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July 7, 2020
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers nutritional psychiatry with expert guest Dr. Laura LaChance, Staff Psychiatrist and Director of Outpatient Psychiatry at St. Mary’s Hospital Centre in Montreal, Quebec and Faculty Lecturer in the Department of Psychiatry at McGill University.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to…   1)      Define nutritional psychiatry 2)      Understand the mechanisms, common misconceptions, challenges, and current evidence supporting the role for nutrition in mental health 3)      Apply this understanding to clinical cases in psychiatry   Guest: Dr. Laura LaChance Hosts: Dr. Sarah Hanafi (PGY2), Dr. Nima Nahiddi (PGY2), Gray Meckling (CC3) Audio editing by Dr. Alex Raben (PGY5) Show notes by Gray Meckling   Interview Content:   ·       Introduction and learning objectives – 0:35 ·       Dr. Laura LaChance’s professional background – 1:50 ·       Definition of nutritional psychiatry and history of the field – 3:35 ·       Putative mechanisms through which nutrition is implicated in mental health – 7:00 ·       Common misconceptions surrounding the role for nutrition in mental health – 11:45 ·       Current evidence supporting the role for nutrition in the management of psychiatric illness – 16:00 ·       Case-based examples of nutrition in clinical psychiatry – 23:35 ·       Challenges to capitalizing on this mode of intervention in psychiatry – 32:30 ·       Taking a dietary history in the context of mental health – 34:50 ·       Future directions in the field of nutritional psychiatry – 41:20 ·       The gut-microbiome – 43:00 ·       Tips for those interested and how to get involved – 48:00 ·       Closing – 50:15   Resources:   ·       International Society for Nutritional Psychiatry Research ·       The Food & Mood Centre at Deakin University ·       Future Learn Online Course – Food and Mood: Improving Mental Health Through Diet and Nutrition ·       The Brain Food Academy ·       Dr. Drew Ramsey ·       Food as Medicine Update – Conference   Articles:   ·       Nutritional Psychiatry: The Gut-Brain Connection (Psychiatric Times) ·       Nutritional Psychiatry: Your Brain on Food (Harvard Health Publishing)   References:   ·       Adan, R. A., van der Beek, E. M., Buitelaar, J. K., Cryan, J. F., Hebebrand, J., Higgs, S., ... & Dickson, S. L. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. ·       Auction, Monique & LaChance, Laura & Cooley, Kieran & Kidd, Sean. (2019). Diet and Psychosis: A Scoping Review. Advances in Integrative Medicine. 6. S101. 10.1016/j.aimed.2019.03.292. ·       Firth J, Veronese N, Cotter J, Shivappa N, Hebert J, Ee C, Smith L, Stubbs B, Jackson S, Sarris J. What is the role of dietary inflammation in severe mental illness? a review of observational and experimental findings. Frontiers in psychiatry. 2019;10:350. ·       Firth, J., Carney, R., Stubbs, B., Teasdale, S. B., Vancampfort, D., Ward, P. B., ... & Sarris, J. (2018). Nutritional deficiencies and clinical correlates in first-episode psychosis: a systematic review and meta-analysis. Schizophrenia bulletin, 44(6), 1275-1292. ·       Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. A brief diet intervention can reduce symptoms of depression in young adults–A randomised controlled trial. PloS one. 2019;14(10). ·       Guu TW, Mischoulon D, Sarris J, Hibbeln J, McNamara RK, Hamazaki K, Freeman MP, Maes M, Matsuoka YJ, Belmaker RH, Jacka F. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder. Psychotherapy and psychosomatics. 2019;88(5):263-73. ·       Jacka, F. N. (2017). Nutritional psychiatry: where to next?. EBioMedicine, 17, 24-29. ·       Jacka F, O’Neil A, Opie R, et al. A randomized controlled trial of dietary improvement for adults with major depression (the SMILES trial). BMC Med. 2017; 15:23. ·       LaChance, L. R., & Ramsey, D. (2018). Antidepressant foods: An evidence-based nutrient profiling system for depression. World journal of psychiatry, 8(3), 97–104. https://doi.org/10.5498/wjp.v8.i3.97 ·       Lachance, L., & Ramsey, D. (2015). Food, mood, and brain health: Implications for the modern clinician. Missouri medicine, 112(2), 111. ·       Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proc Nutr Soc. 2017;76: 427-436. ·       Lakhan, S. E., & Vieira, K. F. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition journal, 9(1), 42. ·       Mörkl S, Butler MI, Holl A, Cyran JF, Dinan TG. Probiotics and the Microbiota-Gut-Brain Axis: Focus on Psychiatry. Current Nutrition Reports. 2020 May 13. ·       Mörkl, S., Wagner-Skacel, J., Lahousen, T., Lackner, S., Holasek, S. J., Bengesser, S. A., ... & Reininghaus, E. (2020). The role of nutrition and the gut-brain axis in psychiatry: a review of the literature. Neuropsychobiology, 79(1-2), 80-88. ·       Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsenga T, Blunden S, Meyer B, Segal L. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutritional neuroscience. 2019 Jul 3;22(7):474-87. ·       Sarris J, Logan AC, Akbaraly TN, et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2: 271-274.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   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.
