PsychEd: educational psychiatry podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Antipsychotic Side Effects with our very own expert Dr Alex Raben, a staff psychiatrist in chronic care at the Centre for Addiction and Mental Health in Toronto.

Dr. Raben graduated from medical school and completed residency at the University of Toronto. His academic interests include teaching and medical education scholarship with a particular interest in novel modalities of knowledge translation within the field of psychiatry. He is a founding member and Executive Director of PsychEd, this educational psychiatry podcast which aims to empower medical learners to seek out current knowledge from mental health experts to share with their colleagues around the world.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to…

1. Outline the side effects of antipsychotics and their known/potential mechanisms
2. Discuss management options for the different side effects
3. Identify which antipsychotics are more likely to cause certain side effects

Guest: Dr Alex Raben

Hosts: Angad Singh and Kate Braithwaite

Audio editing by: Angad Singh

Show notes by: Angad Singh and Kate Braithwaite

Interview Content:

• Introduction - 0:00
• Primer on antipsychotics - 1:54
• Anti-dopamine side effects - 5:04
• Drug potency as it relates to side effects - 38:46
• Anticholinergic side effects - 41:37
• Antiadrenergic side effects - 47:30
• Metabolic side effects - 50:29
• Sedation - 56:46

Please note that this episode does not include a discussion of the life threatening side effects of antipsychotics. These include neuroleptic malignant syndrome, torsades de pointes, laryngospasm, and seizure.

Resources:

• PsychEd Episode 10: Treatment of Schizophrenia Part II with Dr. Albert Wong — PsychEd Podcast
• PsychEd Episode 60: Metabolic Psychiatry with Dr. Cindy Calkin – Psyched Podcast
• AIMSExtendedSample - YouTube
• Anticholinergic Mnemonics: Toxicology Mnemonic Challenge • LITFL • Toxicology Conundrum

References:

• de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC psychiatry. 2016;16:1-0.
• Migirov A, Datta AR. Physiology, Anticholinergic Reaction. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546589/
• Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3-7. PMID: 16001094; PMCID: PMC487011.
• Roerig JL, Steffen KJ, Mitchell JE. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS drugs. 2011;25:1035-59.
• Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press; 2021.
• Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-56.

For more PsychEd, follow us on Instagram (@psyched.podcast), Twitter (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to forensic psychiatry with Dr. Amina Ali, a forensic psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. Dr. Ali joined the Forensic Division at CAMH in 2018. She is an Assistant Professor in the Department of Psychiatry at the University of Toronto. Prior to joining CAMH, Dr. Ali received her Doctor of Medicine at the American University of the Caribbean, completed her Psychiatry residency at the Icahn School of Medicine at Mount Sinai in New York, and fellowship in Forensic Psychiatry at the Albert Einstein College of Medicine.

Dr. Ali's leadership experience includes serving as Chief resident during her residency, for which she was bestowed a Residency Leadership Award from the Bronx Lebanon Hospital Center. She is a Competence By Design coach to residents and serves on the Psychiatry Competency Committee and as a CaRMS file reviewer for the University of Toronto General Psychiatry Residency Program. She is also a supervisor for forensic residents and sits on the subspecialty resident committees. Within the forensic division, Dr. Ali has contributed to the organization and implementation of the Summer Studentship in Forensic Psychiatry Program and is our Medical Education and Wellness Lead. Internationally, Dr. Ali was appointed to serve on the American Academy of Psychiatry and the Law Education Committee and most recently recruited to Chair their Civil Commitment and Consent to Treatment Working Group.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to…

1. Describe the role of forensic psychiatry and its relation to the Ontario Review Board.

2. Outline the criteria for fitness to stand trial.

3. Describe the function and possible outcomes of a treatment order.

4. Outline the criteria for not criminally responsible on account of a mental disorder.

5. Distinguish between the disposition options available under the Ontario Review Board.

6. Demonstrate an enhanced ability to advocate for and support patients in navigating the forensic psychiatric system.

Guest: Dr. Amina Ali

Hosts: Alexander Simmons (PGY3), Kate Braithwaite (MD), and Rhys Linthorst (PGY5)

Audio editing by: Gaurav Sharma (PGY5)

Show notes by: Alexander Simmons (PGY3)

References:

1. Crocker, A. G., Nicholls, T. L., Seto, M. C., Charette, Y., Cote, G., Caulet, M. (2015). The National Trajectory Project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: the people behind the label. The Canadian Journal of Psychiatry, 60(3), 106-116.

