In Part 2 of our Listener Requests series, we will cover a variety of topics that will hopefully be of interest to you, our listeners! The topics included in this series were suggested topics from listeners who e-mailed, tweeted, or gave us feedback on our Facebook page or website. In this episode, we will discuss how to give an oral case presentation, antipsychotic metabolic monitoring guidelines and management, and deprescribing medications.







Photo Credit: Cuba Gallery, “black and white,” flickr



Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In our new Listener Requests series, we will cover a variety of topics that will hopefully be of interest to you, our listeners! The topics included in this series were suggested topics from listeners who e-mailed, tweeted, or gave us feedback on our Facebook page or website. In this episode, we will discuss designer (or synthetic) drugs and prescribing off-label medications.







Photo Credit: Barry Lewis, “One From My Dad-4490,” flickr



Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music



Sound Effects Credits:



https://freesound.org/people/kwahmah_02/sounds/261597/



https://freesound.org/people/felix.blume/sounds/385947/



https://freesound.org/people/mlteenie/sounds/169233/



https://freesound.org/people/Timbre/sounds/73750/

In the final episode of our personality disorder series, we will dig deeper into cluster C personality disorders. We’ll review the three cluster C personality disorders (avoidant, dependent, and obsessive compulsive) and specifically focus on effective communication strategies to use when working with these patients. Using a few different clinical examples, we’ll highlight both helpful and less helpful ways to interact with patients who have cluster C personality disorders.







Photo credit: Jeremy Brooks, “Fail to Understand,” Flickr



Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In this episode of our personality disorder series, we will dig deeper into cluster B personality disorders. Many clinicians struggle working with patients who have cluster B personality disorders since they can trigger very intense emotional reactions in the providers who care for them! We’ll discuss the importance of cultivating empathy and describe common challenges when working with this group of patients. We’ll then focus on effective communication strategies to use when working with patients who have cluster B personality disorders or traits. Using a clinical example, we’ll highlight both helpful and less helpful ways to interact with patients who have cluster B personality disorders.







Photo credit: Ed Scott Livingston, “Frantic,” Flickr



Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In this episode of our personality disorder series, we will dig deeper into cluster A personality disorders. We’ll specifically focus on effective communication strategies to use when working with these patients. Using a clinical example, we’ll highlight both helpful and less helpful ways to interact with patients who have cluster A personality disorders.







Photo credit: Tydence Davis, “Cactus and moonlight,” Flickr



Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

What is the difference between a personality and a personality disorder? When do personality disorders arise, and what do they look like?  In our new series on personality disorders, we’ll discuss all of this and more. We’ll review the 3 personality clusters (cluster A, cluster B, and cluster C) and describe the 10 different personality disorders included in those clusters. We won’t just list off the DSM criteria here…We’ll give some vivid examples of each of the personality disorders to help you to differentiate them in clinical practice.

Photo credit: Dimity B., “Boy with Alexander Calder Sculpture,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the final episode of our Picture This series on the Netflix series 13 Reasons Why, we discuss how to talk about suicide at both the individual and societal level. We’ll discuss how characters in the show react to Hannah’s  mental health crisis and then explore strategies for what to do when someone discloses suicidal thoughts to you. We’ll also examine the public health reaction and controversy around the series 13 Reasons Why, focusing especially on the concerns raised about the depiction of Hannah’s death. We’ll discuss how the show has influenced national discourse on mental health and suicide, examining both its helpful and potentially harmful effects on more vulnerable viewers.

Photo credit: Darren Finders, “Abandoned- RAF Steingot Lincolshire,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the second episode of our Picture This series, we will use the Netflix series 13 Reasons Why as a vehicle for exploring and understanding reactions to suicide. The characters in the show have a wide range of reactions to suicide, which span from anger to grief to altruism. We discuss these different reactions in the show and explore their meaning. We also discuss the concept of violent death, how it differs from natural death, and how it impacts the grieving process.

Photo credit: Tydence Davis, “Cactus and moonlight,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the first episode of our Picture This series, we will use the Netflix series 13 Reasons Why as a vehicle for discussing and understanding suicide. Why do people die by suicide or engage in suicidal behaviors? We will discuss several main theories including the interpersonal theory of suicide, Linehan’s theory of suicidal behavior, and Beck’s cognitive theory of suicide. We will also review chronic risks factors for suicide and psychological warning signs that suggest an individual is at high risk of suicide.

Photo credit: Can Birand, “Window closes, shock rolls over in a tide wave,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

Check out the “trailer” for our upcoming new miniseries “Picture This.” There are tons of movies, songs, books, and other media that talk about mental health. We are going to discuss and analyze some of them from a psychiatric perspective. First up is 13 Reasons Why, a TV miniseries made by Netflix based on a novel by Jay Asher. Hope you will listen in!

In the final episode of our second psychopharmacology series, we will discuss how to manage antipsychotic side effects. Side effects are quite common for patients taking antipsychotics unfortunately. Knowing how to manage common antipsychotic side effects is incredibly valuable for your patients as it can improve tolerability and treatment compliance. We’ll provide a broad overview for how to conceptualize the treatment of side effects based on which receptors are targeted by the drug. We’ll discuss general principles for managing side effects and then review how to manage specific side effects including extrapyramidal symptoms, hyperprolactinemia, metabolic syndrome, orthostatic hypotension, and more!