June 6, 2020
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we explore Attachment Theory, a key foundational framework in psychiatry which concerns relationships and the ways in which infants seek proximity to caregivers in development. Our guest expert is Dr. Diane Philipp, a child and adolescent psychiatrist at the Sick kids Center for Community Mental Health in Toronto and Assistant Professor at the University of Toronto. She has developed a family therapy method called Reflective Family Play, a model of therapy which aims to improve parent-child dynamics, and more specifically attachment. She currently practices reflective family play and also teaches this method locally and internationally. Produced and Hosted by Dr. Chase Thompson (PGY2) and Dr. Lucy Chen (PGY5) Audio Editing by Dr. Alex Raben (PGY5) The learning objectives for this episode are as follows:      Define attachment theory     Review the history of attachment theory and how the field developed     Briefly review the evolutionary basis, and functional role of attachment in infants     Briefly review the neurobiological perspectives of attachment     Outline and describe different types of attachment and attachment disorders     Learn how infant attachment is assessed in contemporary psychiatry/psychology     Learn how attachment disorders impact adult relationships and child rearing Some sources for further reading: Ainsworth, Mary S. “Infant-mother attachment” American psychologist 34.10 (1979): 932 Bowlby, J. "Lecture 2: The origins of attachment theory." A secure base (1988): 20-38. Cicchetti, Dante, Fred A. Rogosch, and Sheree L. Toth. "Fostering secure attachment in infants in maltreating families through preventive interventions." Development and psychopathology 18.3 (2006): 623-649. Cohen, Nancy J., et al. "Watch, wait, and wonder: Testing the effectiveness of a new approach to mother–infant psychotherapy." Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health 20.4 (1999): 429-451. Collins, Nancy L. "Working models of attachment: Implications for explanation, emotion, and behavior." Journal of personality and social psychology 71.4 (1996): 810. Feeney, Judith A., and Patricia Noller. "Attachment style as a predictor of adult romantic relationships." Journal of personality and Social Psychology 58.2 (1990): 281. George, Carol, Nancy Kaplan, and Mary Main. "Adult attachment interview." (1996).  Insel, Thomas R., and Larry J. Young. “The neurobiology of attachment.” Nature Reviews Neuroscience 2.2 (2001):129 Main, Mary. "Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment." Journal of consulting and clinical psychology 64.2 (1996): 237. Simpson, Jeffry A., et al. "Attachment and the experience and expression of emotions in romantic relationships: A developmental perspective." Journal of personality and social psychology 92.2 (2007): 355. Sroufe, L. Alan, et al. "Implications of attachment theory for developmental psychopathology." Development and psychopathology 11.1 (1999): 1-13. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodast@gmail.com For more information visit our website: psychedpodcast.org.  
May 4, 2020
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers medical trainee wellness during the COVID-19 pandemic with expert guest Dr. Deanna Chaukos, Staff Psychiatrist at Mount Sinai Hospital in Toronto and Wellness Lead for the Psychiatry Residency program at the University of Toronto.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define wellness and burnout and their importance in medical education/psychiatry Understand strategies on how to maintain our own wellness and prevent burnout Understand strategies to help others maintain their wellness and deal with burnout *All through the lens of the COVID-19 pandemic   Hosts: Dr. Alex Raben (PGY5), Gray Meckling (CC3), Shaoyuan (Randi) Wang (CC3), Weam Sieffien (CC3)   Guest Staff Psychiatrist: Dr. Deanna Chaukos (Sinai Health Systems, Toronto)   Resources COVID-19 Resources for Residents, infographic prepared by residents at the University of Toronto, including team member of PsychEd Nikhita Singhal Resources for MD Wellness Improving Mental Health During COVID-19 University of Toronto Office of Health Professions Student Affairs OHPSA University of Toronto Postgraduate Wellness Office at UofT Gerstein Crisis Centre CAMH: COVID-19 Information for Healthcare Workers CAMH self-referral for healthcare workers to access mental health services UofT Faculty of Medicine: COVID-19 Wellness Resources for Faculty and Trainees Canadian Psychiatric Association - COVID-19 American Psychiatric Association Well-being Resources Seven tips for staying grounded as the world grapples with COVID-19: UofT Expert AMA: 6 ways to address physician stress during COVID-19 pandemic UBC - COVID-19 Resident Wellness Resources Youtube video: Three steps to coping with anything (including COVID-19) MHCC: Resource Hub: Mental health and wellness during the COVID-19 pandemic CMHA: COVID-19 and mental health   Articles CMA: Maintaining Your and Your Family’s Well-being During a Pandemic BMJ Opinion: COVID-19 - the impact on our medical students will be far-reaching AAMC: “A terrifying privilege”: Residency during the COVID-19 Outbreak AMA: Residency in a pandemic: How COVID-19 is affecting trainees CMAJ: Medical education needs reform to improve student well-being and reduce burnout, say experts   Examples of Medical Student Initiatives UofT News: As COVID-19 battle escalates, U of T students offer busy health-care workers help on the home front UofT News: Medical students collect personal protective gear for front line health-care workers, donate through U of T UofT News: 'We care and are here for them': U of T students help seniors cope with distancing during COVID-19 COVID-19 Central Making a difference: UBC students help frontline medical workers during COVID-19 McGill students rally their peers to provide support to frontline workers U of A medical students offering emergency child care to physicians and front-line health workers UCalgary medical and nursing students quickly answer the call for COVID-19 help News: Medical students providing support during COVID-19 containment effort (Schulich School of Medicine & Dentistry, Western University) Queen's students volunteer to help Kingston's medical professionals UOttawa MD students pitch in to help frontline health workers during COVID-19 McMaster med students help their future colleagues during COVID-19   References  Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. Eckleberry-Hunt, J., Van Dyke, A., Lick, D., & Tucciarone, J. (2009). Changing the conversation from burnout to wellness: physician well-being in residency training programs. Journal of Graduate Medical Education, 1(2), 225-230. Eckleberry-Hunt, J., Lick, D., Boura, J., Hunt, R., Balasubramaniam, M., Mulhem, E., & Fisher, C. (2009). An exploratory study of resident burnout and wellness. Academic Medicine, 84(2), 269-277. Dewey, C., Hingle, S., Goelz, E., & Linzer, M. (2020). Supporting clinicians during the COVID-19 pandemic. Annals of Internal Medicine. Drolet, B. C., & Rodgers, S. (2010). A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine. Academic Medicine, 85(1), 103-110. Dyrbye, L. N., Burke, S. E., Hardeman, R. R., Herrin, J., Wittlin, N. M., Yeazel, M., ... & Satele, D. V. (2018). Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. Jama, 320(11), 1114-1130. Kealy, D., Halli, P., Ogrodniczuk, J. S., & Hadjipavlou, G. (2016). Burnout among Canadian psychiatry residents: a national survey. The Canadian Journal of Psychiatry, 61(11), 732-736. Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., ... & Tan, H. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open, 3(3), e203976-e203976. Lebensohn, P., Dodds, S., Benn, R., Brooks, A. J., & Birch, M. (2013). Resident wellness behaviors. Fam. Med, 45, 541-549. Santarone, K., McKenney, M., & Elkbuli, A. (2020). Preserving mental health and resilience in frontline healthcare workers during COVID-19. The American Journal of Emergency Medicine. Shiralkar, M. T., Harris, T. B., Eddins-Folensbee, F. F., & Coverdale, J. H. (2013). A systematic review of stress-management programs for medical students. Academic Psychiatry, 37(3), 158-164. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website at psychedpodcast.org.
