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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Hello listeners! We are tackling the enormous topic of trauma. We start with how trauma response was stigmatized in history, PTSD's diagnostic criteria, overlap with other conditions such as cPTSD and borderline personality disorder, and the curious roles of memory in trauma. Enjoy!

Topics discussed:

• Shellshock, stigma of trauma
• Diagnosis based on the DSM
• Diagnoses not based on the DSM
• Prevalence
• Resources from the VA

Here is the phenomenal resource by the VA on PTSD: https://www.ptsd.va.gov/

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In this episode, we invite our good friend and colleague, Dr. Michael Couse, to discuss a recent paper that he and Dr. Kelly published in the academic journal, Journal of the American Academy of Child and Adolescent Psychiatry. The paper discusses the highly complicated (and often avoided) topic of electroconvulsive therapy (ECT) for youths with serious mental illness, especially in California. There are many fears and myths surrounding ECT, and we hope to share this story with you to bring to light how lifesaving this procedure can be. 

Topics Discussed:

• Case presentation of a 15 year-old boy diagnosed with catatonia
• Obtaining substitute consent for a child who is catatonic
• Issues with California laws on ECT 
• Requirements for obtaining ECT treatment for youths in California
• The stigma of ECT preventing access to care
• The psychiatrist's role in educating ourselves and in advocacy 

Of note, full consent to discuss this case was obtained from the patient and the patient's family prior to publication of the case. 

Reference: 

Couse, M., Makhinson, M., & Kelly, P. (2024). Regulatory and Service System Challenges in Accessing Electroconvulsive Therapy for Catatonia in the Presence of Autism Spectrum Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 63(3), 293–295. https://doi.org/10.1016/j.jaac.2023.09.540 https://pubmed.ncbi.nlm.nih.gov/37778726/ 

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Welcome to Season 2 of Good Enough Shrink! It has such a fun ride this past year. We are kicking off the new season with a topic that remains controversial in some areas of the country, electroconvulsive therapy (ECT). We want to dispel misunderstandings about this treatment, and provide accurate information for anyone who is wanting to learn more about ECT, which can often be lifesaving. 

Topics discussed:

• Stigma of ECT
• What is ECT and what is it for?
• Safety of ECT
• State laws surrounding ECT

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Hello listeners! In this episode, I bring together neuroscience and everyday life  to present tips on how to communicate when you are feeling at your worst. Whether you are in an argument with your partner, a power struggle with your kid, or a disagreement with friends/coworkers, these concepts are universal and work in any situation. So if you feel like you are constantly in conflict with people, as life goes, take a listen! 

Topics discussed:

• What we do when we run into conflict 
• Neuroscience: 
  • Default Mode Network
  • Frontoparietal Network
  • Salience Network 
• How to calm down and practice the embodied mind
• What is validation?
• How exactly do we validate 
• How to place a boundary

Sources:

Yeshurun, Y., Nguyen, M. & Hasson, U. The default mode network: where the idiosyncratic self meets the shared social world. Nat Rev Neurosci 22, 181–192 (2021). https://doi.org/10.1038/s41583-020-00420-w

Marek, S., & Dosenbach, N. U. F. (2018). The frontoparietal network: function, electrophysiology, and importance of individual precision mapping. Dialogues in clinical neuroscience, 20(2), 133–140. https://doi.org/10.31887/DCNS.2018.20.2/smarek

Schimmelpfennig, J., Topczewski, J., Zajkowski, W., & Jankowiak-Siuda, K. (2023). The role of the salience network in cognitive and affective deficits. Frontiers in human neuroscience, 17, 1133367. https://doi.org/10.3389/fnhum.2023.1133367

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In this episode, our goal is to bring you tools to understand and destigmatize addiction. We discuss the complexity of addiction at the biological, psychological and societal levels. So if you are ready to explore this complex topic, take a listen!

Topics Discussed: 

• Past and present definitions of addiction
• DSM-5's "Substance Use Disorder" - more than a checklist
• Biological, genetic, chemical aspects of addiction 
• Psychological, emotional, experiential aspects of addiction
• Societal, political, economic aspects of addiction
• WHY the addictive behavior is hard to stop
• Trauma and addiction 
  • ACE study 
  • Stress response system 
• Treatment Approaches
  • Motivational Interviewing
  • Caregiver burnout
• Normalizing addiction

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This episode starts with the various ways social media has changed how we view ourselves and others. We then discuss the sobering link between cyberbullying and suicide rates among young people. Finally, we bring you practical tips and ideas about how to fight bullying at the individual, school, state, and systems levels. You are not alone in this fight!

Topics discussed:

• Social media and its socio-cultural revolution 
• Bullying and cyberbullying
• Cyberbullying and suicide rates
• What can we do about this?
  • How to talk to your child 
  • How to talk about screen time 
  • How to talk to the school 
  • Anti-bullying laws 
  • How to handle bullying as a family unit

Resources:

• https://www.stopbullying.gov/
• https://cyberbullying.org/
• AACAP Bullying Resource Center: https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Bullying_Resource_Center/Home.aspx 

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Hello! We are back after a busy month at the clinic! In this episode, we discuss a very niche topic -- the different levels (or continuum) of care in mental health treatment. These acronyms can be so confusing for parents and families, so we hope to clarify them for you as you navigate what is the appropriate level of care for you or your loved ones. 

Topics Discussed:

• Overview of mental health continuum of care
• The importance of the least restrictive treatment environment 
• Emergency and crisis facilities 
• Intensive Outpatient Program (IOP), Partial Hospitalization Program (PHP), Residential Treatment Center (RTC) in detail 
• What are RTCs like?
• What it means to be voluntary 
• What about wilderness programs? 
• Questions to ask the programs to assess goodness of fit

Resources:

• Questions to ask before hospitalization: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/11-Questions-To-Ask-Before-Psychiatric-Hospitalization-Of-Your-Child-Or-Adolescent-032.aspx#:~:text=When%20can%20I%20see%20my,the%20plans%20for%20ongoing%20treatment%3F
• Continuum of Care: https://www.aacap.org/AACAP/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Continuum-Of-Care-For-Children-And-Adolescents-042.aspx
• Residential Treatment Programs: https://www.aacap.org/AACAP/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Residential-Treatment-Programs-097.aspx

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