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 psychedpodcast@gmail.com. For more information, visit our website: psychedpodcast.org.

PsychEd Episode 19: Applying Mental Health Legislation with Kendra Naidoo

This podcast is written and produced by psychiatry residents at the University of Toronto and is aimed at medical students and residents. Listeners will learn about fundamental and more advanced topics in psychiatry as our resident team explore these topics with world-class psychiatrists at U of T and abroad.

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Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the field of critical psychiatry with Dr. Elia Abi-Jaoude and Lucy Costa. Dr. Abi-Jaoude is a staff psychiatrist at The Hospital for Sick Children and Assistant Professor and Clinician Investigator in the Department of Psychiatry at the University of Toronto in Toronto, Canada. Lucy Costa is Deputy Executive Director of the Empowerment Council, a voice for clients of mental health and addiction services primarily at the Centre for Addiction and Mental Health in Toronto.   While this topic could be very philosophical and expansive, we are going to focus our discussion by considering the practical implications of this field on psychiatric practice. What do you need to know about critical psychiatry as a trainee, and how might it impact your clinical practice?   The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to…   Define the term critical psychiatry and describe how the field has evolved over time   Review core principles of critical psychiatry and apply them to a clinical situation   Understand the potential benefits and harms of critical psychiatry and where the field is headed     Guests: Dr. Eila Abi-Jaoude and Lucy Costa   Hosts: Dr. Gaurav Sharma (PGY5), Dr. Nikhita Singhal (PGY5), Dr. Monisha Basu (PGY2), and Saja Jaberi (IMG)   Audio editing by: Gaurav Sharma   Show notes by: Gaurav Sharma and Nikhita Singhal   Conflicts of interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic.  Interview content:   Introduction - 00:13   Learning objectives - 02:35   Defining critical psychiatry - 03:33   How our experts got involved in critical psychiatry and incorporate it into their work - 04:50   What are some of the questions critical psychiatry tries to answer? - 15:07   Why care about critical psychiatry and “holding truths lightly”? - 23:55   Principles of critical psychiatry - 24:55   Applying critical psychiatry principles to a case - 32:40   Potential benefits and harms of a critical psychiatry approach - 41:49   Future directions for critical psychiatry - 58:29   Review of learning objectives and summary - 1:01:30   End credits - 1:03:17     Resources:    Critical Psychiatry Textbook   Restoring Study 329     Psych Debate 14 | Critical Psychiatry and Diagnosis     References:   Barkil-Oteo A. Collaborative care for depression in primary care: how psychiatry could "troubleshoot" current treatments and practices. Yale J Biol Med. 2013 Jun 13;86(2):139-46.   Craddock N, Mynors-Wallis L. Psychiatric diagnosis: impersonal, imperfect and important. The British Journal of Psychiatry. 2014;204(2):93-95. doi:10.1192/bjp.bp.113.133090   Kirsch I. The emperor's new drugs: medication and placebo in the treatment of depression. Handb Exp Pharmacol. 2014;225:291-303. doi:10.1007/978-3-662-44519-8_16   Middleton H, Moncrieff J. Critical psychiatry: a brief overview. BJPsych Advances. 2019;25(1):47-54. doi:10.1192/bja.2018.38   O'Donoghue T, Crossley J. A critical narrative analysis of psychiatrists' engagement with psychosis as a contentious area. Int J Soc Psychiatry. 2020 Nov;66(7):724-730. doi: 10.1177/0020764020934516   Samara MT, Dold M, Gianatsi M, et al. Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia: A Network Meta-analysis. JAMA Psychiatry. 2016;73(3):199–210. doi:10.1001/jamapsychiatry.2015.2955     Important figures in the history of anti-psychiatry and critical psychiatry (discussion edited from episode for length):  Anti-Psychiatrists:   R. D. Laing (UK)   Thomas Szasz (USA)   Michel Foucault (France)     Critical Psychiatrists:   Joanna Moncrieff (UK)   Suman Fernando (UK)   Sami Tamini (UK)   Pat Bracken (UK)   Derek Summerfield (UK)   Sandra Steinguard (USA)   Critical Psychiatry Network  (International Email List)     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.