April 5, 2020
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Autism Spectrum Disorder (ASD) with not one, not two but THREE experts in the field: Dr. Melanie Penner (Developmental Pediatrician at Holland-Bloorview), Dr. Mitesh Patel (Forensic and Child Psychiatrist at CAMH) and Dr. Yona Lunsky (Psychologist at CAMH)   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Have an understanding of the neurobiology and epidemiology of autism Tailor their diagnostic interview for autism in a way that improves accuracy and is empathic Have familiarity with the impact of autism on people and their families and the interdisciplinary and biopsychosocial approaches involved in caring for people with autism   Host(s): Dr. Alex Raben (PGY5), Dr. Sabrina Agnihotri (PGY1)    Produced by: Dr. Alex Raben (PGY5), Dr. Sabrina Agnihotri (PGY1), Weam Sieffien (CC3) and Dr. Gurnaam Kasbia   Guest experts: Dr. Melanie Penner, Dr. Mitesh Patel and Dr. Yona Lunsky   Episode infographic by Weam Sieffien (CC3) and Dr. Nikhita Singhal (PGY1) Resources:   https://cpa.ca/docs/File/Psynopsis/2020-Vol42-1/index.html https://autismcanada.org/#home-row-1 Clinical guide for front line staff to support the management of patients with a learning disability, autism or both during the coronavirus pandemic Magnetoencephalographic (MEG) Brain Activity During a Mental Flexibility Task Suggests Some Shared Neurobiology in Children With Neurodevelopmental Disorders Books: Look Me in the Eye: My Life with Asperger's Neurotribes   References  American Academy of Pediatrics. Management of Children With Autism Spectrum Disorder. Pediatrics. 2007 Nov;120(5):1183-1215. Bartlo P, Klein PJ. Physical activity benefits and needs in adults with intellectual disabilities: systematic review of the literature. Am J Intellect Dev Disabil. 2011 May. 116(3):220-32. Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. Am J Prev Med. 2009 Dec. 37(6 Suppl 1):S201-8. Lyall, K., Croen, L., Daniels, J., Fallin, M. D., Ladd-Acosta, C., Lee, B. K., ... & Windham, G. C.  (2017). The changing epidemiology of autism spectrum disorders. Annual review of public health, 38, 81-102. Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in developmental disabilities, 32(2), 419-436. McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami S, Jerome RN, et al. A systematic review of medical treatments for children with autism spectrum disorders. Pediatrics. 2011 May. 127(5):e1312-21. Rubin IL, Crocker AC. Medical care for children and adults with developmental disabilities. Second edition. Baltimore, MD: Paul H Brookes Publishing Co, Inc; 2006. Rueda JR, Ballesteros J, Tejada MI. Systematic review of pharmacological treatments in fragile X syndrome. BMC Neurol. 2009 Oct 13. 9:53. Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), 3623-3629. Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), 3623-3629. Thapar, A., Cooper, M., & Rutter, M. (2017). Neurodevelopmental disorders. The Lancet Psychiatry, 4(4), 339-346 CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com.  For more information visit our website: psychedpodcast.org.
January 26, 2020
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.    This episode is an introduction to the subspeciality of psychosocial oncology, focusing on 10 key content areas that you want to supplement your general psychiatric interview with. Along the way, we discuss the history of the field, contemporary controversies and useful interviewing techniques that can help with history collection, therapeutic alliance, and formulation.    Learning objectives: Gain familiarity with unique content areas to include in the assessment of patients with cancer Learn interview techniques to facilitate accurate and efficient history taking in this patient population  Increase knowledge around the concept of cancer-related distress and how it informs patient formulation, intervention, and DSM-5 Diagnosis   Host: Dr. Jordan Bawks, PGY4 in Psychiatry at the University of Toronto   Guest: Dr. Elie Isenberg-Grzeda, Psychiatrist at Sunnybrook Health Sciences Centre and Assistant Professor at the University of Toronto   Timestamps for Content:  4-11minutes - History of Psycho-Oncology 11- 14minutes –Distress Screening 14- 16minutes – Overview of specific content areas in psychosocial oncology assessments 15:50 – Cancer history 20:10- Beliefs about illness 24:00- Physical symptoms 26:00- Body Image 33:55- Coping 38:30- Family Supports & 41:00- Counseling on Cancer Disclosure to Family Members 49:30- Work Disruption 52:00- Religion & Spirituality 57:30- Death, Dying, Prognosis 1:04:45- Diagnostic dilemmas 1:10:30- Closing thoughts     CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website: psychedpodcast.org.  
