levin, R., Kowal, M., Setoguchi, S., & Hernández-Díaz, S. (2014). Antidepressant use in pregnancy and the risk of cardiac defects. The New England Journal of Medicine, 370(25), 2397–2407. https://doi.org/10.1056/NEJMoa1312828Imaz, M. L., Oriolo, G., Torra, M., Soy, D., García-Esteve, L., & Martin-Santos, R. (2018). Clozapine Use During Pregnancy and Lactation: A Case-Series Report. Frontiers in Pharmacology, 9, 264. https://doi.org/10.3389/fphar.2018.00264Nörby, U., Forsberg, L., Wide, K., Sjörs, G., Winbladh, B., & Källén, K. (2016). Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy. Pediatrics, 138(5), e20160181. https://doi.org/10.1542/peds.2016-0181Nörby, U., Winbladh, B., & Källén, K. (2017). Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics, 140(6), e20170747. https://doi.org/10.1542/peds.2017-0747Reis, M., & Källén, B. (2013). Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A registered study. BMJ Open, 3, e002166. doi:10.1136/bmjopen-2012-002166Sundram S. (2006). Cannabis and neurodevelopment: implications for psychiatric disorders. Human psychopharmacology, 21(4), 245–254. https://doi.org/10.1002/hup.762   References: Boland, R., Verduin, M., & Ruiz, P. (2021). Psychopharmacology. In Kaplan & Sadock's synopsis of psychiatry (Twelfth edition.). Philadelphia: Wolters Kluwer.Jones, I., Chandra, P.S., Dazzan, P., & Howard, L.K. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2.Nieldson, D., Videbech, P., Hedegaard, M., Dalby, J., & Secher, N.J. (2005). Postpartum depression: identification of women at risk. An International Journal of Obstetrics and Gynaecology, 107(10), 1210-1217. https://doi-org.myaccess.library.utoronto.ca/10.1111/j.1471-0528.2000.tb11609.xSchiller, C.E., Meltzer-Brody, S., & Rubinow, D.R. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48-59. doi: 10.1017/S1092852914000480Viguera, A. (2021). Mild to moderate postpartum unipolar major depression: Treatment. UpToDate. Accessed 2021-01-18.Wisner, K.L., Sit, D.K.Y., & McShea, M.C. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498. doi:10.1001/jamapsychiatry.2013.87   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of reproductive psychiatryDiscuss the possible neurobiological pathways impacting mood and cognition during the reproductive cycle of women. Discuss the influence of sociocultural gender roles on psychopathology.   List the DSM-V diagnostic criteria of premenstrual dysphoric disorder.Recall the epidemiology of premenstrual dysphoric disorder.Describe the steps in the diagnostic evaluation for premenstrual dysphoric disorder.List lifestyle and psychopharmacologic interventions for premenstrual dysphoric disorder.Discuss common mental health concerns during the perimenopausal period. Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00Learning objectives - 01:00Defining the field of perinatal psychiatry - 01:50Discussing neurobiological pathways impacting mood and cognition during the reproductive cycle - 02:47The influence of sociocultural gender roles on psychopathology -05:28DSM-V criteria of premenstrual dysphoric disorder - 11:18Epidemiology of premenstrual dysphoric disorder - 13:40Diagnostic evaluation of premenstrual dysphoric disorder - 14:38Management of premenstrual dysphoric disorder Pharmacologic - 17:45Lifestyle - 24:15 Perimenopausal period - 24:45Closing comments - 31:39   Resources: Brzezinski, A., Brzezinski-Sinai, N.A., & Seeman, M.V. (2017). Treating schizophrenia during menopause. Menopause, 24(5), 582-588. doi: 10.1097/GME.0000000000000772.Epperson, C.N., Steiner, M., Hartlage, A., Eriksson, E., Schmidt, P.J., Jones, I., & Yonkers, K.A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. The American Journal of Psychiatry, 169(5), 465-475. DOI: 10.1176/appi.ajp.2012.11081302Marsh, W.K., Gershenson, B., & Rothschild, A.J. (2015). Symptom severity of bipolar disorder during the menopausal transition. International Journal of Bipolar Disorders, 3(1), 35. DOI: 10.1186/s40345-015-0035-zSoares, C.N., Almeida, O.P.,  Joffe, H., & Cohen, L.S. (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry, 58(6), 529-534. doi:10.1001/archpsyc.58.6.529Weber, M.T., Maki, P.M., & McDermott, M.P. (2013). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001   References: Kornstein S.G., & Clayton, A.H. (2004). Sex differenes in neuroendocrine and neurotransmitter systems. In Women’s mental health: A comprehensive textbook (pp.3-30). Guilford Press. Chrisler, J. C., & Johnston-Robledo, I. (2002). Raging hormones?: Feminist perspectives on premenstrual syndrome and postpartum depression. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 174–197). Guilford Press.American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychedelic-assisted psychotherapy with Dr Emma Hapke and Dr Daniel Rosenbaum, both of whom are psychiatrists at the University Health Network in Toronto and co-founders of UHN’s Nikean Psychedelic Psychotherapy Research Centre (in addition to being lecturers in the Department of Psychiatry at the University of Toronto).   