Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to consultation-liaison psychiatry with Dr. Raed Hawa and Dr. Alan Wai, both from the University of Toronto. Dr. Raed Hawa is an esteemed CL psychiatrist and educator. Dr Hawa's interests are in the areas of undergraduate, postgraduate, and continuing medical education. He also practices general sleep medicine with particular clinical interest in the areas of insomnia, co-morbid psychiatric and medical illnesses, and sleep-related movement disorders. He currently serves as the President of the Canadian Academy of Consultation-Liaison Psychiatry (CACLP) and holds the position of Professor at the Faculty of Medicine, University of Toronto. Additionally, Dr. Hawa is the Deputy Psychiatrist-in-Chief at the Centre for Mental Health, University Health Network. Dr. Hawa has earned American Board Certification in Psychiatry, with subspecialty certifications in Sleep Medicine and Psychosomatic Medicine (Consultation-Liaison Psychiatry). His expertise and contributions to the field have been recognized through his designation as a Distinguished Fellow of both the American Psychiatric Association (APA) and the Canadian Psychiatric Association (CPA). Dr. Alan Wai is a psychiatrist at the University Health Network in Toronto and an Assistant Professor in the Department of Psychiatry at the University of Toronto. He provides inpatient CL psychiatry care and mental health and psychiatric care embedded in the Immunodeficiency Clinic at Toronto General Hospital, where he sees both persons living with and at risk of HIV. He received his medical degree from the University of British Columbia and completed his psychiatric residency training at the University of Toronto. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Outline the history and evolution of CL psychiatry Define the role and scope of CL psychiatrists in diverse medical settings Identify and assess common psychiatric disorders in CL settings Provide differential diagnoses and a general approach to a CL patient through a sample case Guests: Dr. Raed Hawa and Dr. Alan Wai Hosts: Annie Yu (PGY3), Sena Gok (MD), and Matthew Cho (CC3) Audio editing by: Sena Gok Show notes by: Sena Gok Interview content: Introduction - 00:13 Learning objectives - 01:09 First guest introduction - 01:36 History of CL psychiatry - 03:18 Subspecialties within CL psychiatry - 10:33 Collaborative care of CL psychiatry - 14:00 Preparation for CL Rotation - 20:03 Bariatric clinic and CL psychiatry - 22:32 Future of CL psychiatry, AFC Certification - 27:45 Second guest introduction - 33:29 Role and scope of CL psychiatry - 34:18 A day in CL psychiatry - 39:32 Cultural competence in CL psychiatry - 44:08 Introduction to patients in CL clinics - 47:53 Resources for CL psychiatry rotation - 50:14 Clinical vignette - 53:08 CL psychiatric assessment approach - 01:00:25 Agitation management in CL psychiatry - 01:09:24 Closing - 01:13:51 End credits - 01:15:05 Resources: Massachusetts General Hospital Handbook of General Hospital Psychiatry: https://www.sciencedirect.com/book/9781437719277/massachusetts-general-hospital-handbook-of-general-hospital-psychiatry Academy of CL Psychiatry (ACLP) educational resources: https://www.clpsychiatry.org/educationcareers/ AFC (Area of Focused Competence) in CL Psychiatry: https://news.royalcollege.ca/en/eligibility-and-exams/areas-of-focused-competence.html Canadian Academy of Consultation-Liaison Psychiatry website: https://www.clpsychiatry.ca Our previous CL psychiatry-related episodes: PsychEd Episode 22: Psycho-Oncology Assessments with Dr. Elie Isenberg-Grzeda PsychEd Episode 35: Pain Psychiatry with Dr. Leon Tourian PsychEd Episode 36: Understanding Eating Disorders with Dr. Randy Staab PsychEdEpisode 37: Treating Eating Disorders with Dr. Randy Staab PsychEd Episode 57: HIV Psychiatry with Dr. Adriana Carvalhal and Dr. Leigh van den Heuvel References: Ali, S., Ernst, C., Pacheco, M., & Fricchione, G. (2006). Consultation-liaison psychiatry: How far have we come? Current Psychiatry Reports, 8(3), 215–222. https://link.springer.com/article/10.1007/s11920-006-0026-y Beran, C., & Sowa, N. A. (2021). Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision. Journal of the Academy of Consultation-Liaison Psychiatry, 62(2), 186–192. https://pubmed.ncbi.nlm.nih.gov/33288272 Lipowski, Z. J. (1974). Consultation-Liaison Psychiatry: An Overview. American Journal of Psychiatry, 131(6), 623–630. https://doi.org/10.1176/ajp.131.6.623 Lipowski, Z. J. (1992). Consultation-liaison psychiatry at century’s end. Psychosomatics, 33(2), 128–133. https://doi.org/10.1016/S0033-3182(92)71988-4 Swenson, J. R., Abbey, S., & Stewart, D. E. (1993). Consultation-liaison psychiatry as a subspecialty. A Canadian survey. General Hospital Psychiatry, 15(6), 386–391. https://doi.org/10.1016/0163-8343(93)90007-b Taylor, G., & Doody, K. (1979). Psychiatric Consultations in a Canadian General Hospital. The Canadian Journal of Psychiatry, 24(8), 717–723. https://doi.org/10.1177/070674377902400803 For more PsychEd, follow us on Instagram (@psyched.podcast), X (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we discuss the practice of involuntary hospitalization (also referred to as involuntary commitment or certification) with two special guests and fellow podcast creators — Jesse Mangan and Dr. Jim McQuaid. Their podcast, Committable, focuses on the topic of involuntary commitment and features stories from people with lived experience as a window into complex conversations with attorneys, physicians, psychologists, and more. Jesse Mangan is the producer of Committable and someone who has experienced involuntary hospitalization. Dr. Jim McQuaid is an Associate Professor of Sociology at Framingham University. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Appreciate the individual and societal functions of involuntary hospitalization Understand the potential benefits and risks associated with involuntary hospitalization from the perspective of health care professionals as well as service users and the community at large Describe actions you can take as a practitioner (who has the power to certify) that may better serve your community and those you care for Identify meaningful ways to continue the conversation about these issues in medical education or training and beyond *This episode was recorded in 2021. Through a saga involving lost and recovered audio files, we’re thrilled to finally be able to release it, and believe that the topic is just as timely and relevant as ever! Guests: Jesse Mangan and Dr. Jim McQuaid Hosts: Anita Corsini, Nikhita Singhal, Gray Meckling, and Alex Raben Audio editing by: Nikhita Singhal Show notes by: Nikhita Singhal Interview content: Introduction - 00:34 Committable podcast trailer - 01:52 Guest introductions - 04:26 Learning objectives - 07:22 Defining terms and setting the context - 08:11 Jesse’s experience - 12:03 Exploring the functions of involuntary hospitalization - 23:06 Power differentials and the importance of humility - 41:05 Training considerations - 45:18 False divide between patients and providers - 51:39 Primary prevention and public health - 55:57 Professional identity formation - 57:57 Societal functions and processes - 01:05:00 Building trust - 01:11:57 Legal safeguards - 01:20:20 Alternative approaches/systems - 01:30:11 Rosenhan experiment - 01:37:12 Final thoughts - 01:39:21 End credits - 1:43:50 Resources: Committable podcast website: https://sensiblenonsense.squarespace.com PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer On Being Sane in Insane Places References: Jaeger S, Hüther F, Steinert T. Refusing medication therapy in involuntary inpatient treatment—a multiperspective qualitative study. Front Psychiatry. 2019 May 9;10:295. https://doi.org/10.3389%2Ffpsyt.2019.00295 Johansson IM, Lundman B. Patients' experience of involuntary psychiatric care: good opportunities and great losses. J Psychiatr Ment Health Nurs. 2002 Dec;9(6):639-47. https://doi.org/10.1046/j.1365-2850.2002.00547.x McGuinness D, Murphy K, Bainbridge E, Brosnan L, Keys M, Felzmann H, Hallahan B, McDonald C, Higgins A. Individuals' experiences of involuntary admissions and preserving control: qualitative study. BJPsych Open. 2018 Nov 16;4(6):501-509. https://doi.org/10.1192%2Fbjo.2018.59 Ontario Hospital Association. A Practical Guide to Mental Health and the Law, Fourth Edition. Toronto: Ontario Hospital Association; 2023. Available from: https://www.oha.com/Legislative%20and%20Legal%20Issues%20Documents1/A%20Practical%20Guide%20to%20Mental%20Health%20and%20the%20Law%2c%20Fourth%20Edition%2c%202023.pdf Paksarian D, Mojtabai R, Kotov R, Cullen B, Nugent KL, Bromet EJ. Perceived trauma during hospitalization and treatment participation among individuals with psychotic disorders. Psychiatr Serv. 2014 Feb 1;65(2):266-9. https://doi.org/10.1176%2Fappi.ps.201200556 Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):250-8. https://doi.org/10.1126/science.179.4070.250 Sposini FM. Confinement and certificates: consensus, stigma and disability rights. CMAJ. 2020 Nov 30;192(48):E1642-E1643. https://doi.org/10.1503/cmaj.201750 For more PsychEd, follow us on Instagram (@psyched.podcast), X (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Antipsychotic Side Effects with our very own expert Dr Alex Raben, a staff psychiatrist in chronic care at the Centre for Addiction and Mental Health in Toronto. Dr. Raben graduated from medical school and completed residency at the University of Toronto. His academic interests include teaching and medical education scholarship with a particular interest in novel modalities of knowledge translation within the field of psychiatry. He is a founding member and Executive Director of PsychEd, this educational psychiatry podcast which aims to empower medical learners to seek out current knowledge from mental health experts to share with their colleagues around the world. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Outline the side effects of antipsychotics and their known/potential mechanisms Discuss management options for the different side effects Identify which antipsychotics are more likely to cause certain side effects Guest: Dr Alex Raben Hosts: Angad Singh and Kate Braithwaite Audio editing by: Angad Singh Show notes by: Angad Singh and Kate Braithwaite Interview Content: Introduction - 0:00 Primer on antipsychotics - 1:54 Anti-dopamine side effects - 5:04 Drug potency as it relates to side effects - 38:46 Anticholinergic side effects - 41:37 Antiadrenergic side effects - 47:30 Metabolic side effects - 50:29 Sedation - 56:46 Please note that this episode does not include a discussion of the life threatening side effects of antipsychotics. These include neuroleptic malignant syndrome, torsades de pointes, laryngospasm, and seizure. Resources: PsychEd Episode 10: Treatment of Schizophrenia Part II with Dr. Albert Wong — PsychEd Podcast PsychEd Episode 60: Metabolic Psychiatry with Dr. Cindy Calkin – Psyched Podcast AIMSExtendedSample - YouTube Anticholinergic Mnemonics: Toxicology Mnemonic Challenge • LITFL • Toxicology Conundrum References: de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC psychiatry. 2016;16:1-0. Migirov A, Datta AR. Physiology, Anticholinergic Reaction. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546589/ Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3-7. PMID: 16001094; PMCID: PMC487011. Roerig JL, Steffen KJ, Mitchell JE. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS drugs. 2011;25:1035-59. Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press; 2021. Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-56. For more PsychEd, follow us on Instagram (@psyched.podcast), Twitter (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to forensic psychiatry with Dr. Amina Ali, a forensic psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. Dr. Ali joined the Forensic Division at CAMH in 2018. She is an Assistant Professor in the Department of Psychiatry at the University of Toronto. Prior to joining CAMH, Dr. Ali received her Doctor of Medicine at the American University of the Caribbean, completed her Psychiatry residency at the Icahn School of Medicine at Mount Sinai in New York, and fellowship in Forensic Psychiatry at the Albert Einstein College of Medicine. Dr. Ali's leadership experience includes serving as Chief resident during her residency, for which she was bestowed a Residency Leadership Award from the Bronx Lebanon Hospital Center. She is a Competence By Design coach to residents and serves on the Psychiatry Competency Committee and as a CaRMS file reviewer for the University of Toronto General Psychiatry Residency Program. She is also a supervisor for forensic residents and sits on the subspecialty resident committees. Within the forensic division, Dr. Ali has contributed to the organization and implementation of the Summer Studentship in Forensic Psychiatry Program and is our Medical Education and Wellness Lead. Internationally, Dr. Ali was appointed to serve on the American Academy of Psychiatry and the Law Education Committee and most recently recruited to Chair their Civil Commitment and Consent to Treatment Working Group. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Describe the role of forensic psychiatry and its relation to the Ontario Review Board. Outline the criteria for fitness to stand trial. Describe the function and possible outcomes of a treatment order. Outline the criteria for not criminally responsible on account of a mental disorder. Distinguish between the disposition options available under the Ontario Review Board. Demonstrate an enhanced ability to advocate for and support patients in navigating the forensic psychiatric system. Guest: Dr. Amina Ali Hosts: Alexander Simmons (PGY3), Kate Braithwaite (MD), and Rhys Linthorst (PGY5) Audio editing by: Gaurav Sharma (PGY5) Show notes by: Alexander Simmons (PGY3) References: Crocker, A. G., Nicholls, T. L., Seto, M. C., Charette, Y., Cote, G., Caulet, M. (2015). The National Trajectory Project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: the people behind the label. The Canadian Journal of Psychiatry, 60(3), 106-116. Prpa, T., Moulden, H. M., Taylor, L., Chaimowitz, G. A. (2018). A review of patient-level factors related to the assessment of fitness to stand trial in Canada. International Journal of Risk and Recovery, 1(2), 16-22. Carroll, A., McSherry, B., Wood, D., & Yannoulidis, LLB, S. (2008). Drug‐associated psychoses and criminal responsibility. Behavioral sciences & the law, 26(5), 633-653. Watts, J. (2013). Updating toxic psychosis into 21st-century Canadian: Bouchard-Lebrun v. R. Journal of the American Academy of Psychiatry and the Law Online, 41(3), 374-381. Crocker, AG, Nicholls, TL, Seto, MC, Cote, G, Charette, Y, Caulet, M. The national trajectory project of individuals found not criminally responsible on account of a mental disorder in Canada, Part 1: Context and methods. Canadian Journal of Psychiatry. 2015;60(3):98-105. Schneider, RD. Mental health courts. Current Opinion in Psychiatry. 2008;21:510-513. https://www.orb.on.ca/scripts/en/about.asp#dispositions For more PsychEd, follow us on X (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode introduces the field of metabolic psychiatry, with a focus on patients with severe mental illness and metabolic syndrome. Our guest is Dr. Cindy Calkin, an Associate Professor in the Department of Psychiatry and Department of Neuroscience at Dalhousie University in Nova Scotia. Dr. Calkin has been a pioneer in the field of metabolic and neuroendocrine disorders in patients with bipolar disorder. Her research interests include examining the effects of obesity, insulin resistance and type II diabetes on the clinical course and outcomes in bipolar disorder. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to…  Describe the burden of metabolic syndrome in the population with severe mental illnesses Explain reasons for the comorbidity between metabolic syndrome and severe mental illness Identify biopsychosocial strategies to prevent or treat metabolic conditions in this population Guest: Dr. Cindy Calkin Hosts: Angad Singh, Gaurav Sharma, and Sara Abrahamson Audio editing by: Gaurav Sharma Show notes by: Sara Abrahamson & Gaurav Sharma  Conflicts of interest: Neither our guest nor hosts for this episode have declared any conflicts of interest related to this topic. Interview content: 0:00 - Introduction 00:54 - Learning objectives 01:37 - Dr. Calkin’s career trajectory 9:45 - Describing the burden of metabolic syndrome in severe mental illness 14:16 - What is the relationship between metabolic syndrome and severe mental illness 25:23 - Why is metabolic syndrome underdiagnosed in severe mental illness 27:56 - How to measure and monitor insulin resistance in clinical practice 32:44 - How stigma impacts treatment of metabolic syndrome in the mentally ill 34:02 - Lifestyle interventions for metabolic syndrome in the mentally ill 37:06 - Medication interventions for metabolic syndrome in the mentally ill 39:44 - Directions for future research in the metabolic psychiatry 41:48 - Episode summary References: Bai, Y.-M., Li, C.-T., Tsai, S.-J., Tu, P.-C., Chen, M.-H., & Su, T.-P. (2016). Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry, 16(1), 448–448. https://doi.org/10.1186/s12888-016-1143-8 Calkin, C., Kamintsky, L., & Friedman, A. (2022). Reversal of insulin resistance is associated with repair of blood-brain barrier dysfunction and remission in a patient with treatment-resistant bipolar depression. Bipolar Disorders, 24(5), 553-555. https://doi.org/10.1111/bdi.13199 Calkin, C. V., Ruzickova, M., Uher, R., Hajek, T., Slaney, C. M., Garnham, J. S., ... & Alda, M. (2015). Insulin resistance and outcome in bipolar disorder. The British Journal of Psychiatry, 206(1), 52-57. https://doi.org/10.1192/bjp.bp.114.152850 Giménez-Palomo, A., Gomes-da-Costa, S., Dodd, S., Pachiarotti, I., Verdolini, N., Vieta, E., & Berk, M. (2022). Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review. Neuroscience and Biobehavioral Reviews, 132, 142–153. https://doi.org/10.1016/j.neubiorev.2021.11.026 Ho, C. S., Zhang, M. W., Mak, A., & Ho, R. C. (2014). Metabolic syndrome in psychiatry: advances in understanding and management. Advances in psychiatric treatment, 20(2), 101-112. https://doi.org/10.1192/apt.bp.113.011619 Leboyer, M., Godin, O., Llorca, P. M., Aubin, V., Bellivier, F., Belzeaux, R., Courtet, P., Costagliola, D., Dubertret, C., M’Bailara, K., Haffen, E., Henry, C., Laouamri, H., Passerieux, C., Pelletier, A., Polosan, M., Roux, P., Schwan, R., Samalin, L., … Etain, B. (2022). Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort. Journal of Affective Disorders, 307, 149–156. https://doi.org/10.1016/j.jad.2022.03.053 Stogios, N., Humber, B., Agarwal, S. M., & Hahn, M. (2023). Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Current Psychiatry Reports, 25(11), 707-721. https://doi.org/10.1007/s11920-023-01458-0 Vancampfort, D., Vansteelandt, K., Correll, C. U., Mitchell, A. J., De Herdt, A., Sienaert, P., Probst, M., & De Hert, M. (2013). Metabolic Syndrome and Metabolic Abnormalities in Bipolar Disorder: A Meta-Analysis of Prevalence Rates and Moderators. The American Journal of Psychiatry, 170(3), 265–274. https://doi.org/10.1176/appi.ajp.2012.12050620 Ventriglio, A., Gentile, A., Stella, E., & Bellomo, A. (2015). Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management. Frontiers in Neuroscience, 9, 297–297. https://doi.org/10.3389/fnins.2015.00297 For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the field of critical psychiatry with Dr. Elia Abi-Jaoude and Lucy Costa. Dr. Abi-Jaoude is a staff psychiatrist at The Hospital for Sick Children and Assistant Professor and Clinician Investigator in the Department of Psychiatry at the University of Toronto in Toronto, Canada. Lucy Costa is Deputy Executive Director of the Empowerment Council, a voice for clients of mental health and addiction services primarily at the Centre for Addiction and Mental Health in Toronto.   