Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors for self-harm and suicide and components of risk assessment.

Our guest expert is Dr. Juveria Zaheer. She is a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Emergency Department at CAMH. Her research focuses on suicide, gender and culture, and she is the lead author of the Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention.

The learning objectives for this episode are as follows:

1. Be familiar with the risk factors and predictors of suicide, as well as protective factor
2. Be familiar with the components of a Suicide Risk assessment
3. Be familiar with how to comprehensively document and communicate the risk assessment

Recommended Readings:

• Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention
  • Includes safety plan, risk assessment template and clinical cases in the appendix

• Columbia-suicide severity rating scale (c-ssrs)

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

Credits note: Alex Raben provided audio-editing for this episode.

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

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode of our miniseries on psychiatric skills, we review the core content areas of a psychiatric assessment and look at techniques to improve interviewing efficiency, accuracy and alliance building. Our expert for this episode is Dr. Juveria Zaheer, a clinician-scientist at the Centre for Addiction and Mental Health, and an assistant professor at the University of Toronto, in Toronto, ON. 

Learning Objectives:

By the end of the episode you, the learner, should...

1. Have a clear understanding of the goals of a complete psychiatric interview and the general structure and content that should be covered
2. Feel comfortable to begin to use techniques that will help you conduct a professional, compassionate, empathic, efficient, and accurate interview
3. Be familiar with techniques you can use to facilitate information gathering in more challenging interviews 

Episode Timepoints

• 3:15 - Purpose of the psychiatric interview 
• 6:30 - First content areas of the interview; introduction, ID, RFR, CC, HPI, ROS, Past Psych Hx
• 19:00 - Techniques and Strategies for Organized and Efficient Psychiatric ROS
• 26:00 - Details of Past Psychiatric History 
• 29:30 - Past Medical History
• 31:00 - Substance Use History
• 33:30 - Medications
  
• 34:20 - Family Psych History
• 36:25 - Personal and Developmental History (Content & Process discussion)
• 44:00 - Commonly missed areas including Legal/Forensic history
• 45:00 - Shift from content to process discussion “how to best manage a psychiatric interview”
• 49:00 - Self-care and monitoring 
• 52:00 - Building rapport, therapeutic alliance, empathy 
• 53:30 - Alex and Lucy reflect on their growth as interviewers over 4 years in residency 
• 73:00 - Managing challenging interviews

References and Resources
1) Shea, S. C. (1998). Psychiatric Interviewing E-Book: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals

2) Carlat, D. J. (2016). The psychiatric interview: A practical guide. Lippincott Williams & Wilkins.

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) and Facebook. You can provide feedback by email at [email protected]; For more information visit our website: psychedpodcast.org

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we discuss the biopsychosocial formulation--what it is and how we do it . Our guest expert is Dr. Erin Carter, an in-patient psychiatrist at St. Joseph's Healthcare Centre in Toronto, Canada.

The learning objectives for this episode are as follows:

1. Understand the components of a biopsychosocial formulation
2. Develop an approach to organizing and eliciting salient information to aid in formulation
3. Distinguish between summary and synthesis of information
4. Understand how to communicate a formulation effectively
5. Use the biopsychosocial formulation to inform a management plan


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) and Facebook. You can provide feedback by email at [email protected] For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors and management of aggression in the Psychiatric Emergency context.

Our guest expert is Dr. Jodi Lofchy. She is the Chair of the Canadian Psychiatric Association’s Section of Emergency Psychiatry, and Interim Chief and Medical Program Director for the Department of Psychiatry at St. Joseph’s Health Centre. Dr. Lofchy has presented and published many works on Best Practice in Emergency Psychiatry and has been tremendously involved in Medical Education.