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Briefly describe the history of psychedelics in psychiatryList the four classes of psychedelic drugs and their mechanism of actionSummarize the evidence regarding psychedelic-assisted psychotherapy for various psychiatric disordersDiscuss patient selection considerations for psychedelic-assisted psychotherapyDescribe the safety, tolerability and possible side effects of psychedelic-assisted psychotherapyUnderstand how a psychedelic-assisted psychotherapy session is practically carried out   Guests: Dr Emma Hapke and Dr Daniel Rosenbaum   Hosts: Dr Chase Thompson (PGY4), Dr Nikhita Singhal (PGY3), Jake Johnston (CC4), and Annie Yu (CC4)   Audio editing by: Nikhita Singhal   Show notes by: Nikhita Singhal   Interview Content: Introduction - 0:00Learning objectives - 02:47Definitions/categories of psychedelics - 03:24Classic psychedelics - 04:15Empathogens (e.g. MDMA) - 07:15Etymology of the term “psychedelic” - 09:30Ketamine - 12:24Iboga - 13:28 Brief history of psychedelic medicine - 17:51Current evidence and ongoing trials - 27:38MDMA and PTSD - 29:26Psilocybin and treatment-resistant depression - 32:24A word of caution - 34:29End-of-life care - 38:47 Practical aspects of psychedelic-assisted psychotherapy sessions - 45:45Safety considerations - 01:04:04Future directions - 01:10:33Closing comments - 01:19:07   Resources: Books: How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (Michael Pollan) The Doors of Perception (Aldous Huxley) The Human Encounter With Death (Stanislav Grof and Joan Halifax) Brainwashed podcast series (CBC): https://www.cbc.ca/listen/cbc-podcasts/440-brainwashedZendo Project (psychedelic peer support): https://zendoproject.orgNikean Psychedelic Psychotherapy Research Centre: https://www.uhn.ca/MentalHealth/Research/Nikean-Psychedelic-Psychotherapy-Research-CentreCalifornia Institute of Integral Studies (CIIS): https://www.ciis.eduMultidisciplinary Association for Psychedelic Studies (MAPS): https://maps.orgPsychEd Episode 27 - Serotonin Pharmacology: From SSRIs to Psychedelics with Dr Robin Carhart-Harris)PsychEd Episode 34 - Ketamine for Treatment-Resistant Depression with Dr Sandhya Prashad   References: Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021;384(15):1402-1411. https://doi.org/10.1056/nejmoa2032994Carhart-Harris R, Nutt D. Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology. 2017;31(9):1091-1120. https://doi.org/10.1177/0269881117725915Davis AK, Barrett FS, May DG, et al. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(5):481–489. https://doi.org/10.1001/jamapsychiatry.2020.3285Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. dhttps://dx.doi.org/10.1177%2F0269881116675513Griffiths RR, Johnson MW, Richards WA, et al. Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. J Psychopharmacol. 2018;32(1):49-69. https://doi.org/10.1177/0269881117731279Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Ther. 2019;197:83-102. https://doi.org/10.1016/j.pharmthera.2018.11.010Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033. https://doi.org/10.1038/s41591-021-01336-3Mithoefer MC, Mithoefer AT, Feduccia AA, et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. 2018;5(6):486-497. https://doi.org/10.1016/s2215-0366(18)30135-4Nicholas CR, Henriquez KM, Gassman MC, et al. High dose psilocybin is associated with positive subjective effects in healthy volunteers. J Psychopharmacol. 2018;32(7):770-778. https://doi.org/10.1177/0269881118780713Reiff CM, Richman EE, Nemeroff CB, et al. Psychedelics and Psychedelic-Assisted Psychotherapy. Am J Psychiatry. 2020;177(5):391-410. https://doi.org/10.1176/appi.ajp.2019.19010035Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol. 2019;26(4):225-226. https://dx.doi.org/10.3747%2Fco.26.5009Swift TC, Belser AB, Agin-Liebes G, et al. Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress. Journal of Humanistic Psychology. 2017;57(5):488-519. https://doi.org/10.1177/0022167817715966   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers interpersonal psychotherapy (IPT) with Dr. Paula Ravitz, an Associate Professor of Psychiatry at the University of Toronto and Senior Clinician-Scientist at the Lunenfeld-Tanenbaum Research Institute of Mt Sinai Hospital. Dr. Ravitz held the Morgan Firestone Psychotherapy Chair at the Mount Sinai Hospital from 2011 to 2021 and is a past president of the International Society of Interpersonal Psychotherapy. The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define interpersonal psychotherapyDescribe the core principles and phases of IPTBecome familiarized with some psychological theories underpinning IPTList some patient selection considerations for IPTDescribe the efficacy and evidence base for IPT Understand how