While this topic could be very philosophical and expansive, we are going to focus our discussion by considering the practical implications of this field on psychiatric practice. What do you need to know about critical psychiatry as a trainee, and how might it impact your clinical practice?   The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Define the term critical psychiatry and describe how the field has evolved over time Review core principles of critical psychiatry and apply them to a clinical situation Understand the potential benefits and harms of critical psychiatry and where the field is headed   Guests: Dr. Eila Abi-Jaoude and Lucy Costa   Hosts: Dr. Gaurav Sharma (PGY5), Dr. Nikhita Singhal (PGY5), Dr. Monisha Basu (PGY2), and Saja Jaberi (IMG)   Audio editing by: Gaurav Sharma   Show notes by: Gaurav Sharma and Nikhita Singhal   Conflicts of interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Interview content: Introduction - 00:13 Learning objectives - 02:35 Defining critical psychiatry - 03:33 How our experts got involved in critical psychiatry and incorporate it into their work - 04:50 What are some of the questions critical psychiatry tries to answer? - 15:07 Why care about critical psychiatry and “holding truths lightly”? - 23:55 Principles of critical psychiatry - 24:55 Applying critical psychiatry principles to a case - 32:40 Potential benefits and harms of a critical psychiatry approach - 41:49 Future directions for critical psychiatry - 58:29 Review of learning objectives and summary - 1:01:30 End credits - 1:03:17   Resources: Critical Psychiatry Textbook Restoring Study 329  Psych Debate 14 | Critical Psychiatry and Diagnosis   References: Barkil-Oteo A. Collaborative care for depression in primary care: how psychiatry could "troubleshoot" current treatments and practices. Yale J Biol Med. 2013 Jun 13;86(2):139-46. Craddock N, Mynors-Wallis L. Psychiatric diagnosis: impersonal, imperfect and important. The British Journal of Psychiatry. 2014;204(2):93-95. doi:10.1192/bjp.bp.113.133090 Kirsch I. The emperor's new drugs: medication and placebo in the treatment of depression. Handb Exp Pharmacol. 2014;225:291-303. doi:10.1007/978-3-662-44519-8_16 Middleton H, Moncrieff J. Critical psychiatry: a brief overview. BJPsych Advances. 2019;25(1):47-54. doi:10.1192/bja.2018.38 O'Donoghue T, Crossley J. A critical narrative analysis of psychiatrists' engagement with psychosis as a contentious area. Int J Soc Psychiatry. 2020 Nov;66(7):724-730. doi: 10.1177/0020764020934516 Samara MT, Dold M, Gianatsi M, et al. Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia: A Network Meta-analysis. JAMA Psychiatry. 2016;73(3):199–210. doi:10.1001/jamapsychiatry.2015.2955   Important figures in the history of anti-psychiatry and critical psychiatry (discussion edited from episode for length): Anti-Psychiatrists: R. D. Laing (UK) Thomas Szasz (USA) Michel Foucault (France)   Critical Psychiatrists: Joanna Moncrieff (UK) Suman Fernando (UK) Sami Tamini (UK) Pat Bracken (UK) Derek Summerfield (UK) Sandra Steinguard (USA) Critical Psychiatry Network  (International Email List)   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto.   Dr. Courtney earned his MD in 2004 at Queen’s University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth.   Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Outline the prevalence and risk factors for depression in children and adolescents Explain how children and adolescents with depression present in clinical practice Discuss the use of screening tools for depression in this population Describe an approach to the management of depression in children and adolescents Outline the management of an adolescent with suicidal thoughts or behaviours   Guest: Dr. Darren Courtney Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5) Audio editing by: Nikhita Singhal Show notes by: Kate Braithwaite and Nikhita Singhal   Interview Content: Introduction - 0:00 Learning objectives - 02:11 Prevalence of depression in youth - 03:11 Risk factors for depression in youth - 06:25 Diagnosing depression in youth - 08:30 Screening tools - 14:24 Approach to taking a history from youth - 19:45 Management of depression in youth - 30:12 Psychotherapies - 33:20 Medications - 37:37 Assessing and managing suicidality in youth - 44:00 Measurement based care - 51:00 Final thoughts - 55:10   Resources: Previous PsychEd episodes: PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer ICHOM Set of Patient-Centered Outcome Measures for Children & Young People with Depression & Anxiety Screening tools/rating scales: Revised Children's Anxiety and Depression Scale (RCADS) Mood and Feelings Questionnaire (MFQ) NICE guideline: Depression in children and young people: identification and management NICE guideline: Self-harm: assessment, management and preventing recurrence The CARIBOU Pathway by CAMH: A youth-centered program for the treatment of depression Includes links to download free clinician-specific and youth-specific resources co-developed with youth and mental health clinicians Clinical Innovations and Tools | Cundill Centre for Child and Youth Depression | CAMH Includes links to various tools for health care providers, researchers, youth, and other stakeholders (such as teachers and family members) informed by research evidence   References: Bennett K, Courtney D, Duda S, Henderson J, Szatmari P. An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth. Depress Anxiety. 2018 Jun;35(6):530-540. https://doi.org/10.1002/da.22752 Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry. 2020 Aug;14(4):486-494. https://doi.org/10.1111/eip.12918 Georgiades K, Duncan L, Wang L, Comeau J, Boyle MH; 2014 Ontario Child Health Study Team. Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Can J Psychiatry. 2019 Apr;64(4):246-255. https://doi.org/10.1177%2F0706743719830024 Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess. 2017 Mar;21(12):1-94. https://doi.org/10.3310/hta21120 Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. https://doi.org/10.1002/14651858.CD013674.pub2 MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016 Sep;61(9):588-603. https://doi.org/10.1177%2F0706743716659276 National Institute for Health and Care Excellence. Depression in children and young people: Identification and management NG134 [Internet]. London: NICE; 2019 Jun 25 [cited 2023 Sep 22]. Available from: https://www.nice.org.uk/guidance/ng134. Parikh A, Fristad MA, Axelson D, Krishna R. Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2020 Oct;29(4):587-599. https://doi.org/10.1016/j.chc.2020.06.001 Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):479-502. https://doi.org/10.1016/j.jaac.2022.10.001 Wiens K, Bhattarai A, Pedram P, Dores A, Williams J, Bulloch A, Patten S. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr Sci. 2020 Apr 17;29:e115. https://doi.org/10.1017%2FS2045796020000281 World Health Organization. Mental health of adolescents [Internet]. 2021 [cited 2023 Sep 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers HIV/AIDS psychiatry with special guests from two international settings to provide complementary perspectives on HIV psychiatry. Dr. Adriana Carvalhal, HIV Psychiatrist and Staff Psychiatrist at Scarborough Health Network in Canada and Dr. Leigh Van Den Heuvel, Psychiatrist and Associate Professor in the Department of Psychiatry, at Stellenbosch University in South Africa. The learning objectives for this episode are as follows:  By the end of this episode, you should be able to… Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health Identify HIV-specific mental health disorders and how to screen for these conditions Outline the overall approach to treatment for HIV patients with mental health disorders Guests: Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel Produced by: Saja Jaberi (MD), Kate Braithwaite (MD) and Gaurav Sharma (PGY5) Hosts: Kate Braithwaite (MD) and Gaurav Sharma (PGY5) Audio editing by: Gaurav Sharma (PGY5) Show notes by: Saja Jaberi (MD) and Gaurav Sharma (PGY5) Conflicts of Interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Generic names are used for all medications referenced. Contents: Introduction - 0:19 Learning objectives - 3:52 The bidirectional relationship between HIV and psychiatric illness - 4:24 Prevalence of psychiatric illness in HIV - 9:56 Screening for psychiatric illness in HIV populations - 12:11 HIV Associated Neurocognitive Disorder (HAND) - 19:27 Diagnostic Criteria - 20:19 Clinical Presentation & Etiology - 23:03 Risk Factors - 26:56 Screening Tools - 32:06 Treatment - 36:59 HIV Psychiatry case example - 39:48 Navigating the differential diagnosis - 41:44 Initial management & addressing comorbidities - 44:30 Drug-drug interactions between antiretroviral and psychiatric medications - 48:04 Review of learning objectives & final thoughts - 52:04 Outro - 55:55   Resources: Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com) Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020 - Canada.ca   HIV and Clinical Depression  https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Anxiety-2012.pdf  https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-CognitiveDisorder-2012.pdf  International HIV Dementia Scale (IHDS) - Mental Health Screening - National HIV Curriculum (uw.edu)/ Liverpool HIV Interactions (hiv-druginteractions.org) References: Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843. Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843. Awori V, Mativo P, Yonga G, Shah R. The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus. South Afr J HIV Med. 2018 Apr 12;19(1):674. doi: 10.4102/sajhivmed.v19i1.674. PMID: 29707383; PMCID: PMC5913780. Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19. PMID: 27325690; PMCID: PMC4981762. Clinical Care Guidelines for Adults and Adolescents living with HIV in Ontario, Canada. Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com) Core Concepts - Screening for Mental Health Conditions - Basic HIV Primary Care - National HIV Curriculum (uw.edu) Cysique LA, Casaletto KB, Heaton RK. Reliably Measuring Cognitive Change in the Era of Chronic HIV Infection and Chronic HIV-Associated Neurocognitive Disorders. Curr Top Behav Neurosci. 2021;50:271-298. doi: 10.1007/7854_2019_116. PMID: 31559600. EACS Guidelines version 11.1, October 2022. Joska JA, Witten J, Thomas KG, Robertson C, Casson-Crook M, Roosa H et al. A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa. AIDS and behavior. 2016 Aug 1;20(8):1621-1631. doi: 10.1007/s10461-016-1316-y Kolakowska A, Maresca AF, Collins IJ, Cailhol J. Update on Adverse Effects of HIV Integrase Inhibitors. Curr Treat Options Infect Dis. 2019;11(4):372-387. doi: 10.1007/s40506-019-00203-7. Epub 2019 Nov 16. PMID: 33380904; PMCID: PMC7758219. Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci. 2021;50:429-478. doi: 10.1007/7854_2019_117. PMID: 32677005. Rubin LH, Maki PM. Neurocognitive Complications of HIV Infection in Women: Insights from the WIHS Cohort. Curr Top Behav Neurosci. 2021;50:175-191. doi: 10.1007/7854_2019_101. PMID: 31396894. Southern African HIV Clinicians Society. Management of mental health disorders in HIV-positive patients. S Afr J HIV Med 2013; 14(4): 155 - 165  Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. doi: 10.1093/cid/ciaa1391. Erratum in: Clin Infect Dis. 2021 Dec 08;: Erratum in: Clin Infect Dis. 2022 Nov 30;75(11):2052. PMID: 33225349. Turjanski, N., & Lloyd, G. (2005). Psychiatric side-effects of medications: Recent developments. Advances in Psychiatric Treatment, 11(1), 58-70. doi:10.1192/apt.11.1.58 Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, Lu L, Bao Y. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurology. 2020 Nov 10;95(19):e2610-e2621. doi: 10.1212/WNL.0000000000010752. Epub 2020 Sep 4. PMID: 32887786.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers trauma and addictions with Dr. Gabor Maté, a retired physician who, after 20 years of family practice and palliative care experience, worked for over a decade in Vancouver’s Downtown East Side with patients challenged by drug addiction and mental illness. The bestselling author of five books published in thirty languages, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Maté is an internationally renowned speaker highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. For his groundbreaking medical work and writing he has been awarded the Order of Canada, his country’s highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver. His fifth book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture was released on September 13, 2022.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Understand the connection between trauma and the development of addictions and other mental illnesses Critically reflect on current diagnostic and treatment paradigms Apply principles of trauma-informed care to psychiatric assessment and the provision of mental health services   Guest: Dr Gabor Maté   Hosts: Sena Gok, Rhys Linthorst, Angad Singh, Nikhita Singhal, and Alex Raben   Audio editing by: Sena Gok   Show notes by: Nikhita Singhal   Interview Content: Introduction - 0:00 Learning objectives - 01:43 Defining trauma - 02:14 Current dominant views of addiction - 07:27 Defining addiction - 11:05 Relationship between trauma and addiction - 16:15 Neurobiology of addiction - 17:20 Brain development - 25:48 Genetic susceptibility - 36:10 Trauma-informed approach to treatment - 39:45 Importance of therapeutic relationships - 44:10 Societal barriers - 48:15 Harm reduction - 54:32 Closing comments - 01:00:14   Resources: Books: In the Realm of Hungry Ghosts (Gabor Maté) The Myth of Normal (Gabor Maté) The Body Keeps The Score (Bessel van der Kolk) The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions (Jaak Pansepp, Lucy Biven) Dr Gabor Maté’s website: https://www.drgabormate.com Adverse Childhood Experiences (ACEs) study: https://doi.org/10.1016/s0749-3797(98)00017-8 More information on ACEs from Harvard University’s Center on the Developing Child: What Are ACEs? And How Do They Relate to Toxic Stress? Compassionate Inquiry (psychotherapeutic approach developed by Dr Gabor Maté)   References: Brown, T., Berman, S., McDaniel, K., Radford, C., Mehta, P., Potter, J., & Hirsh, D. A. (2021). Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Academic medicine: journal of the Association of American Medical Colleges, 96(5), 661–667. https://doi.org/10.1097/ACM.0000000000003587 Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/ Colon-Rivera Hector, A., Aoun, E. & Vaezazizi, L. M. (2023). Addiction Psychiatric Medicine: A Comprehensive Board Review. Elsevier. Dugosh, K.L. & Cacciola J. (2022). Clinical assessment of substance use disorders. In J. A. Melin (Ed.), UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8 Fundamentals of Addiction: Screening. CAMH. Retrieved from  https://www.camh.ca/en/professionals/treating-conditions-and-disorders/fundamentals-of-addiction/f-of-addiction---screening Michaels, T. I., Stone, E., Singal, S., Novakovic, V., Barkin, R. L., & Barkin, S. (2021). Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World journal of psychiatry, 11(6), 222–231. https://doi.org/10.5498/wjp.v11.i6.222 Olsen Y. (2022). What Is Addiction? History, Terminology, and Core Concepts. The medical clinics of North America, 106(1), 1–12. https://doi.org/10.1016/j.mcna.2021.08.001 Panksepp J. (2011). The basic emotional circuits of mammalian brains: do animals have affective lives? Neuroscience and biobehavioral reviews, 35(9), 1791–1804. https://doi.org/10.1016/j.neubiorev.2011.08.003 Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of anxiety disorders, 88, 102558. https://doi.org/10.1016/j.janxdis.2022.102558 Shonkoff, J. P., Richter, L., van der Gaag, J., & Bhutta, Z. A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), e460–e472. https://doi.org/10.1542/peds.2011-0366 Volkow, N. D., & Li, T. K. (2004). Drug addiction: the neurobiology of behaviour gone awry. Nature reviews. Neuroscience, 5(12), 963–970. https://doi.org/10.1038/nrn1539   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.  

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness as a sequel to our previous episode on MAiD with our guest experts, Dr. Sonu Gaind and Dr. Jeffrey Kirby. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.   The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Gain an understanding of the current state of Medical Assistance in Dying for primarily mental illness in Canada Evaluate the arguments in support of and against implementation of Medical Assistance in Dying for primarily Mental Illness  Understand next steps and future directions of Medical Assistance in Dying for primarily mental illness in Canada Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry    Guest Experts: Dr. Sonu Gaind who is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Sunnybrook Health Sciences Centre, and clinically works as a psycho-oncology consultant. As Medical Assistance in Dying (MAiD) policies have been evolving in Canada, Dr. Gaind has testified in front of numerous expert, parliamentary and senate committees on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, was retained by the former Attorney General of Canada as an expert in the Truchon and Lamb cases, and chaired his former hospitals MAiD team.  He has spoken across the country and internationally on the subject.    Dr. Jeffrey Kirby is a (retired) Professor in the Department of Bioethics, Faculty of Medicine, Dalhousie University. He has an educational background and professional experience in medicine, philosophy and health care ethics. Dr. Kirby has published a set of academic papers in high-impact, international, bioethics journals on a variety of MAID-related topics including: assisted dying for suffering arising from mental health conditions, morally-relevant distinctions between paradigm and non-paradigm MAID circumstances, meso- and macro-level (MAID-related) health policy development, and organ donation after MAID and institutional conscientious objection to MAID. He made several, virtual and written, Bill C-7 related submissions to the Senate Committee on Legal and Constitutional Affairs regarding matters/issues of relevance to the potential consideration of mental health disorders as sole-qualifying conditions for MAID in Canada. He is a former member of the Expert Panel on MAiD and Mental Illness.    Grand Rounds Presenter: Dr. Urvashi Prasad (PGY4) Produced by: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben  (staff psychiatrist) Hosts: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben (Staff Psychiatrist) Peer Reviewer: David Eapen-John (MS4) Audio editing by: Dr. Urvashi Prasad  (PGY4)  Show notes by: Dr. Urvashi Prasad (PGY4)   Resources:   Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html. References: Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.” Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/.  Tabitha Marshall. “Assisted Suicide in Canada.” The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada.   Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.  Canada, Health. “Final Report of the Expert Panel on MAiD and Mental Illness” Canada.ca, / Gouvernement Du Canada, 13 May 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html#exe.  “Medical Assistance in Dying: An Update - Cpa-Apc.org.” Position Statement, https://www.cpa-apc.org/wp-content/uploads/2021-CPA-Position-Statement-MAID-Update-EN-web-Final.pdf.   APA Official Actions Position Statement on Medical Euthanasia. 2016, https://odbapa.org/wp-content/uploads/2022/02/Position-2016-Medical-Euthanasia.pdf.  The Fifth Estate. “Is It Too Easy to Die in Canada? Surprising Approvals for Medically Assisted Death -the Fifth Estate.” YouTube, 19 Jan. 2023, www.youtube.com/watch?v=plinQAHZRvk&ab_channel=TheFifthEstate.  Wiebe K, Mullin A. “Choosing death in unjust conditions: hope, autonomy and harm reduction.” J Med Ethics. 2023 Apr 26:jme-2022-108871. doi: 10.1136/jme-2022-108871. Epub ahead of print. PMID: 37100589. Gaind, KS. “What does “irremediability” in mental illness mean?” Canadian Journal of Psychiatry. Online first May 22, 2020. pp 1‐3. doi: 10.1177/0706743720928656 Kirby, J. (2022) Interpreting Irremediability When a Mental Health Disorder is the sole-Qualifying Medical Condition for MAiD. Peer-reviewed critical commentary. Canadian Journal of Bioethics 5(4): 83-88.  