My Three Shrinks

May 13, 2007:

Topics include:

# Happy Mother's Day! # Turkewicz law blog a hit with Clinkshrink. Her recommendations? Malpractice Primer and Economics. # Q&A: Zoe Brain asks "Is there a Standard of Care for GIDNOS in the case where the patient is intersexed? And does the degree of intersex affect the therapeutic regime, and if so, how? I'm familiar with the WPATH (Formerly HBIGDA) v6 SOC for GID. But once a diagnosis of GIDNOS is established, the SOC does not appear to apply."Answer: Huh? (We did the best we could.) Also, see Farmer v. Brennan. # APA says people with Medicare Part D having trouble getting their psychiatric medications. Also, discussion of the "donut hole." # Medical Truth in Advertising bill: Is your "doctor" really a doctor? # Ethical conundrums: trains and Tarasoffs and guns (oh my!). Also, Maryland's problematic law requiring reporting of childhood abuse, even if you are now 90 or you don't know who the perpetrator is. And, what do you do with a dead astronaut on the way to Mars? # If Dinah had Lost It in Space, she Wishes she would have a Crystal Ball. # A shrink like me?

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

Xanax Blues

May 7, 2007:

* Q&A: Emailing patients * Q&A: What is Psychiatry doing about asexuality? * Q&A: Talk about Munchausen's disease and Dissociative Identity Disorder (DID). * Is denying care malpractice? * California forensic psychiatry staffing problems * More troubles with Xanax

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

BRING YOUR OWN BRAINS

May 1, 2007:

This is our GRAND ROUNDS podcast. Check out this week's Grand Rounds post, containing 50 medicine-related posts from all corners of the blogosphere (actually, that would be a blogocube, wouldn't it?). I'm not even going to try to put everything here, but I will list the blogs that made submissions...

A Chronic DoseAn American Medic in BritainAnxiety, Addiction and Depression TreatmentsClinical CasesDiabetes MineDr AnonymousDr Marc GreensteinDr Val and the Voice of ReasonEmergiblogEnoch ChoiER NurseyHealth Business BlogHealth PsychHealthLineHighlight HealthHospital ImpactInsureBlogInterested ParticipantKevin, M.D.Knocking From InsideLiverpool LeftoversMidwest Med Student Meets East Coast PoliticsMonash Medical StudentMovin' MeatNurse Ratched's PlaceNY Emergency MedicineNY Personal Injury LawyerOdysseys of GeorgeOne Version of ThingsPixelRNRachel's Wide Word of LunacyRickety Contrivances of Doing GoodScienceRollSharpBrainsSix Until MeTales of an Emergency Room NurseTangent 90 DegreesTech MedicineTeen Health 411The Blog That Ate ManhattanThe Differential: Medscape Med Students BlogsThe Doctor BloggerThe Fitness FixerThe Snarky GerbilThe Tangled NeuronTSCDUniversal HealthVitum MedicinusWandering VisitorSend us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

April 22, 2007:

This podcast comes out the day after the 1-year anniversary of our blog. Thank you to all of our well-wishers. It's not always easy to keep something like this, and the podcast, going. But having friends like Dinah and Clink make it easy.

Note that next week will be a special podcast, where we will discuss many of the submissions for our May 1 Grand Rounds. Send us your submissions by Saturday, April 28, 2007, at midnight at mythreeshrinksATgmailDOTcom. We'll even include some brief audio comments about your post (attach a 20-30 sec .m3).

