Navigating the challenging terrains of psychiatry requires a blend of expertise, vision, and ethical grounding. Dr. Rebecca Brendel, MD, JD, exemplifies these qualities. As the immediate past president of the APA and a luminary at Harvard's Center for Bioethics, she has consistently showcased her commitment to upholding ethics in the ever-evolving field of psychiatry. In this episode, she offers a panoramic view of her journey, the APA's strides under her leadership, and the directions in which psychiatry is headed, especially in the realms of technology, diversity, and medical ethics.

Timestamped Shownotes:

• 2:00 - The intricate challenges and accomplishments of leading the APA during and post-pandemic.
• 3:25 - Revelations and historical nuances encountered during her presidency at the APA.
• 5:40 - Dr. Brendel's awe-inspiring journey within the APA: tracing her path from a research fellow to the apex of leadership.
• 10:20 - The inherent attributes and challenges associated with being an ethical spokesperson in today's world.
• 13:20 - The tangible impact of Dr. Brendel's ethics-centered approach at the APA, with a focus on the Goldwater Rule.
• 15:05 - Demystifying the misconceptions around the Goldwater Rule.
• 17:40 - The APA's forward-thinking initiatives in promoting diversity, equity, inclusion, and addressing structural racism.
• 21:10 - The myriad opportunities presented by APA’s 501c foundation, extending its benevolence beyond the clinical realm.
• 22:30 - A deep dive into the PsychPRO Registry: understanding its mechanics and its ambitious vision for the future of psychiatry.
• 26:10 - An overview of the collaborative care model and its relevance.
• 27:00 - Measurement-based care: striking a balance with clinical judgment.
• 32:00 - A spotlight on Dr. Brendel's leadership role at the Center for Bioethics at Harvard University.
• 33:50 - The unwavering significance of hands-on clinical work in Dr. Brendel's illustrious journey.
• 36:20 - Guiding young enthusiasts on how to actively engage with professional psychiatric organizations.
• 38:40 - Dr. Brendel's aspirations and hopes for the future of psychiatry, with a special emphasis on the burgeoning role of technology.
• 41:00 - Exploring the ethical implications of partnerships between psychiatrists and the expansive tech industry.
• 43:05 - The contemporary framework of ethics training tailored for the next generation of medical practitioners.
• 45:00 - Dr. Brendel's reflective words, drawing from her tenure as the president of the APA.

Links and Resources Mentioned:

• Center for Bioethics at Harvard University
• APA's Official Website

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In this insightful episode, Dr. Toby Marton, Chief Medical Officer of Mindful Health Solutions, takes us on a journey through his impactful career in the mental health space and his predictions for the future of mental health treatments. Toby, an expert in brain stimulation techniques for treatment resistant depression, shares his experiences of working with veterans and the efficacy of Ketamine Infusion Therapy (KIT) for PTSD. 

The conversation dives into the evolution of his passion for rapid acting treatment and the role of treatments like TMS, ECT, and esketamine in the long-term management of treatment-resistant depression (TRD). Toby discusses the challenges of scaling treatments like MDMA and offers valuable insights on the future of psychiatry, the role of AI, and the integration of psychiatric care into general healthcare systems. 

This episode promises a comprehensive exploration of the cutting-edge frontiers of mental healthcare, from the perspective of a leader in the field.

Shownotes/Timestamps:

3:00: Toby’s inspiration for pursuing Psychiatry and his choice for an MD in Psychiatry and a PHD in Neuroscience over neurology. His interest in consciousness as a complex subject.

6:45: Toby discusses the prevalence of learned helplessness and nihilism in Psychiatry.

7:40: Insights Toby gathered about the brain from Electroconvulsive Therapy (ECT).

9:00: The motivations behind Toby's shift from bench research to clinical work.

12:30: Exploration of Toby’s research on rapid-acting antidepressants and testing new treatments at the VA.

14:16: Delving into the misleading interpretations of a Naltrexin paper which suggested that ketamine's action was akin to that of an opioid. This conclusion was drawn from a single study with a small sample size.

18:31: Characteristics of patients who didn’t respond as quickly to ketamine treatments for Depression

29:14: The payer/operational decisions on which treatment to try first between ketamine, TMS, and esketamine

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37:57: Cosmetic psychiatry and discussion on if the dissociative experience is paramount to the antidepressant effects of ketamine

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42:40: Preparing for MDMA-assisted therapy45:02: Challenges of scaling psychedelic-assisted therapies and how tech can help.

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Delve into the evolving legal landscape of MDMA-assisted psychotherapy. This episode features Kimberly Chew and Karen Luong, co-leaders of the Psychedelic and Emerging Therapies group at Husch Blackwell. In this enlightening conversation, they decode the legal steps required to offer MDMA treatment for PTSD, a topic of interest for 60% of our surveyed clinicians. 

They discuss the certification requirements for practitioners, liability concerns, state and federal regulations, and risk reduction strategies. They also talk about the potential of insurance coverage for MDMA therapy, informed by their insights into ketamine clinics and the regulations that surround them. Finally, they reflect on the exciting advancements in the field of psychedelic research and therapy, offering their perspective on the future trajectory of this promising therapeutic realm.