PsychEd Episode 59: Critical Psychiatry with Dr. Elia Abi-Jaoude and Lucy Costa

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto.   Dr. Courtney earned his MD in 2004 at Queen’s University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth.   Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to…   Outline the prevalence and risk factors for depression in children and adolescents   Explain how children and adolescents with depression present in clinical practice   Discuss the use of screening tools for depression in this population   Describe an approach to the management of depression in children and adolescents   Outline the management of an adolescent with suicidal thoughts or behaviours     Guest: Dr. Darren Courtney Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5) Audio editing by: Nikhita Singhal Show notes by: Kate Braithwaite and Nikhita Singhal   Interview Content:   Introduction - 0:00   Learning objectives - 02:11   Prevalence of depression in youth - 03:11   Risk factors for depression in youth - 06:25   Diagnosing depression in youth - 08:30   Screening tools - 14:24   Approach to taking a history from youth - 19:45   Management of depression in youth - 30:12    Psychotherapies - 33:20   Medications - 37:37    Assessing and managing suicidality in youth - 44:00   Measurement based care - 51:00   Final thoughts - 55:10     Resources:   Previous PsychEd episodes:     PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn    PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy   PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer     ICHOM Set of Patient-Centered Outcome Measures for Children & Young People with Depression & Anxiety   Screening tools/rating scales:     Revised Children's Anxiety and Depression Scale (RCADS)    Mood and Feelings Questionnaire (MFQ)    NICE guideline: Depression in children and young people: identification and management   NICE guideline: Self-harm: assessment, management and preventing recurrence    The CARIBOU Pathway by CAMH: A youth-centered program for the treatment of depression    Includes links to download free clinician-specific and youth-specific resources co-developed with youth and mental health clinicians     Clinical Innovations and Tools | Cundill Centre for Child and Youth Depression | CAMH    Includes links to various tools for health care providers, researchers, youth, and other stakeholders (such as teachers and family members) informed by research evidence      References:   Bennett K, Courtney D, Duda S, Henderson J, Szatmari P. An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth. Depress Anxiety. 2018 Jun;35(6):530-540. https://doi.org/10.1002/da.22752   Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry. 2020 Aug;14(4):486-494. https://doi.org/10.1111/eip.12918   Georgiades K, Duncan L, Wang L, Comeau J, Boyle MH; 2014 Ontario Child Health Study Team. Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Can J Psychiatry. 2019 Apr;64(4):246-255. https://doi.org/10.1177%2F0706743719830024   Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess. 2017 Mar;21(12):1-94. https://doi.org/10.3310/hta21120   Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. https://doi.org/10.1002/14651858.CD013674.pub2   MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016 Sep;61(9):588-603. https://doi.org/10.1177%2F0706743716659276   National Institute for Health and Care Excellence. Depression in children and young people: Identification and management NG134 [Internet]. London: NICE; 2019 Jun 25 [cited 2023 Sep 22]. Available from: https://www.nice.org.uk/guidance/ng134.   Parikh A, Fristad MA, Axelson D, Krishna R. Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2020 Oct;29(4):587-599. https://doi.org/10.1016/j.chc.2020.06.001   Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):479-502. https://doi.org/10.1016/j.jaac.2022.10.001   Wiens K, Bhattarai A, Pedram P, Dores A, Williams J, Bulloch A, Patten S. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr Sci. 2020 Apr 17;29:e115. https://doi.org/10.1017%2FS2045796020000281   World Health Organization. Mental health of adolescents [Internet]. 2021 [cited 2023 Sep 22]. Available from:  https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health     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.

PsychEd Episode 58: Depression in Children and Adolescents with Dr. Darren Courtney