2. Prpa, T., Moulden, H. M., Taylor, L., Chaimowitz, G. A. (2018). A review of patient-level factors related to the assessment of fitness to stand trial in Canada. International Journal of Risk and Recovery, 1(2), 16-22.

3. Carroll, A., McSherry, B., Wood, D., & Yannoulidis, LLB, S. (2008). Drug‐associated psychoses and criminal responsibility. Behavioral sciences & the law, 26(5), 633-653.

4. Watts, J. (2013). Updating toxic psychosis into 21st-century Canadian: Bouchard-Lebrun v. R. Journal of the American Academy of Psychiatry and the Law Online, 41(3), 374-381.

5. Crocker, AG, Nicholls, TL, Seto, MC, Cote, G, Charette, Y, Caulet, M. The national trajectory project of individuals found not criminally responsible on account of a mental disorder in Canada, Part 1: Context and methods. Canadian Journal of Psychiatry. 2015;60(3):98-105.

6. Schneider, RD. Mental health courts. Current Opinion in Psychiatry. 2008;21:510-513.

7. https://www.orb.on.ca/scripts/en/about.asp#dispositions

For more PsychEd, follow us on X (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode introduces the field of metabolic psychiatry, with a focus on patients with severe mental illness and metabolic syndrome. Our guest is Dr. Cindy Calkin, an Associate Professor in the Department of Psychiatry and Department of Neuroscience at Dalhousie University in Nova Scotia. Dr. Calkin has been a pioneer in the field of metabolic and neuroendocrine disorders in patients with bipolar disorder. Her research interests include examining the effects of obesity, insulin resistance and type II diabetes on the clinical course and outcomes in bipolar disorder.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to… 

1. Describe the burden of metabolic syndrome in the population with severe mental illnesses

2. Explain reasons for the comorbidity between metabolic syndrome and severe mental illness

3. Identify biopsychosocial strategies to prevent or treat metabolic conditions in this population

Guest: Dr. Cindy Calkin

Hosts: Angad Singh, Gaurav Sharma, and Sara Abrahamson

Audio editing by: Gaurav Sharma

Show notes by: Sara Abrahamson & Gaurav Sharma 

Conflicts of interest: Neither our guest nor hosts for this episode have declared any conflicts of interest related to this topic.

Interview content:

• 0:00 - Introduction

• 00:54 - Learning objectives

• 01:37 - Dr. Calkin’s career trajectory

• 9:45 - Describing the burden of metabolic syndrome in severe mental illness

• 14:16 - What is the relationship between metabolic syndrome and severe mental illness

• 25:23 - Why is metabolic syndrome underdiagnosed in severe mental illness

• 27:56 - How to measure and monitor insulin resistance in clinical practice

• 32:44 - How stigma impacts treatment of metabolic syndrome in the mentally ill

• 34:02 - Lifestyle interventions for metabolic syndrome in the mentally ill

• 37:06 - Medication interventions for metabolic syndrome in the mentally ill

• 39:44 - Directions for future research in the metabolic psychiatry

• 41:48 - Episode summary

References:

• Bai, Y.-M., Li, C.-T., Tsai, S.-J., Tu, P.-C., Chen, M.-H., & Su, T.-P. (2016). Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry, 16(1), 448–448. https://doi.org/10.1186/s12888-016-1143-8

• Calkin, C., Kamintsky, L., & Friedman, A. (2022). Reversal of insulin resistance is associated with repair of blood-brain barrier dysfunction and remission in a patient with treatment-resistant bipolar depression. Bipolar Disorders, 24(5), 553-555. https://doi.org/10.1111/bdi.13199