Topics include: # A lot of silly talk about our anniversary, gifts, ducks, and chocolate. # VIRGINIA TECH TRAGEDY. Most of the podcast is about this and related offshoots. We discuss some comments on Dinah's post, Unspeakable. We also point out two past posts, Suicidal Students and Let's Talk About Suicide. # This CBS News story discusses the struggle of BALANCING PRIVACY AND SAFETY on college campuses. # Dr. Michael Welner, a forensic psychiatrist consulting for ABC News, CRITICIZED THE MEDIA for showing the videotapes from Cho Seung-Hui (more here). (What is "Ismail Ax"?) # NAMI has some useful links related to this tragedy. # Clink lists OTHER BAD EVENTS which have happened in the third week of Aprils past, including things to do with Hitler, Lincoln, Oklahoma City, Waco, and Columbine. # There are two MENTAL HEALTH PARITY BILLS before congress. Please let your U.S. Representatives and Senators know you want these passed unamended. # Psychiatric News reports that the number of medical students choosing CAREERS IN PSYCHIATRY is holding steady at 1000 entering psychiatry residencies this summer.Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

April 17, 2007:

ClinkShrink here. I volunteered to help Roy by editing one of our podcasts--heaven help me, I did the best I could. Be patient, I'm using Windows. This is podcast number 16 which was actually podcast number 14 taped about a month ago and taken out of order for no particular reason.Topics include: * First up are the TOP 25 CRIMES OF THE CENTURY, a topic that could only be mine. It's a Time article that lists some of the most infamous or unusual crimes, but I have a couple bones to pick about their choices. Roy and Dinah just think I'm weird for even knowing this stuff. [Listen in to find out Clink's favorite crime. -Roy] * Next we ANSWER A QUESTION from Driving Miss Molly regarding how much and what kind of preparations psychiatrists do before their patients' appointments. * Finally we do the Shrink Rap BLOG ROLLCALL, where Shiny Happy Person deals with medical training in the UK and under the NHS, Roy flirts with the Girl with the Blue Steth, and Intueri talks about bipolar disorder in kids.

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

April 8, 2007:Topics include:* Q&A: from Gerbil, who asks, "I'd love to hear your thoughts on treatment contracts. My specialty is self-injury, and I often give talks on this subject. Invariably, at least one of my attendees will share that he/she has clients agree that they will be discharged if they hurt themselves between sessions. I've heard others talk about making similar contracts regarding substance use, gambling, and other high-risk behaviors. This makes no sense to me--why make the goal of therapy the condition for receiving therapy? ... I was interested in your opinions, especially because of the settings in which you work."

* Dinah rants about Insurance Companies.

* Article on Mentally Ill Presidents from Mental Healthworks Newsletter. Nearly half have had mental illnesses. This leads into a discussion about the validity of doing psychological autopsies, or diagnosing someone without personal examination. The Goldwater Rule is discussed in this context (re: Presidents of The United States, or POTUS), as are the APA's Principles of Medical Ethics.

* Who Reads Shrink Rap? Reader Poll Results: 20% are physicians (13% psychiatrists, 7% others); 9% nurses; 7% social workers; 7% psychologists; ~30% patients; and ~30% others. So more than one-third are mental health professionals, and close to one-half are health care professionals (nearly 200 readers voted).

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

April 1, 2007:Topics include: * Q&A: Midwife with a Knife, an OB/GYN, asks us about whether pedophilia is a disease or something else, and what we think about civil (as opposed to criminal) commitment for it. Clink uses one of her 50-cent words on us (ephebophilia, a term that Clink says was coined by John Money in his book, Love Maps). See also The Last Psychiatrist's posts on this here and here. * NYT article: "The Brain on the Stand", by Jeffrey Rosen. Clink talks about this article about brain diseases being put on trial to explain bad behavior. * Q&A: Dr Anonymous wants us to say more about our recent posts (here and here) on humor and medicine. This whole discussion (and the numerous comments on the blog) was started by Roy's lyrics to "Walk Like a Psychiatrist."

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

March 4, 2007:

Topics include: * How does NASA handle psychiatric emergencies in space? The recent 'astronaut goes wild' headlines get us talking about NASA's procedures for handling acute psychotic breaks and suicidal behavior in space. Also, go to page 847 of the above-linked document to see the list of medications which are kept on the ISS (International Space Station). Listen to the podcast to find out which antidepressant is the SSRI of choice for NASA. * Q&A: Sandra, a prolific, Canadian Barbie Doll (it's true, look at her picture) from Omni Brain and NeuroFuture sent in a multi-part question: "Do you agree that neurological factors may diminish legal responsibility (but not excuse it) in ways not currently considered by the legal system, i.e., that don't fall in line with the McNaughton insanity defence, and the legal system should change in accordance? In what ways, based on what you see in the population you treat? Also, in cases like compulsive sexual offenders, do you support chemical castration and similar means of crime prevention?" This is obviously a Clinkshrink question, but we have a spirited discussion about these areas.

