Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis and treatment of Obsessive Compulsive Disorder (OCD) with Dr. Nik Grujich, a staff psychiatrist at Sunnybrook Hospital, associate of the Frederick W. Thompson Anxiety Disorders Centre and award-winning educator at the University of Toronto.

In this episode, Jordan Bawks (PGY2 resident) and Aarti Rana (PGY1 resident) sit down with Dr. Grujich to talk about OCD. Together, they discuss the phenomenology of OCD (with a focus on differentiating it from Obsessive Compulsive Personality Disorder, OCPD), the epidemiology and natural course of the disorder, the DSM-5 diagnostic criteria, interview techniques to elicit and differentiate OCD from other psychiatric disorders and the pharmacological and psychological treatments for the disorder.

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

1. Recognize the clinical features of OCD using DSM-5 criteria
2. Appreciate the differential diagnosis and how to use specific interviewing questions and the mental status to aid clinical judgment
3. Describe the evidence-based pharmacological and psychological treatments for OCD and their relative efficacy

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 generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto.

In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) reunite with Dr. Peck to talk about the bio-psycho-social management of GAD. They cover recommended lifestyle changes for people with GAD, evidence-based pharmacotherapies, including SSRIs, SNRIs, Pregabalin, Quetiapine, TCAs and benzodiazepines, and how to choose between them, and psychotherapeutic treatments with a focus on CBT and a quick overview of some of the third wave cognitive models.

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

1. List the lifestyle changes recommended for people with GAD
2. Describe the first line and second line medication therapies for GAD and the rationale supporting each agent's place in the treatment hierarchy 
3. Appreciate the key elements of CBT that make it effective for the treatment of GAD

Relevant Articles:

• Generoso et al., 2017 (Pregabalin for GAD metaanalysis)
• Katzman et al., 2014 (Canadian Anxiety Guidelines)
• Perrin et al., 2019 (Laval model)

Please Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association or the University of Toronto and are not meant to replace formal clinical education or judgment.

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 diagnosis of generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto.

In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) sit down with Dr. Peck to help them understand the clinical construct of generalized anxiety disorder (GAD). In addition to understanding how to make the diagnosis they also cover the epidemiology natural course, differential diagnosis and routine investigations for GAD.   

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

1. Recognize the clinical features of GAD using DSM-5 diagnostic criteria
2. Appreciate the differential diagnosis and how to conduct assessments to help clinical judgment

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 Schizophrenia, which guest speakers Dr. Jason Joannou and Dr. Andy Lustig from the CAMH inpatient psychiatry unit.

In this episode we discuss schizophrenia, with the following objectives:

1.      The DSM V diagnostic criteria of schizophrenia

2.      The impact of the disease and its trajectory

3.      The differential diagnosis of schizophrenia

4.      Clinical approach to patients with schizophrenia

5.      The Mental Health Act and involuntary admission

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

1.       Know the DSM V diagnostic criteria of schizophrenia and specific manifestations of the disease

2.      Know some of the epidemiology, triggers and impact of the disease

3.      Know the differential diagnosis of schizophrenia and its subtypes

4.      Know how to elicit a good history and how to approach patients with schizophrenia

5.      Know the Mental Health Act and the legalities around forming a patient with schizophrenia.

The perspectives we have elicited in this episode are from inpatient psychiatrists who generally tend to see more severe cases of schizophrenia.

CPA Note: The content of this podcast are created for medical Learners by medical learners. 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 treatment of bipolar disorder with Dr. Roger McIntyre, Professor of Psychiatry and Pharmacology at University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, Canada.

In this episode, we follow the case of Devon, a 28 year old male who presents to the ER with acute mania and is diagnosed with bipolar disorder. Our team of psychiatry residents from University of Toronto guide you through Devon’s trajectory with reference to CANMAT guidelines and expertise from Dr. McIntyre. We discuss how to manage acute mania and acute depression and what management looks like for outpatients (pharmacological and non-pharmacological). Special topics include treating severe agitation on the inpatient ward and things to consider for lithium treatment. 