Kirby, J. (2021) Reconceptualizing ‘Psychiatric Futility’: Could Harm Reduction, Palliative Psychiatry, and Assisted Death Constitute a Three-Component Spectrum of Appropriate Practices? American Journal of Bioethics 21(7): 65-67.  Kirby, J. (2018) Balancing Competing Interests and Obligations in Mental Health-Care Practice and Policy. Bioethics 33(6): 699-707. Kirby, J. (2017) Medical Assistance in Dying for Suffering Arising from Mental Health Disorders: Could augmented safeguards enhance its ethical acceptability? Journal of Ethics in Mental Health 10: 1-17.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd - the psychiatry podcast for medical learners, by medical learners. This episode covers the relationship between cannabis and psychotic disorders, as well as the potential impact of cannabis legalization in Canada, with our special guest Dr. Nitin Chopra. This episode was originated by Dr. Luke Fraccaro for his Grand Rounds.   The learning objectives for this episode are as follows:  By the end of this episode, you should be able to… Briefly summarize the effects of cannabis on mental health and cognition, with a focus on psychosis. Appreciate the evidence for cannabis use as a potential cause of persistent psychotic disorders. Discuss the possible impact that recent cannabis legislation may have had on cannabis use and psychosis in Canada.   Guest Expert Dr. Nitin Chopra is an addictions psychiatrist at the Centre for Addiction and Mental Health (CAMH) and is an Assistant Professor in the Department of Psychiatry at the University of Toronto. He has an interest in concurrent disorders and is a staff psychiatrist on the Concurrent Addictions Inpatient Treatment Service and Concurrent Outpatient Medical and Psychosocial Addiction Support Service. Through his work on the Psychiatry Addictions Capacity Building and Consultation Service (PACCS) at CAMH and the Addiction Medicine and Psychosocial Addictions ECHO program, he is evolving into a leader in capacity building and education for addictions treatment. Furthermore, Dr. Chopra also works on the Early Psychosis Unit at CAMH and has extensive clinical experience working with patients experiencing psychosis, often with comorbid cannabis and other substance use.    Grand Rounds Presenter: Dr. Luke Fraccaro (PGY3)   Produced by: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)   Hosts: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)   Audio Editing by: Dr. Luke Fraccaro (PGY3)   Show notes by: Dr. Luke Fraccaro (PGY3)   Conflicts of Interest: There are no known conflict of interests to report   Topics: 0:00 - Introduction 2:50 - Objectives 3:55 - Case example 7:25 - Overview of cannabis effects of mental health 10:45 - Differentiating clinically between cannabis-induced psychosis and a primary psychotic disorder 13:11 - Cannabis causing acute psychotic symptoms 14:15 - Back to the case 16:05 - Overlapping risk factors for cannabis use and psychotic disorders 18:14 - Cannabis use as a potential cause of persistent psychotic disorders (Reviewing the evidence) 30:14 - Summary of the relationship between cannabis and psychosis and how to apply it clinically 35:20 - Cannabis legalization in Canada 39:45 - Canadian studies on potential impact of cannabis legalization on psychosis 44:33 - Brief review of American studies on potential impact of cannabis legalization on psychosis. 46:35 - Summary of potential impact of legalization 47:42 - Questions and discussion 1:06:15 - Summary and Outro   Resources: Canada’s Lower-Risk Cannabis Use Guideline: https://www.camh.ca/-/media/files/lrcug_professional-pdf.pdf Cannabis legalization and regulation in Canada: https://www.canada.ca/en/health-canada/programs/engaging-cannabis-legalization-regulation-canada-taking-stock-progress/document.html    References:  American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Arlington, VA: American Psychiatric Association, 2022.  Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. Can J Psychiatry. 2022 Jun 16:7067437221099769. doi: 10.1177/07067437221099769. Epub ahead of print. PMID: 35711159. Xue S, Husain MI, Zhao H, Ravindran AV. Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies. Can J Psychiatry. 2021 Feb;66(2):126-138. doi: 10.1177/0706743720952251. Epub 2020 Sep 10. PMID: 32909828; PMCID: PMC7918873. Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N. Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biol Psychiatry. 2016 Apr 1;79(7):557-67. doi: 10.1016/j.biopsych.2015.12.002. Epub 2015 Dec 8. PMID: 26858214. Wilkinson ST, Radhakrishnan R, D'Souza DC. Impact of Cannabis Use on the Development of Psychotic Disorders. Curr Addict Rep. 2014 Jun 1;1(2):115-128. doi: 10.1007/s40429-014-0018-7. PMID: 25767748; PMCID: PMC4352721. Hindley G, Beck K, Borgan F, Ginestet CE, McCutcheon R, Kleinloog D, Ganesh S, Radhakrishnan R, D'Souza DC, Howes OD. Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis. Lancet Psychiatry. 2020 Apr;7(4):344-353. doi: 10.1016/S2215-0366(20)30074-2. Epub 2020 Mar 17. PMID: 32197092; PMCID: PMC7738353. Ksir, C., Hart, C.L. Cannabis and Psychosis: a Critical Overview of the Relationship. Curr Psychiatry Rep 18, 12 (2016). Ganesh S, D'Souza DC. Cannabis and Psychosis: Recent Epidemiological Findings Continuing the "Causality Debate". Am J Psychiatry. 2022 Jan;179(1):8-10. doi: 10.1176/appi.ajp.2021.21111126. PMID: 34974754. Hasan A, von Keller R, Friemel CM, Hall W, Schneider M, Koethe D, Leweke FM, Strube W, Hoch E. Cannabis use and psychosis: a review of reviews. Eur Arch Psychiatry Clin Neurosci. 2020 Jun;270(4):403-412. doi: 10.1007/s00406-019-01068-z. Epub 2019 Sep 28. PMID: 31563981. Petrilli K, Ofori S, Hines L, Taylor G, Adams S, Freeman TP. Association of cannabis potency with mental ill health and addiction: a systematic review. Lancet Psychiatry. 2022 Sep;9(9):736-750. doi: 10.1016/S2215-0366(22)00161-4. Epub 2022 Jul 25. PMID: 35901795. Buchy L, Perkins D, Woods SW, Liu L, Addington J. Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophr Res. 2014 Jul;156(2-3):277-80. doi: 10.1016/j.schres.2014.04.021. Epub 2014 May 14. PMID: 24837058; PMCID: PMC4082820. Gillespie NA, Kendler KS. Use of Genetically Informed Methods to Clarify the Nature of the Association Between Cannabis Use and Risk for Schizophrenia. JAMA Psychiatry. 2021 May 1;78(5):467-468. doi: 10.1001/jamapsychiatry.2020.3564. PMID: 33146687. Johnson EC, Hatoum AS, Deak JD, Polimanti R, Murray RM, Edenberg HJ, Gelernter J, Di Forti M, Agrawal A. The relationship between cannabis and schizophrenia: a genetically informed perspective. Addiction. 2021 Nov;116(11):3227-3234. doi: 10.1111/add.15534. Epub 2021 May 19. PMID: 33950550; PMCID: PMC8492483. Fischer, B., Lee, A., Robinson, T. et al. An overview of select cannabis use and supply indicators pre- and post-legalization in Canada. Subst Abuse Treat Prev Policy 16, 77 (2021). https://doi.org/10.1186/s13011-021-00405-7 Myran DT, Imtiaz S, Konikoff L, Douglas L, Elton-Marshall T. Changes in health harms due to cannabis following legalisation of non-medical cannabis in Canada in context of cannabis commercialisation: A scoping review. Drug Alcohol Rev. 2023 Feb;42(2):277-298. doi: 10.1111/dar.13546. Epub 2022 Sep 27. PMID: 36165188. Vignault C, Massé A, Gouron D, Quintin J, Asli KD, Semaan W. The Potential Impact of Recreational Cannabis Legalization on the Prevalence of Cannabis Use Disorder and Psychotic Disorders: A Retrospective Observational Study. Can J Psychiatry. 2021 Dec;66(12):1069-1076. doi: 10.1177/0706743720984684. Epub 2021 Feb 11. PMID: 33567893; PMCID: PMC8689454. Callaghan RC, Sanches M, Murray RM, Konefal S, Maloney-Hall B, Kish SJ. Associations Between Canada's Cannabis Legalization and Emergency Department Presentations for Transient Cannabis-Induced Psychosis and Schizophrenia Conditions: Ontario and Alberta, 2015-2019. Can J Psychiatry. 2022 Aug;67(8):616-625. doi: 10.1177/07067437211070650. Epub 2022 Jan 12. PMID: 35019734; PMCID: PMC9301152. D'Souza DC, DiForti M, Ganesh S, George TP, Hall W, Hjorthøj C, Howes O, Keshavan M, Murray RM, Nguyen TB, Pearlson GD, Ranganathan M, Selloni A, Solowij N, Spinazzola E. Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis. World J Biol Psychiatry. 2022 Dec;23(10):719-742. doi: 10.1080/15622975.2022.2038797. Epub 2022 Mar 22. PMID: 35315315. Wang, G. S., Buttorff, C., Wilks, A., Schwam, D., Tung, G., & Pacula, R. L. (2022). Impact of cannabis legalization on healthcare utilization for psychosis and schizophrenia in Colorado. International Journal of Drug Policy, 104, 103685. Kim, H. S., & Monte, A. A. (2016). Colorado Cannabis Legalization and Its Effect on Emergency Care. Annals of emergency medicine, 68(1), 71–75. https://doi-org.proxy3.library.mcgill.ca/10.1016/j.annemergmed.2016.01.004   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the Journey Through Stages of Sleep with Dr. Michael Mak, Assistant Professor in the Department of Psychiatry at the University of Toronto, and an Adjunct Research Professor at Western University.   The learning objectives for this episode are as follows:   Understand the basics of sleep physiology, including the stages of sleep Recognize the clinical features of insomnia disorder using the ICSD-3 and DSM-5-TR criteria  Develop an approach to the assessment of insomnia  Identify the pharmacological and non-pharmacological treatments for insomnia disorder    Guest: Dr. Michael Mak (Staff Psychiatrist)   Hosts: Dr. Vanessa Aversa (PGY4), Andreea Chiorean (CC4), Sena Gok (IMG)   Audio editing by: Sena Gok   Show notes by: Sena Gok   Contents: Introduction:  0:16 Learning Objectives:  01:49 Definition and  Clinical features of insomnia (ICSD-3 and DSM-5-TR criteria):  02:39 Insomnia prevalence, cost effects:  05:25 Sleep physiology:  10:05 Stages of Sleep:  11:37 Changes in Sleep stages during Insomnia:  14:35 Melatonin/Orexin systems:  15:45 Assessment and diagnosis of Insomnia:  21:00 Risk Factors of Insomnia:  30:12 CBT for Insomnia (CBT-I):  31:35 Relaxation-based techniques:  40:25 Contraindication for Insomnia:  42:15 Pharmacological treatments of insomnia:  45:15 Summary:  1:11:10 Resources: 1. Wainberg M, Jones SE, Beaupre LM, Hill SL, Felsky D, Rivas MA, et al. Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank. PLOS Med. 2021 Oct 12;18(10):e1003782.  2. Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial. JAMA. 2009 May 20;301(19):2005–15. : 3. Crescenzo FD, D’Alò GL, Ostinelli EG, Ciabattini M, Franco VD, Watanabe N, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. The Lancet. 2022 Jul 16;400(10347):170–84.  4. Watanabe Y, Kuroki T, Ichikawa D, Ozone M, Uchimura N, Ueno T. Effect of smartphone-based cognitive behavioral therapy app on insomnia: a randomized, double-blind study. Sleep. 2023 Mar 1;46(3):zsac270.  5. Erland LAE, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 13(02):275–81.  6. Sweetman A, McEvoy RD, Smith S, Catcheside PG, Antic NA, Chai-Coetzer CL, et al. The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial. Sleep. 2020 Jul 13;43(7):zsaa002.  7.  Origins of Sleep Medicine: Dr. Nathaniel Kleitman,, Dr. Mark Mahowald, Dr. Carlos Schenck https://aasm.org/mark-mahowald-md-and-carlos-schenck-md-to-receive-william-c-dement-award/ 8.  CBT-Insomnia lab at the Toronto Metropolitan University: https://drcolleencarney.com/lab/ 9.  CBT-Insomnia Applications:  https://www.sleepio.com/  https://www.ptsd.va.gov/appvid/mobile/cbticoach_app_public.asp  https://www.blackdoginstitute.org.au/research-projects/sleep-ninja/  https://www.somryst.com/ 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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode is an introduction to the use and monitoring of lithium in bipolar disorder. Join Tingting Yan (CC4) and Dr. Alex Raben (staff psychiatrist at CAMH and lecturer at the University of Toronto) for a lively case-based discussion. Learning Objectives The learning objectives for this episode are as follows:   By the end of this episode, the listener will be able to… Describe the indications and process for starting lithium Monitor and interpret serum lithium levels List short and long-term adverse effects of lithium Produced by: Tingting Yan CC4, Dr. Alex Raben (staff psychiatrist)   Hosts: Tingting Yan, Alex Raben   Audio editing by: Alex Raben   Show notes by: Alex Raben   Contents: Learning objectives: 00:44 Lithium background and brief history: 2:48 Women’s health and lithium: 5:28 Underutilization of lithium: 8:02 Baseline blood work for lithium: 11:32 Choosing a lithium starting dose: 14:32 Lithium serum levels: 16:17 Lithium titration: 20:46 Lithium toxicity: 23:48 Lithium side effects: 26:52 Summary: 32:11   References Baastrup PC, Poulsen JC, Schou M, Thomsen K, Amdisen A. Prophylactic lithium: double blind discontinuation in manic-depressive and recurrent-depressive disorders. Lancet. 1970;2(7668):326-330. doi:10.1016/s0140-6736(70)92870-9 Bauer LA. Chapter 17. Lithium. In: Bauer LA. eds. Applied Clinical Pharmacokinetics, 2e. McGraw Hill; 2008. Accessed March 16, 2023. https://accesspharmacy.mhmedical.com/content.aspx?bookid=510&sectionid=40843106 Chokhawala K, Lee S, Saadabadi A. Lithium. StatPearls. Davis J, Desmond M, Berk M. Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification. BMC nephrology. 2018 Dec;19:1-7. Draaisma D. Lithium: the gripping history of a psychiatric success story. Nature. 2019 Aug 1;572(7769):584-6. Hedya SA, Avula A, Swoboda HD. Lithium toxicity. Malhi GS, Bell E, Outhred T, Berk M. Lithium therapy and its interactions. Australian Prescriber. 2020 Jun;43(3):91. Malhi GS, Gessler D, Outhred T. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. J Affect Disord. 2017;217:266-280. doi:10.1016/j.jad.2017.03.052 McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721-728. doi:10.1016/S0140-6736(11)61516-X Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S. Lithium use in pregnancy and the risk of cardiac malformations. New England Journal of Medicine. 2017 Jun 8;376(23):2245-54. Tondo L, Alda M, Bauer M, Bergink V, Grof P, Hajek T, Lewitka U, Licht RW, Manchia M, Müller-Oerlinghausen B, Nielsen RE. Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders. 2019 Dec;7(1):1-0. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders. 2018 Mar;20(2):97-170.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.  

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the “big picture” relationship between violence and severe mental illnesses such as schizophrenia and bipolar spectrum disorders. Our guest experts in this episode are Dr. Robert McMaster, Assistant Professor of Forensic Psychiatry at the University of Toronto and Dr. Ragy R. Girgis, Associate Professor of Clinical Psychiatry at Columbia University in New York. This episode is a good companion to Episode 15: Managing Aggression and Agitation with Dr. Jodi Lofchy, which covers how to identify and manage acute risk of violence in a clinical setting. The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Describe the epidemiology of violence in severe mental illness (rates of perpetration vs. victimization, risk factors, quality of evidence)  Understand and critique how society currently addresses violence in those with severe mental illness  Discuss this topic with patients, caregivers and the public, and address common myths  Guests:  Dr. Robert McMaster - Assistant Professor of Forensic Psychiatry at the University of Toronto Dr. Ragy R. Girgis - Associate Professor of Clinical Psychiatry at Columbia University in New York Hosts: Dr. Alex Raben (Staff Psychiatrist), Dr. Gaurav Sharma (PGY4), Sena Gok(IMG), Josh Benchaya (CC4) Audio editing by: Gaurav Sharma Show notes by: Josh Benchaya, Gaurav Sharma, Sena Gok   Interview Content:   Learning Objectives: 02:29 Perceptions of Violence and Mental Illness: 03:53 Mental illness & Violence Link Evidence: 06:48 Violence Perpetration & Victimisation: 10:10 Risk of Violence Assessment (HCR 20 Model): 17:00 Mass Shootings & Mental Illness & Predictions: 20:30 Violence Risk Prediction: 25:25 Severe Mental Illness & Violence Risk Treatments: 29:40 Society’s approach to Severe Mental Illness & Violence Misperceptions: 38:30 Mental Illness and Violence Stigma: 45:03 Case Vignette & Approach: 46:44 Summary of the episode: 58:00   References:   de Mooij, L.D., Kikkert, M., Lommerse, N.M., Peen, J., Meijwaard, S.C., Theunissen, J., Duurkoop, P.W., Goudriaan, A.E., Van, H.L., Beekman, A.T. and Dekker, J.J., 2015. Victimization in adults with severe mental illness: prevalence and risk factors. The British Journal of Psychiatry, 207(6), pp.515-522. Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community violence perpetration and victimization among adults with mental illnesses. American journal of public health, 104(12), 2342-2349. Metzl, J.M., Piemonte, J. and McKay, T., 2021. Mental illness, mass shootings, and the future of psychiatric research into American gun violence. Harvard review of psychiatry, 29(1), p.81.   Buchanan, A., Sint, K., Swanson, J. and Rosenheck, R., 2019. Correlates of future violence in people being treated for schizophrenia. American Journal of Psychiatry, 176(9), pp.694-701.   Rund, B.R., 2018. A review of factors associated with severe violence in schizophrenia. Nordic journal of psychiatry, 72(8), pp.561-571.   Markowitz FE. Mental illness, crime, and violence: Risk, context, and social control. Aggress Violent Behav. 2011 Jan 1;16(1):36–44.   Pescosolido BA, Manago B, Monahan J. Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences. Health Aff Proj Hope. 2019 Oct;38(10):1735–43.   Ross AM, Morgan AJ, Jorm AF, Reavley NJ. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc Psychiatry Psychiatr Epidemiol. 2019 Jan 1;54(1):11–31.   Srivastava K, Chaudhury S, Bhat PS, Mujawar S. Media and mental health. Ind Psychiatry J. 2018;27(1):1–5.   Stuart H. Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness? CNS Drugs. 2006;20(2):99–106.   Rowaert S, Vandevelde S, Lemmens G, Audenaert K. How family members of mentally ill offenders experience the internment measure and (forensic) psychiatric treatment in Belgium: A qualitative study. Int J Law Psychiatry. 2017;54:76–82.   Bjørn Rishovd Rund (2018) A review of factors associated with severe violence in schizophrenia, Nordic Journal of Psychiatry, 72:8, 561-571, DOI: 10.1080/08039488.2018.1497199  References cited by our experts:   Steadman, H.J., Monahan, J., Pinals, D.A., Vesselinov, R. and Robbins, P.C., 2015. Gun violence and victimization of strangers by persons with a mental illness: data from the MacArthur Violence Risk Assessment Study. Psychiatric services, 66(11), pp.1238-1241. [00:05:26]   Appelbaum PS, Robbins PC, Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry. 2000 Apr;157(4):566-72. doi: 10.1176/appi.ajp.157.4.566. PMID: 10739415. [00:05:26]   Torrey EF, Stanley J, Monahan J, Steadman HJ; MacArthur Study Group. The MacArthur Violence Risk Assessment Study revisited: two views ten years after its initial publication. Psychiatr Serv. 2008 Feb;59(2):147-52. doi: 10.1176/ps.2008.59.2.147. PMID: 18245156. [00:05:26]   Witt, K., Hawton, K. and Fazel, S., 2014. The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophrenia research, 154(1-3), pp.61-67. [00:08:46] Sariaslan, A., Arseneault, L., Larsson, H., Lichtenstein, P., & Fazel, S. (2020). Risk of subjection to violence and perpetration of violence in persons with psychiatric disorders in Sweden. JAMA psychiatry, 77(4), 359-367. [00:11:20] Douglas, K. S., Shaffer, C., Blanchard, A. J. E., Guy, L. S., Reeves, K., & Weir, J. (2014). HCR-20 violence risk assessment scheme: Overview and annotated bibliography. HCR-20 Violence Risk Assessment White Paper Series, #1. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University. [00:18:53] Girgis, R.R., Rogers, R.T., Hesson, H., Lieberman, J.A., Appelbaum, P.S. and Brucato, G., 2022. Mass murders involving firearms and other methods in school, college, and university settings: findings from the Columbia Mass Murder Database. Journal of forensic sciences. [00:25:11]       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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.  

