PsychEd: Educational Psychiatry Podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer, a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement. 

The learning objectives for this episode are as follows:

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

1. Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populations
2. Incorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches 
3. Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours 

Guest expert: Dr. Juveria Zaheer 

Hosts: Dr. Chase Thompson (PGY4)

Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson 

Audio editing: Dr. Chase Thompson

Show notes: Dr. Chase Thompson

00:00 – Introduction

01:14 – Learning objectives

04:00 – Overview of suicide rates across populations

07:20 - Sex and gender differences in suicide

08:50 - Suicide following discharge from hospital

14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors

20:50 - Meeting patients and families where they are at

23:30 - Suicide safety plans 

28:30 - Evidence-based approaches to suicide prevention 

32:30 - Commentary on strength of evidence for interventions in suicide prevention

38:40 - Addressing suicidality in borderline personality disorder

47:00 - Ethics of involuntary hospitalization for suicidality

50:00 - Future of suicide prevention 

References:

• Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83.
• Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346.
• Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open, 9(3), e023883.
• Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA psychiatry, 74(7), 694-702.
• Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies. Social psychiatry and psychiatric epidemiology, 54(12), 1459-1470.
• Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168-179.
• Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074.
• Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study. JAMA psychiatry, 74(6), 563-570.
• Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140.
• Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900.
• Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophrenia research, 202, 347-353.
• Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527-543.

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

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 electroconvulsive therapy with Dr. Wei-Yi Song, the Department Head of Psychiatry, Director of Mood Disorder Services, and Director of ECT Services in Victoria, BC, as well as a Clinical Professor at the University of British Columbia, and a past president of the Canadian Psychiatric Association.

The learning objectives for this episode are as follows:

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

1. Briefly describe the history of ECT from inception to the present.
2. Debunk common misconceptions about ECT.
3. Describe the major proposed mechanisms of action of ECT.
4. Describe the efficacy of ECT for common psychiatric illnesses.
5. List the indications, contraindications, side effects and risks of ECT.
6. Understand how the procedure of ECT is performed.

Guest: Dr. Wei-Yi Song

Hosts: Jake Johnston (MS4), Dr. Shaoyuan “Randi” Wang (PGY1), Dr. Arielle Giest (PGY2), Dr. Alex Raben (Staff Psychiatrist)

Audio editing by: Jake Johnston

Show notes by: Jake Johnston

Interview Content:

• Introduction - 0:00
• Learning objectives - 01:54
• History of ECT - 02:45
• Common misconceptions - 06:36
• Mechanism of action - 12:03
• • Summary - 16:06
• Indications - 16:47
• Contraindications - 20:58
• Side effects and risks - 23:31
• Efficacy of ECT - 29:00
• • Major depressive disorder - 29:13
  • Bipolar depression - 33:00
  • Schizophrenia - 34:19
  • Bipolar mania - 36:16
• Procedure - 38:50
• • Steps of performing ECT - 39:20
  • Considerations for electrode placement - 47:29
  • Pulse width - 51:19
• Maintenance treatment - 53:32
• Closing - 59:09

Resources:

• Video showing ECT procedure: https://www.youtube.com/watch?v=9L2-B-aluCE

• • One note on the realism of this depiction: an actual patient would not shake uncontrollably due to the muscle relaxants.

• Summary of electrode placement and pulse width: https://psychscenehub.com/psychinsights/electroconvulsive-therapy-summary-of-ranzcp-guidelines/

References:

• Baldinger, P., Lotan, A., Frey, R., Kasper, S., Lerer, B., & Lanzenberger, R. (2014). Neurotransmitters and electroconvulsive therapy. The journal of ECT, 30(2), 116–121. https://doi.org/10.1097/YCT.0000000000000138
• Francois, D. and DellaCava E. (2018). “10 myths about ECT”. Current Psychiatry. Accessed 2021-06-28 from MDedge.
• Kane, J., Rubio, J., Kishimoto, T., Correll, C., Marder, S., and Friedman, M. (2021). Evaluation and management of treatment-resistant schizophrenia. UpToDate. Accessed 2021-07-27.
• Kellner, C., Keck, P., and Solomon, D. (2021). Bipolar disorder in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
• Kellner, C. and Rasmussen, K. (2015). Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions. Psychiatric Times. Accessed 2021-07-08.
• Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Overview of electroconvulsive therapy for adults. UpToDate. Accessed 2021-06-28.
• Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27.
• Petrides, G., Malur, C., Braga, R. J., Bailine, S. H., Schooler, N. R., Malhotra, A. K., Kane, J. M., Sanghani, S., Goldberg, T. E., John, M., & Mendelowitz, A. (2015). Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. The American journal of psychiatry, 172(1), 52–58. https://doi.org/10.1176/appi.ajp.2014.13060787
• Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 15(3), 210–221. https://doi.org/10.9758/cpn.2017.15.3.210