The Learning Objectives for this episode are as follows:

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

• Treat acute mania and depression in bipolar disorder 
• Prevent relapse in bipolar disorder through maintenance pharmacotherapy
• Prevent relapse through nonpharmacological interventions
• Obtain informed consent for and initiate lithium treatment

Guest staff psychiatrist: Dr. Roger McIntyre (University Health Network, Toronto)

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 diagnosis of bipolar disorder in ther depressive episodes, and a phenomenon termed "episodes with mixed features", with guest Dr. Ariel Shafro, a staff psychiatrist at Trillium Health Partners. 

Bipolar disorder is an illness characterized by manic and depressive episodes; patients in fact spend more time in a depressed state than a manic state. The criteria for diagnosing a bipolar depression is the same as unipolar depression (or major depressive disorder). 

When patients present with a depressive episode, it is important to consider bipolar disorder as a possible differential diagnosis. In addition, we discuss certain features that can point to an increased likelihood of bipolarity in a patient presenting with depression: this includes a strong family of bipolar disorder; previous subthreshold mania and cyclothymic features;atypical depression, psychomotor retardation (and/or catatonia), and psychotic features; and atypical reaction to antidepressants. 

Lastly, we talk about the phenomenon of "episodes with mixed features", where people can present with simultaneous symptoms of depression and mania. We discuss the relevance of recognizing such episodes, including increased vigilance for features of bipolarity and considerations for treatments that have effect in both unipolar and bipolar depression.

The learning objectives for this episode are as follows. By the end of this episode, the listener will be able to:

• Describe criteria for bipolar depression (it's the same as unipolar depression!)
• List features suggestive of bipolarity in a presentation of depression
• Know the DSM-V criteria of and recognize episodes with mixed features
• Describe the relevance of diagnosing episodes with mixed features

Guest Staff Psychiatrist: Dr. Ariel Shafro (Trillium Health Partners, Mississauga)

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 diagnosis of Bipolar Disorder (Type 1 and 2), with insights from guest Dr. Mark Sinyor, Staff Psychiatrist at Sunnybrook Health Sciences Centre. 

Bipolar disorder is characterized by depressive and manic episodes. This episode focuses on the diagnostic criteria and assessment in mania, and presents a fictional case of a patient with a first manic episode. We discuss the epidemiology of bipolar disorder, and a plain-English description of manic episodes. We then explore the DSM-5 diagnostic criteria for manic episodes using the mnemonic GSTPAID. Relating the criteria back to the case, we will talk with Dr. Sinyor about practical methods and tips for assessing a person who presents with manic symptoms. Some common mental status exam terms and findings in mania will be explained. We then discuss common differential diagnoses for bipolar disorder, including schizoaffective disorder, schizophrenia, borderline personality disorder, and substance intoxication/substance-induced mania. 

Lastly, we will differentiate between mania and hypomania, and Bipolar Disorder Type 1 and Type 2. Through the examination of the concept of “bipolar spectrum”, we will discuss some challenges and limitations of the DSM-5 and the current understanding of Bipolar Disorder. 
The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:

• Cite the prevalence and incidence rates of bipolar affective disorder
• Describe the natural history of bipolar disorder including its cyclical nature, and relative ratio of times in mania vs depression
• Know the DSM-V criteria for mania, hypomania
• Suggested mnemonic GSTPAID
• Perform an effective diagnostic interview for manic symptoms
• Perform a differential diagnosis for bipolar disorder including borderline personality disorder and psychotic disorders

Guest Staff Psychiatrist: Dr. Mark Sinyor (Sunnybrook Health Sciences Centre, Toronto)

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 educational psychiatry podcast for medical learners, by medical learners.

This episode covers the approach to treating Major Depressive Disorder, as described by the CANMAT (Canadian Network for Mood and Anxiety Treatments) Guidelines. We discuss with Dr. Sid Kennedy, the founding chair of CANMAT, the past president of International Society for Affective Disorders, as well as a staff psychiatrist and scientist at Toronto Western and St. Michael’s Hospitals in Toronto.

In this episode, Dr. Kennedy discusses the origins of the CANMAT and how the guidelines are structured and constructed. We talk briefly about consideration of specifiers and symptoms in tailoring treatment. We then approach psychotherapy, pharmacotherapy, electrostimulation, and complementary and alternative therapies as treatment options, using the case from the previous episode on the diagnosis of depression.