October 25, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Motivational Interviewing (MI) with Dr. Wiplove Lamba (staff psychiatrist), Dr. Anees Bahji (PGY5 resident), and Dr. Marlon Danilewitz (PGY5 resident) who we caught up with after their workshop on MI at the CPA annual conference in Quebec City. In addition to learning the basics about MI, Alex also volunteered to do a real-play with Dr. Lamba to demonstrate some MI techniques (and all in one take!).   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define MI and its utility Appreciate some of the techniques that are used in MI to increase motivation Start to use some of these techniques with your patients   Guest staff psychiatrist: Dr. Wiplove Lamba   Episode infographic by Nikhita Singhal   Resources:   MITI scale (available through google search)   Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & Mash, B. (2010). Motivational interviewing. Bmj, 340, c1900.   BMJ Learning: Motivational Interviewing Module   Youtube video of Carl Rogers interviewing Gloria    Motivational Interviewing: Helping People Change by Miller and Rollnick (textbook)    MINT (Motivational Interviewing Network of Trainers)   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.  
September 24, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers repetitive transcranial magnetic stimulation (rTMS) with Dr. Jonathan Downar, a world expert and leading researcher on rTMS, and clinical fellow Dr. Jean-Phillippe Miron. In addition to learning the basics about rTMS, you will also be listening to Henry Barron’s first-hand experience with non-therapeutic rTMS treatment to help bring some of the learning principles to life.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Understand generally how rTMS is conducted and some of the theory behind how it works Understand where rTMS fits in the treatment algorithm for depression and what kind of patient characteristics should be considered before initiating rTMS Appreciate the benefits, side effects and drawbacks of rTMS and how it compares to other depression treatments   Guest staff psychiatrist: Dr. Jonathan Downar, Associate Professor at the University of Toronto and Co-Director of the MRI-Guided rTMS Clinic at University Health Network.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
July 19, 2019
Welcome to PsychEd, the psychiatry podcast by medical learners, for medical learners. In this episode from our EPA mini-series on clinical skills we review the Ontario mental health act. Our guest expert is Kendra Naidoo, legal counsel at the Center for Addiction and Mental Health (CAMH) in Toronto.   The learning objectives for this episode are as follows: Review some of the history behind mental health legislation in Ontario. Discuss involuntary hospitalization, including criteria and relevant documentation. Understand capacity assessments and processes for substitute decision making. Discuss the role of Consent and Capacity Boards.   References/resources: A Practical Guide to Mental Health and the Law in Ontario Revised Edition, September 2016 Tips for completing the Form 1 under the Mental Health Act, by Patricia Cavanagh, MD FRCPC   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more Psyched, follow us on Twitter and Facebook @PsychEdPodcast. You can provide feedback by email at info@psychedpodcast.com. For more information, visit our website: psychedpodcast.org.
July 17, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors for self-harm and suicide and components of risk assessment.   Our guest expert is Dr. Juveria Zaheer. She is a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Emergency Department at CAMH. Her research focuses on suicide, gender and culture, and she is the lead author of the Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention.   The learning objectives for this episode are as follows: Be familiar with the risk factors and predictors of suicide, as well as protective factor Be familiar with the components of a Suicide Risk assessment Be familiar with how to comprehensively document and communicate the risk assessment   Recommended Readings: Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention Includes safety plan, risk assessment template and clinical cases in the appendix Columbia-suicide severity rating scale (c-ssrs)   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   Credits note: Alex Raben provided audio-editing for this episode. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website:psychedpodcast.org.
July 17, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode of our miniseries on psychiatric skills, we review the core content areas of a psychiatric assessment and look at techniques to improve interviewing efficiency, accuracy and alliance building. Our expert for this episode is Dr. Juveria Zaheer, a clinician-scientist at the Centre for Addiction and Mental Health, and an assistant professor at the University of Toronto, in Toronto, ON.    Learning Objectives: By the end of the episode you, the learner, should... Have a clear understanding of the goals of a complete psychiatric interview and the general structure and content that should be covered Feel comfortable to begin to use techniques that will help you conduct a professional, compassionate, empathic, efficient, and accurate interview Be familiar with techniques you can use to facilitate information gathering in more challenging interviews  Episode Timepoints 3:15 - Purpose of the psychiatric interview  6:30 - First content areas of the interview; introduction, ID, RFR, CC, HPI, ROS, Past Psych Hx 19:00 - Techniques and Strategies for Organized and Efficient Psychiatric ROS 26:00 - Details of Past Psychiatric History  29:30 - Past Medical History 31:00 - Substance Use History 33:30 - Medications 34:20 - Family Psych History 36:25 - Personal and Developmental History (Content & Process discussion) 44:00 - Commonly missed areas including Legal/Forensic history 45:00 - Shift from content to process discussion “how to best manage a psychiatric interview” 49:00 - Self-care and monitoring  52:00 - Building rapport, therapeutic alliance, empathy  53:30 - Alex and Lucy reflect on their growth as interviewers over 4 years in residency  73:00 - Managing challenging interviews References and Resources1) Shea, S. C. (1998). Psychiatric Interviewing E-Book: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals 2) Carlat, D. J. (2016). The psychiatric interview: A practical guide. Lippincott Williams & Wilkins.   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 info@psychedpodcast.com; For more information visit our website: psychedpodcast.org
July 13, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we discuss the biopsychosocial formulation--what it is and how we do it . Our guest expert is Dr. Erin Carter, an in-patient psychiatrist at St. Joseph's Healthcare Centre in Toronto, Canada. The learning objectives for this episode are as follows: 1. Understand the components of a biopsychosocial formulation 2. Develop an approach to organizing and eliciting salient information to aid in formulation 3. Distinguish between summary and synthesis of information 4. Understand how to communicate a formulation effectively 5. Use the biopsychosocial formulation to inform a management plan CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
July 13, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors and management of aggression in the Psychiatric Emergency context. Our guest expert is Dr. Jodi Lofchy. She is the Chair of the Canadian Psychiatric Association’s Section of Emergency Psychiatry, and Interim Chief and Medical Program Director for the Department of Psychiatry at St. Joseph’s Health Centre. Dr. Lofchy has presented and published many works on Best Practice in Emergency Psychiatry and has been tremendously involved in Medical Education.  The learning objectives for this episode are as follows: Identify risk factors for violence in the ER, static and dynamic risks Know how to take a history for violence, and communicate risk Describe the indications for non-chemical interventions in the management of the agitated patient Describe pharmacologic interventions in managing the agitated patient How to apply legislation regarding risk of violence Recommended Readings: Emergency Psychiatry: Clinical and Training Approaches Jodi Lofchy, MD, FRCPC1; Peter Boyles, MD, FRCPC2; Justin Delwo, MD, FRCPC3 http://www.cpa-apc.org/wp-content/uploads/Emergency-Psychiatry-2004%E2%80%9344-R1-EN-FIN-web.pdf   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 info@psychedpodast.com For more information visit our website: psychedpodcast.org.  