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 Clinical High Risk for Psychosis with Dr. Thomas Raedler, Psychiatrist and associate professor at the University of Calgary and one of the authors of the Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis.

The learning objectives for this episode are as follows:

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

1. Recognize a patient who may be clinically high-risk for psychosis and provide a differential diagnosis 

2. Understand the importance, utility and prognosis of these risk categories 

3. Have an approach to initial management and the array of treatment options for a patient with 

Hosts: Dr. Luke Fraccaro (PGY-2), Dr. Rebecca Marsh (PGY-1), Dr. Alex Raben

Episode lead: Dr. Luke Fraccaro

Audio-engineered by: Dr. Rebecca Marsh

Guest experts: Dr. Thomas Raedler

Show Notes by: Dr. Luke Fraccaro

Resources:

• Addington, J., Francey, S., Morrison, A.  (2006). Working with People at High Risk of Developing Psychosis: A Treatment Handbook 

• McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: handbook for diagnosis and follow-up. Oxford University Press.

References :

Addington, J., Addington, D., Abidi, S., Raedler, T., & Remington, G. (2017). Canadian treatment guidelines for individuals at clinical high risk of psychosis. The Canadian Journal of Psychiatry, 62(9), 656-661.

Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., ... & Heinssen, R. (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry, 168(8), 800-805.

Addington, J., & Heinssen, R. (2012). Prediction and prevention of psychosis in youth at clinical high risk. Annual review of clinical psychology, 8, 269–289. 

Carrión, R. E., McLaughlin, D., Goldberg, T. E., Auther, A. M., Olsen, R. H., Olvet, D. M., Correll, C. U., & Cornblatt, B. A. (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA psychiatry, 70(11), 1133–1142. https://doi.org/10.1001/jamapsychiatry.2013.1909

Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., Barale, F., Caverzasi, E., & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220–229. 

Fusar-Poli P, Salazar de Pablo G, Correll CU, et al. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. 2020;77(7):755–765. doi:10.1001/jamapsychiatry.2019.4779

Fusar-Poli, P., Schultze-Lutter, F., Cappucciati, M., Rutigliano, G., Bonoldi, I., Stahl, D., Borgwardt, S., Riecher-Rössler, A., Addington, J., Perkins, D. O., Woods, S. W., McGlashan, T., Lee, J., Klosterkötter, J., Yung, A. R., & McGuire, P. (2016). The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophrenia bulletin, 42(3), 732–743. 

Kuharic, D. B., Kekin, I., Hew, J., Kuzman, M. R., & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews, (11).

Nelson, B., Amminger, G. P., Bechdolf, A., French, P., Malla, A., Morrison, A. P., ... & Wood, S. J. (2020). Evidence for preventive treatments in young patients at clinical high risk of psychosis: the need for context. The lancet. Psychiatry, 7(5), 378.

Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., ... & Morrison, A. (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European psychiatry, 30(3), 388-404.

Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., ... & Buckby, J. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11-12), 964-971.

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 is the second of two episodes covering the topic of eating disorders. In this episode, we explore the treatment of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. 

The learning objectives for the episode are as follows:

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

1. Outline the management of eating disorders using a biopsychosocial framework.
2. Identify the indications for various levels of care (inpatient, residential, day hospital, outpatient, etc).
3. Understand the ethical and medicolegal dilemmas (i.e. involuntary treatment) that may arise in treatment of eating disorders.
4. Consider the treatment of special populations (i.e. children and adolescents, older adults, men, LGBTQ+ individuals).