 The learning objectives for this episode are as follows:

1. Identify risk factors for violence in the ER, static and dynamic risks
2. Know how to take a history for violence, and communicate risk
3. Describe the indications for non-chemical interventions in the management of the agitated patient
4. Describe pharmacologic interventions in managing the agitated patient
5. How to apply legislation regarding risk of violence

Recommended Readings:

Emergency Psychiatry: Clinical and Training Approaches

Jodi Lofchy, MD, FRCPC1; Peter Boyles, MD, FRCPC2; Justin Delwo, MD, FRCPC3

http://www.cpa-apc.org/wp-content/uploads/Emergency-Psychiatry-2004%E2%80%9344-R1-EN-FIN-web.pdf

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) and Facebook. You can provide feedback by email at [email protected] For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we comprehensively review the diagnosis and treatment of PTSD, and explore the psychological and physiological underpinnings of trauma.

Our guest expert is Dr. Dana Ross. She is a psychiatrist in the Trauma Therapy Program at Women’s College Hospital in Toronto, Canada. She is also a founder of Trauma Education Essentials Inc. which provides trauma-focused educational webinars, online courses, and workshops to health professionals and organizations

The learning objectives for this episode are as follows:

1. Know the prevalence and incidence rates of Posttraumatic Stress Disorder (PTSD)
2. Recognize the clinical features of PTSD using DSM-5 diagnostic criteria
3. List 5 common risk factors for the development of PTSD
4. Identify 3 neurophysiological mechanisms underlying PTSD
5. Differentiate the three stages of trauma therapy
6. Describe evidence-based pharmacological and psychological treatments for

Recommended Readings by Dr. Ross:

• The Body Keeps the Score by Bessel Van der Kolk, MD
• Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care by Clark, Classen, Fourt, & Shetty
• Trauma and Recovery by Judith Herman, MD
• The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris, MD

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) and Facebook. You can provide feedback by email at [email protected] For more information visit our website:psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Psychiatric Rehabilitation with guest Dr. Abraham Rudnick, who is currently a Professor in the Department of Psychiatry at the University of Dalhousie.

In this episode, Aarti and Alex learn about Psychiatric Rehabilitation, also known as Psychosocial Rehabilitation (PSR), a rarely discussed or taught “4th branch” of mental health intervention. Join our residents as they discover the definition, purpose, history, process, character, and possibilities of psychiatric rehabilitation from a world expert.

The learning objectives for this episode are as follows:

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

1. Define psychiatric rehabilitation (PSR)
2. Differentiate clinical and personal recovery
3. Understand how PSR supports personal recovery
4. Differentiate psychiatric rehabilitation from other mental health interventions
5. Identify key areas of overlap with psychotherapy
6. Identify key concepts within the process of PSR: readiness assessment and development, skills, supports, environment of choice, lack of coercion, maintenance of hope
7. Locate resources to further their own knowledge and skills in PSR*

As referenced in the podcast*:

Online PSR training courses: https://www.mohawkcollege.ca/ce/programs/health-and-nursing/psychosocial-rehabilitation-016

https://www.douglascollege.ca/programs-courses/faculties/humanities-social-sciences/psychology/psychosocial-rehabilitation

Books/Journals:
1) Psychiatric Rehabilitation Journal

2) Work of Dr. William Anthony

3) Dr. Patrick Corrigan’s Principles and Practice of Psychiatric Rehabilitation

Guest staff psychiatrist: Dr. Abraham Rudnick, BMedSc, MD, MPsych, PhD, CPRP, FRCPC, CCPE, DFESPCH, FCPA, CSLI, CPRRP

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) and Facebook. You can provide feedback by email at [email protected] For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode is our fourth and final episode in our mini-series on schizophrenia. In this episode, we take an advanced look at the clinical management of schizophrenia, including a discussion of treatment-resistant schizophrenia and clozapine. Warning: this content in this episode is a little bit more advanced than usual, but also ultra interesting.  

Our guest expert is Dr. Gary Remington. He is a researcher, psychiatrist, Chief of the Schizophrenia Division at CAMH and an author of the 2017 Canadian schizophrenia guidelines

 The learning objectives for this episode are as follows:

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

1. Have an approach to treating a first episode psychosis of schizophrenia
2. Understand the important components of maintenance treatment in schizophrenia
3. Understand the concept of treatment-resistant schizophrenia (TRS)
4. Know when to initiate clozapine
5. List some of the psychosocial interventions involved in treating schizophrenia

References:

• Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616.

• Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., ... & Severe, J. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209-1223.
• Kapur, S., Remington, G., Jones, C., & Wilson, A. (1996). High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study. The American journal of psychiatry, 153(7), 948.

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) and Facebook. You can provide feedback by email at [email protected] For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers community treatment orders (CTOs) and assertive community treatment (ACT) teams in the context of schizophrenia treatment with Dr. Arash Nakhost a staff psychiatrist who works on the FOCUS ACT team at St. Michael’s Hospital.

The learning objectives for this episode are as follows:

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

1. Provide a brief description of the history of ACT teams and CTOs, as well as the challenges in establishing evidence for their use

2. Compare and contrast ACT teams with intensive case management teams in terms of their composition, methods, and respective strengths and weaknesses

3. Describe the array of services that an ACT team can help provide to its clients as well as some of the challenges and drawbacks of ACT teams

4. Outline the major reasons someone might be put on a community treatment order and describe how a CTO is applied and enforced

5. Outline the major challenges in using CTOs as a treatment tool

Guest staff psychiatrist: Dr. Arash Nakhost (St. Michael’s Hospital, Toronto)

References:

• Ontario Hospital Association. (2016). A practical guide to mental health and the law in Ontario. Government of Ontario, Health Care Consent Act.

• Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane database of systematic reviews, (3).

• Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T. (2014). A systematic review of the effect of community treatment orders on service use. Social psychiatry and psychiatric epidemiology, 49(4), 651-663.

• Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., ... & Tsemberis, S. (2015). A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67(3), 275-281.

• Bromley, E., Mikesell, L., Whelan, F., Hellemann, G., Hunt, M., Cuddeback, G., ... & Young, A. S. (2017). Clinical factors associated with successful discharge from assertive community treatment. Community mental health journal, 53(8), 916-921.

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) and Facebook. You can provide feedback by email at [email protected] For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode is part II in the treatment of schizophrenia series with our expert Dr. Albert Wong, a psychiatrist and research scientist who is an expert in schizophrenia at the Centre for Addiction and Mental Health (CAMH) and professor at the University of Toronto.

The learning objectives for this episode are as follows:

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

1. Conceptualize antipsychotic drugs categories in in different and clinically relevant ways

2. Have an approach for choosing an antipsychotic medication for a patient and be able to consent them by going over the benefits and limitations of the medications

3. Understand the limitations of our understanding of schizophrenia and our current treatments and some of the problems that remain to be solved in this area of psychiatry

 References:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

• Robinson, D. J. (1997). Brain calipers: A guide to a successful mental status exam. Fort Gratiot, Mich., USA: Rapid Psychler Press.

• Kuipers, E., Yesufu-Udechuku, A., Taylor, C., & Kendall, T. (2014). Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ: British Medical Journal (Online), 348.

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) and Facebook. You can provide feedback by email at [email protected]. For more information visit our website:psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of schizophrenia with Dr. Jason Joannou and Dr. Andrew Lustig, two inpatient staff psychiatrists at the Centre for Addiction and Mental Health (CAMH) and assistant professors at the University of Toronto.

The learning objectives for this episode are as follows:

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

• Articulate the basic psychopharmacology of antipsychotics
• Create a basic treatment presenting with a first episode of schizophrenia, based on the 2017 Guidelines for the Pharmacotherapy of Schizophrenia in Adults
• Summarize principles of longitudinal treatment, which includes treatment-resistant schizophrenia and psychosocial approaches to the illness.
  
  

References:

• Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616.
• Norman, R., Lecomte, T., Addington, D., & Anderson, E. (2017). Canadian treatment guidelines on psychosocial treatment of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 617-623.
• Tiihonen, J., Haukka, J., Taylor, M., Haddad, P. M., Patel, M. X., & Korhonen, P. (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. American Journal of Psychiatry, 168(6), 603-609.

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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) and Facebook. You can provide feedback by email at [email protected]. For more information visit our website: psychedpodcast.org.