Shownotes and Timestamps:

• 3:00: MDMA for PTSD certification requirements for practitioners
• 5:20: REMS program explanation and how they’re collecting post-marketing data.
• 6:30: Liability concerns practitioners should be aware of with MDMA and current lawsuit types they’re currently seeing, and how to avoid them.
• 8:45: Any litigation concerns we can learn from ketamine as an example (different types of insurance practioners should get to avoid a lawsuit or claim)
• 11:40: Other training considerations to avoid legal issues to be prepared
• 12:30: state and federal regulations that govern MDMA therapy (false start) - start over at 11:45
• 15:30:How state and federal laws intersect, and the significance of trigger laws
• 16:25: How friendly is California to these MDMA developments?
• 16:55: How can practioners make sure they’re within compliance with MDMA laws?
• 18:11: Will the public have an opportunity to chime in with commentary and support for MDMA’s legal status/rescheduling? How to use the public comment system to advocate.
• 19:20: Once rescheduled, what are the rules for purchasing and storing MDMA?
• 21:10: Security concerns
• 21:40: Legal considerations for MDMA therapy compared to other substances - how intense will the regulations be?
• 23:40: Will there be standard operating procedures (SOPs) for uniform standards for psychedelics?
• 25:05: Insurance coverage for psychedelics and CPT codes
• 27:00: Why approving psychedelics for insurance reimbursment saves insurance companies money? The case for covering psychedelics.
• 28:18: What’s the best way to reduce risk and reduce malpractice claims heading into this decade? Details about transporting patients.‍

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Join us in this captivating episode as we explore the transformative potential of psychedelics with our guest, Andrew Penn, a registered Psychiatric Mental Health Nurse Practitioner (NP) and expert in the therapeutic use of psychedelics. We delve into the concept of small psycholytic changes versus monumental breakthrough experiences and the need for further research in this area. Andrew emphasizes the crucial role of set and setting in creating a safe and supportive environment for psychedelic experiences, and discusses the importance of cultivating a sense of safety. 

We also delve into the impact of psychedelics on changing our relationship to illness, particularly depression, and how they can provide a profound sense of interconnectedness. Throughout the episode, Andrew shares practical tips for individuals considering psychedelic therapy, highlights the role of mindset and placebo effects, addresses healthcare inequities, and recommends resources and training programs. Tune in for an enlightening conversation on the transformative power of psychedelics with with Andrew Penn, MS, PMHNP.

Get the full digest of insights here!

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Join us in this riveting podcast as Ben McCauley, the founder of Denovo Therapy, sheds light on the evolution of his Lubbock-based clinic from a single provider to a beacon of hope for the broader community. The episode explores Denovo's commitment to meeting patients where they are and their innovative use of ketamine-assisted therapy, particularly in a conservative community often wary of such treatments. McCauley reveals how the clinic navigates these challenges, maintaining high clinical standards and a cross-disciplinary approach.

Learn about a unique patient's journey and how the innovative use of journaling during treatment sessions contributed to their recovery. Listen as McCauley stresses the importance of patient-directed treatment guided by inner wisdom, safety, and curiosity.

Ben discusses the pivotal role of Osmind's user-friendly Electronic Health Records (EHR) in delivering patient-centered care at Denovo. McCauley shares the process of transitioning from paper to digital records, emphasizing the advantages of home access and easy consent form delivery that Osmind provides.

Glean valuable insights into the future of mental health care, patient-centric approaches, and the unique power of journaling in therapy sessions.

Timestamps from the episode:

• [00:15:00] Introduction of external therapists and Texas Tech students for ketamine-assisted psychotherapy best practice sharing and learning.
• [00:16:00] Discussion on training and consulting, merging therapy and medical model into a psychedelic model, especially in a small conservative town that might not be receptive to ketamine treatments initially.
• [00:22:00] Conversation on the benefits of patients live-journaling during treatment sessions.
• [00:23:00] Follow-up on a patient's journey resolving suicidality, PTSD within a month, and most symptoms in eight months.
• [00:24:00] Emphasis on patient-directed treatment guided by inner wisdom, safety, and curiosity.
• [00:25:00] Highlighting Osmind's role as an easy-to-use electronic health record in care delivery.
• [00:32:00] Encouragement for patients to use the Osmind app for journaling while adjusting to their needs.
• [00:33:00] Dialogue about transitioning from paper to Osmind's electronic health records, including home access and consent form delivery.
• [00:34:00] Further talk on electronic health records transition, consent form reformatting for mobile, and the advantages of letting patients fill forms from home.
• [00:35:00] Process of moving existing patients to an electronic system, including writing summary notes and archiving old records.

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In Psychiatry Tomorrow, we'll delve into the challenges and opportunities that lie ahead. We'll explore the delicate balance between new evidence-generating practices and timeless therapeutic wisdom. Our podcast is not intended to be individual medical advice. 