Guest: Dr. Randolf “Randy” Staab

Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY3), Dr. Vanessa Aversa (PGY4)

Audio editing by: Dr. Vanessa Aversa

Show notes by: Dr. Vanessa Aversa, Dr. Nikhita Singhal

Interview Content:

• Introduction - 0:00 
• Learning objectives - 00:39
• Biological approaches to treatment:
• • Nutritional rehabilitation - 03:47
  • Medications - 06:00
• Psychological approaches to treatment -16:35
• Treatment of comorbidities - 23:45
• Levels of care - 26:00
• Ethical dilemmas - 32:40
• Special populations:
• • Children and adolescents - 35:35
  • Older adults - 36:45
  • Men - 37:55
  • LGBTQ+ - 40:23
• Novel interventions - 42:48
• Closing - 51:47

Resources:

• The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca.
• The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca.
• Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.

References:

• American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10
• Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019.
• Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017.
• American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. 2006.
• Geller J, Isserlin L, Seale E, et al. The short treatment allocation tool for eating disorders: current practices in assigning patients to level of care. J Eat Disord. 2018;6(45). https://doi.org/10.1186/s40337-018-0230-2
• McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008
• Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232
• Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7
• Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f

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 is the first of two episodes covering the topic of eating disorders. In this episode, we explore the diagnosis, etiology, and symptomatology of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. Dr. Staab joins us again for Part 2, which will focus on eating disorder treatment.

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

1. Recognize the clinical features of the following eating disorders using DSM-5 diagnostic criteria: 
2. • Anorexia Nervosa (AN)
   • Bulimia Nervosa (BN)
   • Binge Eating Disorder (BED)
   • Avoidant/Restrictive Food Intake Disorder (ARFID)
   • Other Specified Feeding or Eating Disorder (OSFED)
3. Identify predisposing factors for eating disorders using a biopsychosocial framework.
4. List common comorbid psychiatric conditions associated with eating disorders.
5. Identify and describe the medical complications of eating disorders.

Guest: Dr. Randolf “Randy” Staab

Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY2), Dr. Vanessa Aversa (PGY3)

Audio editing by: Dr. Nikhita Singhal, Dr. Vanessa Aversa

Show notes by: Dr. Vanessa Aversa

Interview Content:

• Introduction - 0:00 
• Learning objectives - 2:08
• DSM-5 definition, clinical features, and associated comorbidities of:
• • Anorexia Nervosa (AN) - 4:27
  • Bulimia Nervosa (BN) - 12:36
  • Binge Eating Disorder (BED) - 18:08
  • Avoidant/Restrictive Food Intake Disorder (ARFID) - 21:43
  • Other Specified Feeding or Eating Disorder (OSFED) - 26:21
• Approach to the initial assessment of a patient with an eating disorder - 29:45
• Predisposing factors and explanatory models for the development of eating disorders:
• • Biological factors - 38:10
  • Psychological factors - 44:00
  • Sociocultural factors - 48:02
• Onset of eating disorders - 49:34
• Possible precipitating factors - 51:50
• Medical complications of eating disorders:
• • Cardiovascular - 56:13
  • Endocrine - 58:09
  • Musculoskeletal - 1:03:20
  • Gastrointestinal - 1:05:17
  • Neurological - 1:08:13
  • Renal - 1:08:59
  • Dermatological - 1:09:26
• Relevant laboratory investigations - 1:11:27
• Overview of refeeding syndrome - 1:12:30
• Closing - 1:14:27

Resources:

• The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca.
• The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca.
• Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.

References:

• American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10
• Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019.
• Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017.
• McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008
• Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232
• Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7
• Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f

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 psychiatric aspects of chronic pain with expert guest:

Dr. Leon Tourian, Associate Professor in the Department of Psychiatry at McGill University, and psychiatrist at the MUHC Alan Edwards Pain Management Unit.

