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:

1. Understand the basics of sleep physiology, including the stages of sleep

2. Recognize the clinical features of insomnia disorder using the ICSD-3 and DSM-5-TR criteria 

3. Develop an approach to the assessment of insomnia 

4. 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 psychedpodcast@gmail.com. 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…

1. Describe the indications and process for starting lithium

2. Monitor and interpret serum lithium levels

3. 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

1. 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

2. 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§ionid=40843106

3. Chokhawala K, Lee S, Saadabadi A. Lithium. StatPearls.

4. 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.

5. Draaisma D. Lithium: the gripping history of a psychiatric success story. Nature. 2019 Aug 1;572(7769):584-6.

6. Hedya SA, Avula A, Swoboda HD. Lithium toxicity.

7. Malhi GS, Bell E, Outhred T, Berk M. Lithium therapy and its interactions. Australian Prescriber. 2020 Jun;43(3):91.

8. 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

9. 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

10. 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.

11. 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.

12. 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 psychedpodcast@gmail.com. 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…

1. Describe the epidemiology of violence in severe mental illness (rates of perpetration vs. victimization, risk factors, quality of evidence) 

2. Understand and critique how society currently addresses violence in those with severe mental illness 

3. 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 psychedpodcast@gmail.com. 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…

1. Explain the utility and purpose of the mental status examination in psychiatry

2. Describe the major components of the mental status examination and be familiar with some of the common vocabulary used

3. 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).620160913-28497-y2c5d5-libre.pdf?1473758564=&response-content-disposition=inline%3B+filename%3DMini_mental_state_A_practical_method_for.pdf&Expires=1674785015&Signature=gihCz5KNqzGBR5xFPcbEvQHNYlfu4EjBVvvma4lBUoMDr7Ef5avbmRXJNGr13zVB~egHRZS1rymc9TPNPkK7rQlFZm8wVFZ6WKYQE6alYAk3j7t9btroYySRlQTEsOfl2M0xDAvgM-Lmamxna8mA0dvhR9nlVUnzbNWYv8rPA0utrJTmVzhUdjJ4tCc-CQ~O8AfNYa70hBEYcUkP03oPkCqwYB9uD-29zK1BmaOU3YlVrmoRKkR4ZK~-~erQgL~ydlTIhVGfy2smO~5RNKN-AhTYEL9oIeXeEWGKNUOk1I5i6YQpQqtIQTQyM2GKPhUdi58patVMfK7rbUsyIhWIDQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA">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.

• adults.pdf#page=71"> 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 psychedpodcast@gmail.com. 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:

1. Define Major Neurocognitive Disorder (aka Dementia) as per DSM-5 diagnostic criteria

2. Identify differential diagnoses for cognitive decline and list differentiating clinical features 

3. 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] 

4. 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 ( Lesley.Wiesenfeld@sinaihealthsystem.ca">Lesley.Wiesenfeld@sinaihealthsystem.ca )

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 psychedpodcast@gmail.com. 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…

1. Gain an appreciation for the historical context of the field of psychiatry
2. Understand how illness categories and treatments have been shaped by this history 
3. Compare and contrast how various past societies viewed and conceptualized mental illness
4. 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 psychedpodcast@gmail.com. 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:

1. Understand the rationale for undertaking a DSM-5-TR as well as the revision process itself

2.  To become familiar with disorder, text and symptom code additions and modifications to the DSM-5-TR

3.  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 psychedpodcast@gmail.com. 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:

1. Develop a basic understanding of what is meant by antisocial personality and psychopathy

2. Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors 

3. 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 psychedpodcast@gmail.com. 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…

1. Define the field of perinatal psychiatry
2. Describe the key issues that should be addressed in pre-conception psychiatric counseling
3. Discuss the management approach for prescribing medications during pregnancy
4. Recognize the prevalence of mood disorders during the perinatal period
5. Recall the diagnostic criteria for postpartum depression
6. Consider the risk factors and explanatory models for postpartum depression
7. Discuss the use of screening tools for postpartum depression
8. Outline the treatment for postpartum depression
9. Describe the clinical presentation of postpartum psychosis and recognize the urgency of this condition
10. List important risk factors for postpartum psychosis
11. 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. org.myaccess.library.utoronto.ca/10.1111/j.1471-0528.2000.tb11609.x">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 psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to…

1. Define the field of reproductive psychiatry
2. Discuss the possible neurobiological pathways impacting mood and cognition during the reproductive cycle of women. 
3. Discuss the influence of sociocultural gender roles on psychopathology.   
4. List the DSM-V diagnostic criteria of premenstrual dysphoric disorder.
5. Recall the epidemiology of premenstrual dysphoric disorder.
6. Describe the steps in the diagnostic evaluation for premenstrual dysphoric disorder.
7. List lifestyle and psychopharmacologic interventions for premenstrual dysphoric disorder.
8. 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 psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.