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers HIV/AIDS psychiatry with special guests from two international settings to provide complementary perspectives on HIV psychiatry. Dr. Adriana Carvalhal, HIV Psychiatrist and Staff Psychiatrist at Scarborough Health Network in Canada and Dr. Leigh Van Den Heuvel, Psychiatrist and Associate Professor in the Department of Psychiatry, at Stellenbosch University in South Africa. The learning objectives for this episode are as follows:  By the end of this episode, you should be able to…   Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health   Identify HIV-specific mental health disorders and how to screen for these conditions   Outline the overall approach to treatment for HIV patients with mental health disorders   Guests: Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel Produced by: Saja Jaberi (MD), Kate Braithwaite (MD) and Gaurav Sharma (PGY5) Hosts: Kate Braithwaite (MD) and Gaurav Sharma (PGY5) Audio editing by: Gaurav Sharma (PGY5) Show notes by: Saja Jaberi (MD) and Gaurav Sharma (PGY5) Conflicts of Interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Generic names are used for all medications referenced. Contents:   Introduction - 0:19   Learning objectives - 3:52   The bidirectional relationship between HIV and psychiatric illness - 4:24    Prevalence of psychiatric illness in HIV - 9:56   Screening for psychiatric illness in HIV populations - 12:11    HIV Associated Neurocognitive Disorder (HAND) - 19:27    Diagnostic Criteria - 20:19   Clinical Presentation & Etiology - 23:03   Risk Factors - 26:56   Screening Tools - 32:06   Treatment - 36:59    HIV Psychiatry case example - 39:48    Navigating the differential diagnosis - 41:44   Initial management & addressing comorbidities - 44:30   Drug-drug interactions between antiretroviral and psychiatric medications - 48:04    Review of learning objectives & final thoughts - 52:04   Outro - 55:55     Resources:   Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)    Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020 - Canada.ca      HIV and Clinical Depression     https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Anxiety-2012.pdf     https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-CognitiveDisorder-2012.pdf    International HIV Dementia Scale (IHDS) - Mental Health Screening - National HIV Curriculum (uw.edu)/   Liverpool HIV Interactions (hiv-druginteractions.org)   References:   Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.   Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.   Awori V, Mativo P, Yonga G, Shah R. The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus. South Afr J HIV Med. 2018 Apr 12;19(1):674. doi: 10.4102/sajhivmed.v19i1.674. PMID: 29707383; PMCID: PMC5913780.   Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19. PMID: 27325690; PMCID: PMC4981762.   Clinical Care Guidelines for Adults and Adolescents living with HIV in Ontario, Canada. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)   Core Concepts - Screening for Mental Health Conditions - Basic HIV Primary Care - National HIV Curriculum (uw.edu)   Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci. 2021;50:271-298. doi: 10.1007/7854_2019_116. PMID: 31559600.   EACS Guidelines version 11.1, October 2022.   Joska JA, Witten J, Thomas KG, Robertson C, Casson-Crook M, Roosa H et al. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS and behavior. 2016 Aug 1;20(8):1621-1631. doi: 10.1007/s10461-016-1316-y   Kolakowska A, Maresca AF, Collins IJ, Cailhol J. Update on Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options Infect Dis. 2019;11(4):372-387. doi: 10.1007/s40506-019-00203-7. Epub 2019 Nov 16. PMID: 33380904; PMCID: PMC7758219.   Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci. 2021;50:429-478. doi: 10.1007/7854_2019_117. PMID: 32677005.   Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci. 2021;50:175-191. doi: 10.1007/7854_2019_101. PMID: 31396894.   Southern African HIV Clinicians Society. Management of mental health disorders in HIV-positive patients. S Afr J HIV Med 2013; 14(4): 155 - 165    Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Erratum in: Clin Infect Dis. 2021 Dec 08;: Erratum in: Clin Infect Dis. 2022 Nov 30;75(11):2052. PMID: 33225349.   Turjanski, N., & Lloyd, G. (2005). Psychiatric side-effects of medications: Recent developments. Advances in Psychiatric Treatment, 11(1), 58-70. doi:10.1192/apt.11.1.58   Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, Lu L, Bao Y. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurology. 2020 Nov 10;95(19):e2610-e2621. doi: 10.1212/WNL.0000000000010752. Epub 2020 Sep 4. PMID: 32887786.     CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.  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.