Rather, our goal is to create a space for critical and in-depth conversations about where the field has been, and make predictions on where it's going. ‍ As we navigate the complexities of this new era for psychiatry, we strive to be a reliable beacon amidst uncertainty—a compass directing you toward the forefront of mental health innovation. We'll bring together thought leaders and mental health professionals advancing the field in groundbreaking ways, from neuromodulation and rapid-acting antidepressants to metabolic psychiatry and psychedelic medicine. We’ll also share practical advice on starting and growing your professional practice to thrive amidst these changes. ‍ As you know, mental health takes a village, and clinical practice doesn’t exist in a vacuum. That’s why we’ll bring panelists together to discuss the broader issues that interact with mental health, from Ai and software applications to cultural policy shifts transforming how we practice. ‍ Together, let's transform mental health care by staying ahead of the curve and engaging in these vital conversations. Follow the Psychiatry Tomorrow podcast on your favorite podcast platform, and join us on this thrilling journey through psychiatry’s next frontier. See you in you the future! ‍ Ready to dive in?

Find your favorite episode, and subscribe to Psychiatry Tomorrow on your favorite podcast platform. That way, you won't miss a new episode!

Behind the Cover: In ancient Greek, the word for butterfly was "psyche," which means the "mind" or "soul."

Just as a butterfly emerges from its cocoon, the state of the butterflies being set free mirrors the journey of withdrawal and depression often experienced by those impacted by mental illness—to emerging anew with potential for change and growth.

In "Psychiatry Tomorrow," we navigate the challenges and opportunities of the future. Our cover art features a statue's head that opens to reveal a renaissance of new perspectives, breaking away from entrenched ways of thinking.

Join us as we explore the ongoing metamorphosis of psychiatric care. Together, we’ll chart psychiatry’s next frontier.

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In this episode, we engage in a nuanced discussion with Dr. Awais Aftab, a leading figure in critical psychiatry, exploring key issues in the field. We distinguish critical psychiatry from "anti-psychiatry," explore the influence of cultural movements on mental health discourse, and discuss the role of service users in advocating for better care. Dr. Aftab shares insights on the role and challenges of crisis hotlines, advocates for a shift in focus of inpatient psychiatric care from risk management to therapeutic outcomes, and discusses the potential and pitfalls of telepsychiatry. Join us as we aim for a more patient-centered approach in mental health care.

What you'll learn in this episode:

• Understanding the landscape of critical psychiatry and contrasting it with the divisive term "anti-psychiatry"
• The role of cultural movements and groups like mad pride, service users, psychiatric survivors—in shaping language around how we conceptualize mental illness
• The role of service users in advocating for better care, especially regarding involuntary hospitalizations and crisis hotlines
• How practicing psychiatrists can move the field forward in a meaningful way 

Dive deeper into these insights in the full blog post (coming soon)

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The "placebo effect" gets a bad rap. The human mind is a powerful thing, capable of incredible feats of healing and transformation. Nowhere is this more evident than in the world of psychedelic research. Dr. Boris Heifets has spent years studying the neurobiological underpinnings of these compounds, but he knows that their true power lies in something much deeper.

In this interview, Dr. Boris Heifets discusses:

•His efforts to understand the neurobiological underpinnings of psychedelics, and how that translates to the future of psychiatry

•The healing power of suggestion (and an amazing first-person account)

•How he uses his knowledge to turn ideas into real-world applications
 

Read the summarized blog post of this interview (originally published in Northern California Psychiatric Society Magazine).

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In this enlightening episode, host Carlene MacMillan, M.D., and guest Brittainy Wagner, LPC, delve into the potential of Esketamine (SPRAVATO®) as a breakthrough solution for treatment-resistant depression and acute suicidality. They explore how to successfully incorporate this novel treatment into your psychiatric practice, despite challenges like navigating the REMS program and understanding complex billing procedures.

Listen in as they provide a deep dive into the essential facets of SPRAVATO®: its function, typical treatment protocol, potential side effects, and the crucial SPRAVATO® REMS program. The episode also covers patient eligibility, crafting a comfortable treatment space, and tips on streamlining REMS administration for your practice.

The conversation doesn't stop there. Carlene and Brittainy also tackle the often perplexing topic of reimbursement, offering insights into the cost of SPRAVATO®, understanding billing codes, and how to navigate Medicaid reimbursement. They also discuss potential financial assistance through the Janssen Carepath program and strategies for dealing with common payer issues.

Finally, they highlight how Osmind EHR's integration with SPRAVATO® REMS program can save hours of administrative work, allowing you to focus on patient care. Tune in to learn how to make offering SPRAVATO® simpler and more profitable.

Read the quick and comprehensive guide to adding SPRAVATO® to your practice here. 

You'll learn:

• What is SPRAVATO® (esketamine)?
• What is the typical treatment protocol for SPRAVATO?
• What are the Potential Side Effects of SPRAVATO®?
• What is the SPRAVATO® REMS program?
• How can you set up a comfortable treatment space?
• How can you streamline REMS administration and protect yourself?
• How do you navigate reimbursement challenges?

Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice