My Three Shrinks

July 22, 2007: Suicidal Breast Implants

Topics include:

* Brief discussion about iTUNES. We hit #6 in the MEDICINE SECTION in iTunes last week, thanks in part to KevinMD blogging about our last podcast. We are now getting about 8-9000 podcast downloads per month, which we all find rather amazing. Of course, after the U.S., the country we get the most hits from is China, so we figure there must be Chinese people somewhere trying to learn English from us (big mistake). For the handful of psychiatrists out there (Chinese or otherwise), perhaps we'll release one of those Dummies books about how to make podcasts. * CURBING NOCTURNAL BINGES IN SLEEP-RELATED EATING DISORDER. Clink talks about this article from Current Psychiatry, about eating in your sleep, particularly after taking AMBIEN, or zolpidem. Clink read us a related poem: My Grandma had a habit

Of chewing in her sleep.

She chewed on Grandpa's whiskers,

And called it Shredded Wheat. The article lists weird things people eat in their sleep, including coffee grounds, cat food, and buttered cigarettes (yum!). [I don't think it mentioned eating your own placenta.] * YOU'RE SUPPOSED TO GET BETTER. Dinah's post about how to know when you are making progress in therapy, and when to move on. (On the blog, this led to a series of emotional posts and comments about therapy, the power inequity between therapist and patient, and the differences between docs blogging about pts and vice versa. Go here, here, and there to read more.) * ARCHETYPEWRITING.COM. Dinah provides an unsolicited (and unpaid) advertisement for this website ("The Fiction Writer's Guide to Psychology") about injecting believable shrinkiness into your fiction, while Clink shows off her new nerdy book (2000 Most Challenging and Obscure Words, by Norman W. Schur) by declaring the word of the day to be HIRCINE. * COSMETIC BREAST AUGMENTATION AND SUICIDE. Dinah reviews this article from the July issue of AJP, from David B. Sarwer, et al., which finds "Across the six studies, the suicide rate of women who received cosmetic breast implants is approximately twice the expected rate based on estimates of the general population." I guess we need a black box warning on silicone breast implants now. (We had a post a year ago about the Good Breast; this one is obviously the Bad Breast.) * Q&A: "Is chronic antidepressant use harmful in the long term?" We don't really do this topic justice, but Dinah refers to a prior post here. * Coming up on the NEXT PODCAST: 3 AJP articles on suicide and depression treatment; federal parity laws; managing agitated patients in your office.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

July 9, 2007: Can You Hear Me Now?

Topics include:

* Panetti v. Quarterman. Clink talks about a hot-off-the-press, landmark Supreme Court case about COMPETENCY TO BE EXECUTED and death penalty cases for people with mental illness. She also refers to the Ford v. Wainwright case. "It's a hint that, down the road, we will probably not have a death penalty for mentally ill people, just like we no longer have a death penalty for juveniles or mentally retarded people."

* Dinah goes back to Podcast #27 and refers to Dr. Kay Redfield Jamison's book, An Unquiet Mind, talking about therapists' DISCLOSURE to patients about their own mental health issues (which was blogged about here).

* ON BEING A FEMALE INTERN. Clink rants against DrCrippen's (NHS Blog Doctor) rant about part-time doctors (mostly mothers): DrC: "You need to grow up a little. You can't expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? ... If you won't do the hours, you can't have job... Just because you are a girlie, you can't expect medical training to be turned on its head."

* PHYSICIAN STRESS & BURNOUT. This discussion transitions into talk of a 2004 article (IC McManus, et al.) on physician stress and burnout, finding that the consequences of physician training stress has more to do with how one handles stress in general.

* iPHONE aPATHY. Roy mentions his iPhone post. Who cares?

* iTUNES REVIEWS. Clink asks our listeners to do more reviews of our podcast, and we offer to mention the next 3 reviewers (good or bad) on our next podcast (whoopee!).

* SEX CHANGE OPERATIONS IN PRISON?. Clink talks about a recent case of many thousands of dollars being spent litigating a case of a prisoner requesting a sex change operation.