June 30, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we comprehensively review the diagnosis and treatment of PTSD, and explore the psychological and physiological underpinnings of trauma.   Our guest expert is Dr. Dana Ross. She is a psychiatrist in the Trauma Therapy Program at Women’s College Hospital in Toronto, Canada. She is also a founder of Trauma Education Essentials Inc. which provides trauma-focused educational webinars, online courses, and workshops to health professionals and organizations   The learning objectives for this episode are as follows:   Know the prevalence and incidence rates of Posttraumatic Stress Disorder (PTSD) Recognize the clinical features of PTSD using DSM-5 diagnostic criteria List 5 common risk factors for the development of PTSD Identify 3 neurophysiological mechanisms underlying PTSD Differentiate the three stages of trauma therapy Describe evidence-based pharmacological and psychological treatments for   Recommended Readings by Dr. Ross:   The Body Keeps the Score by Bessel Van der Kolk, MD Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care by Clark, Classen, Fourt, & Shetty Trauma and Recovery by Judith Herman, MD The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris, MD   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website:psychedpodcast.org.  
May 29, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Psychiatric Rehabilitation with guest Dr. Abraham Rudnick, who is currently a Professor in the Department of Psychiatry at the University of Dalhousie. In this episode, Aarti and Alex learn about Psychiatric Rehabilitation, also known as Psychosocial Rehabilitation (PSR), a rarely discussed or taught “4th branch” of mental health intervention. Join our residents as they discover the definition, purpose, history, process, character, and possibilities of psychiatric rehabilitation from a world expert. The learning objectives for this episode are as follows:   By the end of this episode, the listener will be able to Define psychiatric rehabilitation (PSR) Differentiate clinical and personal recovery Understand how PSR supports personal recovery Differentiate psychiatric rehabilitation from other mental health interventions Identify key areas of overlap with psychotherapy Identify key concepts within the process of PSR: readiness assessment and development, skills, supports, environment of choice, lack of coercion, maintenance of hope Locate resources to further their own knowledge and skills in PSR*   As referenced in the podcast*:   Online PSR training courses: https://www.mohawkcollege.ca/ce/programs/health-and-nursing/psychosocial-rehabilitation-016   https://www.douglascollege.ca/programs-courses/faculties/humanities-social-sciences/psychology/psychosocial-rehabilitation   Books/Journals: 1) Psychiatric Rehabilitation Journal 2) Work of Dr. William Anthony 3) Dr. Patrick Corrigan’s Principles and Practice of Psychiatric Rehabilitation   Guest staff psychiatrist: Dr. Abraham Rudnick, BMedSc, MD, MPsych, PhD, CPRP, FRCPC, CCPE, DFESPCH, FCPA, CSLI, CPRRP   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
April 15, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode is our fourth and final episode in our mini-series on schizophrenia. In this episode, we take an advanced look at the clinical management of schizophrenia, including a discussion of treatment-resistant schizophrenia and clozapine. Warning: this content in this episode is a little bit more advanced than usual, but also ultra interesting.     Our guest expert is Dr. Gary Remington. He is a researcher, psychiatrist, Chief of the Schizophrenia Division at CAMH and an author of the 2017 Canadian schizophrenia guidelines    The learning objectives for this episode are as follows:    By the end of this episode, the listener will be able to… Have an approach to treating a first episode psychosis of schizophrenia Understand the important components of maintenance treatment in schizophrenia Understand the concept of treatment-resistant schizophrenia (TRS) Know when to initiate clozapine List some of the psychosocial interventions involved in treating schizophrenia   References: Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616. Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., ... & Severe, J. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209-1223. Kapur, S., Remington, G., Jones, C., & Wilson, A. (1996). High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study. The American journal of psychiatry, 153(7), 948.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
March 7, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers community treatment orders (CTOs) and assertive community treatment (ACT) teams in the context of schizophrenia treatment with Dr. Arash Nakhost a staff psychiatrist who works on the FOCUS ACT team at St. Michael’s Hospital. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Provide a brief description of the history of ACT teams and CTOs, as well as the challenges in establishing evidence for their use Compare and contrast ACT teams with intensive case management teams in terms of their composition, methods, and respective strengths and weaknesses Describe the array of services that an ACT team can help provide to its clients as well as some of the challenges and drawbacks of ACT teams Outline the major reasons someone might be put on a community treatment order and describe how a CTO is applied and enforced Outline the major challenges in using CTOs as a treatment tool Guest staff psychiatrist: Dr. Arash Nakhost (St. Michael’s Hospital, Toronto) References: Ontario Hospital Association. (2016). A practical guide to mental health and the law in Ontario. Government of Ontario, Health Care Consent Act. Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane database of systematic reviews, (3). Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T. (2014). A systematic review of the effect of community treatment orders on service use. Social psychiatry and psychiatric epidemiology, 49(4), 651-663. Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., ... & Tsemberis, S. (2015). A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67(3), 275-281. Bromley, E., Mikesell, L., Whelan, F., Hellemann, G., Hunt, M., Cuddeback, G., ... & Young, A. S. (2017). Clinical factors associated with successful discharge from assertive community treatment. Community mental health journal, 53(8), 916-921. 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 info@psychedpodast.com For more information visit our website: psychedpodcast.org.
