Good Enough Shrink

Hello listeners, we are back! As mainstream media continues to recognize the immense challenges of the postpartum time, this is an important topic that is rarely discussed. If you are a parent who is suddenly having to navigate the NICU, this episode is for you. I hope this reminds you of the healing powers of human connection.

Topics discussed:

• Mind-brain disconnect problem 
• Positive NICU facts 
• 7 Lessons from the NICU by a child psychiatrist 

Resources:

• https://www.dearnicumama.com/
• https://www.childrenscolorado.org/doctors-and-departments/departments/neonatal-intensive-care-unit/nicu-family-resources/nicu-patient-stories/

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Hi listeners! Today's episode is a bit off the cuff. In this age of information overload and phone addiction, it is so easy to lose ourselves in it. Let's explore how the bigger system is splitting us apart by first tapping into our own psyche. 

Topics Discussed: 

• How sense of self is different from self-worth, self-esteem, etc.
• How the digital world divides us up 
• Projecting your sense of self onto the world
• Understanding your development
• The unconscious

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In this episode, we are skimming the surface of this vast and important field of perinatal mental health. Whether you are an expecting mother, father, partner, concerned family member or friend, or a mental health professional, we hope to leave you with a sense of hope that there are many options for treatment and that you are not alone. 

**Content in this podcast is not direct medical advice. Please always seek your own psychiatrist, physician, or licensed mental health professional for individually recommended treatments.** 

Topics Discussed: 

• Perinatal and Postpartum Mental Health Conditions
  • Anxiety
  • Baby Blues vs. Postpartum Depression
  • OCD
  • PTSD
  • Bipolar disorder
  • Psychosis
• Causes of Perinatal and Postpartum Mental Health Conditions
  • Biological, psychological, and social factors
• Treatments
  • Therapy first!!
  • SSRIs
  • Antipsychotics 
  • Neurosteroids 
  • TMS, ECT
• Paternal Mental Health
• Special Cases: Infertility, Miscarriages, NICU stays

Resources: 

https://womensmentalhealth.org/

https://postpartum.net/

Lacmed: https://www.ncbi.nlm.nih.gov/books/NBK501922/

https://postpartum.net/professionals/certification/

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Hello listeners! This episode, I was inspired by conversations with my closest friends on what exactly it means to endure suffering. I wanted to demonstrate what it actually looks like to "weather the storm" or "ride the wave" as they call it. If you are typically a person who has the answers and currently at a loss, this episode is for you.

*Trigger warning on a brief discussion of suicide

Topics Discussed:

• Important introduction to set the stage
• What happens to your brain and body in chronic stress?
• Story time 
• Processing your emotions one by one
• Clinical depression and antidepressants 

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As we continue to see violence, political conflict, and distressing news in the world, we  bring to you this episode to help guide parents on how to talk to their kids about difficult news. The physical and mental effects of high stress-states, trauma, and disasters are devastating, and we are right here figuring this out with you. 

• Core concepts to share with your kids
• Case 1: Your 7 year-old is scared of school shootings
• Case 2: Your 14 year-old is afraid for attacks on the LGBTQ+ community
• Case 3: Your 20 year-old is wanting to participate in ICE protests

Resources:

https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Disaster_Resource_Center/Home.aspx

https://www.aap.org/en/patient-care/disasters-and-children/?srsltid=AfmBOoo0r1lGRsII7rhW3dc2X6_bLPxh8jxYpIs5H3TDfS77dcQK0lQQ

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As you face the new year (and possibly Sunday blues today), you might be questioning your sense of purpose, direction, and life’s meaning. This is an episode to help you through this time of transition, which often feels crushingly paralyzing. Inspired by none other than the great psychiatrist and Holocaust survivor, Dr. Viktor Frankl, sit back and explore with me the world of existentialism. 

Topics Discussed:

• Why finding your life’s purpose is important
• What does having purpose mean?
• Viktor Frankl’s logotherapy
• Philosophers: Nietzsche, Dostoevsky, Schopenhauer
• Jacques Lacan’s meaning of Love
• Love your failures

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This time of year, severe mental health conditions like bipolar disorder can worsen. In this episode, we discuss the evolution of bipolar disorder and how it came to be understood. We start with adult bipolar disorder and dive into pediatric bipolar disorder, especially its diagnostic challenges. This is a highly debated topic, so sit back, ponder, send us any questions or comments! 