* PRISTIQ. Desvenlafaxine (a metabolite of Effexor or venlafaxine) is up for final approval at the FDA (I misspoke in the podcast... Pristiq is not an extended release of Effexor, but rather a metabolite of it).Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

July 1, 2007: Shrinks on the Take

Topics include: * Doctor Anonymous has new Podcast, where he talks about chatty doctors, nursing home patients, and discovers BlogTalk Radio (similar to TalkShoe). * Vermont Shrinks Rolling in Pharma Dough. The New York Times reported on doctors who get money from drug companies, finding that in Vermont the #1 specialty to cash in is Psychiatry. Vermont has a law requiring the reporting of such income, and the story misleading suggests that the average Vermont psychiatrist gets $45,000 from drug companies. Closer reading shows that there were 11 psychiatrists who received an average of $45,000. Still. What are they getting paid for? Here's some insight from a #2 specialty: Endocrinologists. A US Senator has suggested that all such income get reported, just like they have to do (makes sense to me). * Zyprexa Class Action Lawsuit for Fraudulent Marketing Zips Ahead. CL Psych informs us that a judge is allowing this suit to go forwards, based on allegations that Lilly engaged in fraudulent marketing of Zyprexa for unapproved uses. See also the March FDA Drugs for an FDA warning against Provigil. We launch into a wider discussion about off-label prescribing and combination medications. Listen to find out the #1 prescribed drug which is FDA-approved for bipolar depression (hint: it's not an SSRI). * Doctors Who Talk Too Much. The Archives of Internal Medicine has an article by McDaniel et al., which has been in the news. They sent fake patients into participating physician offices over the course of a year and recorded the interactions, categorizing the utterances in various ways. One-third of the visits contained physician "self-disclosures" (talking about themselves), with 85% of these not being useful. It doesn't seem that they asked the pretend patients how useful these discussions were. I view the study's conclusions with suspicion. I would like to see compliance rates and outcome measures compared between a group of patients whose physicians self-disclose and one whose physicians do not (ideally, assignment would be randomized, and a physician would have patients in both groups). * Q&A: Can you have a mental disorder and still become a mental health professional? Listen in as we address this question from a listener.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 24, 2007: Black Box Reloaded

Topics include: * Side Effects of Psychotherapy. Sharon Begley from Newsweek wrote an article entitled, "Get Shrunk at Your Own Risk." We discuss this particularly in reference to grief and bereavement, PTSD, and CISD. * Discussion at Cheryl Fuller's Jung at Heart about therapy as a treatment for an illness vs. as a tool to improve one's life. And here's an afterthought. * The Impact of the FDA's SSRI Black Box on the Decline in Depression Treatment in Kids. We discuss the June 2007 AJP article by Libby et al. showing that there was a 58% drop in expected number of antidepressant prescriptions for this population after the black boxes went up, and that the proportion of depressed children who remained untreated with antidepressants increased some three-fold. Other data has showed an increase in the suicide rate if this population afterwards. In the graph below, the black line represents the percentage of kids with major depression who were prescribed no antidepressant.

* Q&A: "In my neck of the woods there is pretty much NO 'talk' therapy in short term inpatient settings. I know of many depressed individuals who have decompensated in these settings, and have had their depression actually increase on their departure. Any thoughts?"Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 17, 2007: Sibling Reveille

Topics include: * Clink wonders if iPOD USERS have more musical auditory hallucinations. But, can deaf people get auditory hallucinations, or do they hallucinate people signing at them? "Yes, We Have No Bananas" seems to be a popular musical hallucination with older folks. Wonder if "Reveille" is heard by folks who were in the military? This is clearly a wake-up call for all you iPod users. * KevinMD placed us on his "Power 8" list of medical blogs with an "exceptional week" of blogging, particularly noting Clink's post on forensic psychiatry issues raised by the latest PARIS HILTON SAGA, which also leads to a discussion of the Goldwater Rule, of high profile cases (like Cho... see Face to Face and Unspeakable), and of freedom of speech. * Dinah talks a bit about Dr Melfi's firing of TONY SOPRANO. * We talk at length about a June 2007 AJP article by Waldinger, Vaillant, and Orav, entitled "CHILDHOOD SIBLING RELATIONSHIPS AS A PREDICTOR OF MAJOR DEPRESSION IN ADULTHOOD: A 30-Year Prospective Study." This is an amazing study in that they followed a group of some 229 men from age 20 to age 50, doing lots of interviews and tests along the way. In this analysis, they looked at the quality of their sibling and parental relationships, as well as family history of mood disorder, and made a surprising finding.

Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 15, 2007: Dr Phil gag w/KLF Mashup

* Dr. Phil visits My Three Shrinks. THIS IS A MUST-LISTEN SEGMENT! Clink and I play a trick on Dinah by "calling" Dr. Phil on Skype and he "interviews" us. This is a riot!! Dinah is such a good sport. [link to DrPhil Soundboard] (this is the prank from podcast #24... without all the other stuff...if you've already heard it, there is nothing new here so just delete it... or post it all over the internet, as Dinah would be oh-so-appreciative).Go to http://mythreeshrinks.com for show notes with links.