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the mental status examination and makes use of practical and fictional examples to delve deeper into the skills and concepts   Learning Objectives:   The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Explain the utility and purpose of the mental status examination in psychiatry Describe the major components of the mental status examination and be familiar with some of the common vocabulary used Incorporate the mental status in a way that respects patients in presentation, documentation and formulation in clinical practice    Topics: 2:37 - Learning objectives 3:10 - Definition of the MSE 6:48 - History of the MSE 9:00 - Limitations of the MSE 15:37 - Strengths of the MSE 21:30 - ASEPTIC Mnemonic 23:04 - Appearance and Behaviour 37:42 - Speech 51:51 - Emotion (mood and affect) 1:03:51 - Perception 1:08:38 - Thought Form and Content 1:17:30 - Insight and Judgement 1:27:40 - Cognition   Hosts: Andreea Chiorean (CC4), Saja Jaberi (IMG), Dr. Weam Seiffien (PGY2), Angad Singh (CC2), Dr. Annie Yu (PGY1), and Dr. Alex Raben, staff psychiatrist.   Guest Experts: Us!   Video clips: Speech:  Mojo Jojo: https://youtu.be/y4qNWPPlYE4?t=48 Family guy video: no longer available   Emotion Eeyore: https://youtu.be/7xPnUe6Xcbw?t=12   Squidward: https://youtu.be/FjrOWnywPok?t=195   Bubbles: https://youtu.be/rAC4W563Ayk?t=339   Perception A Beautiful Mind: https://youtu.be/vNa37tOB4rE   Insight and Judgement Simpsons: no longer available Mr. Magoo: https://youtu.be/eWEnzLFd4P4?t=201   Cognition Still Alice: https://youtu.be/mhiXAJO8kBc?t=67 Resources: MSE template: https://www.therapistaid.com/therapy-worksheet/mental-status-exam Emotion wheel: https://feelingswheel.com/ MSE vocabulary: http://www.columbia.edu/itc/hs/medical/psychmed/1_2004/mental_status_exam.pdf References: Bell, R. (1977). The Mental Status Examination. 16(5).Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198. Donnelly, J., Rosenberg, M., & Fleeson, W. P. (1970). The evolution of the mental status—past and future. American Journal of Psychiatry, 126(7), 997-1002. Norris, D. R., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. 94(8). Norton, J. W., & Corbett, J. J. (2000, February). Visual perceptual abnormalities: hallucinations and illusions. In Seminars in neurology (Vol. 20, No. 01, pp. 0111-0122). Copyright© 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Notes, T. (2020). Comprehensive Medical Reference and Review for the Medical Council of Canada Qualifying Exam (MCCQE) Part I and the United States Medical Licensing Exam (USMLE) Step II 36th ed: Toronto Notes for Medical Students. Recupero, P. R. (2010). The Mental Status Examination in the Age of the Internet. The Journal of the American Academy of Psychiatry and the Law, 38(1). Robinson D. J. (2002). Mental status exam explained (2nd ed.). Rapid Psychler Press. Robinson D. J. (1998). Brain Calipers: a guide to a successful mental status exam. Rapid Psychler Press. Ross, C. A., & Leichner, P. (1988). Residents Performance on the Mental Status Examination. The Canadian Journal of Psychiatry, 33(2), 108–111. https://doi.org/10.1177/070674378803300207 Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Lippincott Williams & Wilkins Publishers. Segal, D. L. (Ed.). (2019). Diagnostic interviewing. Springer. Snyderman, D., & Rovner, B. (2009). Mental status examination in primary care: a review. American family physician, 80(8), 809-814. Spencer, R. J., Noyes, E. T., Bair, J. L., & Ransom, M. T. (2022). Systematic Review of the Psychometric Properties of the Saint Louis University Mental Status (SLUMS) Examination. Clinical Gerontologist, 45(3), 454–466. https://doi.org/10.1080/07317115.2022.2032523 The Collected Papers of Adolf Meyer. Volume III: Medical Teaching. (1952) JAMA. 148(17):1544. https://www.statpearls.com/ArticleLibrary/viewarticle/24998 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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we’ll explore a topic that we’re sure many listeners are eager to learn about: The Assessment of Major Neurocognitive Disorder, also known as dementia with Dr. Lesley Wiesenfeld who is a Geriatric Psychiatrist and Psychiatrist-in-Chief at Mount Sinai Hospital in Toronto, where she leads the Geriatric Consult Liaison Psychiatry Service. She is also an Associate Professor in the Department of Psychiatry at the University of Toronto.   The learning objectives for this episode are as follows:   Define Major Neurocognitive Disorder (aka Dementia) as per DSM-5 diagnostic criteria Identify differential diagnoses for cognitive decline and list differentiating clinical features  Outline an approach to the assessment of a patient presenting with cognitive decline, including the role of a comprehensive history, psychometric tools and other investigations [ Relevant PMH/risk factors, ADLs/IADLs to cover on history, psychometric tools such as MMSE, MoCA and tie this back into major cognitive domains when to consider imaging, bloodwork including specialized testing such as ApoE genetic tests]  Classify the major subtypes of Neurocognitive Disorders, their epidemiology, and clinical presentations [ Vascular dementia, Alzheimer’s, Frontotemporal, Lewy Body, Parkinson’s,    Mixed dementia - Early onset dementia]   Guest: Dr. Lesley Wiesenfeld ( [email protected] )   Hosts: Dr. Luke Fraccaro (PGY-3), Dr. Mark Fraccaro (PGY-4), Sena Gok (international medical graduate)   Audio editing by: Sena Gok   Show notes by: Sena Gok   Interview Content: Introduction: 0:13 Learning Objectives: 02:35 Diagnostic criteria of Major Neurocognitive Disorder: 03:20 Difference between Major and Mild Neurocognitive Disorder: 05:20 Red Flags of Cognitive Declines: 06:50 Normal Aging vs Major Neurocognitive Disorder: 10:00 Clinical Vignette – introduction: 11:35 Patient Assessment: 16:50 Past medical/family / Psychosocial history: 21:55 Clinical Vignette - Assessment: 37:45 Physical examination: 43:50 Investigations: 45:53 Role of genetic testing: 53:24 Clinical Vignette – Diagnosis: 57:50   References:   American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).   Sadock, B. J., Sadock, V. A., Ruiz, P., & Kaplan, H. I. (2015). Neurocognitive Disorders. Kaplan and Sadock’s Synopsis of Psychiatry (11th ed.). Wolters Kluwer   DSM-5-TR Fact Sheets (https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets )   Gauthier S, Patterson C, Chertkow H, Gordon M, Herrmann N, Rockwood K, Rosa-Neto P, Soucy JP. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012 Dec;15(4):120-6. doi: 10.5770/cgj.15.49. Epub 2012 Dec 4. PMID: 23259025; PMCID: PMC3516356.   Gauthier S, Chertkow H, Theriault J, Chayer C, Ménard MC, Lacombe G, Rosa-Neto P, Ismail Z. CCCDTD5: research diagnostic criteria for Alzheimer's Disease. Alzheimers Dement (N Y). 2020 Aug 25;6(1):e12036. doi: 10.1002/trc2.12036. Erratum in: Alzheimers Dement (N Y). 2022 Feb 03;6(1):e12088. PMID: 32864413; PMCID: PMC7446944. 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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode delves into the history of psychiatry with Dr David Castle, the inaugural Scientific Director of the Centre for Complex Interventions at the Centre for Addictions and Mental Health and a Professor in the Department of Psychiatry at the University of Toronto. Prior to migrating to Canada in 2021, he spent 15 years as a Professor of Psychiatry at St Vincent’s Hospital and the University of Melbourne in Australia.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Gain an appreciation for the historical context of the field of psychiatry Understand how illness categories and treatments have been shaped by this history  Compare and contrast how various past societies viewed and conceptualized mental illness Apply lessons learned from historical practices to appraise current approaches   Guest: Dr David Castle   Hosts: Dr Alex Raben (Staff Psychiatrist), Gaurav Sharma (PGY4), Nikhita Singhal (PGY4), Andreea Chiorean (CC4)   Audio editing by: Dr Alex Raben   Show notes by: Dr Nikhita Singhal   Interview Content:   1:45 - Learning Objectives   3:25 - Ancient Times   14:42 - Middles Ages    23:56 - Renaissance to Enlightenment   34:55 - 19th-20th Centuries   47:55 - 20th-21st Centuries   1:00:48 - Final Thoughts   Resources: Shrinks: The Untold Story of Psychiatry (Jeffrey A Lieberman)   References: The Emotional Foundations of Personality: A Neurobiological and Evolutionary Approach (Kenneth L Davis, Jaak Panksepp) Illustration of Bedlam (William Hogarth) Pinel, médecin en chef de la Salpêtrière en 1795 (Tony Robert-Fleury) Castle, D., Bassett, D., King, J., & Gleason, A. (2013). A primer of clinical psychiatry. Elsevier Health Sciences. de Leon J. DSM-5 and the research domain criteria: 100 years after Jaspers' General psychopathology. Am J Psychiatry. 2014 May;171(5):492-4. https://doi.org/10.1176/appi.ajp.2013.13091218 Eisenberg L. Mindlessness and brainlessness in psychiatry. Br J Psychiatry. 1986 May;148:497-508. https://doi.org/10.1192/bjp.148.5.497 Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36. https://doi.org/10.1126/science.847460 Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003 Jan;160(1):4-12. https://doi.org/10.1176/appi.ajp.160.1.4 Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970 Jan;126(7):983-7. https://doi.org/10.1176/ajp.126.7.983 Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):250-8. https://doi.org/10.1126/science.179.4070.250 Scheff TJ. The labelling theory of mental illness. Am Sociol Rev. 1974 Jun;39(3):444-52. https://doi.org/10.2307/2094300 Szasz T. The myth of mental illness: 50 years later. The Psychiatrist. Cambridge University Press; 2011;35(5):179–182. https://doi.org/10.1192/pb.bp.110.031310   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a focused summary of the latest changes in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) with our guest expert — Dr. Michael First, a Professor of Clinical Psychiatry at Columbia University, NY. Dr. First is an internationally recognized expert on psychiatric diagnosis and assessment issues, he is the editor and co-chair of the DSM-5 text revision project (DSM-5-TR), the editorial and coding Consultant for the DSM-5, the chief technical and editorial consultant on the World Health Organization ICD-11 revision project and was an external consultant to the NIMH Research Domain Criteria project (RDOC).   The learning objectives for this episode are as follows: Understand the rationale for undertaking a DSM-5-TR as well as the revision process itself  To become familiar with disorder, text and symptom code additions and modifications to the DSM-5-TR  To understand the purpose and function of the DSM in its current form and be able to contemplate future directions   Guest Expert: Dr. Michael First – staff psychiatrist and professor of clinical psychiatry at Columbia University, USA. Produced and hosted by: Dr. Alex Raben (staff psychiatrist) and Saja Jaberi (international medical graduate) Audio editing by: Dr. Alex Raben Show notes by: Saja Jaberi Interview Content: 2:53 - Learning objectives 3:34 - Brief description of the DSM and its history 4:54 – ICD vs. DSM  7:43 - Rationale behind the new revision 11:11 - Characteristics of the DSM-5-TR revision process and the people behind it 16:54 - Case presentation and Differential Diagnosis 23:07 - Prolonged Greif disorder 27:04 - Most important changes to the terminology used in the manual 39:34 - Pros and cons of the DSM 44:30 - A brief Comparison to the RDOC Framework 49:04 – Future Directions of the DSM   References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Text Revision ed. 2022.  DSM-5-TR Fact Sheets https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a broad overview of antisocial personality disorder and psychopathy with our guest expert - Dr. Donald Lynam. Dr. Lynam is a clinical psychologist by training, and professor at Purdue university, where he heads the Purdue's Developmental Psychopathology, Psychopathy and Personality Lab. While there may be some disagreement in the field, Dr. Lynam and I discuss how ASPD and psychopathy are two diagnostic constructs that are attempting to outline the same psychopathology, with the main difference being the degree of severity - for this reason, we use the terms antisocial and psychopathic interchangeably.    While not necessary, it may be of benefit for listeners to familiarize themselves with the DSM-V criteria for antisocial personality disorder, the psychopathy checklist (PCL), as well as the 5-factor model of personality. References for each are listed below in the references section, however, for a brief overview, one could do a quick google image search for each term (Wikipedia also has a succinct overview of the psychopathy checklist).   The learning objectives for this episode are as follows:   Develop a basic understanding of what is meant by antisocial personality and psychopathy Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors  Describe the theoretical basis for the development of antisocial personalities    Guest Expert: Dr. Donald Lynam - Clinical psychologist, Investigator at Purdue University, Indiana Produced and hosted by: Dr. Chase Thompson (PGY5 in Psychiatry) Episode guidance and feedback: Dr. Gaurav Sharma (PGY4 in Psychiatry)   Interview Content:   0:50 - Learning objectives 1:40 - Dr. Lynam discusses his path to his current research interests 3:40 - Defining the terms antisocial personality disorder, sociopathy, psychopathy 8:30 - Discussing the possibility of antisocial behaviors without an antisocial personality 12:07 - Laying out the core features of antisocial individuals  18:20 - Antisocial personality from the perspective of the Big 5 personality model 22:00 - Discussion of the high-functioning psychopathy  25:06 - Prevalence of psychopathy 30:10 - Factors relevant to the development of psychopathy 39:30 - Prognosis and clinical trajectory  44:30 - Comorbid psychopathology  46:30 - Functions of antagonism or antisocial behaviours  49:30 - Treatment    References   American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R, Lynam DR. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Developmental psychology. 2003 Mar;39(2):222. Babiak P, Hare RD, McLaren T. Snakes in suits: When psychopaths go to work. New York: Harper; 2007 May 8. Hare RD. The psychopathy checklist–Revised. Toronto, ON. 2003;412. Hare RD, Harpur TJ, Hakstian AR, Forth AE, Hart SD, Newman JP. The revised psychopathy checklist: reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Sep;2(3):338. Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of abnormal psychology. 1991 Aug;100(3):391. Jones SE, Miller JD, Lynam DR. Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice. 2011 Jul 1;39(4):329-37. Lynam DR. Early identification of chronic offenders: Who is the fledgling psychopath?. Psychological bulletin. 1996 Sep;120(2):209. Miller JD, Lynam DR. Psychopathy and the five-factor model of personality: A replication and extension. Journal of personality assessment. 2003 Oct 1;81(2):168-78.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of perinatal psychiatry Describe the key issues that should be addressed in pre-conception psychiatric counseling Discuss the management approach for prescribing medications during pregnancy Recognize the prevalence of mood disorders during the perinatal period Recall the diagnostic criteria for postpartum depression Consider the risk factors and explanatory models for postpartum depression Discuss the use of screening tools for postpartum depression Outline the treatment for postpartum depression Describe the clinical presentation of postpartum psychosis and recognize the urgency of this condition List important risk factors for postpartum psychosis Discuss the management for postpartum psychosis   Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Produced by: Nima Nahiddi (PGY4), Audrey Le (PGY1), Rebecca Marsh (PGY2) and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00 Learning objectives - 00:43 Defining the field of perinatal psychiatry - 01:55 Key issues to address in preconception counseling - 02:50 Management approach for prescribing medications during pregnancy - 07:00 Prevalence of mood disorders during the perinatal period - 12:11 Diagnostic criteria for postpartum depression - 14:05 Differentiating postpartum psychosis from postpartum depression - 16:52 Risk factors and explanatory models for postpartum depression - 18:58 Screening tools for postpartum depression - 20:15 Treatment for postpartum depression - 22:13 Pharmacotherapy - 22:20 Psychotherapy - 27:34 Clinical presentation of postpartum psychosis - 29:07 Risk factors for postpartum psychosis - 30:43 Postpartum psychosis prognosis and impacts on attachment- 32:57 Management of postpartum psychosis -35:30 Closing comments - 38:00   Resources: Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ open, 7(1), e013372. https://doi.org/10.1136/bmjopen-2016-013372 Boukhris, T., Sheehy, O., Mottron, L., & Bérard, A. (2016). Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children. Jama Pediatrics, 170(2), 117-24. doi: 10.1001/jamapediatrics.2015.3356. Brown, A. S., Gyllenberg, D., Malm, H., McKeague, I. W., Hinkka-Yli-Salomäki, S., Artama, M., Gissler, M., Cheslack-Postava, K., Weissman, M. M., Gingrich, J. A., & Sourander, A. (2016). Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring. JAMA psychiatry, 73(11), 1163–1170. https://doi.org/10.1001/jamapsychiatry.2016.2594 Cohen, J. , Hernández-Díaz, S. , Bateman, B. , Park, Y. , Desai, R. , Gray, K. , Patorno, E. , Mogun, H. & Huybrechts, K. (2017). Placental Complications Associated With Psychostimulant Use in Pregnancy. Obstetrics & Gynecology, 130(6), 1192-1201. doi: 10.1097/AOG.0000000000002362. Huybrechts, K. F., Hernández-Díaz, S., Patorno, E., Desai, R. J., Mogun, H., Dejene, S. Z., Cohen, J. M., Panchaud, A., Cohen, L., & Bateman, B. T. (2016). Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations. JAMA psychiatry, 73(9), 938–946. https://doi.org/10.1001/jamapsychiatry.2016.1520 Huybrechts, K. F., Palmsten, K., Avorn, J., Cohen, L. S., Holmes, L. B., Franklin, J. M., Mogun, H., Levin, R., Kowal, M., Setoguchi, S., & Hernández-Díaz, S. (2014). Antidepressant use in pregnancy and the risk of cardiac defects. The New England Journal of Medicine, 370(25), 2397–2407. https://doi.org/10.1056/NEJMoa1312828 Imaz, M. L., Oriolo, G., Torra, M., Soy, D., García-Esteve, L., & Martin-Santos, R. (2018). Clozapine Use During Pregnancy and Lactation: A Case-Series Report. Frontiers in Pharmacology, 9, 264. https://doi.org/10.3389/fphar.2018.00264 Nörby, U., Forsberg, L., Wide, K., Sjörs, G., Winbladh, B., & Källén, K. (2016). Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy. Pediatrics, 138(5), e20160181. https://doi.org/10.1542/peds.2016-0181 Nörby, U., Winbladh, B., & Källén, K. (2017). Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics, 140(6), e20170747. https://doi.org/10.1542/peds.2017-0747 Reis, M., & Källén, B. (2013). Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A registered study. BMJ Open, 3, e002166. doi:10.1136/bmjopen-2012-002166 Sundram S. (2006). Cannabis and neurodevelopment: implications for psychiatric disorders. Human psychopharmacology, 21(4), 245–254. https://doi.org/10.1002/hup.762   References: Boland, R., Verduin, M., & Ruiz, P. (2021). Psychopharmacology. In Kaplan & Sadock's synopsis of psychiatry (Twelfth edition.). Philadelphia: Wolters Kluwer. Jones, I., Chandra, P.S., Dazzan, P., & Howard, L.K. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2. Nieldson, D., Videbech, P., Hedegaard, M., Dalby, J., & Secher, N.J. (2005). Postpartum depression: identification of women at risk. An International Journal of Obstetrics and Gynaecology, 107(10), 1210-1217. https://doi-org.myaccess.library.utoronto.ca/10.1111/j.1471-0528.2000.tb11609.x Schiller, C.E., Meltzer-Brody, S., & Rubinow, D.R. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48-59. doi: 10.1017/S1092852914000480 Viguera, A. (2021). Mild to moderate postpartum unipolar major depression: Treatment. UpToDate. Accessed 2021-01-18. Wisner, K.L., Sit, D.K.Y., & McShea, M.C. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498. doi:10.1001/jamapsychiatry.2013.87   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of reproductive psychiatry Discuss the possible neurobiological pathways impacting mood and cognition during the reproductive cycle of women.  Discuss the influence of sociocultural gender roles on psychopathology.    List the DSM-V diagnostic criteria of premenstrual dysphoric disorder. Recall the epidemiology of premenstrual dysphoric disorder. Describe the steps in the diagnostic evaluation for premenstrual dysphoric disorder. List lifestyle and psychopharmacologic interventions for premenstrual dysphoric disorder. Discuss common mental health concerns during the perimenopausal period. Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00 Learning objectives - 01:00 Defining the field of perinatal psychiatry - 01:50 Discussing neurobiological pathways impacting mood and cognition during the reproductive cycle - 02:47 The influence of sociocultural gender roles on psychopathology -05:28 DSM-V criteria of premenstrual dysphoric disorder - 11:18 Epidemiology of premenstrual dysphoric disorder - 13:40 Diagnostic evaluation of premenstrual dysphoric disorder - 14:38 Management of premenstrual dysphoric disorder  Pharmacologic - 17:45 Lifestyle - 24:15 Perimenopausal period - 24:45 Closing comments - 31:39   Resources: Brzezinski, A., Brzezinski-Sinai, N.A., & Seeman, M.V. (2017). Treating schizophrenia during menopause. Menopause, 24(5), 582-588. doi: 10.1097/GME.0000000000000772. Epperson, C.N., Steiner, M., Hartlage, A., Eriksson, E., Schmidt, P.J., Jones, I., & Yonkers, K.A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. The American Journal of Psychiatry, 169(5), 465-475. DOI: 10.1176/appi.ajp.2012.11081302 Marsh, W.K., Gershenson, B., & Rothschild, A.J. (2015). Symptom severity of bipolar disorder during the menopausal transition. International Journal of Bipolar Disorders, 3(1), 35. DOI: 10.1186/s40345-015-0035-z Soares, C.N., Almeida, O.P.,  Joffe, H., & Cohen, L.S. (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry, 58(6), 529-534. doi:10.1001/archpsyc.58.6.529 Weber, M.T., Maki, P.M., & McDermott, M.P. (2013). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001   References: Kornstein S.G., & Clayton, A.H. (2004). Sex differenes in neuroendocrine and neurotransmitter systems. In Women’s mental health: A comprehensive textbook (pp.3-30). Guilford Press.  Chrisler, J. C., & Johnston-Robledo, I. (2002). Raging hormones?: Feminist perspectives on premenstrual syndrome and postpartum depression. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 174–197). Guilford Press. American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychedelic-assisted psychotherapy with Dr Emma Hapke and Dr Daniel Rosenbaum, both of whom are psychiatrists at the University Health Network in Toronto and co-founders of UHN’s Nikean Psychedelic Psychotherapy Research Centre (in addition to being lecturers in the Department of Psychiatry at the University of Toronto).   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Briefly describe the history of psychedelics in psychiatry List the four classes of psychedelic drugs and their mechanism of action Summarize the evidence regarding psychedelic-assisted psychotherapy for various psychiatric disorders Discuss patient selection considerations for psychedelic-assisted psychotherapy Describe the safety, tolerability and possible side effects of psychedelic-assisted psychotherapy Understand how a psychedelic-assisted psychotherapy session is practically carried out   Guests: Dr Emma Hapke and Dr Daniel Rosenbaum   Hosts: Dr Chase Thompson (PGY4), Dr Nikhita Singhal (PGY3), Jake Johnston (CC4), and Annie Yu (CC4)   Audio editing by: Nikhita Singhal   Show notes by: Nikhita Singhal   Interview Content: Introduction - 0:00 Learning objectives - 02:47 Definitions/categories of psychedelics - 03:24 Classic psychedelics - 04:15 Empathogens (e.g. MDMA) - 07:15 Etymology of the term “psychedelic” - 09:30 Ketamine - 12:24 Iboga - 13:28 Brief history of psychedelic medicine - 17:51 Current evidence and ongoing trials - 27:38 MDMA and PTSD - 29:26 Psilocybin and treatment-resistant depression - 32:24 A word of caution - 34:29 End-of-life care - 38:47 Practical aspects of psychedelic-assisted psychotherapy sessions - 45:45 Safety considerations - 01:04:04 Future directions - 01:10:33 Closing comments - 01:19:07   Resources: Books: How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (Michael Pollan) The Doors of Perception (Aldous Huxley) The Human Encounter With Death (Stanislav Grof and Joan Halifax) Brainwashed podcast series (CBC): https://www.cbc.ca/listen/cbc-podcasts/440-brainwashed Zendo Project (psychedelic peer support): https://zendoproject.org Nikean Psychedelic Psychotherapy Research Centre: https://www.uhn.ca/MentalHealth/Research/Nikean-Psychedelic-Psychotherapy-Research-Centre California Institute of Integral Studies (CIIS): https://www.ciis.edu Multidisciplinary Association for Psychedelic Studies (MAPS): https://maps.org PsychEd Episode 27 - Serotonin Pharmacology: From SSRIs to Psychedelics with Dr Robin Carhart-Harris) PsychEd Episode 34 - Ketamine for Treatment-Resistant Depression with Dr Sandhya Prashad   References: Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021;384(15):1402-1411. https://doi.org/10.1056/nejmoa2032994 Carhart-Harris R, Nutt D. Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology. 2017;31(9):1091-1120. https://doi.org/10.1177/0269881117725915 Davis AK, Barrett FS, May DG, et al. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(5):481–489. https://doi.org/10.1001/jamapsychiatry.2020.3285 Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. dhttps://dx.doi.org/10.1177%2F0269881116675513 Griffiths RR, Johnson MW, Richards WA, et al. Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. J Psychopharmacol. 2018;32(1):49-69. https://doi.org/10.1177/0269881117731279 Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Ther. 2019;197:83-102. https://doi.org/10.1016/j.pharmthera.2018.11.010 Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033. https://doi.org/10.1038/s41591-021-01336-3 Mithoefer MC, Mithoefer AT, Feduccia AA, et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. 2018;5(6):486-497. https://doi.org/10.1016/s2215-0366(18)30135-4 Nicholas CR, Henriquez KM, Gassman MC, et al. High dose psilocybin is associated with positive subjective effects in healthy volunteers. J Psychopharmacol. 2018;32(7):770-778. https://doi.org/10.1177/0269881118780713 Reiff CM, Richman EE, Nemeroff CB, et al. Psychedelics and Psychedelic-Assisted Psychotherapy. Am J Psychiatry. 2020;177(5):391-410. https://doi.org/10.1176/appi.ajp.2019.19010035 Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol. 2019;26(4):225-226. https://dx.doi.org/10.3747%2Fco.26.5009 Swift TC, Belser AB, Agin-Liebes G, et al. Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress. Journal of Humanistic Psychology. 2017;57(5):488-519. https://doi.org/10.1177/0022167817715966   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers interpersonal psychotherapy (IPT) with Dr. Paula Ravitz, an Associate Professor of Psychiatry at the University of Toronto and Senior Clinician-Scientist at the Lunenfeld-Tanenbaum Research Institute of Mt Sinai Hospital. Dr. Ravitz held the Morgan Firestone Psychotherapy Chair at the Mount Sinai Hospital from 2011 to 2021 and is a past president of the International Society of Interpersonal Psychotherapy. The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define interpersonal psychotherapy Describe the core principles and phases of IPT Become familiarized with some psychological theories underpinning IPT List some patient selection considerations for IPT Describe the efficacy and evidence base for IPT  Understand how IPT is practically carried  out  Briefly compare and contrast IPT to other common psychotherapies   Guest: Dr. Paula Ravitz ([email protected])   Hosts: Jake Johnston and Sena Gok   Audio editing by: Jake Johnston   Show notes by: Jake Johnston   Interview Content: Introduction - 00:00 Learning objectives - 02:10 Definition/overview of IPT - 02:53 Core principles and phases - 07:20 Psychological theories - 19:30 Patient selection considerations - 24:42 Contraindications - 35:57 Evidence base and history - 38:10 Practical components of IPT - 43:57 Maintenance IPT - 59:52 IPT vs other psychotherapies - 62:56  Closing comments - 71:17 Online IPT course - 74:30   Resources: Summary of IPT written in layman's terms: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/interpersonal-psychotherapy The International Society of Interpersonal Psychotherapy (ISIPT) has a helpful overview of IPT and helpful resources for finding more information and IPT training opportunities: https://interpersonalpsychotherapy.org/ ‘Psychotherapy Essentials to Go’ book series mentioned during episode:  https://www.penguinrandomhouse.ca/series/CNL/psychotherapy-essentials-to-go Course for learning IPT mentioned at the end of the episode (email Dr. Ravitz at [email protected] to inquire about access): www.learnipt.com     References: Bernecker, S. L., Coyne, A. E., Constantino, M. J., & Ravitz, P. (2017). For whom does interpersonal psychotherapy work? A systematic review. Clinical psychology review, 56, 82–93. https://doi.org/10.1016/j.cpr.2017.07.001 Chaimowitz, G., Weerasekera, P., & Ravitz, P. (2021). Psychotherapy in Psychiatry. The Canadian Journal of Psychiatry, 66(11), 999–1004. https://doi.org/10.1177/07067437211040958 Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis. The American journal of psychiatry, 173(7), 680–687. https://doi.org/10.1176/appi.ajp.2015.15091141  Dennis, C. L., Grigoriadis, S., Zupancic, J., Kiss, A., & Ravitz, P. (2020). Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial. The British journal of psychiatry : the journal of mental science, 216(4), 189–196. https://doi.org/10.1192/bjp.2019.275  Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., & Docherty, J. P. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of general psychiatry, 46(11), 971–983. https://doi.org/10.1001/archpsyc.1989.01810110013002 Klerman, G. L., Dimascio, A., Weissman, M., Prusoff, B., & Paykel, E. S. (1974). Treatment of depression by drugs and psychotherapy. The American journal of psychiatry, 131(2), 186–191. https://doi.org/10.1176/ajp.131.2.186  MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 588–603. https://doi.org/10.1177/0706743716659276 Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., Velyvis, V., Kennedy, S. H., Lam, R. W., MacQueen, G. M., Milev, R. V., Ravindran, A. V., Uher, R., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 524–539. https://doi.org/10.1177/0706743716659418 Ravitz, P., & Watson, P. (2014). Interpersonal Psychotherapy: Healing with a Relational Focus. FOCUS, 12(3), 275-284. https://doi.org/10.1176/appi.focus.12.3.275 Ravitz, P., Watson, P., Lawson, A., Constantino, M. J., Bernecker, S., Park, J., & Swartz, H. A. (2019). Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974-2017). Harvard review of psychiatry, 27(3), 165–180. https://doi.org/10.1097/HRP.0000000000000219 Swartz, H. (2021). Interpersonal Psychotherapy (IPT) for depressed adults: Indications, theoretical foundation, general concepts, and efficacy. UpToDate. Accessed 2021-10-12.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.  

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness with our guest expert Dr. Sonu Gaind. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.    The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Briefly summarize the history of Medical Assistance in Dying in Canada Define the present policy on Medical Assistance in Dying and Mental Health in Canada Evaluate the arguments in support of and against the implementation of Medical Assistance in Dying in Mental Health Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry   Guest expert: Dr. Sonu Gaind  is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Humber River Hospital. Dr. Gaind has testified in front of the Federal External Panel on Options for a Legislative Response to Carter v. Canada, the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the Special Joint Commons/Senate Committee on Physician-Assisted Dying, and the Senate Committee on Legal and Constitutional Affairs on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, and has spoken across the country and internationally on the subject.   Grand Rounds Presenter: Dr. Urvashi Prasad (PGY3)   Produced by: Dr. Urvashi Prasad (PGY3) and Dr. Alex Raben  (staff psychiatrist)   Hosts: David Eapen-John (MS2), Dr. Alex Raben (Staff Psychiatrist)   Audio editing by: Dr. Alex Raben (Staff Psychiatrist)   Show notes by: Dr. Urvashi Prasad (PGY3)     Resources: Assisted Suicide in Canada https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada (Website) Council of Canadian Academies, 2018. The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition. Ottawa (ON):  The Expert Panel Working Group on MAID Where a Mental Disorder Is the Sole Underlying Medical Condition  https://cca-reports.ca/wp-content/uploads/2018/12/The-State-of-Knowledge-on-Medical-Assistance-in-Dying-Where-a-Mental-Disorder-is-the-Sole-Underlying-Medical-Condition.pdf References: Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.” Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/. Tabitha Marshall. “Assisted Suicide in Canada.” The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada. “Get the Facts: Canada's Medical Assistance in Dying Law.” Dying With Dignity Canada, https://www.dyingwithdignity.ca/get_the_facts_assisted_dying_law_in_canada#mental_illness. Jones, Roland M, and Alexander I F Simpson. “ Medical Assistance in Dying: Challenges for Psychiatry.” Frontiers in psychiatry vol. 9 678. 10 Dec. 2018, doi:10.3389/fpsyt.2018.00678 Thienpont, Lieve et al. “Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study.” BMJ open vol. 5,7 e007454. 27 Jul. 2015, doi:10.1136/bmjopen-2014-007454 Gaind, KS. (2020). What does “irremediability” in mental illness mean? Canadian Journal of Psychiatry. Online first May 22, 2020. pp 1‐3. doi: 10.1177/0706743720928656 “Maid Volunteer Advocacy Council.” Mental Illness and MAID, https://sencanada.ca/content/sen/committee/432/LCJC/Briefs/MentalIllnessandMAID_e.pdf. Canada, Health. “Second Annual Report on Medical Assistance in Dying in Canada 2020.” Canada.ca, / Government of Canada Gouvernement Du Canada, 30 June 2021, https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html#highlights.  Komrad, Mark S. “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients.” Psychiatric Times, 1 June 2021, https://www.psychiatrictimes.com/view/canada-law-provide-not-prevent-suicide.      CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer, a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populations Incorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches  Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours    Guest expert: Dr. Juveria Zaheer    Hosts: Dr. Chase Thompson (PGY4)   Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson    Audio editing: Dr. Chase Thompson   Show notes: Dr. Chase Thompson   00:00 – Introduction 01:14 – Learning objectives 04:00 – Overview of suicide rates across populations 07:20 - Sex and gender differences in suicide 08:50 - Suicide following discharge from hospital 14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors 20:50 - Meeting patients and families where they are at 23:30 - Suicide safety plans  28:30 - Evidence-based approaches to suicide prevention  32:30 - Commentary on strength of evidence for interventions in suicide prevention 38:40 - Addressing suicidality in borderline personality disorder 47:00 - Ethics of involuntary hospitalization for suicidality 50:00 - Future of suicide prevention  References: Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83. Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346. Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open, 9(3), e023883. Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA psychiatry, 74(7), 694-702. Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies. Social psychiatry and psychiatric epidemiology, 54(12), 1459-1470. Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168-179. Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074. Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study. JAMA psychiatry, 74(6), 563-570. Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140. Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900. Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophrenia research, 202, 347-353. Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527-543. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers electroconvulsive therapy with Dr. Wei-Yi Song, the Department Head of Psychiatry, Director of Mood Disorder Services, and Director of ECT Services in Victoria, BC, as well as a Clinical Professor at the University of British Columbia, and a past president of the Canadian Psychiatric Association.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Briefly describe the history of ECT from inception to the present. Debunk common misconceptions about ECT. Describe the major proposed mechanisms of action of ECT. Describe the efficacy of ECT for common psychiatric illnesses. List the indications, contraindications, side effects and risks of ECT. Understand how the procedure of ECT is performed.   Guest: Dr. Wei-Yi Song   Hosts: Jake Johnston (MS4), Dr. Shaoyuan “Randi” Wang (PGY1), Dr. Arielle Giest (PGY2), Dr. Alex Raben (Staff Psychiatrist)   Audio editing by: Jake Johnston   Show notes by: Jake Johnston   Interview Content: Introduction - 0:00 Learning objectives - 01:54 History of ECT - 02:45 Common misconceptions - 06:36 Mechanism of action - 12:03 Summary - 16:06 Indications - 16:47 Contraindications - 20:58 Side effects and risks - 23:31 Efficacy of ECT - 29:00 Major depressive disorder - 29:13 Bipolar depression - 33:00 Schizophrenia - 34:19 Bipolar mania - 36:16 Procedure - 38:50 Steps of performing ECT - 39:20 Considerations for electrode placement - 47:29 Pulse width - 51:19 Maintenance treatment - 53:32 Closing - 59:09   Resources: Video showing ECT procedure: https://www.youtube.com/watch?v=9L2-B-aluCE   One note on the realism of this depiction: an actual patient would not shake uncontrollably due to the muscle relaxants.   Summary of electrode placement and pulse width: https://psychscenehub.com/psychinsights/electroconvulsive-therapy-summary-of-ranzcp-guidelines/   References: Baldinger, P., Lotan, A., Frey, R., Kasper, S., Lerer, B., & Lanzenberger, R. (2014). Neurotransmitters and electroconvulsive therapy. The journal of ECT, 30(2), 116–121. https://doi.org/10.1097/YCT.0000000000000138 Francois, D. and DellaCava E. (2018). “10 myths about ECT”. Current Psychiatry. Accessed 2021-06-28 from MDedge. Kane, J., Rubio, J., Kishimoto, T., Correll, C., Marder, S., and Friedman, M. (2021). Evaluation and management of treatment-resistant schizophrenia. UpToDate. Accessed 2021-07-27. Kellner, C., Keck, P., and Solomon, D. (2021). Bipolar disorder in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27. Kellner, C. and Rasmussen, K. (2015). Contemporary ECT, Part 2: Mechanism of Action and Future Research Directions. Psychiatric Times. Accessed 2021-07-08. Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Overview of electroconvulsive therapy for adults. UpToDate. Accessed 2021-06-28. Kellner, C., Roy-Byrne, P., and Solomon, D. (2021). Unipolar major depression in adults: Indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. Accessed 2021-07-27. Petrides, G., Malur, C., Braga, R. J., Bailine, S. H., Schooler, N. R., Malhotra, A. K., Kane, J. M., Sanghani, S., Goldberg, T. E., John, M., & Mendelowitz, A. (2015). Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study. The American journal of psychiatry, 172(1), 52–58. https://doi.org/10.1176/appi.ajp.2014.13060787 Singh, A., & Kar, S. K. (2017). How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 15(3), 210–221. https://doi.org/10.9758/cpn.2017.15.3.210   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Clinical High Risk for Psychosis with Dr. Thomas Raedler, Psychiatrist and associate professor at the University of Calgary and one of the authors of the Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis.   The learning objectives for this episode are as follows: By the end of this episode, you should be able to…   Recognize a patient who may be clinically high-risk for psychosis and provide a differential diagnosis  Understand the importance, utility and prognosis of these risk categories  Have an approach to initial management and the array of treatment options for a patient with    Hosts: Dr. Luke Fraccaro (PGY-2), Dr. Rebecca Marsh (PGY-1), Dr. Alex Raben Episode lead: Dr. Luke Fraccaro Audio-engineered by: Dr. Rebecca Marsh Guest experts: Dr. Thomas Raedler Show Notes by: Dr. Luke Fraccaro   Resources:   Addington, J., Francey, S., Morrison, A.  (2006). Working with People at High Risk of Developing Psychosis: A Treatment Handbook  McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: handbook for diagnosis and follow-up. Oxford University Press.   References : Addington, J., Addington, D., Abidi, S., Raedler, T., & Remington, G. (2017). Canadian treatment guidelines for individuals at clinical high risk of psychosis. The Canadian Journal of Psychiatry, 62(9), 656-661. Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., ... & Heinssen, R. (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry, 168(8), 800-805. Addington, J., & Heinssen, R. (2012). Prediction and prevention of psychosis in youth at clinical high risk. Annual review of clinical psychology, 8, 269–289.  Carrión, R. E., McLaughlin, D., Goldberg, T. E., Auther, A. M., Olsen, R. H., Olvet, D. M., Correll, C. U., & Cornblatt, B. A. (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA psychiatry, 70(11), 1133–1142. https://doi.org/10.1001/jamapsychiatry.2013.1909 Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., Barale, F., Caverzasi, E., & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220–229.  Fusar-Poli P, Salazar de Pablo G, Correll CU, et al. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. 2020;77(7):755–765. doi:10.1001/jamapsychiatry.2019.4779 Fusar-Poli, P., Schultze-Lutter, F., Cappucciati, M., Rutigliano, G., Bonoldi, I., Stahl, D., Borgwardt, S., Riecher-Rössler, A., Addington, J., Perkins, D. O., Woods, S. W., McGlashan, T., Lee, J., Klosterkötter, J., Yung, A. R., & McGuire, P. (2016). The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophrenia bulletin, 42(3), 732–743.  Kuharic, D. B., Kekin, I., Hew, J., Kuzman, M. R., & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews, (11). Nelson, B., Amminger, G. P., Bechdolf, A., French, P., Malla, A., Morrison, A. P., ... & Wood, S. J. (2020). Evidence for preventive treatments in young patients at clinical high risk of psychosis: the need for context. The lancet. Psychiatry, 7(5), 378. Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., ... & Morrison, A. (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European psychiatry, 30(3), 388-404. Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., ... & Buckby, J. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11-12), 964-971.   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 is the second of two episodes covering the topic of eating disorders. In this episode, we explore the treatment of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital.    The learning objectives for the episode are as follows:   By the end of this episode, you should be able to… Outline the management of eating disorders using a biopsychosocial framework. Identify the indications for various levels of care (inpatient, residential, day hospital, outpatient, etc). Understand the ethical and medicolegal dilemmas (i.e. involuntary treatment) that may arise in treatment of eating disorders. Consider the treatment of special populations (i.e. children and adolescents, older adults, men, LGBTQ+ individuals).   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY3), Dr. Vanessa Aversa (PGY4)   Audio editing by: Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa, Dr. Nikhita Singhal   Interview Content: Introduction - 0:00  Learning objectives - 00:39 Biological approaches to treatment: Nutritional rehabilitation - 03:47 Medications - 06:00 Psychological approaches to treatment -16:35 Treatment of comorbidities - 23:45 Levels of care - 26:00 Ethical dilemmas - 32:40 Special populations: Children and adolescents - 35:35 Older adults - 36:45 Men - 37:55 LGBTQ+ - 40:23 Novel interventions - 42:48 Closing - 51:47   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca. The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca. Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10 Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019. Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. 2006. Geller J, Isserlin L, Seale E, et al. The short treatment allocation tool for eating disorders: current practices in assigning patients to level of care. J Eat Disord. 