Topics Discussed:

• Statistics of Pediatric Bipolar Disorder
• History of Manic Depressive Illness to Bipolar Disorder
  • Dementia praecox & manic depressive insanity
  • DSM-1 through DSM-5
• Diagnostic Challenge of Pediatric Bipolar Disorder 
• The Question of DMDD vs. Bipolar Disorder
• Differential Diagnoses of Bipolar Disorder:
  • ADHD, major depression, psychosis/schizophrenia, autism spectrum disorder, PTSD, borderline personality disorder, TBI, hyperthyroidism
• Pharmacological Treatments
• Psychosocial Treatments 

Resources:

APA: https://www.apa.org/topics/bipolar-disorder

AACAP: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Bipolar-Disorder-In-Children-And-Teens-038.aspx 

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Hello listeners! Münchausen Syndrome or factitious disorder is a fascinating yet devastating topic that we’ve taken a few recordings to discuss, especially in light of the recent Florida appeals court ruling on the famous case of Maya Kowalski. As child psychiatrists, we hope to share with you that we are relentlessly searching for answers in conditions like this, and not giving up on the pursuit despite our own vulnerabilities. 

Topics Discussed:

1. History of Münchausen Syndrome
2. Diagnosis of Exclusion
3. Differential Diagnoses: malingering, somatic symptoms disorder, functional neurological symptom disorder 
4. Clues to Diagnosis 
5. Theories Behind Münchausen Syndrome & Münchausen by Proxy
6. Statistics on Münchausen Syndrome & Münchausen by Proxy
7. Case 1: Gypsy-Rose Blanchard
8. Case 2: Maya Kowalski
9. How families can cope with someone with possible Münchausen Syndrome 
10. Treatment Approaches: Team Effort 
11. Countertransference 
12. Vulnerability as Physicians 

**Disclaimer: Any discussion or commentary regarding the mentioned public cases is only intended for educational or illustrative purposes. No confidential or privileged information is being disclosed, and any statements made do not constitute a clinical, psychiatric nor medical evaluation or diagnosis. 

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Hello listeners! We are so excited to share this episode with you. We get into the nitty gritty of treatment for PTSD in both psychotherapy and medications. 

**This information is for general knowledge and does not substitute for professional medical advice, diagnosis, or treatment. Please always consult your own healthcare provider for your care.**

Psychotherapy

• Trauma-Focused CBT
• EMDR
• CPT, Prolonged Exposure, Narrative Exposure, Psychoanalytic  psychotherapy (very brief, this shall be its own episode!)
• Somatic Therapy

Medications

• SSRIs: sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil)
• SNRIs: Cymbalta
• Alpha 1 antagonists: prazosin
• Beta-Blockers: propranolol
• 2nd Generation Antipsychotics: risperidone (Risperdal), quetiapine (Seroquel)
• Other antidepressants: trazodone, TCAs, MAOIs, zuranolone, lamotrigine, Topamax 

Interventional Psychiatry

• TMS
• VNS
• Neurofeedback

Hallucinogens & Psychedelics 

• Ketamine
• Psilocybin, MDMA
• LSD, ayahuasca

Medications NOT Recommended

• Benzodiazepines
• High-dose stimulants

Novel Research

• Hydrocortisone & neuroinflammation
• Opioids & pain control

PTSD Treatment Decision Aid by the VA: https://www.ptsd.va.gov/apps/decisionaid/

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In this episode, we discuss how trauma symptoms present in children, the challenges of diagnosing and treating trauma in children, including the limitations of current diagnostic systems, and the neurobiology of trauma response. Lastly, we discuss marginalized groups to emphasize the most important part of recovery from trauma: not feeling alone. 

Topics Discussed:

• How trauma symptoms present in children 
• Developmental Trauma Disorder and why it did not make it into the DSM
• The Perspectives Approach to differential diagnosis in psychiatry 
• Neurobiology of trauma response
• Theories behind trauma that make sense
• The crucial role of a support system in healing from trauma

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