IPT is practically carried  out Briefly compare and contrast IPT to other common psychotherapies   Guest: Dr. Paula Ravitz (paula.ravitz@sinaihealthsystem.ca)   Hosts: Jake Johnston and Sena Gok   Audio editing by: Jake Johnston   Show notes by: Jake Johnston   Interview Content: Introduction - 00:00Learning objectives - 02:10Definition/overview of IPT - 02:53Core principles and phases - 07:20Psychological theories - 19:30Patient selection considerations - 24:42Contraindications - 35:57Evidence base and history - 38:10Practical components of IPT - 43:57Maintenance IPT - 59:52IPT vs other psychotherapies - 62:56 Closing comments - 71:17Online IPT course - 74:30   Resources: Summary of IPT written in layman's terms: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/interpersonal-psychotherapyThe International Society of Interpersonal Psychotherapy (ISIPT) has a helpful overview of IPT and helpful resources for finding more information and IPT training opportunities: https://interpersonalpsychotherapy.org/‘Psychotherapy Essentials to Go’ book series mentioned during episode:  https://www.penguinrandomhouse.ca/series/CNL/psychotherapy-essentials-to-goCourse for learning IPT mentioned at the end of the episode (email Dr. Ravitz at Paula.Ravitz@sinaihealth.ca to inquire about access): www.learnipt.com     References: Bernecker, S. L., Coyne, A. E., Constantino, M. J., & Ravitz, P. (2017). For whom does interpersonal psychotherapy work? A systematic review. Clinical psychology review, 56, 82–93. https://doi.org/10.1016/j.cpr.2017.07.001Chaimowitz, G., Weerasekera, P., & Ravitz, P. (2021). Psychotherapy in Psychiatry. The Canadian Journal of Psychiatry, 66(11), 999–1004. https://doi.org/10.1177/07067437211040958Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis. The American journal of psychiatry, 173(7), 680–687. https://doi.org/10.1176/appi.ajp.2015.15091141 Dennis, C. L., Grigoriadis, S., Zupancic, J., Kiss, A., & Ravitz, P. (2020). Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial. The British journal of psychiatry : the journal of mental science, 216(4), 189–196. https://doi.org/10.1192/bjp.2019.275 Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., & Docherty, J. P. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of general psychiatry, 46(11), 971–983. https://doi.org/10.1001/archpsyc.1989.01810110013002Klerman, G. L., Dimascio, A., Weissman, M., Prusoff, B., & Paykel, E. S. (1974). Treatment of depression by drugs and psychotherapy. The American journal of psychiatry, 131(2), 186–191. https://doi.org/10.1176/ajp.131.2.186 MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 588–603. https://doi.org/10.1177/0706743716659276Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., Velyvis, V., Kennedy, S. H., Lam, R. W., MacQueen, G. M., Milev, R. V., Ravindran, A. V., Uher, R., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 524–539. https://doi.org/10.1177/0706743716659418Ravitz, P., & Watson, P. (2014). Interpersonal Psychotherapy: Healing with a Relational Focus. FOCUS, 12(3), 275-284. https://doi.org/10.1176/appi.focus.12.3.275Ravitz, P., Watson, P., Lawson, A., Constantino, M. J., Bernecker, S., Park, J., & Swartz, H. A. (2019). Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974-2017). Harvard review of psychiatry, 27(3), 165–180. https://doi.org/10.1097/HRP.0000000000000219Swartz, H. (2021). Interpersonal Psychotherapy (IPT) for depressed adults: Indications, theoretical foundation, general concepts, and efficacy. UpToDate. Accessed 2021-10-12.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness with our guest expert Dr. Sonu Gaind. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.    The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Briefly summarize the history of Medical Assistance in Dying in CanadaDefine the present policy on Medical Assistance in Dying and Mental Health in CanadaEvaluate the arguments in support of and against the implementation of Medical Assistance in Dying in Mental HealthDiscuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry   Guest expert: Dr. Sonu Gaind  is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Humber River Hospital. Dr. Gaind has testified in front of the Federal External Panel on Options for a Legislative Response to Carter v. Canada, the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the Special Joint Commons/Senate Committee on Physician-Assisted Dying, and the Senate Committee on Legal and Constitutional Affairs on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, and has spoken across the country and internationally on the subject.   