2018;6(45). https://doi.org/10.1186/s40337-018-0230-2 McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008 Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7 Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the first of two episodes covering the topic of eating disorders. In this episode, we explore the diagnosis, etiology, and symptomatology of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. Dr. Staab joins us again for Part 2, which will focus on eating disorder treatment.   By the end of this episode, you should be able to… Recognize the clinical features of the following eating disorders using DSM-5 diagnostic criteria:  Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Avoidant/Restrictive Food Intake Disorder (ARFID) Other Specified Feeding or Eating Disorder (OSFED) Identify predisposing factors for eating disorders using a biopsychosocial framework. List common comorbid psychiatric conditions associated with eating disorders. Identify and describe the medical complications of eating disorders.   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY2), Dr. Vanessa Aversa (PGY3)   Audio editing by: Dr. Nikhita Singhal, Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa   Interview Content: Introduction - 0:00  Learning objectives - 2:08 DSM-5 definition, clinical features, and associated comorbidities of: Anorexia Nervosa (AN) - 4:27 Bulimia Nervosa (BN) - 12:36 Binge Eating Disorder (BED) - 18:08 Avoidant/Restrictive Food Intake Disorder (ARFID) - 21:43 Other Specified Feeding or Eating Disorder (OSFED) - 26:21 Approach to the initial assessment of a patient with an eating disorder - 29:45 Predisposing factors and explanatory models for the development of eating disorders: Biological factors - 38:10 Psychological factors - 44:00 Sociocultural factors - 48:02 Onset of eating disorders - 49:34 Possible precipitating factors - 51:50 Medical complications of eating disorders: Cardiovascular - 56:13 Endocrine - 58:09 Musculoskeletal - 1:03:20 Gastrointestinal - 1:05:17 Neurological - 1:08:13 Renal - 1:08:59 Dermatological - 1:09:26 Relevant laboratory investigations - 1:11:27 Overview of refeeding syndrome - 1:12:30 Closing - 1:14:27   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca. The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca. Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10 Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019. Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017. McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008 Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7 Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.   This episode covers the psychiatric aspects of chronic pain with expert guest:   Dr. Leon Tourian, Associate Professor in the Department of Psychiatry at McGill University, and psychiatrist at the MUHC Alan Edwards Pain Management Unit.   The learning objectives for this episode are as follows: By the end of this episode, you should be able to Explore the role of psychiatry in the management of pain Discuss the epidemiology of psychiatric comorbidities in pain disorders. Outline the pathophysiology of pain and its relationship to psychiatric disorders. Outline the role of non-pharmacological management/treatment of pain including psychotherapy and central neuromodulation Discuss a general psychopharmacology approach in the management of pain relief and psychiatric comorbidities with chronic pain (including SNRI, TCAs, anticonvulsants, antipsychotics and cannabinoids). Discuss the intersection of pain medicine with somatic symptom and related disorders   Guest: Dr. Leon Tourian Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4) Audio editing by Audrey Le Show notes by Dr. Nima Nahiddi Episode Infographic by Dr. Luba Bryushkova     Interview Content: Introduction and learning objectives – 0:00 Role of psychiatry in management of chronic pain – 1:45 Psychiatric co-morbidities in patients with chronic pain – 5:45 Biological link between pain and psychiatric co-morbidities – 11:00 Psychological approach to understanding and management of chronic pain– 14:30 Central neuromodulation strategies for chronic pain – 21:00 General pharmacological approach to the management of chronic pain – 22:30 Pathogenesis of neuropathic and somatic visceral pain – 30:00 Antipsychotics in the management of chronic pain – 37:00 Cannabis in the management of chronic pain – 40:30 Somatic symptom disorder – 46:00 Stigma in chronic pain disorders – 53:10 Treatment of somatic symptom disorder – 58:30 Psychiatry and the stigma of chronic pain disorders– 61:00 Closing remarks – 65:15   Articles and Resources: Guideline for opioid therapy and chronic noncancer pain (CMAJ) Guideline The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (McMaster University) List of Pain & Opioid Initiatives (2017) (CFPC) Canadian Pain Task Force Report: June 2019   References: Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations. Psychosomatic medicine, 64(5), 773–786. https://doi.org/10.1097/01.psy.0000024232.11538.54   Katz, J., Rosenbloom, B. N., & Fashler, S. (2015). Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(4), 160–167. https://doi.org/10.1177/070674371506000402   O'Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H., & Wand, B. M. (2018). Non-invasive brain stimulation techniques for chronic pain. The Cochrane database of systematic reviews, 4(4), CD008208. https://doi.org/10.1002/14651858.CD008208.pub5   Ratcliffe, G. E., Enns, M. W., Belik, S. L., & Sareen, J. (2008). Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. The Clinical journal of pain, 24(3), 204–210. https://doi.org/10.1097/AJP.0b013e31815ca2a3   Tunks, E. R., Crook, J., & Weir, R. (2008). Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 53(4), 224–234. https://doi.org/10.1177/070674370805300403   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers ketamine for treatment-resistant depression (TRD) with Dr. Sandhya Prashad, a psychiatrist and the founder and medical director of Houston Ketamine Therapeutics. She has extensive expertise using ketamine and is one of the most experienced ketamine psychiatrists in the United States, with her clinical practice focusing on TRD and incorporating transcranial magnetic stimulation (TMS), sometimes in conjunction with ketamine. Dr. Prashad is also a founding member and current president of the American Society of Ketamine Physicians (ASKP), a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy.   We’re also experimenting with something new for this episode — providing a transcript of the entire interview! The transcript can be found at psychedpodcast.org/transcripts/ketamine. We’d love to hear your feedback as listeners on this as a feature, including whether it’s something you’d be interested in seeing for other episodes moving forward!   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Describe ketamine and how it came to be used in the field of psychiatry. Develop an appreciation for benefits and potential harms associated with ketamine and how this compares to other treatments for depression. Understand how ketamine fits into the treatment of depression and suicidality, patient characteristics to consider before initiation, potential mechanisms of action, different models of administration, and incorporation of psychotherapy.   Guest expert: Dr. Sandhya Prashad   Hosts: Jimmy Qian (MS2), Dr. Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3)   Audio editing by: Dr. Chase Thompson   Show notes by: Gray Meckling (MS4)   Interview transcript by: Gray Meckling   00:00 – Introduction 03:00 – Learning objectives 03:30 – History of ketamine 06:20 – Recreational use of ketamine, phenomenology of the ketamine experience 09:45 – Where does ketamine fall in the algorithm for treatment of depression? 11:50 – Ketamine’s use in acute suicidality 13:40 – Ketamine contraindications 14:40 – Ketamine efficacy 19:00 – Combining ketamine with rTMS 21:15 – Limitations to ketamine 24:35 – Ketamine mechanism of action 26:05 – Ketamine formulations, and integrating ketamine into psychotherapy 33:10 – Combining ketamine with traditional antidepressant treatment 37:30 – Practicalities of administering ketamine 39:40 – Ketamine as treatment for OCD and PTSD 41:40 – Closing remarks   Resources: American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP) Sandhya Prashad, MD (Website) NEJM interview with Dr. Roy Perlis: Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class   References: Berman, R., Cappiello, A., Anand, A., Oren, D., Heninger, G., Charney, D.. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 47: 351–354. Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA psychiatry, 76(9), 893-903. J.W. Murrough, D.V. Iosifescu, L.C. Chang, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two site randomized controlled trial. Am. J. Psychiatry, 2013 (170) (2013), pp. 1134-1142 Kim, J., Farchione, T., Potter, A., Chen, Q., & Temple, R. (2019). Esketamine for treatment-resistant depression-first FDA-approved antidepressant in a new class. N Engl J Med, 381(1), 1-4. McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S. (2021). Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. American Journal of Psychiatry, appi-ajp. Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence [Internet]. 2008 Jun 1;95(3):219–29. Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405. Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15. Williams NR, Heifets BD, Bentzley BS, Blasey C, Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of antidepressant and anti suicidal effects of ketamine by opioid receptor antagonism. Molecular psychiatry. 2019 Dec;24(12):1779-86. Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63: 856–864.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of borderline personality disorder with expert guests: Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, and inpatient psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as the inpatient psychiatrist at the Jewish General Hospital. Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, and head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre. The learning objectives for this episode are as follows:  By the end of this episode, you should be able to… Understand the frame and principles of care for the treatment of individuals with borderline personality disorder. Explore the approach to the treatment of individuals with borderline personality disorder: On presentation in crisis to the emergency department. During an inpatient psychiatric admission. In the context of psychiatric outpatient care. Understand the use of psychotherapy in the treatment of individuals with borderline personality disorder. Understand the use of pharmacotherapy in the treatment of individuals with borderline personality disorder Guest: Dr. Robert Biskin and Dr. Ronald Fraser Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4) Audio editing by Audrey Le Show notes by Dr. Nima Nahiddi Interview Content:  Introduction – 0:00 Learning objectives – 0:35 Principles of care for treatment of BPD – 1:16 The therapeutic frame – 5:40  Approach to the management of emergency department presentations – 9:10 Dialectical behaviour therapy (DBT) – 16:15 Suicidality and self-harm in BPD diagnosis – 21:05 Pharmacotherapy for symptom treatment – 22:40 Treatment of co-morbid disorders – 32:35  Management of safety risk – 39:30 Stigma in treatment of BPD – 46:05 Closing remarks – 52:00 Resources/Articles: The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome | Annual Review of Clinical Psychology (annualreviews.org) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis | Psychiatry | JAMA Psychiatry | JAMA Network National Education Alliance for Borderline Personality Disorder References:   Cristea I.A., Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. (2017) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry. 74(4):319–328. doi:10.1001/jamapsychiatry.2016.4287 Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H  J. (2010) Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. Clin Psychiatry. 71(1):14.  Paris J. (2009). The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome. Review of Clinical Psychology. 5:1, 277-290 Stoffers J, Vollm BA, Rucker G, Timmer A, Huband N. (2010) Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD005653. DOI: 10.1002/14651858.CD005653 Storebø  OJ, Stoffers-Winterling  JM, Völlm  BA, Kongerslev  MT, Mattivi  JT, Jørgensen  MS, Faltinsen  E, Todorovac  A, Sales  CP, Callesen  HE, Lieb  K, Simonsen  E.  (2020) Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD012955. DOI: 10.1002/14651858.CD012955.pub2     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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.  

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of borderline personality disorder with expert guests: Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as inpatient psychiatrist at the Jewish General Hospital. Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre.   By the end of this episode, you should be able to… List the DSM-5 diagnostic criteria of borderline personality disorder. Recall the epidemiology of borderline personality disorder. Consider the risk factors and posited causal mechanisms for borderline personality disorder, including developmental and neurobiological mechanisms.  Discuss the clinical presentation of borderline personality in different clinical settings, including the Emergency and Outpatient settings.  Recognize the differential diagnoses for patients presenting with borderline personality disorder. List the common comorbid psychiatric and general medical conditions with borderline personality disorder. Discuss the common diagnostic challenges and pitfalls. Explore the stigma surrounding the diagnosis of borderline personality disorder, and discuss a therapeutic approach to providing psychoeducation to patients with this diagnosis.    Guests: Dr. Robert Biskin and Dr. Ronald Fraser. Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4). Audio editing by Audrey Le. Show notes by Dr. Nima Nahiddi.   Interview Content: Introduction – 0:00 Learning objectives – 2:03 DSM-5 definition of personality disorder, and borderline personality disorder (BPD) – 3:00 Other associated features of BPD – 4:36 Distinguishing BPD from other psychiatric and co-morbid conditions – 5:55 Epidemiology of BPD – 13:48 BPD over the lifecycle – 18:05 Explanatory models for the development of BPD – 21:20 Differences in the presentation of BPD – 26:00 Approach to a BPD diagnosis in the emergency department – 31:05 Stigma surrounding BPD diagnosis and disclosure of diagnosis – 33:51 Clinical pearls for screening of BPD – 41:11 Evidenced based screening tools or scales for BPD diagnosis – 46:22 Closing – 48:40 Resources: MSI-BDP: MacLean Screening Index for BPD Diagnostic Interview for BPD – Revised (DIB-R): https://psycnet.apa.org/record/1990-11356-001 Articles: Diagnosing borderline personality disorder | CMAJ   References: Biskin, R.S., Paris, J. (2012). Diagnosing borderline personality disorder. CMAJ. 184 (16), 1789-1794. Zanarini, M. C., Gunderson, J. G., Frankenburg, F. R., & Chauncey, D. L. (1989). The revised Diagnostic Interview for Borderlines: Discriminating BPD from other Axis II disorders. Journal of Personality Disorders, 3(1), 10–18. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychodynamic psychotherapy with Dr. Rex Kay. Dr. Kay is a staff psychiatrist at Mount Sinai Hospital, assistant professor and modality lead for dynamic psychotherapy at the University of Toronto, as well as a faculty member at the Toronto Institute for Contemporary Psychoanalysis.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define psychodynamic psychotherapy.  Describe the core concepts of psychodynamic therapy.  Determine who may be an appropriate patient for psychodynamic psychotherapy.  Describe the evidence base for psychodynamic psychotherapy.  Compare and contrast psychodynamic therapy to other psychotherapies.    Guest: Dr. Rex Kay   Produced and Hosted by: Jordan Bawks and Anita Corsini   Audio editing by: Anita Corsini   Resources: Ars Medica: A Journal of Medicine, the Arts, and Humanities Canadian Institute for Child and Adolescent Psychoanalytic Psychotherapy  Narrative Competence Psychotherapy Group at Mount Sinai Hospital Toronto Institute for Contemporary Psychoanalysis Toronto Institute of Psychoanalysis    References: Black, M. & Mitchell, S. (2016). Freud and beyond: A history of modern psychoanalytic thought. Basic Books.  Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2017). Psychodynamic psychotherapy: A clinical manual. Wiley.   Driessen, E., Hegelmaier, L. M., Abbass, A. A., Barber, J. P., Dekker, J. J., Van, H. L., Jansma, E. P., & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clinical Psychology Review, 42, 1-15. doi: 10.1016/j.cpr.2015.07.004 Eppel, A. (2018). Short-term psychodynamic psychotherapy. Springer.  Karen, R. (1994). Becoming attached: First relationships and how they shape our capacity to love. Oxford.  Safran, J. D. (2012). Psychoanalysis and Psychoanalytic Therapies. American Psychological Association.  Summers, R. F. & Barber, J. P. (2010). Psychodynamic Therapy: A Guide to Evidence-Based Practice. Guilford. 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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers anti-black racism and mental health with Dr. Kwame McKenzie. Dr. McKenzie is an international expert on the social causes of illness, suicide and the development of effective, equitable health systems. He is a Professor of Psychiatry at University of Toronto and a staff psychiatrist and Director of Health Equity at the Centre of Addiction and Mental Health.   The learning objectives:   By the end of this episode, you should be able to… Understand the history and legacy of racism and mental health in the black community Understand the current state of racism towards black people and the impacts on their mental health. Explore how healthcare workers can be anti-racist in providing mental health care and how the system can change to improve the mental health of black people.   Host(s): Anita Corsini (social worker), Dr. Alex Raben (staff psychiatrist), and Rebecca Marsh (CC4)   Produced by: Anita Corsini, Rebecca Marsh, Randi Wang (CC4), and Dr. Alex Raben   Guest experts: Dr. Kwame McKenzie, staff psychiatrist   Resources:   Manual for Cognitive-Behavioural Therapy for English-Speaking People of Caribbean Origin The City of Toronto has curated a list of Mental Health Resources for Black Communities. Organizations include: Across Boundaries Black Creek Community Health Centre Caribbean African Canadian Social Services Rexdale Community Health Centre TAIBU Community Health Centre The Black Health Alliance Women’s Health in Women’s Hands Community Health Centre   References:   Adelman, J. (2003). Study in Blue and Grey, Police Interventions with People with Mental Illness: A Review of Challenges and Responses [Ebook]. Canadian Mental Health Association. Retrieved 7 October 2020, from https://cmha.bc.ca/wp-content/uploads/2016/07/policereport.pdf. Bailey, R. K., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: current perspectives. Neuropsychiatric disease and treatment, 15, 603–609. https://doi.org/10.2147/NDT.S128584 Bor, J., Venkataramani, A., Williams, D., & Tsai, A. (2018). Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. The Lancet, 392(10144), 302-310. https://doi.org/10.1016/s0140-6736(18)31130-9 Bresnahan, M., Begg, M., Brown, A., Schaefer, C., Sohler, N., & Insel, B. et al. (2007). Race and risk of schizophrenia in a US birth cohort: another example of health disparity?. International Journal Of Epidemiology, 36(4), 751-758. https://doi.org/10.1093/ije/dym041 Chakraborty, A., McKenzie, K., & King, M. (2009). Discrimination, ethnicity and psychosis — a qualitative study. Ethnicity And Inequalities In Health And Social Care, 2(1), 18-29. https://doi.org/10.1108/17570980200900004 Fernando, S. (2014). Racism in psychiatry. In R. Moodley & M. Ocampo (Eds.), Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando in Clinical Practice (pp. 22-32). Taylor & Francis.   Kirkmayer, L. J. (2014). Critical psychiatry in Canada. In R. Moodley & M. Ocampo (Eds.), Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando in Clinical Practice (pp. 170-181). Taylor & Francis.   Kuper, A. (2018). Cultural Safety & Equity [Lecture PDF]. Retrieved from University of Toronto Faculty of Medicine.  Maynard, R. (2017). Policing Black Lives: State Violence in Canada from Slavery to the Present. Fernwood. McKenzie, K. (2002). Does racial discrimination cause mental illness?. European Psychiatry, 17, 84. https://doi.org/10.1016/s0924-9338(02)80385-6 McKenzie, K., & Bhui, K. (2007). Institutional racism in mental health care. BMJ, 334(7595), 649-650. https://doi.org/10.1136/bmj.39163.395972.80 MCRRT - St. Joseph's Healthcare Hamilton. St. Joseph's Healthcare Hamilton. (2020). Retrieved 7 October 2020, from https://www.stjoes.ca/health-services/mental-health-addiction-services/mental-health-services/coast/mcrrt. Richardson, L. (2019). Diversity and Advocacy [Lecture PDF]. Retrieved from University of Toronto Faculty of Medicine.  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 topic of cultural psychiatry with expert guest Dr. Eric Jarvis, Staff Psychiatrist and Director of the Cultural Consultation Service and the First Episode Psychosis Program at the Jewish General Hospital in Montreal, Quebec and Associate Professor in the Department of Psychiatry at McGill University.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define culture Describe how culture affects psychiatric care Outline the goal and structure of a Cultural Formulation Interview Evaluate clinical scenarios to determine whether to employ the Cultural Formulation Interview or seek a cultural consultation Define the three types of cultural concepts of distress, and compare these with DSM-5 nosology Discuss the concept of cultural competency  Explore the role of advocacy in psychiatric practice   Guest expert: Dr. Eric Jarvis Hosts: Dr. Sarah Hanafi (PGY3), Audrey Le (CC4) Audio editing by Dr. Sarah Hanafi (PGY3) Show notes by Dr. Sarah Hanafi (PGY3)   Interview Content: Introductions: 0:28 Learning objectives: 3:01 Definition of cultural psychiatry: 3:52 Definition of culture: 6:50 Disparities in mental health outcomes 12:48 The Cultural Formulation Interview (CFI) 15:59 Cultural concepts of distress 34:28 Cultural competency 40:46 Role of advocacy in psychiatry 48:04 Tips for those interested and training opportunities 51:26 Closing 61:01   Resources: McGill Summer Program in Social and Cultural Psychiatry McGill Advanced Study Institute in Cultural Psychiatry Society for the Study of Psychiatry and Culture Cultural Psychiatry Day   References: Cultural Formulation. (2017). In Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association. Kirmayer, L. J., Fung, K., Rousseau, C., Lo, H. T., Menzies, P., Guzder, J., . . . Mckenzie, K. (2020). Guidelines for Training in Cultural Psychiatry. The Canadian Journal of Psychiatry, 070674372090750. doi:10.1177/0706743720907505 Kirmayer, L. J., Kronick, R., & Rousseau, C. (2018). Advocacy as Key to Structural Competency in Psychiatry. JAMA Psychiatry, 75(2), 119. doi:10.1001/jamapsychiatry.2017.3897  Kirmayer, L.J., Rousseau, C., Jarvis, G.E. and Guzder, J. (2008). The Cultural Context of Clinical Assessment. In Psychiatry (eds A. Tasman, J. Kay, J.A. Lieberman, M.B. First and M. Maj). doi:10.1002/9780470515167.ch4    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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Immigrant and Refugee mental health with not one, not two but three experts in the field: Dr. Lisa Andermann, Dr. Clare Pain, and Norma Hannant.