• Calkin, C. V., Ruzickova, M., Uher, R., Hajek, T., Slaney, C. M., Garnham, J. S., ... & Alda, M. (2015). Insulin resistance and outcome in bipolar disorder. The British Journal of Psychiatry, 206(1), 52-57. https://doi.org/10.1192/bjp.bp.114.152850

• Giménez-Palomo, A., Gomes-da-Costa, S., Dodd, S., Pachiarotti, I., Verdolini, N., Vieta, E., & Berk, M. (2022). Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review. Neuroscience and Biobehavioral Reviews, 132, 142–153. https://doi.org/10.1016/j.neubiorev.2021.11.026

• Ho, C. S., Zhang, M. W., Mak, A., & Ho, R. C. (2014). Metabolic syndrome in psychiatry: advances in understanding and management. Advances in psychiatric treatment, 20(2), 101-112. https://doi.org/10.1192/apt.bp.113.011619

• Leboyer, M., Godin, O., Llorca, P. M., Aubin, V., Bellivier, F., Belzeaux, R., Courtet, P., Costagliola, D., Dubertret, C., M’Bailara, K., Haffen, E., Henry, C., Laouamri, H., Passerieux, C., Pelletier, A., Polosan, M., Roux, P., Schwan, R., Samalin, L., … Etain, B. (2022). Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort. Journal of Affective Disorders, 307, 149–156. https://doi.org/10.1016/j.jad.2022.03.053

• Stogios, N., Humber, B., Agarwal, S. M., & Hahn, M. (2023). Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Current Psychiatry Reports, 25(11), 707-721. https://doi.org/10.1007/s11920-023-01458-0

• Vancampfort, D., Vansteelandt, K., Correll, C. U., Mitchell, A. J., De Herdt, A., Sienaert, P., Probst, M., & De Hert, M. (2013). Metabolic Syndrome and Metabolic Abnormalities in Bipolar Disorder: A Meta-Analysis of Prevalence Rates and Moderators. The American Journal of Psychiatry, 170(3), 265–274. https://doi.org/10.1176/appi.ajp.2012.12050620

• Ventriglio, A., Gentile, A., Stella, E., & Bellomo, A. (2015). Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management. Frontiers in Neuroscience, 9, 297–297. https://doi.org/10.3389/fnins.2015.00297

For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

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…

1. Define the term critical psychiatry and describe how the field has evolved over time

2. Review core principles of critical psychiatry and apply them to a clinical situation

3. 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 [email protected]. For more information, visit our website at psychedpodcast.org.

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…

1. Outline the prevalence and risk factors for depression in children and adolescents

2. Explain how children and adolescents with depression present in clinical practice

3. Discuss the use of screening tools for depression in this population

4. Describe an approach to the management of depression in children and adolescents

5. 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 [email protected]. For more information, visit our website at psychedpodcast.org.

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…

1. Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health

2. Identify HIV-specific mental health disorders and how to screen for these conditions

3. 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:

1. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)

2. Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020 - Canada.ca  

3. HIV and Clinical Depression 

4. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Anxiety-2012.pdf 

5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-CognitiveDisorder-2012.pdf 

6. International HIV Dementia Scale (IHDS) - Mental Health Screening - National HIV Curriculum (uw.edu)/

7. 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 [email protected]. For more information, visit our website at psychedpodcast.org.

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…

1. Understand the connection between trauma and the development of addictions and other mental illnesses

2. Critically reflect on current diagnostic and treatment paradigms

3. 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 [email protected]. For more information, visit our website at psychedpodcast.org.

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…

1. Gain an understanding of the current state of Medical Assistance in Dying for primarily mental illness in Canada

2. Evaluate the arguments in support of and against implementation of Medical Assistance in Dying for primarily Mental Illness 

3. Understand next steps and future directions of Medical Assistance in Dying for primarily mental illness in Canada

4. 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 [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd - the psychiatry podcast for medical learners, by medical learners. This episode covers the relationship between cannabis and psychotic disorders, as well as the potential impact of cannabis legalization in Canada, with our special guest Dr. Nitin Chopra. This episode was originated by Dr. Luke Fraccaro for his Grand Rounds.