Grand Rounds Presenter: Dr. Urvashi Prasad (PGY3)   Produced by: Dr. Urvashi Prasad (PGY3) and Dr. Alex Raben  (staff psychiatrist)   Hosts: David Eapen-John (MS2), Dr. Alex Raben (Staff Psychiatrist)   Audio editing by: Dr. Alex Raben (Staff Psychiatrist)   Show notes by: Dr. Urvashi Prasad (PGY3)     Resources: Assisted Suicide in Canada https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada (Website) Council of Canadian Academies, 2018. The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition. Ottawa (ON):  The Expert Panel Working Group on MAID Where a Mental Disorder Is the Sole Underlying Medical Condition  https://cca-reports.ca/wp-content/uploads/2018/12/The-State-of-Knowledge-on-Medical-Assistance-in-Dying-Where-a-Mental-Disorder-is-the-Sole-Underlying-Medical-Condition.pdf References: Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.” Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/.Tabitha Marshall. “Assisted Suicide in Canada.” The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada.“Get the Facts: Canada's Medical Assistance in Dying Law.” Dying With Dignity Canada, https://www.dyingwithdignity.ca/get_the_facts_assisted_dying_law_in_canada#mental_illness.Jones, Roland M, and Alexander I F Simpson. “ Medical Assistance in Dying: Challenges for Psychiatry.” Frontiers in psychiatry vol. 9 678. 10 Dec. 2018, doi:10.3389/fpsyt.2018.00678Thienpont, Lieve et al. “Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study.” BMJ open vol. 5,7 e007454. 27 Jul. 2015, doi:10.1136/bmjopen-2014-007454 Gaind, KS. (2020). What does “irremediability” in mental illness mean? Canadian Journal of Psychiatry. Online first May 22, 2020. pp 1‐3. doi: 10.1177/0706743720928656 “Maid Volunteer Advocacy Council.” Mental Illness and MAID, https://sencanada.ca/content/sen/committee/432/LCJC/Briefs/MentalIllnessandMAID_e.pdf.Canada, Health. “Second Annual Report on Medical Assistance in Dying in Canada 2020.” Canada.ca, / Government of Canada Gouvernement Du Canada, 30 June 2021, https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html#highlights. Komrad, Mark S. “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients.” Psychiatric Times, 1 June 2021, https://www.psychiatrictimes.com/view/canada-law-provide-not-prevent-suicide.      CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer, a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populationsIncorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours    Guest expert: Dr. Juveria Zaheer    Hosts: Dr. Chase Thompson (PGY4)   Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson    Audio editing: Dr. Chase Thompson   Show notes: Dr. Chase Thompson   00:00 – Introduction 01:14 – Learning objectives 04:00 – Overview of suicide rates across populations 07:20 - Sex and gender differences in suicide 08:50 - Suicide following discharge from hospital 14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors 20:50 - Meeting patients and families where they are at 23:30 - Suicide safety plans  28:30 - Evidence-based approaches to suicide prevention  32:30 - Commentary on strength of evidence for interventions in suicide prevention 38:40 - Addressing suicidality in borderline personality disorder 47:00 - Ethics of involuntary hospitalization for suicidality 50:00 - Future of suicide prevention  References: Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83.Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346.Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open, 9(3), e023883.Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA psychiatry, 74(7), 694-702.Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies. Social psychiatry and psychiatric epidemiology, 54(12), 1459-1470.Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168-179.Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074.Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study. JAMA psychiatry, 74(6), 563-570.Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140.Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900.Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophrenia research, 202, 347-353.Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527-543. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers electroconvulsive therapy with Dr. Wei-Yi Song, the Department Head of Psychiatry, Director of Mood Disorder Services, and Director of ECT Services in Victoria, BC, as well as a Clinical Professor at the University of British Columbia, and a past president of the Canadian Psychiatric Association.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Briefly describe the history of ECT from inception to the present.Debunk common misconceptions about ECT.Describe the major proposed mechanisms of action of ECT.Describe the efficacy of ECT for common psychiatric illnesses.List the indications, contraindications, side effects and risks of ECT.Understand how the procedure of ECT is performed.   