Evidence-based psychotherapies for depression include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). We explain briefly the theoretical underpinnings of each. Patient suitability and availability of quality therapy are considered. Some evidence demonstrate a superiority of combining psychotherapy with pharmacotherapy (Cuijpers 2009).

The first-line pharmacotherapy includes antidepressant classes SSRI (selective serotonin reuptake inhibitor), SNRI (serotonin and norepinephrine reuptake inhibitor), NDRI (norepinephrine and dopamine reuptake inhibitor), and NaSSA (norepinephrine and specific serotonergic antidepressant). We discuss side effects with a focus on SSRIs, and understanding them from serotonin receptor profiles. We talk about the delayed onset of antidepressants, using validated tools to measure improvement, and strategies to optimize dosage, or using adjuncts with partial responses. We explore results from STAR*D (Trivedi et al, 2006) regarding response rates to medications.We touch briefly on antidepressant selection and the limited evidence of superiority of one medication/class over another (Cipriani et al 2009).

Brain stimulation includes electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and Deep Brain Stimulation (DBS). Dr. Kennedy discusses the cultural origins of misconceptions around ECT and explores the current practice of ECT today, which includes general anesthesia for the comfort of patients. We explain briefly the practice of rTMS and DBS.

Complementary and alternative therapies are briefly explored, including light therapy which has increasing evidence not only for seasonal patterns of depression. Dr. Kennedy discusses the limited evidence available to support any complementary therapies including nutraceuticals and exercise.

The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:

1. Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features

2. Apply the CANMAT Guidelines in discussing treatment options for MDD

3. Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD

4. Psychotherapy

   • Identify CBT, IPT, and MBCT as evidence-based psychotherapies for depression

   • Explain factors for choosing psychotherapy versus pharmacotherapy as first-line treatment

   • Describe the efficacy of psychotherapy in relation to pharmacotherapy

5. Pharmacotherapy

   • Identify SSRI, SNRI, NDRI, and NaSSA as classes of antidepressants that are first-line for depression

   • Explain the time of onset and side effect profile of SSRIs

   • Apply the guideline to either optimize, switch, or add adjunctive therapies with limited or partial responses to medication

   • Identify some factors to consider in choice of antidepressants

6. Brain Stimulation

   • Identify ECT, rTMS, and DBS as brain stimulation treatments for depression

   • Criticize the cultural origins of stigma around ECT

   • Describe the current practice of ECT, rTMS, and DBS

7. Complementary and Alternative Therapies

   • Describe Light Therapy as the only evidence-based complementary treatment strategy

   • Recognize the limited data in support of other therapies including nutraceuticals and exercise

Guest Staff Psychiatrist: Dr. Sid Kennedy (Toronto Western Hospital and St. Michael’s Hospital, Toronto)

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 educational psychiatry podcast for medical learners, by medical learners.

This episode covers the diagnosis of major depressive disorder (MDD), leveraging experience from Dr. Ilana Shawn, Staff Emergency and Outpatient Psychiatrist at St. Michael’s Hospital in Toronto.

In this episode we talk about a hypothetical case of someone presenting for the first time with a depressive illness. Using the metric of DALY (disability-adjusted life-years), we highlight the high global disease burden of depression. We then briefly discuss the purpose and limitations of using a diagnostic manual. We describe in depth the symptoms of depression using the mnemonic MSIGECAPS, including Dr. Shawn’s thoughts on how the they can be elicited more naturally in an assessment. We talk about common challenges in performing a suicide assessment, and the misconception that asking about suicide increases the risk of suicide. Finally, we highlight other medical and psychiatric conditions that can mimic depression.

The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:

• Understand the societal impact of depression

• Describe the diagnostic criteria of MDD

  • Describe strategies to elicit depression symptoms

  • Apply Mental State Exam findings to support or a diagnosis of depression

  • Understand the limitations of the Diagnostic and Statistical Manual (DSM)

• Perform a differential diagnosis of major depression

Guest Staff Psychiatrist: Dr. Ilana Shawn (St. Michael’s Hospital, Toronto)

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.