The learning objectives for this episode are as follows:

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

1. Explore the role of psychiatry in the management of pain
2. Discuss the epidemiology of psychiatric comorbidities in pain disorders.
3. Outline the pathophysiology of pain and its relationship to psychiatric disorders.
4. Outline the role of non-pharmacological management/treatment of pain including psychotherapy and central neuromodulation
5. Discuss a general psychopharmacology approach in the management of pain relief and psychiatric comorbidities with chronic pain (including SNRI, TCAs, anticonvulsants, antipsychotics and cannabinoids).
6. Discuss the intersection of pain medicine with somatic symptom and related disorders

Guest: Dr. Leon Tourian

Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4)

Audio editing by Audrey Le

Show notes by Dr. Nima Nahiddi

Episode Infographic by Dr. Luba Bryushkova

Interview Content:

• Introduction and learning objectives – 0:00
• Role of psychiatry in management of chronic pain – 1:45
• Psychiatric co-morbidities in patients with chronic pain – 5:45
• Biological link between pain and psychiatric co-morbidities – 11:00
• Psychological approach to understanding and management of chronic pain– 14:30
• Central neuromodulation strategies for chronic pain – 21:00
• General pharmacological approach to the management of chronic pain – 22:30
• Pathogenesis of neuropathic and somatic visceral pain – 30:00
• Antipsychotics in the management of chronic pain – 37:00
• Cannabis in the management of chronic pain – 40:30
• Somatic symptom disorder – 46:00
• Stigma in chronic pain disorders – 53:10
• Treatment of somatic symptom disorder – 58:30
• Psychiatry and the stigma of chronic pain disorders– 61:00
• Closing remarks – 65:15

Articles and Resources:

Guideline for opioid therapy and chronic noncancer pain (CMAJ)

Guideline The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (McMaster University)

List of Pain & Opioid Initiatives (2017) (CFPC)

Canadian Pain Task Force Report: June 2019

References:

Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic medicine, 64(5), 773–786. https://doi.org/10.1097/01.psy.0000024232.11538.54

Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(4), 160–167. https://doi.org/10.1177/070674371506000402

O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. The Cochrane database of systematic reviews, 4(4), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5

Ratcliffe, G. E., Enns, M. W., Belik, S. L., & Sareen, J. (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. The Clinical journal of pain, 24(3), 204–210. https://doi.org/10.1097/AJP.0b013e31815ca2a3

Tunks, E. R., Crook, J., & Weir, R. (2008). Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 53(4), 224–234. https://doi.org/10.1177/070674370805300403

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 ketamine for treatment-resistant depression (TRD) with Dr. Sandhya Prashad, a psychiatrist and the founder and medical director of Houston Ketamine Therapeutics. She has extensive expertise using ketamine and is one of the most experienced ketamine psychiatrists in the United States, with her clinical practice focusing on TRD and incorporating transcranial magnetic stimulation (TMS), sometimes in conjunction with ketamine. Dr. Prashad is also a founding member and current president of the American Society of Ketamine Physicians (ASKP), a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy.

We’re also experimenting with something new for this episode — providing a transcript of the entire interview! The transcript can be found at psychedpodcast.org/transcripts/ketamine. We’d love to hear your feedback as listeners on this as a feature, including whether it’s something you’d be interested in seeing for other episodes moving forward!

The learning objectives for this episode are as follows:

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

1. Describe ketamine and how it came to be used in the field of psychiatry.
2. Develop an appreciation for benefits and potential harms associated with ketamine and how this compares to other treatments for depression.
3. Understand how ketamine fits into the treatment of depression and suicidality, patient characteristics to consider before initiation, potential mechanisms of action, different models of administration, and incorporation of psychotherapy.

Guest expert: Dr. Sandhya Prashad

Hosts: Jimmy Qian (MS2), Dr. Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3)

Audio editing by: Dr. Chase Thompson

Show notes by: Gray Meckling (MS4)

Interview transcript by: Gray Meckling

00:00 – Introduction

03:00 – Learning objectives

03:30 – History of ketamine

06:20 – Recreational use of ketamine, phenomenology of the ketamine experience

09:45 – Where does ketamine fall in the algorithm for treatment of depression?