Guest: Dr. Wei-Yi Song   Hosts: Jake Johnston (MS4), Dr. Shaoyuan “Randi” Wang (PGY1), Dr. Arielle Giest (PGY2), Dr. Alex Raben (Staff Psychiatrist)   Audio editing by: Jake Johnston   Show notes by: Jake Johnston   Interview Content: Introduction - 0:00Learning objectives - 01:54History of ECT - 02:45Common misconceptions - 06:36Mechanism of action - 12:03 Summary - 16:06 Indications - 16:47Contraindications - 20:58Side effects and risks - 23:31Efficacy of ECT - 29:00 Major depressive disorder - 29:13Bipolar depression - 33:00Schizophrenia - 34:19Bipolar mania - 36:16 Procedure - 38:50 Steps of performing ECT - 39:20Considerations for electrode placement - 47:29Pulse width - 51:19 Maintenance treatment - 53:32Closing - 59:09   Resources: Video showing ECT procedure: https://www.youtube.com/watch?v=9L2-B-aluCE   One note on the realism of this depiction: an actual patient would not shake uncontrollably due to the muscle relaxants.   Summary of electrode placement and pulse width: https://psychscenehub.com/psychinsights/electroconvulsive-therapy-summary-of-ranzcp-guidelines/   References: Baldinger, P., Lotan, A., Frey, R., Kasper, S., Lerer, B., & Lanzenberger, R. (2014). Neurotransmitters and electroconvulsive therapy. The journal of ECT, 30(2), 116–121. https://doi.org/10.1097/YCT.0000000000000138Francois, D. and DellaCava E. (2018). “10 myths about ECT”. Current Psychiatry. Accessed 2021-06-28 from MDedge.Kane, J., Rubio, J., Kishimoto, T., Correll, C., Marder, S., and Friedman, M. (2021). Evaluation and management of treatment-resistant schizophrenia. UpToDate. Accessed 2021-07-27.Kellner, C., Keck, P., and Solomon, D. (2021). Bipolar disorder in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.Kellner, C. and Rasmussen, K. (2015). Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions. Psychiatric Times. Accessed 2021-07-08.Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Overview of electroconvulsive therapy for adults. UpToDate. Accessed 2021-06-28.Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.Petrides, G., Malur, C., Braga, R. J., Bailine, S. H., Schooler, N. R., Malhotra, A. K., Kane, J. M., Sanghani, S., Goldberg, T. E., John, M., & Mendelowitz, A. (2015). Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. The American journal of psychiatry, 172(1), 52–58. https://doi.org/10.1176/appi.ajp.2014.13060787Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 15(3), 210–221. https://doi.org/10.9758/cpn.2017.15.3.210   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Clinical High Risk for Psychosis with Dr. Thomas Raedler, Psychiatrist and associate professor at the University of Calgary and one of the authors of the Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis.   The learning objectives for this episode are as follows: By the end of this episode, you should be able to…   Recognize a patient who may be clinically high-risk for psychosis and provide a differential diagnosis  Understand the importance, utility and prognosis of these risk categories  Have an approach to initial management and the array of treatment options for a patient with    Hosts: Dr. Luke Fraccaro (PGY-2), Dr. Rebecca Marsh (PGY-1), Dr. Alex Raben Episode lead: Dr. Luke Fraccaro Audio-engineered by: Dr. Rebecca Marsh Guest experts: Dr. Thomas Raedler Show Notes by: Dr. Luke Fraccaro   Resources:   Addington, J., Francey, S., Morrison, A.  (2006). Working with People at High Risk of Developing Psychosis: A Treatment Handbook  McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: handbook for diagnosis and follow-up. Oxford University Press.   References : Addington, J., Addington, D., Abidi, S., Raedler, T., & Remington, G. (2017). Canadian treatment guidelines for individuals at clinical high risk of psychosis. The Canadian Journal of Psychiatry, 62(9), 656-661. Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., ... & Heinssen, R. (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry, 168(8), 800-805. Addington, J., & Heinssen, R. (2012). Prediction and prevention of psychosis in youth at clinical high risk. Annual review of clinical psychology, 8, 269–289.  Carrión, R. E., McLaughlin, D., Goldberg, T. E., Auther, A. M., Olsen, R. H., Olvet, D. M., Correll, C. U., & Cornblatt, B. A. (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA psychiatry, 70(11), 1133–1142. https://doi.org/10.1001/jamapsychiatry.2013.1909 Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., Barale, F., Caverzasi, E., & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220–229.  Fusar-Poli P, Salazar de Pablo G, Correll CU, et al. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. 2020;77(7):755–765. doi:10.1001/jamapsychiatry.2019.4779 Fusar-Poli, P., Schultze-Lutter, F., Cappucciati, M., Rutigliano, G., Bonoldi, I., Stahl, D., Borgwardt, S., Riecher-Rössler, A., Addington, J., Perkins, D. O., Woods, S. W., McGlashan, T., Lee, J., Klosterkötter, J., Yung, A. R., & McGuire, P. (2016). The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophrenia bulletin, 42(3), 732–743.  