PsychEd Episode 57: HIV psychiatry with Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers trauma and addictions with Dr. Gabor Maté, a retired physician who, after 20 years of family practice and palliative care experience, worked for over a decade in Vancouver’s Downtown East Side with patients challenged by drug addiction and mental illness. The bestselling author of five books published in thirty languages, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Maté is an internationally renowned speaker highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. For his groundbreaking medical work and writing he has been awarded the Order of Canada, his country’s highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver. His fifth book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture was released on September 13, 2022.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to…   Understand the connection between trauma and the development of addictions and other mental illnesses   Critically reflect on current diagnostic and treatment paradigms   Apply principles of trauma-informed care to psychiatric assessment and the provision of mental health services     Guest: Dr Gabor Maté   Hosts: Sena Gok, Rhys Linthorst, Angad Singh, Nikhita Singhal, and Alex Raben   Audio editing by: Sena Gok   Show notes by: Nikhita Singhal   Interview Content:   Introduction - 0:00   Learning objectives - 01:43   Defining trauma - 02:14   Current dominant views of addiction - 07:27   Defining addiction - 11:05   Relationship between trauma and addiction - 16:15   Neurobiology of addiction - 17:20   Brain development - 25:48   Genetic susceptibility - 36:10   Trauma-informed approach to treatment - 39:45   Importance of therapeutic relationships - 44:10   Societal barriers - 48:15   Harm reduction - 54:32   Closing comments - 01:00:14     Resources:   Books:    In the Realm of Hungry Ghosts (Gabor Maté)   The Myth of Normal (Gabor Maté)    The Body Keeps The Score (Bessel van der Kolk)    The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions (Jaak Pansepp, Lucy Biven)    Dr Gabor Maté’s website: https://www.drgabormate.com   Adverse Childhood Experiences (ACEs) study: https://doi.org/10.1016/s0749-3797(98)00017-8    More information on ACEs from Harvard University’s Center on the Developing Child:  What Are ACEs? And How Do They Relate to Toxic Stress?    Compassionate Inquiry (psychotherapeutic approach developed by Dr Gabor Maté)     References:   Brown, T., Berman, S., McDaniel, K., Radford, C., Mehta, P., Potter, J., & Hirsh, D. A. (2021). Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Academic medicine: journal of the Association of American Medical Colleges, 96(5), 661–667. https://doi.org/10.1097/ACM.0000000000003587   Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/   Colon-Rivera Hector, A., Aoun, E. & Vaezazizi, L. M. (2023). Addiction Psychiatric Medicine: A Comprehensive Board Review. Elsevier.   Dugosh, K.L. & Cacciola J. (2022). Clinical assessment of substance use disorders. In J. A. Melin (Ed.), UpToDate. Retrieved from  https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders   Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8   Fundamentals of Addiction: Screening. CAMH. Retrieved from   https://www.camh.ca/en/professionals/treating-conditions-and-disorders/fundamentals-of-addiction/f-of-addiction---screening   Michaels, T. I., Stone, E., Singal, S., Novakovic, V., Barkin, R. L., & Barkin, S. (2021). Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World journal of psychiatry, 11(6), 222–231. https://doi.org/10.5498/wjp.v11.i6.222   Olsen Y. (2022). What Is Addiction? History, Terminology, and Core Concepts. The medical clinics of North America, 106(1), 1–12. https://doi.org/10.1016/j.mcna.2021.08.001   Panksepp J. (2011). The basic emotional circuits of mammalian brains: do animals have affective lives? Neuroscience and biobehavioral reviews, 35(9), 1791–1804. https://doi.org/10.1016/j.neubiorev.2011.08.003   Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of anxiety disorders, 88, 102558. https://doi.org/10.1016/j.janxdis.2022.102558   Shonkoff, J. P., Richter, L., van der Gaag, J., & Bhutta, Z. A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), e460–e472. https://doi.org/10.1542/peds.2011-0366   Volkow, N. D., & Li, T. K. (2004). Drug addiction: the neurobiology of behaviour gone awry. Nature reviews. Neuroscience, 5(12), 963–970. https://doi.org/10.1038/nrn1539     CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   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.  

