It is unlikely that any model of major depressive disorder is likely to find universal signals among those diagnosed because the symptoms are so diverse.  However, it does seem likely that models, such as brain-network models, will be able to identify common dysfunctions among those with similar symptom burdens (for example, those with primarily anhedonic symptoms, dysphoria, or with excessive rumination over their own worthlessness), and then help identify how various modalities may be more or less effective to treat these symptoms specifically. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Bipolar disorder is a complex, often debilitating and potentially life threatening illness in which the patient goes from episodes of depression to episodes of mania or hypomania, most often with periods of relative euthymia in between these episodes.  The most common way to conceptualize the treatment of bipolar disorder is by phase. The ideal goal would be preventing the distinct manic and depressive episodes. This is done mostly with medications although psychotherapy, lifestyle modifications and even neuromodulation potentially have a role.  A particularly difficult aspect of bipolar disorder is treating the acute phase of bipolar depression. Each is treated mostly with psychotropic medication. In this Episode, Dr. DePietro will focus on treating acute bipolar depression.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

In previous episodes I have tried to draw pictures in your mind (using those fat crayons that babies like to chew on) of some of the brain networks that are important in many mental illnesses.  We have talked specifically about the Default Mode Network (that is concerned with imaginal thoughts and self-referential thoughts and memories), the Dorsal and Ventral Attention Networks (that help us to identify and pick out details of both our environment and our thoughts and memories), and the Salience Network (that brings the most important details of our perceptions, thoughts, and memories to the forefront of our mind).  What we are missing is a network that takes those salient things, considers alternative options about what they mean and what to do about them, organizes a plan to execute, and motivates us to move.  Our Central Executive Network and its connections to the other networks are integral in these processes.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

What is salience?  Fundamentally it is a value judgment that determines where your brain will place its limited resources.  There are a lot of things that could draw our attention.  The world is full of sights, sounds, smells, pressures, temperatures, stretches.  Our mind is full of thoughts.  Without a salience network, we wouldn’t know what matters and what doesn’t.  We would just randomly scan our thoughts and the environment and hope what we are noticing at any point in time is what will help keep us alive.  That is a losing evolutionary strategy.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Today, I am going to explore the Attention Networks, which are the parts of our brain that get really excited when, for example, we see something that we have never seen before, something that appears to be moving on its own volition (and might harm us), something that appears out of place (like an eyeball on the floor), or something that reminds us of something we really want (I’ll let you pick the example).Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Behaviors are complex.  We have networks of neurons functioning in systems, some of which ramp other systems up, and some of which dampen others down.  This ballet of correlation (when increased activity in one network predicts increased activity in another) and anticorrelation (when increased activity in one network predicts decreased activity in another) can help us to understand what is going on in the brains of humans who qualify for psychiatric diagnoses, and can help us to develop better targeted treatments that will predictably increase activity in select areas of the brain. Today I  discuss a single networking hub in the brain: the default mode network.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

One of the most influential models in psychiatry’s history for understanding brain dysfunction is the monoamine hypothesis.  In short, it proposes that deficiencies or excess of certain neuromodulating agents, in particular the monoamines serotonin, dopamine, and norepinephrine (AKA noradrenaline) drive many psychiatric disorders.  The paper I will primarily reference is a publication by the same name in 2016 by Montoya, Bruins, Katzman, and Blier in Neuropsychiatric Disease and Treatment.  Its basic proposal is that, at the time of publication, there were at least 52 controlled clinical trials published that consistently showed a benefit of using SNRIs (like venlafaxine and duloxetine) and NERIs (like atomoxetine and reboxitine) for reducing anxiety in patients without the expected side effect of noradrenergic agents: to increase anxiety.  This is a paradox. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

This is an episode to report updates in the DSM 5-TR that can be practice changing.  I will also divulge a little about myself and how my philosophy and values have changed. In particular, I am reminded of how I have struggled to understand transgendered and other gendered individuals.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

I originally promised a review of the Bush Francis Catatonia Rating Scale, but while reviewing it, I came across some questions that I think are even more interesting.  I will discuss Bush Francis, but I want to do it in a larger context of the challenges that Psychiatrists face with diagnosis in general.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Dr. O discusses the remaining hyperactive or “excited” signs of catatonia including echolalia, echopraxia, and agitation.  In previous episodes, Dr. O discussed other hyperactive or “excited” signs, including mannerisms and stereotypy.  All of these signs share the common feature that the patient is doing something odd, repetitive, or unexpected.  Dr. O also gets on his soap box about the arbitrary use of the term agitation to describe patients.Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.