Photo Credit: Hernan Pinera, “Move,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In today’s episode of our psychopharmacology series, we will discuss insomnia and treatments for insomnia. Most of the time, sleep medications are not the solution for addressing insomnia! We’ll briefly describe cognitive behavioral therapy for insomnia (CBT-I), which is THE first line treatment for insomnia.  We will then review 6 different classes of medications used to treat insomnia including benzodiazepines, non-benzodiazepine sedative hypnotics (i.e. Z-drugs), melatonin agonists, TCAs, orexin receptor antagonists, and miscellaneous non-FDA approved medications for insomnia. We’ll discuss the evidence base for these medications in treating chronic insomnia (hint: it’s not good) and what factors might make you choose behavioral treatment versus medications. We’ll then review common side effects of sleep medications and test your clinical reasoning with some cases!

Photo Credit: Joao Santos, “Smooth Antelope Canyon b&w,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In today’s episode, we will discuss benzodiazepines, a commonly used type of sedative-hypnotic medication. We will start by reviewing their mechanism of action, common indications for use, contraindications for use, and side effects. We’ll also discuss how to differentiate benzodiazepines based on their unique pharamacologic properties. Finally, we’ll explore some of the controversy around benzodiazepines, particularly in the treatment of chronic anxiety or insomnia, and provide some general guidelines to consider before prescribing these medications to patients.

Photo Credit: Juan Carlos Molina Gimenez, “Ice and Geometry,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music
The Rolling Stones, “Mother’s Little Helper,” Forty Licks

We are revisiting psychopharmacology in our second psychopharm series. We will kick things off by talking about the “older antidepressants”- tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). While these medications are used less frequently than SSRIs due to their side effect profiles, both TCAs and MAOIs have their select uses in psychiatry (i.e. treatment resistant depression or comorbid pain). We’ll discuss the history behind TCAs and MAOIs, their respective mechanisms of action, common class side effects, and specific medications within each class. We’ll also review unique considerations with MAOIs (including dietary restrictions, hypertensive crisis, and serotonin syndrome) and TCAs (including cardiac toxicity in overdose).

Photo Credit: CiaoHo, “DSC_4598,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the second episode of our series on somatic treatments in psychiatry, we will discuss transcranial magnetic stimulation, otherwise known as TMS. TMS is a newer procedure used to treat depression and represents an alternative to medications and ECT. We will review the mechanism of action for TMS, what is entailed in the procedure, indications for TMS, medical contraindications, and potential side effects.

Photo Credit: Jeremy Brooks, “Anti-Mass, Plate 1,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the first episode of our series on somatic treatments in psychiatry, we will discuss electroconvulsive therapy, otherwise known as ECT. ECT is one of the few procedures used in psychiatry. Despite its excellent safety record and remarkable efficacy for treating many psychiatric disorders, there is still significant stigma around ECT. We’ll dispel some of the myths around ECT and explain how ECT differs from the sensationalized portrayals of ECT in the media. We’ll discuss its uses in psychiatry, focusing particularly on treatment-resistant depression. We’ll also review the medical evaluation in ECT and side effects of ECT including general medical risks and cognitive side effects.

Photo Credit: Thomas Hawk, “I Think I’ll Park It Here,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the final episode of our psychotherapy series, we will discuss cognitive behavioral therapy (CBT).  We’ll review the cognitive triangle and illustrate how our thoughts, behaviors, and feelings influence one another using a hypothetical scenario.  Finally, we’ll discuss the rationale behind key CBT concepts and techniques including monitoring, behavioral activation, relaxation, exposure, cognitive errors, and cognitive restructuring.

Photo Credit: Kaisea, “Retail Therapy,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

In the second episode of our psychotherapy series, we will discuss supportive and psychodynamic therapy. To illustrate principles of supportive and psychodynamic therapy, we will do a role play and then afterward, use the role play to explore the difference between supportive and dynamic approaches to the situation. We will discuss how to use reflections and validations in your interviews with patients, and we will also explore key concepts in psychodynamic therapy including defense mechanisms, transference, countertransference, and more!

Photo Credit: Ming Chun Or, “Or week 2 06–Cut off,” Flickr
Episode Music Credit: Javier Suárez, Tumbling Dishes, Better With Music

In the first episode of our miniseries on psychotherapy, we will provide an introduction to psychotherapy, one of psychiatry’s most powerful and misunderstood tools. We will discuss common misconceptions about therapy and provide you with a clear picture of what psychotherapy is and what it isn’t. We’ll discuss who goes to therapy, how to access therapy, and the most common therapeutic frameworks used in therapy including supportive/psychodynamic, CBT, DBT and ACT. Finally, we’ll identify common factors that are universal to all psychotherapies.

Photo Credit: micaeh, “sit in,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music

Now that we can identify common intoxication/withdrawal syndromes, we will shift our focus to substance use treatment in the second part of our two-part series on substance use. While therapies are a huge part of substance use treatment, we will primarily discuss medication management of withdrawal and relapse prevention. By the end of this episode, you will have a better sense of how to manage withdrawal and prevent relapse for patients with alcohol, benzodiazepine, nicotine, stimulant, opioid, cannabis, and hallucinogen use disorders. We’ll also highlight key medications that have been used to fight the opioid epidemic including suboxone, methadone, naltrexone, and naloxone.

Photo Credit: Curtis Simmons, “the monaco-sails-into sandstorm-burning-man-2014,” Flickr
Episode Music Credits: Javier Suárez, Tumbling Dishes, Better With Music