February 13, 2019
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode is part II in the treatment of schizophrenia series with our expert Dr. Albert Wong, a psychiatrist and research scientist who is an expert in schizophrenia at the Centre for Addiction and Mental Health (CAMH) and professor at the University of Toronto. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to…   Conceptualize antipsychotic drugs categories in in different and clinically relevant ways Have an approach for choosing an antipsychotic medication for a patient and be able to consent them by going over the benefits and limitations of the medications Understand the limitations of our understanding of schizophrenia and our current treatments and some of the problems that remain to be solved in this area of psychiatry    References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Robinson, D. J. (1997). Brain calipers: A guide to a successful mental status exam. Fort Gratiot, Mich., USA: Rapid Psychler Press. Kuipers, E., Yesufu-Udechuku, A., Taylor, C., & Kendall, T. (2014). Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ: British Medical Journal (Online), 348. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com. For more information visit our website:psychedpodcast.org.
October 30, 2018
Please take our 5-minute RESEARCH SURVEY. (see details below) Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of schizophrenia with Dr. Jason Joannou and Dr. Andrew Lustig, two inpatient staff psychiatrists at the Centre for Addiction and Mental Health (CAMH) and assistant professors at the University of Toronto.   The learning objectives for this episode are as follows:   By the end of this episode, the listener will be able to… Articulate the basic psychopharmacology of antipsychotics Create a basic treatment presenting with a first episode of schizophrenia, based on the 2017 Guidelines for the Pharmacotherapy of Schizophrenia in Adults Summarize principles of longitudinal treatment, which includes treatment-resistant schizophrenia and psychosocial approaches to the illness. References: Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616. Norman, R., Lecomte, T., Addington, D., & Anderson, E. (2017). Canadian treatment guidelines on psychosocial treatment of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 617-623. Tiihonen, J., Haukka, J., Taylor, M., Haddad, P. M., Patel, M. X., & Korhonen, P. (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. American Journal of Psychiatry, 168(6), 603-609.  If you are interested in contributing to our research project to improve PsychEd and better understand how medical learners use podcasts, please complete this brief 5-minute RESEARCH SURVEY.Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $230 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change!   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com. For more information visit our website: psychedpodcast.org.
July 23, 2018
Please take our 5-minute RESEARCH SURVEY. (more details below)   Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. We apologize that we don't have a new episode for you this month but we are working hard behind the scenes both on new episodes and on medical education research into podcasting. Don't fear, new episodes are on the way! In the meantime, we have a favour to ask. We have started a research project to improve PsychEd and to better understand how medical learners use podcasts. We are asking for our listeners help in completing this brief 5-minute RESEARCH SURVEY. Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $250 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change! CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
May 17, 2018
Please take our 5-minute RESEARCH SURVEY. (more details below)   Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis and treatment of Obsessive Compulsive Disorder (OCD) with Dr. Nik Grujich, a staff psychiatrist at Sunnybrook Hospital, associate of the Frederick W. Thompson Anxiety Disorders Centre and award-winning educator at the University of Toronto. In this episode, Jordan Bawks (PGY2 resident) and Aarti Rana (PGY1 resident) sit down with Dr. Grujich to talk about OCD. Together, they discuss the phenomenology of OCD (with a focus on differentiating it from Obsessive Compulsive Personality Disorder, OCPD), the epidemiology and natural course of the disorder, the DSM-5 diagnostic criteria, interview techniques to elicit and differentiate OCD from other psychiatric disorders and the pharmacological and psychological treatments for the disorder. By the end of this episode, the listener will be able to… Recognize the clinical features of OCD using DSM-5 criteria Appreciate the differential diagnosis and how to use specific interviewing questions and the mental status to aid clinical judgment Describe the evidence-based pharmacological and psychological treatments for OCD and their relative efficacy If you are interested in contributing to our research project to improve PsychEd and better understand how medical learners use podcasts, please complete this brief 5-minute RESEARCH SURVEY. Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $230 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change! CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
April 15, 2018
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto. In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) reunite with Dr. Peck to talk about the bio-psycho-social management of GAD. They cover recommended lifestyle changes for people with GAD, evidence-based pharmacotherapies, including SSRIs, SNRIs, Pregabalin, Quetiapine, TCAs and benzodiazepines, and how to choose between them, and psychotherapeutic treatments with a focus on CBT and a quick overview of some of the third wave cognitive models. By the end of this episode, the listener will be able to… List the lifestyle changes recommended for people with GAD Describe the first line and second line medication therapies for GAD and the rationale supporting each agent's place in the treatment hierarchy  Appreciate the key elements of CBT that make it effective for the treatment of GAD Relevant Articles: Generoso et al., 2017 (Pregabalin for GAD metaanalysis) Katzman et al., 2014 (Canadian Anxiety Guidelines) Please Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association or the University of Toronto and are not meant to replace formal clinical education or judgment. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
March 23, 2018
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto.   In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) sit down with Dr. Peck to help them understand the clinical construct of generalized anxiety disorder (GAD). In addition to understanding how to make the diagnosis they also cover the epidemiology natural course, differential diagnosis and routine investigations for GAD.      By the end of this episode, the listener will be able to… Recognize the clinical features of GAD using DSM-5 diagnostic criteria Appreciate the differential diagnosis and how to conduct assessments to help clinical judgment   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at info@psychedpodast.com For more information visit our website: psychedpodcast.org.
January 17, 2018
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Schizophrenia, which guest speakers Dr. Jason Joannou and Dr. Andy Lustig from the CAMH inpatient psychiatry unit. In this episode we discuss schizophrenia, with the following objectives: 1.      The DSM V diagnostic criteria of schizophrenia 2.      The impact of the disease and its trajectory 3.      The differential diagnosis of schizophrenia 4.      Clinical approach to patients with schizophrenia 5.      The Mental Health Act and involuntary admission By the end of this episode, the listener will be able to… 1.       Know the DSM V diagnostic criteria of schizophrenia and specific manifestations of the disease 2.      Know some of the epidemiology, triggers and impact of the disease 3.      Know the differential diagnosis of schizophrenia and its subtypes 4.      Know how to elicit a good history and how to approach patients with schizophrenia 5.      Know the Mental Health Act and the legalities around forming a patient with schizophrenia. The perspectives we have elicited in this episode are from inpatient psychiatrists who generally tend to see more severe cases of schizophrenia. CPA Note: The content of this podcast are created for medical Learners by medical learners. The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter @psychedpodcast, and subscribe to us at our website: psychedpodcast.org.
September 23, 2017
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers treatment of bipolar disorder with Dr. Roger McIntyre, Professor of Psychiatry and Pharmacology at University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, Canada. In this episode, we follow the case of Devon, a 28 year old male who presents to the ER with acute mania and is diagnosed with bipolar disorder. Our team of psychiatry residents from University of Toronto guide you through Devon’s trajectory with reference to CANMAT guidelines and expertise from Dr. McIntyre. We discuss how to manage acute mania and acute depression and what management looks like for outpatients (pharmacological and non-pharmacological). Special topics include treating severe agitation on the inpatient ward and things to consider for lithium treatment.  The Learning Objectives for this episode are as follows: By the end of this episode, the listener will be able to… Treat acute mania and depression in bipolar disorder  Prevent relapse in bipolar disorder through maintenance pharmacotherapy Prevent relapse through nonpharmacological interventions Obtain informed consent for and initiate lithium treatment Guest staff psychiatrist: Dr. Roger McIntyre (University Health Network, Toronto) For more PsychEd, follow us on Twitter @psychedpodcast, and subscribe to us at our website: psychedpodcast.org.
August 11, 2017
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of bipolar disorder in ther depressive episodes, and a phenomenon termed "episodes with mixed features", with guest Dr. Ariel Shafro, a staff psychiatrist at Trillium Health Partners.  Bipolar disorder is an illness characterized by manic and depressive episodes; patients in fact spend more time in a depressed state than a manic state. The criteria for diagnosing a bipolar depression is the same as unipolar depression (or major depressive disorder).  When patients present with a depressive episode, it is important to consider bipolar disorder as a possible differential diagnosis. In addition, we discuss certain features that can point to an increased likelihood of bipolarity in a patient presenting with depression: this includes a strong family of bipolar disorder; previous subthreshold mania and cyclothymic features;atypical depression, psychomotor retardation (and/or catatonia), and psychotic features; and atypical reaction to antidepressants.  Lastly, we talk about the phenomenon of "episodes with mixed features", where people can present with simultaneous symptoms of depression and mania. We discuss the relevance of recognizing such episodes, including increased vigilance for features of bipolarity and considerations for treatments that have effect in both unipolar and bipolar depression. The learning objectives for this episode are as follows. By the end of this episode, the listener will be able to: Describe criteria for bipolar depression (it's the same as unipolar depression!) List features suggestive of bipolarity in a presentation of depression Know the DSM-V criteria of and recognize episodes with mixed features Describe the relevance of diagnosing episodes with mixed features Guest Staff Psychiatrist: Dr. Ariel Shafro (Trillium Health Partners, Mississauga) For more PsychEd, follow us on Twitter @psychedpodcast, and subscribe to us at our website: psychedpodcast.org.
July 7, 2017
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of Bipolar Disorder (Type 1 and 2), with insights from guest Dr. Mark Sinyor, Staff Psychiatrist at Sunnybrook Health Sciences Centre.  Bipolar disorder is characterized by depressive and manic episodes. This episode focuses on the diagnostic criteria and assessment in mania, and presents a fictional case of a patient with a first manic episode. We discuss the epidemiology of bipolar disorder, and a plain-English description of manic episodes. We then explore the DSM-5 diagnostic criteria for manic episodes using the mnemonic GSTPAID. Relating the criteria back to the case, we will talk with Dr. Sinyor about practical methods and tips for assessing a person who presents with manic symptoms. Some common mental status exam terms and findings in mania will be explained. We then discuss common differential diagnoses for bipolar disorder, including schizoaffective disorder, schizophrenia, borderline personality disorder, and substance intoxication/substance-induced mania.  Lastly, we will differentiate between mania and hypomania, and Bipolar Disorder Type 1 and Type 2. Through the examination of the concept of “bipolar spectrum”, we will discuss some challenges and limitations of the DSM-5 and the current understanding of Bipolar Disorder.  The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to: Cite the prevalence and incidence rates of bipolar affective disorder Describe the natural history of bipolar disorder including its cyclical nature, and relative ratio of times in mania vs depression Know the DSM-V criteria for mania, hypomania Suggested mnemonic GSTPAID Perform an effective diagnostic interview for manic symptoms Perform a differential diagnosis for bipolar disorder including borderline personality disorder and psychotic disorders Guest Staff Psychiatrist: Dr. Mark Sinyor (Sunnybrook Health Sciences Centre, Toronto) For more PsychEd, follow us on Twitter @psychedpodcast, and subscribe to us at our website: psychedpodcast.org.