The learning objectives for this episode are as follows:

 By the end of this episode, you should be able to…

1. Briefly summarize the effects of cannabis on mental health and cognition, with a focus on psychosis.

2. Appreciate the evidence for cannabis use as a potential cause of persistent psychotic disorders.

3. Discuss the possible impact that recent cannabis legislation may have had on cannabis use and psychosis in Canada.

Guest Expert Dr. Nitin Chopra is an addictions psychiatrist at the Centre for Addiction and Mental Health (CAMH) and is an Assistant Professor in the Department of Psychiatry at the University of Toronto. He has an interest in concurrent disorders and is a staff psychiatrist on the Concurrent Addictions Inpatient Treatment Service and Concurrent Outpatient Medical and Psychosocial Addiction Support Service. Through his work on the Psychiatry Addictions Capacity Building and Consultation Service (PACCS) at CAMH and the Addiction Medicine and Psychosocial Addictions ECHO program, he is evolving into a leader in capacity building and education for addictions treatment. Furthermore, Dr. Chopra also works on the Early Psychosis Unit at CAMH and has extensive clinical experience working with patients experiencing psychosis, often with comorbid cannabis and other substance use. 

Grand Rounds Presenter: Dr. Luke Fraccaro (PGY3)

Produced by: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)

Hosts: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)

Audio Editing by: Dr. Luke Fraccaro (PGY3)

Show notes by: Dr. Luke Fraccaro (PGY3)

Conflicts of Interest: There are no known conflict of interests to report

Topics:

• 0:00 - Introduction

• 2:50 - Objectives

• 3:55 - Case example

• 7:25 - Overview of cannabis effects of mental health

• 10:45 - Differentiating clinically between cannabis-induced psychosis and a primary psychotic disorder

• 13:11 - Cannabis causing acute psychotic symptoms

• 14:15 - Back to the case

• 16:05 - Overlapping risk factors for cannabis use and psychotic disorders

• 18:14 - Cannabis use as a potential cause of persistent psychotic disorders (Reviewing the evidence)

• 30:14 - Summary of the relationship between cannabis and psychosis and how to apply it clinically

• 35:20 - Cannabis legalization in Canada

• 39:45 - Canadian studies on potential impact of cannabis legalization on psychosis

• 44:33 - Brief review of American studies on potential impact of cannabis legalization on psychosis.

• 46:35 - Summary of potential impact of legalization

• 47:42 - Questions and discussion

• 1:06:15 - Summary and Outro

Resources:

• Canada’s Lower-Risk Cannabis Use Guideline: https://www.camh.ca/-/media/files/lrcug_professional-pdf.pdf

• Cannabis legalization and regulation in Canada: https://www.canada.ca/en/health-canada/programs/engaging-cannabis-legalization-regulation-canada-taking-stock-progress/document.html 

References: 

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Arlington, VA: American Psychiatric Association, 2022. 

2. Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. Can J Psychiatry. 2022 Jun 16:7067437221099769. doi: 10.1177/07067437221099769. Epub ahead of print. PMID: 35711159.

3. Xue S, Husain MI, Zhao H, Ravindran AV. Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies. Can J Psychiatry. 2021 Feb;66(2):126-138. doi: 10.1177/0706743720952251. Epub 2020 Sep 10. PMID: 32909828; PMCID: PMC7918873.

4. Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N. Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 2016 Apr 1;79(7):557-67. doi: 10.1016/j.biopsych.2015.12.002. Epub 2015 Dec 8. PMID: 26858214.

5. Wilkinson ST, Radhakrishnan R, D'Souza DC. Impact of Cannabis Use on the Development of Psychotic Disorders. Curr Addict Rep. 2014 Jun 1;1(2):115-128. doi: 10.1007/s40429-014-0018-7. PMID: 25767748; PMCID: PMC4352721.

6. Hindley G, Beck K, Borgan F, Ginestet CE, McCutcheon R, Kleinloog D, Ganesh S, Radhakrishnan R, D'Souza DC, Howes OD. Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis. Lancet Psychiatry. 2020 Apr;7(4):344-353. doi: 10.1016/S2215-0366(20)30074-2. Epub 2020 Mar 17. PMID: 32197092; PMCID: PMC7738353.