Kuharic, D. B., Kekin, I., Hew, J., Kuzman, M. R., & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews, (11). Nelson, B., Amminger, G. P., Bechdolf, A., French, P., Malla, A., Morrison, A. P., ... & Wood, S. J. (2020). Evidence for preventive treatments in young patients at clinical high risk of psychosis: the need for context. The lancet. Psychiatry, 7(5), 378. Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., ... & Morrison, A. (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European psychiatry, 30(3), 388-404. Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., ... & Buckby, J. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11-12), 964-971.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com.  For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the second of two episodes covering the topic of eating disorders. In this episode, we explore the treatment of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital.    The learning objectives for the episode are as follows:   By the end of this episode, you should be able to… Outline the management of eating disorders using a biopsychosocial framework.Identify the indications for various levels of care (inpatient, residential, day hospital, outpatient, etc).Understand the ethical and medicolegal dilemmas (i.e. involuntary treatment) that may arise in treatment of eating disorders.Consider the treatment of special populations (i.e. children and adolescents, older adults, men, LGBTQ+ individuals).   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY3), Dr. Vanessa Aversa (PGY4)   Audio editing by: Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa, Dr. Nikhita Singhal   Interview Content: Introduction - 0:00 Learning objectives - 00:39Biological approaches to treatment: Nutritional rehabilitation - 03:47Medications - 06:00 Psychological approaches to treatment -16:35Treatment of comorbidities - 23:45Levels of care - 26:00Ethical dilemmas - 32:40Special populations: Children and adolescents - 35:35Older adults - 36:45Men - 37:55LGBTQ+ - 40:23 Novel interventions - 42:48Closing - 51:47   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca.The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca.Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019.Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017.American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. 2006.Geller J, Isserlin L, Seale E, et al. The short treatment allocation tool for eating disorders: current practices in assigning patients to level of care. J Eat Disord. 2018;6(45). https://doi.org/10.1186/s40337-018-0230-2McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the first of two episodes covering the topic of eating disorders. In this episode, we explore the diagnosis, etiology, and symptomatology of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. Dr. Staab joins us again for Part 2, which will focus on eating disorder treatment.   By the end of this episode, you should be able to… Recognize the clinical features of the following eating disorders using DSM-5 diagnostic criteria:  Anorexia Nervosa (AN)Bulimia Nervosa (BN)Binge Eating Disorder (BED)Avoidant/Restrictive Food Intake Disorder (ARFID)Other Specified Feeding or Eating Disorder (OSFED) Identify predisposing factors for eating disorders using a biopsychosocial framework.List common comorbid psychiatric conditions associated with eating disorders.Identify and describe the medical complications of eating disorders.   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY2), Dr. Vanessa Aversa (PGY3)   Audio editing by: Dr. Nikhita Singhal, Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa   Interview Content: Introduction - 0:00 Learning objectives - 2:08DSM-5 definition, clinical features, and associated comorbidities of: Anorexia Nervosa (AN) - 4:27Bulimia Nervosa (BN) - 12:36Binge Eating Disorder (BED) - 18:08Avoidant/Restrictive Food Intake Disorder (ARFID) - 21:43Other Specified Feeding or Eating Disorder (OSFED) - 26:21 Approach to the initial assessment of a patient with an eating disorder - 29:45Predisposing factors and explanatory models for the development of eating disorders: Biological factors - 38:10Psychological factors - 44:00Sociocultural factors - 48:02 Onset of eating disorders - 49:34Possible precipitating factors - 51:50Medical complications of eating disorders: Cardiovascular - 56:13Endocrine - 58:09Musculoskeletal - 1:03:20Gastrointestinal - 1:05:17Neurological - 1:08:13Renal - 1:08:59Dermatological - 1:09:26 Relevant laboratory investigations - 1:11:27Overview of refeeding syndrome - 1:12:30Closing - 1:14:27   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca.The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca.Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019.Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017.McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.   This episode covers the psychiatric aspects of chronic pain with expert guest:   Dr. Leon Tourian, Associate Professor in the Department of Psychiatry at McGill University, and psychiatrist at the MUHC Alan Edwards Pain Management Unit.   The learning objectives for this episode are as follows: By the end of this episode, you should be able to Explore the role of psychiatry in the management of painDiscuss the epidemiology of psychiatric comorbidities in pain disorders.Outline the pathophysiology of pain and its relationship to psychiatric disorders.Outline the role of non-pharmacological management/treatment of pain including psychotherapy and central neuromodulationDiscuss a general psychopharmacology approach in the management of pain relief and psychiatric comorbidities with chronic pain (including SNRI, TCAs, anticonvulsants, antipsychotics and cannabinoids).Discuss the intersection of pain medicine with somatic symptom and related disorders   Guest: Dr. Leon Tourian Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4) Audio editing by Audrey Le Show notes by Dr. Nima Nahiddi Episode Infographic by Dr. Luba Bryushkova     Interview Content: Introduction and learning objectives – 0:00Role of psychiatry in management of chronic pain – 1:45Psychiatric co-morbidities in patients with chronic pain – 5:45Biological link between pain and psychiatric co-morbidities – 11:00Psychological approach to understanding and management of chronic pain– 14:30Central neuromodulation strategies for chronic pain – 21:00General pharmacological approach to the management of chronic pain – 22:30Pathogenesis of neuropathic and somatic visceral pain – 30:00Antipsychotics in the management of chronic pain – 37:00Cannabis in the management of chronic pain – 40:30Somatic symptom disorder – 46:00Stigma in chronic pain disorders – 53:10Treatment of somatic symptom disorder – 58:30Psychiatry and the stigma of chronic pain disorders– 61:00Closing remarks – 65:15   Articles and Resources: Guideline for opioid therapy and chronic noncancer pain (CMAJ) Guideline The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (McMaster University) List of Pain & Opioid Initiatives (2017) (CFPC) Canadian Pain Task Force Report: June 2019   References: Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic medicine, 64(5), 773–786. https://doi.org/10.1097/01.psy.0000024232.11538.54   Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(4), 160–167. https://doi.org/10.1177/070674371506000402   O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. The Cochrane database of systematic reviews, 4(4), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5   Ratcliffe, G. E., Enns, M. W., Belik, S. L., & Sareen, J. (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. The Clinical journal of pain, 24(3), 204–210. https://doi.org/10.1097/AJP.0b013e31815ca2a3   Tunks, E. R., Crook, J., & Weir, R. (2008). Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 53(4), 224–234. https://doi.org/10.1177/070674370805300403   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers ketamine for treatment-resistant depression (TRD) with Dr. Sandhya Prashad, a psychiatrist and the founder and medical director of Houston Ketamine Therapeutics. She has extensive expertise using ketamine and is one of the most experienced ketamine psychiatrists in the United States, with her clinical practice focusing on TRD and incorporating transcranial magnetic stimulation (TMS), sometimes in conjunction with ketamine. Dr. Prashad is also a founding member and current president of the American Society of Ketamine Physicians (ASKP), a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy.   We’re also experimenting with something new for this episode — providing a transcript of the entire interview! The transcript can be found at psychedpodcast.org/transcripts/ketamine. We’d love to hear your feedback as listeners on this as a feature, including whether it’s something you’d be interested in seeing for other episodes moving forward!   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Describe ketamine and how it came to be used in the field of psychiatry.Develop an appreciation for benefits and potential harms associated with ketamine and how this compares to other treatments for depression.Understand how ketamine fits into the treatment of depression and suicidality, patient characteristics to consider before initiation, potential mechanisms of action, different models of administration, and incorporation of psychotherapy.   Guest expert: Dr. Sandhya Prashad   Hosts: Jimmy Qian (MS2), Dr. Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3)   Audio editing by: Dr. Chase Thompson   Show notes by: Gray Meckling (MS4)   Interview transcript by: Gray Meckling   00:00 – Introduction 03:00 – Learning objectives 03:30 – History of ketamine 06:20 – Recreational use of ketamine, phenomenology of the ketamine experience 09:45 – Where does ketamine fall in the algorithm for treatment of depression? 