The authors of the famous sequenced treatment alternatives to relieve depression trial or STAR*D reported that about two-thirds or 67% of patients had achieved remission after 4 trials of antidepressant medication.   This remission rate has been questioned over the years and in October of 2023, the journal BMJ Open published an article that reports to have reanalyzed the date from STAR*D using the original study design.  This re-analysis found much much lower rates of remission.  It reported the cumulative remission rate as only 35 percent.  How do two different sets of researchers using the same data set get a result that is just half of what the other researchers reported?  That is the mystery that I report on today.

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References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode is about dopamine.  In episode 32, I discussed the pseudoscientific trend of the “dopamine detox”  or "dopamine fasting."  Instead of talking about pseudoscience in this episode, I discuss the actual science surrounding dopamine and its relationship with the neuroleptics or antipsychotics as they are more commonly known.   The effects and side effects of antipsychotics are related to the function of the major dopamine networks of the brain: the mesolimbic, mesocortical, nigrostriatal, and tuberoinfundibular pathways.  Dopamine levels in each of these pathways can be regulated also by serotonin receptors, and so this episode contains a discussion of how first generation, second generation, and novel antipsychotics affect dopamine by affecting serotonin receptors.

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In this Episode, I  continue an intermittent series called “In A Word.”  The difference between prior episodes and this one is that today I have two words.  I chose these words because I don’t really know the difference between them, and even after reading and trying to understand the difference, I am not sure that there is a clear difference.  The two words are Impulsive and Compulsive.

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

I discuss something  that is likely to present itself to a physician long after the fact: a single mild brain injury.  This episode focuses on how to classify the severity of a single brain injury.  While working in a brain injury unit, I noticed that some providers used the term severe brain injury when referring patients to neurology or neuropsychiatry, and this communicates something very specific that they may not realize they are communicating. Those of us seeing a patient after a brain injury may not know the specific terminology to use, so this episode is meant to help the listener understand how brain injury experts classify these injuries.

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode continues a series on the prefrontal cortex, a complex region of the brain that gives us the ability to have the kinds of thoughts no other species on earth is known to have.   The medial (or mesial) prefrontal cortex is especially important for emotional and autonomic regulation, attention and goal-directed behaviors (including addiction), and building our sense of self (that is our identity as a thing separate from the world around us), and considering salient aspects of the social context we are in and what others might be thinking (among many other things).

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In this episode, I am sliding down and under the front part of the brain and consider the orbital frontal cortex, that part of the brain right above and a little behind your eyes.  It is much smaller than the lateral gyri on the prefrontal cortex, but appears to be an important probability generator in our brain when we need to consider different options that can result in different rewards or in order to avoid aversive stimuli.  The most basic kinds of rewards that neuroscientists can study are for food, because lab animals will respond to those, and while the OFC is definitely intimately related to food, in humans, its powers of prognostication are much more generalized.

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

We seem to understand the specializations of the the dorsolateral prefrontal cortex on the left better than the right side of our brain.  That is because most of us do a lot more language processing on the left or dominant side.  The more inferior and caudal parts of the dorsolateral PFC on the left side are more specialized for speech.  The more superior parts are more involved in working memory, attention control, and task switching.  The entire DLPFC is extensively connected to other cortical regions that pass information to it for consideration, and the DLPFC is extensively connected to the supplementary and motor regions that help to plan actions, and the striatum, which helps coordinate those actions.   It is also intimately involved with motivation and helps us to control our emotions.

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Besides being relatively hairless apes, there are some things about humans that make us special among animals.  In the past we have noted things like, “We have big brains and we use tools,” or “We contemplate the future and our own mortality,” or “We use a truly complex language both verbal and written to communicate complex ideas.”  These are things we have and do, but what is it about our brains that makes that possible.  More and more we are identifying crucial hubs or nodes within our brain that specialize in various tasks, but none of these work alone. I am going to start by discussing that big blob of gooey mush on the front of our brains called the prefrontal cortex, and in subsequent episodes, I will discuss how these regions function in tandem with deeper structures within the brain to create what we think of when we say “human.”

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode is about how to decide whether to send a patient to get neuropsychological or just psychological testing, and this decision is determined by at least two things.  The first is the question that you are trying to answer.   The second  is, what can the service that I am referring to provide for the patient?  In this episode, I will focus primarily on the first consideration:  the question that you are asking.  As a referring provider, then, it is helpful to know what kinds of tests a psychologist or neuropsychologist can administer, because these are designed to answer very specific questions. 

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Today I discuss the term “validity.”  Let’s say we wanted to develop a test that identifies pathological character traits or quantifies depression symptom burden on a patient.  A good test is going to do more than simply list the diagnostic criteria for various diagnoses and then ask the patient if they think that sounds like them.  A test needs to have a few things.  First it needs to have a defined purpose.  Is it to be used for diagnosis in a clinic or for research?  Is it going to measure symptoms in already diagnosed patients and track their response to therapy?  Is it meant to predict if a person would be a good candidate for something like being an astronaut or a member of the military?  Once the purpose is determined, then you need to define something called a construct, and then you have to determine the validity of that construct.

Please leave feedback at https://www.psydactic.com or send any comments to [email protected].

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.