7. Ksir, C., Hart, C.L. Cannabis and Psychosis: a Critical Overview of the Relationship. Curr Psychiatry Rep 18, 12 (2016).

8. Ganesh S, D'Souza DC. Cannabis and Psychosis: Recent Epidemiological Findings Continuing the "Causality Debate". Am J Psychiatry. 2022 Jan;179(1):8-10. doi: 10.1176/appi.ajp.2021.21111126. PMID: 34974754.

9. Hasan A, von Keller R, Friemel CM, Hall W, Schneider M, Koethe D, Leweke FM, Strube W, Hoch E. Cannabis use and psychosis: a review of reviews. Eur Arch Psychiatry Clin Neurosci. 2020 Jun;270(4):403-412. doi: 10.1007/s00406-019-01068-z. Epub 2019 Sep 28. PMID: 31563981.

10. Petrilli K, Ofori S, Hines L, Taylor G, Adams S, Freeman TP. Association of cannabis potency with mental ill health and addiction: a systematic review. Lancet Psychiatry. 2022 Sep;9(9):736-750. doi: 10.1016/S2215-0366(22)00161-4. Epub 2022 Jul 25. PMID: 35901795.

11. Buchy L, Perkins D, Woods SW, Liu L, Addington J. Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophr Res. 2014 Jul;156(2-3):277-80. doi: 10.1016/j.schres.2014.04.021. Epub 2014 May 14. PMID: 24837058; PMCID: PMC4082820.

12. Gillespie NA, Kendler KS. Use of Genetically Informed Methods to Clarify the Nature of the Association Between Cannabis Use and Risk for Schizophrenia. JAMA Psychiatry. 2021 May 1;78(5):467-468. doi: 10.1001/jamapsychiatry.2020.3564. PMID: 33146687.

13. Johnson EC, Hatoum AS, Deak JD, Polimanti R, Murray RM, Edenberg HJ, Gelernter J, Di Forti M, Agrawal A. The relationship between cannabis and schizophrenia: a genetically informed perspective. Addiction. 2021 Nov;116(11):3227-3234. doi: 10.1111/add.15534. Epub 2021 May 19. PMID: 33950550; PMCID: PMC8492483.

14. Fischer, B., Lee, A., Robinson, T. et al. An overview of select cannabis use and supply indicators pre- and post-legalization in Canada. Subst Abuse Treat Prev Policy 16, 77 (2021). https://doi.org/10.1186/s13011-021-00405-7

15. Myran DT, Imtiaz S, Konikoff L, Douglas L, Elton-Marshall T. Changes in health harms due to cannabis following legalisation of non-medical cannabis in Canada in context of cannabis commercialisation: A scoping review. Drug Alcohol Rev. 2023 Feb;42(2):277-298. doi: 10.1111/dar.13546. Epub 2022 Sep 27. PMID: 36165188.

16. Vignault C, Massé A, Gouron D, Quintin J, Asli KD, Semaan W. The Potential Impact of Recreational Cannabis Legalization on the Prevalence of Cannabis Use Disorder and Psychotic Disorders: A Retrospective Observational Study. Can J Psychiatry. 2021 Dec;66(12):1069-1076. doi: 10.1177/0706743720984684. Epub 2021 Feb 11. PMID: 33567893; PMCID: PMC8689454.

17. Callaghan RC, Sanches M, Murray RM, Konefal S, Maloney-Hall B, Kish SJ. Associations Between Canada's Cannabis Legalization and Emergency Department Presentations for Transient Cannabis-Induced Psychosis and Schizophrenia Conditions: Ontario and Alberta, 2015-2019. Can J Psychiatry. 2022 Aug;67(8):616-625. doi: 10.1177/07067437211070650. Epub 2022 Jan 12. PMID: 35019734; PMCID: PMC9301152.

18. D'Souza DC, DiForti M, Ganesh S, George TP, Hall W, Hjorthøj C, Howes O, Keshavan M, Murray RM, Nguyen TB, Pearlson GD, Ranganathan M, Selloni A, Solowij N, Spinazzola E. Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis. World J Biol Psychiatry. 2022 Dec;23(10):719-742. doi: 10.1080/15622975.2022.2038797. Epub 2022 Mar 22. PMID: 35315315.

19. Wang, G. S., Buttorff, C., Wilks, A., Schwam, D., Tung, G., & Pacula, R. L. (2022). Impact of cannabis legalization on healthcare utilization for psychosis and schizophrenia in Colorado. International Journal of Drug Policy, 104, 103685.

20. Kim, H. S., & Monte, A. A. (2016). Colorado Cannabis Legalization and Its Effect on Emergency Care. Annals of emergency medicine, 68(1), 71–75. https://doi-org.proxy3.library.mcgill.ca/10.1016/j.annemergmed.2016.01.004

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 [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the Journey Through Stages of Sleep with Dr. Michael Mak, Assistant Professor in the Department of Psychiatry at the University of Toronto, and an Adjunct Research Professor at Western University.

The learning objectives for this episode are as follows:

1. Understand the basics of sleep physiology, including the stages of sleep

2. Recognize the clinical features of insomnia disorder using the ICSD-3 and DSM-5-TR criteria 

3. Develop an approach to the assessment of insomnia 

4. Identify the pharmacological and non-pharmacological treatments for insomnia disorder 

Guest: Dr. Michael Mak (Staff Psychiatrist)

Hosts: Dr. Vanessa Aversa (PGY4), Andreea Chiorean (CC4), Sena Gok (IMG)

Audio editing by: Sena Gok

Show notes by: Sena Gok

Contents:

Introduction:  0:16

Learning Objectives:  01:49

Definition and  Clinical features of insomnia (ICSD-3 and DSM-5-TR criteria):  02:39

Insomnia prevalence, cost effects:  05:25

Sleep physiology:  10:05

Stages of Sleep:  11:37

Changes in Sleep stages during Insomnia:  14:35

Melatonin/Orexin systems:  15:45

Assessment and diagnosis of Insomnia:  21:00

Risk Factors of Insomnia:  30:12

CBT for Insomnia (CBT-I):  31:35

Relaxation-based techniques:  40:25

Contraindication for Insomnia:  42:15

Pharmacological treatments of insomnia:  45:15

Summary:  1:11:10

Resources:

1. Wainberg M, Jones SE, Beaupre LM, Hill SL, Felsky D, Rivas MA, et al. Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank. PLOS Med. 2021 Oct 12;18(10):e1003782. 

2. Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial. JAMA. 2009 May 20;301(19):2005–15. :

3. Crescenzo FD, D’Alò GL, Ostinelli EG, Ciabattini M, Franco VD, Watanabe N, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. The Lancet. 2022 Jul 16;400(10347):170–84. 

4. Watanabe Y, Kuroki T, Ichikawa D, Ozone M, Uchimura N, Ueno T. Effect of smartphone-based cognitive behavioral therapy app on insomnia: a randomized, double-blind study. Sleep. 2023 Mar 1;46(3):zsac270. 

5. Erland LAE, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 13(02):275–81. 

6. Sweetman A, McEvoy RD, Smith S, Catcheside PG, Antic NA, Chai-Coetzer CL, et al. The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial. Sleep. 2020 Jul 13;43(7):zsaa002. 

7.  Origins of Sleep Medicine: Dr. Nathaniel Kleitman,, Dr. Mark Mahowald, Dr. Carlos Schenck

https://aasm.org/mark-mahowald-md-and-carlos-schenck-md-to-receive-william-c-dement-award/

8.  CBT-Insomnia lab at the Toronto Metropolitan University:

https://drcolleencarney.com/lab/

9.  CBT-Insomnia Applications:

 https://www.sleepio.com/

 https://www.ptsd.va.gov/appvid/mobile/cbticoach_app_public.asp

 https://www.blackdoginstitute.org.au/research-projects/sleep-ninja/

 https://www.somryst.com/

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 [email protected]. For more information, visit our website at psychedpodcast.org.