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,...

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,...

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...

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...

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,...

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...

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...

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:...

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...

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...

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,...

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...

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...

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:...

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...

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,”...

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...

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...

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,...

In our two-part series on substance use, we will first discuss drugs of abuse and intoxication/withdrawal syndromes. We’ll provide a conceptual framework for how to differentiate common toxidromes frequently encountered in psychiatry. We’ll then reinforce your knowledge through a series of cases highlighting the clinical presentations of  sedatives, opioids, stimulants, hallucinogens, cannabinoids, and dissociatives. Come on down to the (metaphorical) Burning Man medical tent and learn to...

In the fourth and final episode of our “Art of Psychiatry” series, we will discuss anxiety disorders. We’ll start by discussing the  purpose of anxiety, why it is often a normal reaction to stressful circumstances, and what it looks like when anxiety becomes more maladaptive and functionally impairing. We’ll provide an overview of common anxiety disorders, disclose a few tips on how to interact with patients with anxiety disorders, and discuss how to how to conceptualize anxiety when you are...

In the third episode of our “Art of Psychiatry” series, we will discuss schizophrenia, a chronic mental illness that affects 1% of the population. We will focus especially on the patient experience of what it’s like to live with schizophrenia. We’ll start by reviewing the key symptoms of schizophrenia as well as other diagnoses to consider in your differential. We’ll then discuss what it’s like to interview a patient with schizophrenia and provide some tips for your next interview. As usual,...

In the second episode of our “Art of Psychiatry” series, we will discuss bipolar disorder, a chronic mood disorder that affects 1% of the population. We’ll start by reviewing the diagnostic criteria for bipolar 1 and bipolar 2 disorder. We’ll then spend some time discussing mania, a key feature of bipolar disorder. What is it like to interview a manic patient? What questions should you ask them? What else is on the differential? And what medications are used to treat bipolar disorder? We’ll...