March 12, 2017
Welcome to PsychED, the educational psychiatry podcast for medical learners, by medical learners. This episode covers the approach to treating Major Depressive Disorder, as described by the CANMAT (Canadian Network for Mood and Anxiety Treatments) Guidelines. We discuss with Dr. Sid Kennedy, the founding chair of CANMAT, the past president of International Society for Affective Disorders, as well as a staff psychiatrist and scientist at Toronto Western and St. Michael’s Hospitals in Toronto. In this episode, Dr. Kennedy discusses the origins of the CANMAT and how the guidelines are structured and constructed. We talk briefly about consideration of specifiers and symptoms in tailoring treatment. We then approach psychotherapy, pharmacotherapy, electrostimulation, and complementary and alternative therapies as treatment options, using the case from the previous episode on the diagnosis of depression. Evidence-based psychotherapies for depression include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). We explain briefly the theoretical underpinnings of each. Patient suitability and availability of quality therapy are considered. Some evidence demonstrate a superiority of combining psychotherapy with pharmacotherapy (Cuijpers 2009). The first-line pharmacotherapy includes antidepressant classes SSRI (selective serotonin reuptake inhibitor), SNRI (serotonin and norepinephrine reuptake inhibitor), NDRI (norepinephrine and dopamine reuptake inhibitor), and NaSSA (norepinephrine and specific serotonergic antidepressant). We discuss side effects with a focus on SSRIs, and understanding them from serotonin receptor profiles. We talk about the delayed onset of antidepressants, using validated tools to measure improvement, and strategies to optimize dosage, or using adjuncts with partial responses. We explore results from STAR*D (Trivedi et al, 2006) regarding response rates to medications.We touch briefly on antidepressant selection and the limited evidence of superiority of one medication/class over another (Cipriani et al 2009). Brain stimulation includes electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and Deep Brain Stimulation (DBS). Dr. Kennedy discusses the cultural origins of misconceptions around ECT and explores the current practice of ECT today, which includes general anesthesia for the comfort of patients. We explain briefly the practice of rTMS and DBS. Complementary and alternative therapies are briefly explored, including light therapy which has increasing evidence not only for seasonal patterns of depression. Dr. Kennedy discusses the limited evidence available to support any complementary therapies including nutraceuticals and exercise. The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to: Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features Apply the CANMAT Guidelines in discussing treatment options for MDD Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD Psychotherapy Identify CBT, IPT, and MBCT as evidence-based psychotherapies for depression Explain factors for choosing psychotherapy versus pharmacotherapy as first-line treatment Describe the efficacy of psychotherapy in relation to pharmacotherapy Pharmacotherapy Identify SSRI, SNRI, NDRI, and NaSSA as classes of antidepressants that are first-line for depression Explain the time of onset and side effect profile of SSRIs Apply the guideline to either optimize, switch, or add adjunctive therapies with limited or partial responses to medication Identify some factors to consider in choice of antidepressants Brain Stimulation Identify ECT, rTMS, and DBS as brain stimulation treatments for depression Criticize the cultural origins of stigma around ECT Describe the current practice of ECT, rTMS, and DBS Complementary and Alternative Therapies Describe Light Therapy as the only evidence-based complementary treatment strategy Recognize the limited data in support of other therapies including nutraceuticals and exercise Guest Staff Psychiatrist: Dr. Sid Kennedy (Toronto Western Hospital and St. Michael’s Hospital, Toronto) For more PsychED, follow us on Twitter @psychedpodcast, and subscribe to us at our website: psychedpodcast.org.
March 12, 2017
Welcome to PsychEd, the educational psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of major depressive disorder (MDD), leveraging experience from Dr. Ilana Shawn, Staff Emergency and Outpatient Psychiatrist at St. Michael’s Hospital in Toronto. In this episode we talk about a hypothetical case of someone presenting for the first time with a depressive illness. Using the metric of DALY (disability-adjusted life-years), we highlight the high global disease burden of depression. We then briefly discuss the purpose and limitations of using a diagnostic manual. We describe in depth the symptoms of depression using the mnemonic MSIGECAPS, including Dr. Shawn’s thoughts on how the they can be elicited more naturally in an assessment. We talk about common challenges in performing a suicide assessment, and the misconception that asking about suicide increases the risk of suicide. Finally, we highlight other medical and psychiatric conditions that can mimic depression. The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to: Understand the societal impact of depression Describe the diagnostic criteria of MDD Describe strategies to elicit depression symptoms Apply Mental State Exam findings to support or a diagnosis of depression Understand the limitations of the Diagnostic and Statistical Manual (DSM) Perform a differential diagnosis of major depression Guest Staff Psychiatrist: Dr. Ilana Shawn (St. Michael’s Hospital, Toronto) For more PsychEd, follow us on Twitter @psychedpodcast, and subscribe to us at our website: psychedpodcast.org.
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