June 10, 2007: Dr. Phil on Skype

Topics include: * Genetics of Cocaine-Induced Paranoia. Roy talks about a recent article in Biological Psychiatry by Kalayasiri which suggests that a particular mutation (C1021T) in the dopamine beta-hydroxylase (DBH) gene was associated with significantly increased paranoia in a small group of cocaine abusers. Genetics is playing an increasing role in understanding how we respond to drugs AND to our environment. * Dinah wins an award for her writing. * Expectation vs Evidence-based Medicine. We get into a detailed discussion about how patients' perceptions and expectations get in the way of evidence-based medicine (with examples from Flea's post on admitting children and direct-to-consumer advertising). "Doc, my friend got better with DrugX so I want to try it." "It goes back to 'who deserves care'." * Dr. Phil visits My Three Shrinks. THIS IS A MUST-LISTEN SEGMENT! Clink and I play a trick on Dinah by "calling" Dr. Phil on Skype and he "interviews" us. This is a riot!! Dinah is such a good sport. [link to DrPhil Soundboard] * Dark Tourism. After reading a NYT piece on touring prisons, Clink discusses the concept of dark tourism, where people seek out notorious sites to see (like cemeteries and prisons). She sent us a humongous scholarly piece on the subject (see Clink's Travelogue for more fun).Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 3, 2007

Topics include:# Doctor Anonymous to be guest on June 17 podcast.

# Clink brings back notepads with loons on them and cinnamon lefse from the midwest.# Flea's medical blog affects his malpractice trial. This is a fascinating story, which is well-summarized and explained on Eric Turkewitz's legal blog. We're waiting for Flea's (Dr. Lindeman's) book to come out.# Dinah talks about transference. Also see prior post on Transference to the Blog.# Rules for Bloggers. In response to Flea's troubles, ClinicalCases suggests Five Rules for Blogging: 1-Write as if your boss and your patients are reading your blog every day 2-Comply with HIPAA 3-Do not blog anonymously. List your name and contact information 4-If your blog is work-related, it is probably better to let your employer know 5-Use a disclaimer# We mention a survey of medical bloggers that was done last year. Anyone have a link?# Movie Review: Away From Her. Clink thought this movie about a woman with dementia was very good.# Oh, remember... check out next week's podcast, when Dr. Phil will be joining us for a brief interview.

Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

May 27, 2007

Topics include: * Physician-Assisted Executions. The American Medical News had a story by Kevin B. O'Reilly about how some states are trying to force physicians to participate in executions. The ethics of such activities are debated. * Realizing the Promise of Pharmacogenomics. A draft federal report is available for public comment (by June 1) about the development of pharmacogenetics and the impact of genomic medicine on the future of health care. You can find the report and comment form here. "The report identifies a number of challenges for the development of pharmacogenomics and its effective integration into health care practice, including the need to improve the health-information infrastructure, to provide education and training for practitioners, and to maintain the confidence of all stakeholders by effectively addressing ethical, legal and social issues arising from pharmacogenomics." * Dopamine, Genetics, and Environmental Stressors in ADHD. As an example of the above, this month's Archives of General Psychiatry has an article by Manfred Laucht, et al., showing evidence of an interaction between a mutation in the Dopamine Transporter (DAT) gene and severe environmental stress (e.g., abuse) triggering symptoms of ADHD. Also mentioned in the podcast is data suggesting that certain Serotonin Transporter Promoter (5HTTP) mutations predict one's response to SSRI antidepressants, the development of side effects to these drugs, and the propensity to develop psychiatric symptoms. * Forced Outpatient Treatment in PA. Liz Spikol, who writes the blog and newspaper column, Trouble with Spikol, for the Philadelphia Weekly, writes about Pennsylvania Senate Bill 226, which would make it easier to make people with severe mental illness who are "unlikely to survive safely in the community without supervision." A long debate on the podcast ensues (half the 'cast) about the ethics and practicality of such tactics. * Don't miss Roy's telling of the official (according to psychologist, Richard Wiseman) funniest joke in the world (around the 25 minute mark). Just to be on the safe side, be sure you aren't driving when you listen to it.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

May 20, 2007:

Topics include:

# Intersex disorders: This is where one is born with ambiguous genitalia, and one is raised a gender which is different from one's genetic gender. It is a rare condition. Dr. Kraft discusses the many complications that this can cause. This is part of an answer to Zoe Brain's question, continued from last week's podcast. # What is a "mother"? A Maryland court has determined that a surrogate mother can have her name removed from a baby's birth certificate, like fathers have been capable of for years. Can a child be born with no parents on its birth certificate?

See Show Notes for links to the King Missile song, Detachable Penis, on eMusic and YouTube.

Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.