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to: Explore the social, political and legal context of refugees and immigrants presenting with mental health concerns: Appreciate the specific mental health needs of refugee and immigrant populations in Canada. Describe the clinical approach to providing mental health care for this population: Produced and Hosted by: Dr. Sarah Hanafi (PGY 3), Weam Sieffien (CC3), and Shaoyuan (Randi) Wang (CC3)   Produced by: Dr. Sarah Hanafi (PGY 3), Weam Sieffien (CC3), and Shaoyuan (Randi) Wang (CC3)   Guest experts: Dr. Lisa Andermann, Dr. Clare Pain, Norma Hannant  Resources:  Immigrant and Refugee Mental Health Project (courses, community of practice and toolkits) Listen to Weam’s hands-on impressions of this resource in the post-credits of this episode References  Edmonston, B. (2016). Canadian immigration trends and patterns. Canadian Studies in Population, 43(1-2), 78-116.  Duffin, E. (2020). Immigration in Canada - Statistics & Facts. Statista. Retrieved 2020-06-16 from https://www.statista.com/topics/2917/immigration-in-canada/ Statistics Canada. (2019). Classification of admission category of immigrant. Retrieved 2020-06-16 from https://www23.statcan.gc.ca/imdb/p3VD.pl?Function=getVD&TVD=323293&CVD=323294&CLV=0&MLV=4&D=1 Robert, A. & Gilkinson, T. (2012). Mental health and well-being of recent immigrants in Canada: Evidence from the Longitudinal Survey of Immigrants to Canada. Citizenship and Immigration Canada. Retrieved 2020-06-16 from https://novascotia.cmha.ca/wp-content/uploads/2020/01/mental-health.pdf Ng, E. (2015). The healthy immigrant effect and mortality rates. Statistics Canada. Retrieved 2020-06-16 from https://www150.statcan.gc.ca/n1/pub/82-003-x/2011004/article/11588-eng.htm Immigrant and Refugee Mental Health Project. (n.d.). Retrieved from https://irmhp-psmir.camhx.ca/ Stats Canada 2016 Stats Canada 2017 Blair AH, Schneeberg A. Changes in the ‘healthy migrant effect’ in Canada: are recent immigrants healthier than they were a decade ago?. Journal of immigrant and minority health. 2014 Feb 1;16(1):136-42 Vang Z, Sigouin J, Flenon A, Gagnon A. The healthy immigrant effect in Canada: A systematic review. Population Change and Lifecourse Strategic Knowledge Cluster Discussion Paper Series/Un Réseau stratégique de connaissances Changements de population et parcours de vie Document de travail. 2015;3(1):4. Close C, Kouvonen A, Bosqui T, Patel K, O’Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Globalization and health. 2016 Dec;12(1):47. Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, Hassan G, Rousseau C, Pottie K. Common mental health problems in immigrants and refugees: general approach in primary care. Cmaj. 2011 Sep 6;183(12):E959-67 Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118, 293-302. Harris, M. & Fallot, R.D. (2001). Envisioning a Trauma-informed service system: A vital paradigm shift. New Directions in Mental Health Services, 89, 3-22. Chen AW, Kazanjian A, Wong H. Why do Chinese Canadians not consult mental health services: health status, language or culture?. Transcultural psychiatry. 2009 Dec;46(4):623-41. Durbin A, Lin E, Moineddin R, Steele LS, Glazier RH. Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada. Open Medicine. 2014;8(4):e136. Hansson, E., Tuck, A., Lurie, S., and McKenzie, K. for the Task Group of the Services Systems Advisory Committee, Mental Health Commission of Canada.  (2010). Improving mental health services for immigrant, refugee, ethno-cultural and racialized groups: Issues and options for service improvement. Available: http://www.mentalhealthcommission.ca/English/document/457/improving-mental-health-services-immigrant-refugee-ethno-cultural-and-racialized-groups Paniagua, F. (2014). Assessing and Treating Culturally Diverse Clients: A Practical Guide. Thousand Oaks, California: Sage 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.   In this episode, we begin to explore the neurobiology of the serotonin system — along with key pharmacological agents (SSRIs and classical psychedelics) that act on this system — with guest expert Dr. Robin Carhart-Harris, a neuroscientist and head of the Centre for Psychedelic Research at Imperial College London.   Our discussion is more theoretical than directly clinically relevant, striving to provide a mechanistic understanding of how serotonin functions within the brain and how serotonin-modulating drugs influence this system. The episode was inspired by a review published by our guest expert and Dr. David Nutt called “Serotonin and brain function: a tale of two receptors” (cited below). If you are interested in the topic, you might consider reading this review in full! Please note that the figures referenced during this episode can be accessed at https://journals.sagepub.com/doi/figure/10.1177/0269881117725915.   The learning objectives for this episode are as follows:    By the end of this episode, you should be able to…   Understand the general anatomy and function of the serotonin system, with a focus on the purported activity of the more common serotonin receptors and transporters. Describe the effects of serotonin reuptake inhibitors and how they lead to symptom improvement in mood and anxiety disorders, in addition to the mechanism of action of other serotonergic medications. Consider the two-pronged serotonin system conceptualized by Dr. Carhart-Harris, and understand how serotonergic agents (including SSRIs and classic psychedelics) and the concepts of active and passive coping fit within this theory.   Guest: Dr. Robin Carhart-Harris, a neuroscientist and head of the Centre for Psychedelic Research at Imperial College London.   Produced and hosted by: Dr. Chase Thompson (PGY3), Dr. Lucy Chen (Psychiatrist), Dr. Nikhita Singhal (PGY2)   Audio editing by: Dr. Chase Thompson   Infographic by: Dr Chase Thompson, Dr Nikhita Singhal   Interview Content:   00:18 - Introductions 3:00 - Learning objectives 4:10 - Introduction to serotonin 10:30 - 5HT1A receptors 24:30 - 5HT2A receptors 30:20 - Serotonin system operation under normal conditions 35:00 - Introduction of bipartite model / two divergent methods for addressing depression 42:20 - Parallels between psychological destabilization (through therapy) and the psychedelic effect  46:20 - Who should not have a psychedelic experience? Are psychedelics intrinsically psychotherapeutic or facilitative in nature? 50:20 - Brief discussion of the neuroimaging correlates of psychotherapeutic benefits from psychedelic experiences 58:40 - Discussion of why 2A agonists cause psychedelic effects but high serotonin release does not   Resources:   Carhart-Harris RL, Nutt DJ. Serotonin and brain function: a tale of two receptors. J Psychopharmacol. 2017;31(9):1091-1120. https://doi.org/10.1177/0269881117725915 Artigas F, Nutt DJ, Shelton R. Mechanism of action of antidepressants. Psychopharmacol Bull. 2002;36 Suppl 2:123-132. Antidepressants. In: Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 4th ed. Cambridge University Press; 2013:284-369. Beliveau V, Ganz M, Feng L, et al. A High-Resolution In Vivo Atlas of the Human Brain's Serotonin System. J Neurosci. 2017;37(1):120-128. https://doi.org/10.1523/JNEUROSCI.2830-16.2016 Carhart-Harris RL, Bolstridge M, Rucker J, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry. 2016;3(7):619-627. https://doi.org/10.1016/S2215-0366(16)30065-7 Carhart-Harris RL, Leech R, Hellyer PJ, et al. The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Front Hum Neurosci. 2014;8:20. https://doi.org/10.3389/fnhum.2014.00020 Carhart-Harris RL, Friston KJ. REBUS and the Anarchic Brain: Toward a Unified Model of the Brain Action of Psychedelics. Pharmacol Rev. 2019;71(3):316-344. https://doi.org/10.1124/pr.118.017160 Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. https://doi.org/10.1177/0269881116675513 Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology (Berl). 2006;187(3):268-292. https://doi.org/10.1007/s00213-006-0457-5   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers nutritional psychiatry with expert guest Dr. Laura LaChance, Staff Psychiatrist and Director of Outpatient Psychiatry at St. Mary’s Hospital Centre in Montreal, Quebec and Faculty Lecturer in the Department of Psychiatry at McGill University.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to…   1)      Define nutritional psychiatry 2)      Understand the mechanisms, common misconceptions, challenges, and current evidence supporting the role for nutrition in mental health 3)      Apply this understanding to clinical cases in psychiatry   Guest: Dr. Laura LaChance Hosts: Dr. Sarah Hanafi (PGY2), Dr. Nima Nahiddi (PGY2), Gray Meckling (CC3) Audio editing by Dr. Alex Raben (PGY5) Show notes by Gray Meckling   Interview Content:   ·       Introduction and learning objectives – 0:35 ·       Dr. Laura LaChance’s professional background – 1:50 ·       Definition of nutritional psychiatry and history of the field – 3:35 ·       Putative mechanisms through which nutrition is implicated in mental health – 7:00 ·       Common misconceptions surrounding the role for nutrition in mental health – 11:45 ·       Current evidence supporting the role for nutrition in the management of psychiatric illness – 16:00 ·       Case-based examples of nutrition in clinical psychiatry – 23:35 ·       Challenges to capitalizing on this mode of intervention in psychiatry – 32:30 ·       Taking a dietary history in the context of mental health – 34:50 ·       Future directions in the field of nutritional psychiatry – 41:20 ·       The gut-microbiome – 43:00 ·       Tips for those interested and how to get involved – 48:00 ·       Closing – 50:15   Resources:   ·       International Society for Nutritional Psychiatry Research ·       The Food & Mood Centre at Deakin University ·       Future Learn Online Course – Food and Mood: Improving Mental Health Through Diet and Nutrition ·       The Brain Food Academy ·       Dr. Drew Ramsey ·       Food as Medicine Update – Conference   Articles:   ·       Nutritional Psychiatry: The Gut-Brain Connection (Psychiatric Times) ·       Nutritional Psychiatry: Your Brain on Food (Harvard Health Publishing)   References:   ·       Adan, R. A., van der Beek, E. M., Buitelaar, J. K., Cryan, J. F., Hebebrand, J., Higgs, S., ... & Dickson, S. L. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. ·       Auction, Monique & LaChance, Laura & Cooley, Kieran & Kidd, Sean. (2019). Diet and Psychosis: A Scoping Review. Advances in Integrative Medicine. 6. S101. 10.1016/j.aimed.2019.03.292. ·       Firth J, Veronese N, Cotter J, Shivappa N, Hebert J, Ee C, Smith L, Stubbs B, Jackson S, Sarris J. What is the role of dietary inflammation in severe mental illness? a review of observational and experimental findings. Frontiers in psychiatry. 2019;10:350. ·       Firth, J., Carney, R., Stubbs, B., Teasdale, S. B., Vancampfort, D., Ward, P. B., ... & Sarris, J. (2018). Nutritional deficiencies and clinical correlates in first-episode psychosis: a systematic review and meta-analysis. Schizophrenia bulletin, 44(6), 1275-1292. ·       Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. A brief diet intervention can reduce symptoms of depression in young adults–A randomised controlled trial. PloS one. 2019;14(10). ·       Guu TW, Mischoulon D, Sarris J, Hibbeln J, McNamara RK, Hamazaki K, Freeman MP, Maes M, Matsuoka YJ, Belmaker RH, Jacka F. International Society for Nutritional Psychiatry Research Practice Guidelines for Omega-3 Fatty Acids in the Treatment of Major Depressive Disorder. Psychotherapy and psychosomatics. 2019;88(5):263-73. ·       Jacka, F. N. (2017). Nutritional psychiatry: where to next?. EBioMedicine, 17, 24-29. ·       Jacka F, O’Neil A, Opie R, et al. A randomized controlled trial of dietary improvement for adults with major depression (the SMILES trial). BMC Med. 2017; 15:23. ·       LaChance, L. R., & Ramsey, D. (2018). Antidepressant foods: An evidence-based nutrient profiling system for depression. World journal of psychiatry, 8(3), 97–104. https://doi.org/10.5498/wjp.v8.i3.97 ·       Lachance, L., & Ramsey, D. (2015). Food, mood, and brain health: Implications for the modern clinician. Missouri medicine, 112(2), 111. ·       Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proc Nutr Soc. 2017;76: 427-436. ·       Lakhan, S. E., & Vieira, K. F. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition journal, 9(1), 42. ·       Mörkl S, Butler MI, Holl A, Cyran JF, Dinan TG. Probiotics and the Microbiota-Gut-Brain Axis: Focus on Psychiatry. Current Nutrition Reports. 2020 May 13. ·       Mörkl, S., Wagner-Skacel, J., Lahousen, T., Lackner, S., Holasek, S. J., Bengesser, S. A., ... & Reininghaus, E. (2020). The role of nutrition and the gut-brain axis in psychiatry: a review of the literature. Neuropsychobiology, 79(1-2), 80-88. ·       Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsenga T, Blunden S, Meyer B, Segal L. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutritional neuroscience. 2019 Jul 3;22(7):474-87. ·       Sarris J, Logan AC, Akbaraly TN, et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2: 271-274.   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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we explore Attachment Theory, a key foundational framework in psychiatry which concerns relationships and the ways in which infants seek proximity to caregivers in development. Our guest expert is Dr. Diane Philipp, a child and adolescent psychiatrist at the Sick kids Center for Community Mental Health in Toronto and Assistant Professor at the University of Toronto. She has developed a family therapy method called Reflective Family Play, a model of therapy which aims to improve parent-child dynamics, and more specifically attachment. She currently practices reflective family play and also teaches this method locally and internationally. Produced and Hosted by Dr. Chase Thompson (PGY2) and Dr. Lucy Chen (PGY5) Audio Editing by Dr. Alex Raben (PGY5) The learning objectives for this episode are as follows:      Define attachment theory     Review the history of attachment theory and how the field developed     Briefly review the evolutionary basis, and functional role of attachment in infants     Briefly review the neurobiological perspectives of attachment     Outline and describe different types of attachment and attachment disorders     Learn how infant attachment is assessed in contemporary psychiatry/psychology     Learn how attachment disorders impact adult relationships and child rearing Some sources for further reading: Ainsworth, Mary S. “Infant-mother attachment” American psychologist 34.10 (1979): 932 Bowlby, J. "Lecture 2: The origins of attachment theory." A secure base (1988): 20-38. Cicchetti, Dante, Fred A. Rogosch, and Sheree L. Toth. "Fostering secure attachment in infants in maltreating families through preventive interventions." Development and psychopathology 18.3 (2006): 623-649. Cohen, Nancy J., et al. "Watch, wait, and wonder: Testing the effectiveness of a new approach to mother–infant psychotherapy." Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health 20.4 (1999): 429-451. Collins, Nancy L. "Working models of attachment: Implications for explanation, emotion, and behavior." Journal of personality and social psychology 71.4 (1996): 810. Feeney, Judith A., and Patricia Noller. "Attachment style as a predictor of adult romantic relationships." Journal of personality and Social Psychology 58.2 (1990): 281. George, Carol, Nancy Kaplan, and Mary Main. "Adult attachment interview." (1996).  Insel, Thomas R., and Larry J. Young. “The neurobiology of attachment.” Nature Reviews Neuroscience 2.2 (2001):129 Main, Mary. "Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment." Journal of consulting and clinical psychology 64.2 (1996): 237. Simpson, Jeffry A., et al. "Attachment and the experience and expression of emotions in romantic relationships: A developmental perspective." Journal of personality and social psychology 92.2 (2007): 355. Sroufe, L. Alan, et al. "Implications of attachment theory for developmental psychopathology." Development and psychopathology 11.1 (1999): 1-13. 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 medical trainee wellness during the COVID-19 pandemic with expert guest Dr. Deanna Chaukos, Staff Psychiatrist at Mount Sinai Hospital in Toronto and Wellness Lead for the Psychiatry Residency program at the University of Toronto.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define wellness and burnout and their importance in medical education/psychiatry Understand strategies on how to maintain our own wellness and prevent burnout Understand strategies to help others maintain their wellness and deal with burnout *All through the lens of the COVID-19 pandemic   Hosts: Dr. Alex Raben (PGY5), Gray Meckling (CC3), Shaoyuan (Randi) Wang (CC3), Weam Sieffien (CC3)   Guest Staff Psychiatrist: Dr. Deanna Chaukos (Sinai Health Systems, Toronto)   Resources COVID-19 Resources for Residents, infographic prepared by residents at the University of Toronto, including team member of PsychEd Nikhita Singhal Resources for MD Wellness Improving Mental Health During COVID-19 University of Toronto Office of Health Professions Student Affairs OHPSA University of Toronto Postgraduate Wellness Office at UofT Gerstein Crisis Centre CAMH: COVID-19 Information for Healthcare Workers CAMH self-referral for healthcare workers to access mental health services UofT Faculty of Medicine: COVID-19 Wellness Resources for Faculty and Trainees Canadian Psychiatric Association - COVID-19 American Psychiatric Association Well-being Resources Seven tips for staying grounded as the world grapples with COVID-19: UofT Expert AMA: 6 ways to address physician stress during COVID-19 pandemic UBC - COVID-19 Resident Wellness Resources Youtube video: Three steps to coping with anything (including COVID-19) MHCC: Resource Hub: Mental health and wellness during the COVID-19 pandemic CMHA: COVID-19 and mental health   Articles CMA: Maintaining Your and Your Family’s Well-being During a Pandemic BMJ Opinion: COVID-19 - the impact on our medical students will be far-reaching AAMC: “A terrifying privilege”: Residency during the COVID-19 Outbreak AMA: Residency in a pandemic: How COVID-19 is affecting trainees CMAJ: Medical education needs reform to improve student well-being and reduce burnout, say experts   Examples of Medical Student Initiatives UofT News: As COVID-19 battle escalates, U of T students offer busy health-care workers help on the home front UofT News: Medical students collect personal protective gear for front line health-care workers, donate through U of T UofT News: 'We care and are here for them': U of T students help seniors cope with distancing during COVID-19 COVID-19 Central Making a difference: UBC students help frontline medical workers during COVID-19 McGill students rally their peers to provide support to frontline workers U of A medical students offering emergency child care to physicians and front-line health workers UCalgary medical and nursing students quickly answer the call for COVID-19 help News: Medical students providing support during COVID-19 containment effort (Schulich School of Medicine & Dentistry, Western University) Queen's students volunteer to help Kingston's medical professionals UOttawa MD students pitch in to help frontline health workers during COVID-19 McMaster med students help their future colleagues during COVID-19   References  Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. Eckleberry-Hunt, J., Van Dyke, A., Lick, D., & Tucciarone, J. (2009). Changing the conversation from burnout to wellness: physician well-being in residency training programs. Journal of Graduate Medical Education, 1(2), 225-230. Eckleberry-Hunt, J., Lick, D., Boura, J., Hunt, R., Balasubramaniam, M., Mulhem, E., & Fisher, C. (2009). An exploratory study of resident burnout and wellness. Academic Medicine, 84(2), 269-277. Dewey, C., Hingle, S., Goelz, E., & Linzer, M. (2020). Supporting clinicians during the COVID-19 pandemic. Annals of Internal Medicine. Drolet, B. C., & Rodgers, S. (2010). A comprehensive medical student wellness program—design and implementation at Vanderbilt School of Medicine. Academic Medicine, 85(1), 103-110. Dyrbye, L. N., Burke, S. E., Hardeman, R. R., Herrin, J., Wittlin, N. M., Yeazel, M., ... & Satele, D. V. (2018). Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. Jama, 320(11), 1114-1130. Kealy, D., Halli, P., Ogrodniczuk, J. S., & Hadjipavlou, G. (2016). Burnout among Canadian psychiatry residents: a national survey. The Canadian Journal of Psychiatry, 61(11), 732-736. Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., ... & Tan, H. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open, 3(3), e203976-e203976. Lebensohn, P., Dodds, S., Benn, R., Brooks, A. J., & Birch, M. (2013). Resident wellness behaviors. Fam. Med, 45, 541-549. Santarone, K., McKenney, M., & Elkbuli, A. (2020). Preserving mental health and resilience in frontline healthcare workers during COVID-19. The American Journal of Emergency Medicine. Shiralkar, M. T., Harris, T. B., Eddins-Folensbee, F. F., & Coverdale, J. H. (2013). A systematic review of stress-management programs for medical students. Academic Psychiatry, 37(3), 158-164. 