11:50 – Ketamine’s use in acute suicidality

13:40 – Ketamine contraindications

14:40 – Ketamine efficacy

19:00 – Combining ketamine with rTMS

21:15 – Limitations to ketamine

24:35 – Ketamine mechanism of action

26:05 – Ketamine formulations, and integrating ketamine into psychotherapy

33:10 – Combining ketamine with traditional antidepressant treatment

37:30 – Practicalities of administering ketamine

39:40 – Ketamine as treatment for OCD and PTSD

41:40 – Closing remarks

Resources:

• American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP)
• Sandhya Prashad, MD (Website)
• NEJM interview with Dr. Roy Perlis: Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class

References:

• Berman, R., Cappiello, A., Anand, A., Oren, D., Heninger, G., Charney, D.. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 47: 351–354.
• Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA psychiatry, 76(9), 893-903.
• J.W. Murrough, D.V. Iosifescu, L.C. Chang, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two site randomized controlled trial. Am. J. Psychiatry, 2013 (170) (2013), pp. 1134-1142
• Kim, J., Farchione, T., Potter, A., Chen, Q., & Temple, R. (2019). Esketamine for treatment-resistant depression-first FDA-approved antidepressant in a new class. N Engl J Med, 381(1), 1-4.
• McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S. (2021). Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. American Journal of Psychiatry, appi-ajp.
• Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence [Internet]. 2008 Jun 1;95(3):219–29.
• Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405.
• Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15.
• Williams NR, Heifets BD, Bentzley BS, Blasey C, Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of antidepressant and anti suicidal effects of ketamine by opioid receptor antagonism. Molecular psychiatry. 2019 Dec;24(12):1779-86.
• Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63: 856–864.

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

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 treatment of borderline personality disorder with expert guests:

• Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, and inpatient psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as the inpatient psychiatrist at the Jewish General Hospital.
• Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, and head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre.

The learning objectives for this episode are as follows: 

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

1. Understand the frame and principles of care for the treatment of individuals with borderline personality disorder.
2. Explore the approach to the treatment of individuals with borderline personality disorder:

1. On presentation in crisis to the emergency department.
2. During an inpatient psychiatric admission.
3. In the context of psychiatric outpatient care.

1. Understand the use of psychotherapy in the treatment of individuals with borderline personality disorder.
2. Understand the use of pharmacotherapy in the treatment of individuals with borderline personality disorder

Guest: Dr. Robert Biskin and Dr. Ronald Fraser

Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4)

Audio editing by Audrey Le

Show notes by Dr. Nima Nahiddi

Interview Content:

•  Introduction – 0:00
• Learning objectives – 0:35
• Principles of care for treatment of BPD – 1:16
• The therapeutic frame – 5:40 
• Approach to the management of emergency department presentations – 9:10
• Dialectical behaviour therapy (DBT) – 16:15
• Suicidality and self-harm in BPD diagnosis – 21:05
• Pharmacotherapy for symptom treatment – 22:40
• Treatment of co-morbid disorders – 32:35 
• Management of safety risk – 39:30
• Stigma in treatment of BPD – 46:05
• Closing remarks – 52:00

Resources/Articles:

• The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome | Annual Review of Clinical Psychology (annualreviews.org)
• Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis | Psychiatry | JAMA Psychiatry | JAMA Network
• National Education Alliance for Borderline Personality Disorder

References:

• Cristea I.A., Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. (2017) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry. 74(4):319–328. doi:10.1001/jamapsychiatry.2016.4287
• Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H  J. (2010) Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. Clin Psychiatry. 71(1):14. 
• Paris J. (2009). The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome. Review of Clinical Psychology. 5:1, 277-290
• Stoffers J, Vollm BA, Rucker G, Timmer A, Huband N. (2010) Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD005653. DOI: 10.1002/14651858.CD005653
• Storebø  OJ, Stoffers-Winterling  JM, Völlm  BA, Kongerslev  MT, Mattivi  JT, Jørgensen  MS, Faltinsen  E, Todorovac  A, Sales  CP, Callesen  HE, Lieb  K, Simonsen  E.  (2020) Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD012955. DOI: 10.1002/14651858.CD012955.pub2

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 diagnosis of borderline personality disorder with expert guests:

• Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as inpatient psychiatrist at the Jewish General Hospital.
• Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre.