PsychEd Episode 56: Understanding Trauma and Addictions with Dr. Gabor Maté

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness as a sequel to our previous episode on MAiD with our guest experts, Dr. Sonu Gaind and Dr. Jeffrey Kirby. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.   The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to…   Gain an understanding of the current state of Medical Assistance in Dying for primarily mental illness in Canada   Evaluate the arguments in support of and against implementation of Medical Assistance in Dying for primarily Mental Illness    Understand next steps and future directions of Medical Assistance in Dying for primarily mental illness in Canada   Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry      Guest Experts: Dr. Sonu Gaind who is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Sunnybrook Health Sciences Centre, and clinically works as a psycho-oncology consultant. As Medical Assistance in Dying (MAiD) policies have been evolving in Canada, Dr. Gaind has testified in front of numerous expert, parliamentary and senate committees on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, was retained by the former Attorney General of Canada as an expert in the Truchon and Lamb cases, and chaired his former hospitals MAiD team.  He has spoken across the country and internationally on the subject.    Dr. Jeffrey Kirby is a (retired) Professor in the Department of Bioethics, Faculty of Medicine, Dalhousie University. He has an educational background and professional experience in medicine, philosophy and health care ethics. Dr. Kirby has published a set of academic papers in high-impact, international, bioethics journals on a variety of MAID-related topics including: assisted dying for suffering arising from mental health conditions, morally-relevant distinctions between paradigm and non-paradigm MAID circumstances, meso- and macro-level (MAID-related) health policy development, and organ donation after MAID and institutional conscientious objection to MAID. He made several, virtual and written, Bill C-7 related submissions to the Senate Committee on Legal and Constitutional Affairs regarding matters/issues of relevance to the potential consideration of mental health disorders as sole-qualifying conditions for MAID in Canada. He is a former member of the Expert Panel on MAiD and Mental Illness.    Grand Rounds Presenter: Dr. Urvashi Prasad (PGY4) Produced by: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben  (staff psychiatrist) Hosts: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben (Staff Psychiatrist) Peer Reviewer: David Eapen-John (MS4) Audio editing by: Dr. Urvashi Prasad  (PGY4)  Show notes by: Dr. Urvashi Prasad (PGY4)   Resources:     Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.     References:   Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.” Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/.    Tabitha Marshall. “Assisted Suicide in Canada.” The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada.     Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.    Canada, Health. “Final Report of the Expert Panel on MAiD and Mental Illness” Canada.ca, / Gouvernement Du Canada, 13 May 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html#exe.    “Medical Assistance in Dying: An Update - Cpa-Apc.org.” Position Statement, https://www.cpa-apc.org/wp-content/uploads/2021-CPA-Position-Statement-MAID-Update-EN-web-Final.pdf.     APA Official Actions Position Statement on Medical Euthanasia. 2016, https://odbapa.org/wp-content/uploads/2022/02/Position-2016-Medical-Euthanasia.pdf.    The Fifth Estate. “Is It Too Easy to Die in Canada? Surprising Approvals for Medically Assisted Death -the Fifth Estate.” YouTube, 19 Jan. 2023, www.youtube.com/watch?v=plinQAHZRvk&ab;_channel=TheFifthEstate.    Wiebe K, Mullin A. “Choosing death in unjust conditions: hope, autonomy and harm reduction.” J Med Ethics. 2023 Apr 26:jme-2022-108871. doi: 10.1136/jme-2022-108871. Epub ahead of print. PMID: 37100589.   Gaind, KS. “What does “irremediability” in mental illness mean?” Canadian Journal of Psychiatry. Online first May 22, 2020. pp 1‐3. doi: 10.1177/0706743720928656   Kirby, J. (2022) Interpreting Irremediability When a Mental Health Disorder is the sole-Qualifying Medical Condition for MAiD. Peer-reviewed critical commentary. Canadian Journal of Bioethics 5(4): 83-88.    Kirby, J. (2021) Reconceptualizing ‘Psychiatric Futility’: Could Harm Reduction, Palliative Psychiatry, and Assisted Death Constitute a Three-Component Spectrum of Appropriate Practices? American Journal of Bioethics 21(7): 65-67.    Kirby, J. (2018) Balancing Competing Interests and Obligations in Mental Health-Care Practice and Policy. Bioethics 33(6): 699-707.   Kirby, J. (2017) Medical Assistance in Dying for Suffering Arising from Mental Health Disorders: Could augmented safeguards enhance its ethical acceptability? Journal of Ethics in Mental Health 10: 1-17.     CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   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.

PsychEd Episode 19: Applying Mental Health Legislation with Kendra Naidoo

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