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), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Autism Spectrum Disorder (ASD) with not one, not two but THREE experts in the field: Dr. Melanie Penner (Developmental Pediatrician at Holland-Bloorview), Dr. Mitesh Patel (Forensic and Child Psychiatrist at CAMH) and Dr. Yona Lunsky (Psychologist at CAMH)   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Have an understanding of the neurobiology and epidemiology of autism Tailor their diagnostic interview for autism in a way that improves accuracy and is empathic Have familiarity with the impact of autism on people and their families and the interdisciplinary and biopsychosocial approaches involved in caring for people with autism   Host(s): Dr. Alex Raben (PGY5), Dr. Sabrina Agnihotri (PGY1)    Produced by: Dr. Alex Raben (PGY5), Dr. Sabrina Agnihotri (PGY1), Weam Sieffien (CC3) and Dr. Gurnaam Kasbia   Guest experts: Dr. Melanie Penner, Dr. Mitesh Patel and Dr. Yona Lunsky   Episode infographic by Weam Sieffien (CC3) and Dr. Nikhita Singhal (PGY1) Resources:   https://cpa.ca/docs/File/Psynopsis/2020-Vol42-1/index.html https://autismcanada.org/#home-row-1 Clinical guide for front line staff to support the management of patients with a learning disability, autism or both during the coronavirus pandemic Magnetoencephalographic (MEG) Brain Activity During a Mental Flexibility Task Suggests Some Shared Neurobiology in Children With Neurodevelopmental Disorders Books: Look Me in the Eye: My Life with Asperger's Neurotribes   References  American Academy of Pediatrics. Management of Children With Autism Spectrum Disorder. Pediatrics. 2007 Nov;120(5):1183-1215. Bartlo P, Klein PJ. Physical activity benefits and needs in adults with intellectual disabilities: systematic review of the literature. Am J Intellect Dev Disabil. 2011 May. 116(3):220-32. Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. Am J Prev Med. 2009 Dec. 37(6 Suppl 1):S201-8. Lyall, K., Croen, L., Daniels, J., Fallin, M. D., Ladd-Acosta, C., Lee, B. K., ... & Windham, G. C.  (2017). The changing epidemiology of autism spectrum disorders. Annual review of public health, 38, 81-102. Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in developmental disabilities, 32(2), 419-436. McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami S, Jerome RN, et al. A systematic review of medical treatments for children with autism spectrum disorders. Pediatrics. 2011 May. 127(5):e1312-21. Rubin IL, Crocker AC. Medical care for children and adults with developmental disabilities. Second edition. Baltimore, MD: Paul H Brookes Publishing Co, Inc; 2006. Rueda JR, Ballesteros J, Tejada MI. Systematic review of pharmacological treatments in fragile X syndrome. BMC Neurol. 2009 Oct 13. 9:53. Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), 3623-3629. Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), 3623-3629. Thapar, A., Cooper, M., & Rutter, M. (2017). Neurodevelopmental disorders. The Lancet Psychiatry, 4(4), 339-346 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 is an introduction to the subspeciality of psychosocial oncology, focusing on 10 key content areas that you want to supplement your general psychiatric interview with. Along the way, we discuss the history of the field, contemporary controversies and useful interviewing techniques that can help with history collection, therapeutic alliance, and formulation.    Learning objectives: Gain familiarity with unique content areas to include in the assessment of patients with cancer Learn interview techniques to facilitate accurate and efficient history taking in this patient population  Increase knowledge around the concept of cancer-related distress and how it informs patient formulation, intervention, and DSM-5 Diagnosis   Host: Dr. Jordan Bawks, PGY4 in Psychiatry at the University of Toronto   Guest: Dr. Elie Isenberg-Grzeda, Psychiatrist at Sunnybrook Health Sciences Centre and Assistant Professor at the University of Toronto   Timestamps for Content:  4-11minutes - History of Psycho-Oncology 11- 14minutes –Distress Screening 14- 16minutes – Overview of specific content areas in psychosocial oncology assessments 15:50 – Cancer history 20:10- Beliefs about illness 24:00- Physical symptoms 26:00- Body Image 33:55- Coping 38:30- Family Supports & 41:00- Counseling on Cancer Disclosure to Family Members 49:30- Work Disruption 52:00- Religion & Spirituality 57:30- Death, Dying, Prognosis 1:04:45- Diagnostic dilemmas 1:10:30- Closing thoughts     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 Motivational Interviewing (MI) with Dr. Wiplove Lamba (staff psychiatrist), Dr. Anees Bahji (PGY5 resident), and Dr. Marlon Danilewitz (PGY5 resident) who we caught up with after their workshop on MI at the CPA annual conference in Quebec City. In addition to learning the basics about MI, Alex also volunteered to do a real-play with Dr. Lamba to demonstrate some MI techniques (and all in one take!).   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define MI and its utility Appreciate some of the techniques that are used in MI to increase motivation Start to use some of these techniques with your patients   Guest staff psychiatrist: Dr. Wiplove Lamba   Episode infographic by Nikhita Singhal   Resources:   MITI scale (available through google search)   Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & Mash, B. (2010). Motivational interviewing. Bmj, 340, c1900.   BMJ Learning: Motivational Interviewing Module   Youtube video of Carl Rogers interviewing Gloria    Motivational Interviewing: Helping People Change by Miller and Rollnick (textbook)    MINT (Motivational Interviewing Network of Trainers)   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 repetitive transcranial magnetic stimulation (rTMS) with Dr. Jonathan Downar, a world expert and leading researcher on rTMS, and clinical fellow Dr. Jean-Phillippe Miron. In addition to learning the basics about rTMS, you will also be listening to Henry Barron’s first-hand experience with non-therapeutic rTMS treatment to help bring some of the learning principles to life.   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Understand generally how rTMS is conducted and some of the theory behind how it works Understand where rTMS fits in the treatment algorithm for depression and what kind of patient characteristics should be considered before initiating rTMS Appreciate the benefits, side effects and drawbacks of rTMS and how it compares to other depression treatments   Guest staff psychiatrist: Dr. Jonathan Downar, Associate Professor at the University of Toronto and Co-Director of the MRI-Guided rTMS Clinic at University Health Network.   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 by medical learners, for medical learners. In this episode from our EPA mini-series on clinical skills we review the Ontario mental health act. Our guest expert is Kendra Naidoo, legal counsel at the Center for Addiction and Mental Health (CAMH) in Toronto.   The learning objectives for this episode are as follows: Review some of the history behind mental health legislation in Ontario. Discuss involuntary hospitalization, including criteria and relevant documentation. Understand capacity assessments and processes for substitute decision making. Discuss the role of Consent and Capacity Boards.   References/resources: A Practical Guide to Mental Health and the Law in Ontario Revised Edition, September 2016 Tips for completing the Form 1 under the Mental Health Act, by Patricia Cavanagh, MD FRCPC   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 and Facebook @PsychEdPodcast. 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. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors for self-harm and suicide and components of risk assessment.   Our guest expert is Dr. Juveria Zaheer. She is a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Emergency Department at CAMH. Her research focuses on suicide, gender and culture, and she is the lead author of the Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention.   The learning objectives for this episode are as follows: Be familiar with the risk factors and predictors of suicide, as well as protective factor Be familiar with the components of a Suicide Risk assessment Be familiar with how to comprehensively document and communicate the risk assessment   Recommended Readings: Canadian Armed Forces (CAF) Clinician Handbook on Suicide Prevention Includes safety plan, risk assessment template and clinical cases in the appendix Columbia-suicide severity rating scale (c-ssrs)   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   Credits note: Alex Raben provided audio-editing for this episode. 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. In this episode of our miniseries on psychiatric skills, we review the core content areas of a psychiatric assessment and look at techniques to improve interviewing efficiency, accuracy and alliance building. Our expert for this episode is Dr. Juveria Zaheer, a clinician-scientist at the Centre for Addiction and Mental Health, and an assistant professor at the University of Toronto, in Toronto, ON.    Learning Objectives: By the end of the episode you, the learner, should... Have a clear understanding of the goals of a complete psychiatric interview and the general structure and content that should be covered Feel comfortable to begin to use techniques that will help you conduct a professional, compassionate, empathic, efficient, and accurate interview Be familiar with techniques you can use to facilitate information gathering in more challenging interviews  Episode Timepoints 3:15 - Purpose of the psychiatric interview  6:30 - First content areas of the interview; introduction, ID, RFR, CC, HPI, ROS, Past Psych Hx 19:00 - Techniques and Strategies for Organized and Efficient Psychiatric ROS 26:00 - Details of Past Psychiatric History  29:30 - Past Medical History 31:00 - Substance Use History 33:30 - Medications 34:20 - Family Psych History 36:25 - Personal and Developmental History (Content & Process discussion) 44:00 - Commonly missed areas including Legal/Forensic history 45:00 - Shift from content to process discussion “how to best manage a psychiatric interview” 49:00 - Self-care and monitoring  52:00 - Building rapport, therapeutic alliance, empathy  53:30 - Alex and Lucy reflect on their growth as interviewers over 4 years in residency  73:00 - Managing challenging interviews References and Resources1) Shea, S. C. (1998). Psychiatric Interviewing E-Book: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals 2) Carlat, D. J. (2016). The psychiatric interview: A practical guide. Lippincott Williams & Wilkins.   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. In this episode, we discuss the biopsychosocial formulation--what it is and how we do it . Our guest expert is Dr. Erin Carter, an in-patient psychiatrist at St. Joseph's Healthcare Centre in Toronto, Canada. The learning objectives for this episode are as follows: 1. Understand the components of a biopsychosocial formulation 2. Develop an approach to organizing and eliciting salient information to aid in formulation 3. Distinguish between summary and synthesis of information 4. Understand how to communicate a formulation effectively 5. Use the biopsychosocial formulation to inform a management plan 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. In this episode from our EPA mini-series on clinical skills, we comprehensively review the risk factors and management of aggression in the Psychiatric Emergency context. Our guest expert is Dr. Jodi Lofchy. She is the Chair of the Canadian Psychiatric Association’s Section of Emergency Psychiatry, and Interim Chief and Medical Program Director for the Department of Psychiatry at St. Joseph’s Health Centre. Dr. Lofchy has presented and published many works on Best Practice in Emergency Psychiatry and has been tremendously involved in Medical Education.  The learning objectives for this episode are as follows: Identify risk factors for violence in the ER, static and dynamic risks Know how to take a history for violence, and communicate risk Describe the indications for non-chemical interventions in the management of the agitated patient Describe pharmacologic interventions in managing the agitated patient How to apply legislation regarding risk of violence Recommended Readings: Emergency Psychiatry: Clinical and Training Approaches Jodi Lofchy, MD, FRCPC1; Peter Boyles, MD, FRCPC2; Justin Delwo, MD, FRCPC3 http://www.cpa-apc.org/wp-content/uploads/Emergency-Psychiatry-2004%E2%80%9344-R1-EN-FIN-web.pdf   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. In this episode, we comprehensively review the diagnosis and treatment of PTSD, and explore the psychological and physiological underpinnings of trauma.   Our guest expert is Dr. Dana Ross. She is a psychiatrist in the Trauma Therapy Program at Women’s College Hospital in Toronto, Canada. She is also a founder of Trauma Education Essentials Inc. which provides trauma-focused educational webinars, online courses, and workshops to health professionals and organizations   The learning objectives for this episode are as follows:   Know the prevalence and incidence rates of Posttraumatic Stress Disorder (PTSD) Recognize the clinical features of PTSD using DSM-5 diagnostic criteria List 5 common risk factors for the development of PTSD Identify 3 neurophysiological mechanisms underlying PTSD Differentiate the three stages of trauma therapy Describe evidence-based pharmacological and psychological treatments for   Recommended Readings by Dr. Ross:   The Body Keeps the Score by Bessel Van der Kolk, MD Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care by Clark, Classen, Fourt, & Shetty Trauma and Recovery by Judith Herman, MD The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris, MD   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 Psychiatric Rehabilitation with guest Dr. Abraham Rudnick, who is currently a Professor in the Department of Psychiatry at the University of Dalhousie. In this episode, Aarti and Alex learn about Psychiatric Rehabilitation, also known as Psychosocial Rehabilitation (PSR), a rarely discussed or taught “4th branch” of mental health intervention. Join our residents as they discover the definition, purpose, history, process, character, and possibilities of psychiatric rehabilitation from a world expert. The learning objectives for this episode are as follows:   By the end of this episode, the listener will be able to Define psychiatric rehabilitation (PSR) Differentiate clinical and personal recovery Understand how PSR supports personal recovery Differentiate psychiatric rehabilitation from other mental health interventions Identify key areas of overlap with psychotherapy Identify key concepts within the process of PSR: readiness assessment and development, skills, supports, environment of choice, lack of coercion, maintenance of hope Locate resources to further their own knowledge and skills in PSR*   As referenced in the podcast*:   Online PSR training courses: https://www.mohawkcollege.ca/ce/programs/health-and-nursing/psychosocial-rehabilitation-016   https://www.douglascollege.ca/programs-courses/faculties/humanities-social-sciences/psychology/psychosocial-rehabilitation   Books/Journals: 1) Psychiatric Rehabilitation Journal 2) Work of Dr. William Anthony 3) Dr. Patrick Corrigan’s Principles and Practice of Psychiatric Rehabilitation   Guest staff psychiatrist: Dr. Abraham Rudnick, BMedSc, MD, MPsych, PhD, CPRP, FRCPC, CCPE, DFESPCH, FCPA, CSLI, CPRRP   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 is our fourth and final episode in our mini-series on schizophrenia. In this episode, we take an advanced look at the clinical management of schizophrenia, including a discussion of treatment-resistant schizophrenia and clozapine. Warning: this content in this episode is a little bit more advanced than usual, but also ultra interesting.     Our guest expert is Dr. Gary Remington. He is a researcher, psychiatrist, Chief of the Schizophrenia Division at CAMH and an author of the 2017 Canadian schizophrenia guidelines    The learning objectives for this episode are as follows:    By the end of this episode, the listener will be able to… Have an approach to treating a first episode psychosis of schizophrenia Understand the important components of maintenance treatment in schizophrenia Understand the concept of treatment-resistant schizophrenia (TRS) Know when to initiate clozapine List some of the psychosocial interventions involved in treating schizophrenia   References: Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616. Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., ... & Severe, J. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209-1223. Kapur, S., Remington, G., Jones, C., & Wilson, A. (1996). High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study. The American journal of psychiatry, 153(7), 948.   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 community treatment orders (CTOs) and assertive community treatment (ACT) teams in the context of schizophrenia treatment with Dr. Arash Nakhost a staff psychiatrist who works on the FOCUS ACT team at St. Michael’s Hospital. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Provide a brief description of the history of ACT teams and CTOs, as well as the challenges in establishing evidence for their use Compare and contrast ACT teams with intensive case management teams in terms of their composition, methods, and respective strengths and weaknesses Describe the array of services that an ACT team can help provide to its clients as well as some of the challenges and drawbacks of ACT teams Outline the major reasons someone might be put on a community treatment order and describe how a CTO is applied and enforced Outline the major challenges in using CTOs as a treatment tool Guest staff psychiatrist: Dr. Arash Nakhost (St. Michael’s Hospital, Toronto) References: Ontario Hospital Association. (2016). A practical guide to mental health and the law in Ontario. Government of Ontario, Health Care Consent Act. Kisely, S. R., Campbell, L. A., & O'Reilly, R. (2017). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane database of systematic reviews, (3). Maughan, D., Molodynski, A., Rugkåsa, J., & Burns, T. (2014). A systematic review of the effect of community treatment orders on service use. Social psychiatry and psychiatric epidemiology, 49(4), 651-663. Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., ... & Tsemberis, S. (2015). A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67(3), 275-281. Bromley, E., Mikesell, L., Whelan, F., Hellemann, G., Hunt, M., Cuddeback, G., ... & Young, A. S. (2017). Clinical factors associated with successful discharge from assertive community treatment. Community mental health journal, 53(8), 916-921. 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 is part II in the treatment of schizophrenia series with our expert Dr. Albert Wong, a psychiatrist and research scientist who is an expert in schizophrenia at the Centre for Addiction and Mental Health (CAMH) and professor at the University of Toronto. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to…   Conceptualize antipsychotic drugs categories in in different and clinically relevant ways Have an approach for choosing an antipsychotic medication for a patient and be able to consent them by going over the benefits and limitations of the medications Understand the limitations of our understanding of schizophrenia and our current treatments and some of the problems that remain to be solved in this area of psychiatry    References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Robinson, D. J. (1997). Brain calipers: A guide to a successful mental status exam. Fort Gratiot, Mich., USA: Rapid Psychler Press. Kuipers, E., Yesufu-Udechuku, A., Taylor, C., & Kendall, T. (2014). Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ: British Medical Journal (Online), 348. 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 schizophrenia with Dr. Jason Joannou and Dr. Andrew Lustig, two inpatient staff psychiatrists at the Centre for Addiction and Mental Health (CAMH) and assistant professors at the University of Toronto.   The learning objectives for this episode are as follows:   By the end of this episode, the listener will be able to… Articulate the basic psychopharmacology of antipsychotics Create a basic treatment presenting with a first episode of schizophrenia, based on the 2017 Guidelines for the Pharmacotherapy of Schizophrenia in Adults Summarize principles of longitudinal treatment, which includes treatment-resistant schizophrenia and psychosocial approaches to the illness. References: Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616. Norman, R., Lecomte, T., Addington, D., & Anderson, E. (2017). Canadian treatment guidelines on psychosocial treatment of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 617-623. Tiihonen, J., Haukka, J., Taylor, M., Haddad, P. M., Patel, M. X., & Korhonen, P. (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. American Journal of Psychiatry, 168(6), 603-609. Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $230 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change!   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.

Please take our 5-minute RESEARCH SURVEY. (more details below)   Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. We apologize that we don't have a new episode for you this month but we are working hard behind the scenes both on new episodes and on medical education research into podcasting. Don't fear, new episodes are on the way! In the meantime, we have a favour to ask. We have started a research project to improve PsychEd and to better understand how medical learners use podcasts. We are asking for our listeners help in completing this brief 5-minute RESEARCH SURVEY. Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $250 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change! 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 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… Recognize the clinical features of OCD using DSM-5 criteria Appreciate the differential diagnosis and how to use specific interviewing questions and the mental status to aid clinical judgment 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… List the lifestyle changes recommended for people with GAD Describe the first line and second line medication therapies for GAD and the rationale supporting each agent's place in the treatment hierarchy  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… Recognize the clinical features of GAD using DSM-5 diagnostic criteria 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: Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features Apply the CANMAT Guidelines in discussing treatment options for MDD Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD 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 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 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 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.