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

1. List the DSM-5 diagnostic criteria of borderline personality disorder.
2. Recall the epidemiology of borderline personality disorder.
3. Consider the risk factors and posited causal mechanisms for borderline personality disorder, including developmental and neurobiological mechanisms. 
4. Discuss the clinical presentation of borderline personality in different clinical settings, including the Emergency and Outpatient settings. 
5. Recognize the differential diagnoses for patients presenting with borderline personality disorder.
6. List the common comorbid psychiatric and general medical conditions with borderline personality disorder.
7. Discuss the common diagnostic challenges and pitfalls.
8. Explore the stigma surrounding the diagnosis of borderline personality disorder, and discuss a therapeutic approach to providing psychoeducation to patients with this diagnosis. 

Guests: Dr. Robert Biskin and Dr. Ronald Fraser.

Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4).

Audio editing by Audrey Le.

Show notes by Dr. Nima Nahiddi.

Interview Content:

• Introduction – 0:00
• Learning objectives – 2:03
• DSM-5 definition of personality disorder, and borderline personality disorder (BPD) – 3:00
• Other associated features of BPD – 4:36
• Distinguishing BPD from other psychiatric and co-morbid conditions – 5:55
• Epidemiology of BPD – 13:48
• BPD over the lifecycle – 18:05
• Explanatory models for the development of BPD – 21:20
• Differences in the presentation of BPD – 26:00
• Approach to a BPD diagnosis in the emergency department – 31:05
• Stigma surrounding BPD diagnosis and disclosure of diagnosis – 33:51
• Clinical pearls for screening of BPD – 41:11
• Evidenced based screening tools or scales for BPD diagnosis – 46:22
• Closing – 48:40

Resources:

• MSI-BDP: MacLean Screening Index for BPD
• Diagnostic Interview for BPD – Revised (DIB-R): https://psycnet.apa.org/record/1990-11356-001

Articles: Diagnosing borderline personality disorder | CMAJ

References:

• Biskin, R.S., Paris, J. (2012). Diagnosing borderline personality disorder. CMAJ. 184 (16), 1789-1794.
• Zanarini, M. C., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised Diagnostic Interview for Borderlines: Discriminating BPD from other Axis II disorders. Journal of Personality Disorders, 3(1), 10–18.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

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 psychodynamic psychotherapy with Dr. Rex Kay. Dr. Kay is a staff psychiatrist at Mount Sinai Hospital, assistant professor and modality lead for dynamic psychotherapy at the University of Toronto, as well as a faculty member at the Toronto Institute for Contemporary Psychoanalysis. 

The learning objectives for this episode are as follows:

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

1. Define psychodynamic psychotherapy. 
2. Describe the core concepts of psychodynamic therapy. 
3. Determine who may be an appropriate patient for psychodynamic psychotherapy. 
4. Describe the evidence base for psychodynamic psychotherapy. 
5. Compare and contrast psychodynamic therapy to other psychotherapies. 

Guest: Dr. Rex Kay

Produced and Hosted by: Jordan Bawks and Anita Corsini

Audio editing by: Anita Corsini

Resources:

• Ars Medica: A Journal of Medicine, the Arts, and Humanities
• Canadian Institute for Child and Adolescent Psychoanalytic Psychotherapy 
• Narrative Competence Psychotherapy Group at Mount Sinai Hospital
• Toronto Institute for Contemporary Psychoanalysis
• Toronto Institute of Psychoanalysis   

References:

Black, M. & Mitchell, S. (2016). Freud and beyond: A history of modern psychoanalytic thought. Basic Books. 

Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2017). Psychodynamic psychotherapy: A clinical manual. Wiley.  

Driessen, E., Hegelmaier, L. M., Abbass, A. A., Barber, J. P., Dekker, J. J., Van, H. L., Jansma, E. P., & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clinical Psychology Review, 42, 1-15. doi: 10.1016/j.cpr.2015.07.004

Eppel, A. (2018). Short-term psychodynamic psychotherapy. Springer. 

Karen, R. (1994). Becoming attached: First relationships and how they shape our capacity to love. Oxford. 

Safran, J. D. (2012). Psychoanalysis and Psychoanalytic Therapies. American Psychological Association. 

Summers, R. F. & Barber, J. P. (2010). Psychodynamic Therapy: A Guide to Evidence-Based Practice. Guilford.

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.