11:50 – Ketamine’s use in acute suicidality 13:40 – Ketamine contraindications 14:40 – Ketamine efficacy 19:00 – Combining ketamine with rTMS 21:15 – Limitations to ketamine 24:35 – Ketamine mechanism of action 26:05 – Ketamine formulations, and integrating ketamine into psychotherapy 33:10 – Combining ketamine with traditional antidepressant treatment 37:30 – Practicalities of administering ketamine 39:40 – Ketamine as treatment for OCD and PTSD 41:40 – Closing remarks   Resources: American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP)Sandhya Prashad, MD (Website)NEJM interview with Dr. Roy Perlis: Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class   References: Berman, R., Cappiello, A., Anand, A., Oren, D., Heninger, G., Charney, D.. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 47: 351–354.Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA psychiatry, 76(9), 893-903.J.W. Murrough, D.V. Iosifescu, L.C. Chang, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two site randomized controlled trial. Am. J. Psychiatry, 2013 (170) (2013), pp. 1134-1142Kim, J., Farchione, T., Potter, A., Chen, Q., & Temple, R. (2019). Esketamine for treatment-resistant depression-first FDA-approved antidepressant in a new class. N Engl J Med, 381(1), 1-4.McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S. (2021). Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. American Journal of Psychiatry, appi-ajp.Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence [Internet]. 2008 Jun 1;95(3):219–29.Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405.Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15.Williams NR, Heifets BD, Bentzley BS, Blasey C, Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of antidepressant and anti suicidal effects of ketamine by opioid receptor antagonism. Molecular psychiatry. 2019 Dec;24(12):1779-86.Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63: 856–864.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of borderline personality disorder with expert guests: Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, and inpatient psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as the inpatient psychiatrist at the Jewish General Hospital.Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, and head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre. The learning objectives for this episode are as follows:  By the end of this episode, you should be able to… Understand the frame and principles of care for the treatment of individuals with borderline personality disorder.Explore the approach to the treatment of individuals with borderline personality disorder: On presentation in crisis to the emergency department.During an inpatient psychiatric admission.In the context of psychiatric outpatient care. Understand the use of psychotherapy in the treatment of individuals with borderline personality disorder.Understand the use of pharmacotherapy in the treatment of individuals with borderline personality disorder Guest: Dr. Robert Biskin and Dr. Ronald Fraser Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4) Audio editing by Audrey Le Show notes by Dr. Nima Nahiddi Interview Content:  Introduction – 0:00Learning objectives – 0:35Principles of care for treatment of BPD – 1:16The therapeutic frame – 5:40 Approach to the management of emergency department presentations – 9:10Dialectical behaviour therapy (DBT) – 16:15Suicidality and self-harm in BPD diagnosis – 21:05Pharmacotherapy for symptom treatment – 22:40Treatment of co-morbid disorders – 32:35 Management of safety risk – 39:30Stigma in treatment of BPD – 46:05Closing remarks – 52:00 Resources/Articles: The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome | Annual Review of Clinical Psychology (annualreviews.org) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis | Psychiatry | JAMA Psychiatry | JAMA NetworkNational Education Alliance for Borderline Personality Disorder References:   Cristea I.A., Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. (2017) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry. 74(4):319–328. doi:10.1001/jamapsychiatry.2016.4287Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H  J. (2010) Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. Clin Psychiatry. 71(1):14. Paris J. (2009). The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome. Review of Clinical Psychology. 5:1, 277-290Stoffers J, Vollm BA, Rucker G, Timmer A, Huband N. (2010) Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD005653. DOI: 10.1002/14651858.CD005653Storebø  OJ, Stoffers-Winterling  JM, Völlm  BA, Kongerslev  MT, Mattivi  JT, Jørgensen  MS, Faltinsen  E, Todorovac  A, Sales  CP, Callesen  HE, Lieb  K, Simonsen  E.  (2020) Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD012955. DOI: 10.1002/14651858.CD012955.pub2     CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.