Next week: Visitor survey; Top 25 crimes of the last century; What do psychiatrists do to prepare for the next session (thanks, DrivingMissMolly); NHS fiasco. Send us your questions at mythreeshrinksATgmailDOTcom.Last week's musical snippet was from Suzanne Vega's 1987 release of Language from the album, Solitude Standing. (Also, you've gotta check out this Tom's Diner-inspired I Dream of Jeannie video.)

Go to http://mythreeshrinks.com for show notes with links.

February 25, 2007:

Topics include: * Evolutionary Psychopathology. LA Times article, The Mind as it Evolves, by Julia M. Klein, about a developing area that theorizes that the illness of depression developed as an evolutionary strategy, which helped signal and stabilize social ranking. Very interesting reading. See also the journal article, The evolutionary significance of depressive symptoms, by Matthew Keller and Randolph Nesse from VCU. * Mental Health Parity Act of 2007. Well, we have been trying to get this passed for years (see NAMI's review), despite popular bipartisan support. It passed the Senate, and will hopefully pass the House for the president's signature. We also talk about Maryland's 1993 landmark parity legislation. * Psych Blog: Psychiatry for All, by Saminkie. A psychiatry resident in Baghdad who writes about learning psychiatry while having to deal with bullets, explosions, no electricity and other war-related problems. (Sent to us by DrivingMissMolly.) * The Psychiatrist Blog, by Michelle Tempest. A UK psychiatrist, and author of The Future of the NHS, blogs about psychiatry, health and politics.Next week: Could be anything. Send us your questions at mythreeshrinksATgmailDOTcom.Last week's musical snippet was from Monty Python -- Spam; and Finland, Finland, Finland.

Go to http://mythreeshrinks.com for show notes with links.

February 18, 2007:Topics include: * FDA Antidepressants Hearing, Revisited. We had previously blogged about suicide and antidepressants, followed by Roy's first-hand account of the December 2006 FDA hearing which Roy attended, where the committee voted to expand the black box warnings on antidepressants to indicate the risks of untreated depression and to mention the protective effects that antidepressants appear to have on older folks. The FDA has now released two transcripts of the hearing (Transcript 1 and Transcript 2), as well as the slide presentations from some of the speakers. These are excellent resources if you want to find out more on the subject. The recommended changes (see summary) to the black box include text to highlight the following: o increased risk of antidepressant-associated suicidal thoughts and behaviors up to around age 25 o protective effect of antidepressants against suicidal thoughts and behaviors for older folks, particularly seniors o balancing language which points out the increased risks associated with NOT treating depression (eg, suicide rates have increased for children since the 2004 decision to add black box warnings for antidepressants) * Finland, Finland, Finland. The Finnish study that Dinah mentioned is discussed here. The Monty Python audio was found here. * The Zyprexa Documents. The FuriousSeasons blog details the concerns that Lilly is holding out on important information about its antipsychotic drug. * NYT: Bipolar toddler dead from medications. Raises questions about diagnosing severe mental illness in very young children. * Lovely Spam. on YouTube. * QandA at mythreeshrinksATgmailDOTcom. Schizoid personality disorder: Is it real and does it predispose to schizophrenia? By Seamonkey. Diagnostic criteria. Pubmed review. * Amygdala size and eye contact in Autism. * Asperger's syndrome.Next week: Side effects of psychotherapy; evolutionary psychopathology; what happens in Vegas.Last week's musical snippet was from the 2000 release, Strangelove Addiction, from the self-titled album by Supreme Beings of Leisure.

Go to http://mythreeshrinks.com for show notes with links.