Psychiatry Boot Camp

Dr. Allen Frances, Chair of the DSM-IV Task Force and Chair Emeritus at Duke University returns to kick off Season 3. We discuss the unique role of consultation-liaison psychiatry in today's healthcare system, and Dr. Frances provides us with a framework for understanding and helping each individual patient during a medical hospitalization. Dr. Frances provides wisdom and encouragement to set the stage for our journey into the world of consultation-liaison psychiatry.Support our partners:⁠Simplepractice.com/bootcamp⁠⁠Beat The Boards⁠ (enter referral code BOOTCAMP at checkout)

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Dr. Sameer Jauhar, Senior Clinical Lecturer in Affective Disorders and Psychosis at the Institute of Psychiatry, Psychology and Neuroscience, King's College, London, and as a Consultant Psychiatrist at Maudsley NHS Foundation Trust, introduces us to schizophrenia. Explore core clinical features of schizophrenia and what is known about the neuroscience of schizophrenia. We'll also discuss psychopharmacological and psychosocial treatment approaches, rooted in Dr. Jauhar's humanistic approach. This episode is intended to supplement Dr. Jauhar's Lancet Seminar on Schizophrenia (2022). Connect with Dr. Jauhar: @SameerJauhar This is the final episode of Season 2! We welcome any feedback or ideas for future seasons! Email: psychiatrybootcamppodcast@gmail.com

Dr. Laura Watkins, Clinical Psychologist and Assistant Professor of Psychiatry at Emory University School of Medicine, introduces us to post-traumatic stress disorder (PTSD). We walk though the diagnostic criteria and discuss how these symptoms can impact a person's day-to-day life. We then learn to conceptualize PTSD in terms of both classical and operant conditioning. Finally, we explain evidence based psychotherapies for PTSD and conclude with a primer on psychopharmacology for PTSD. Essential references: 1) Osser Psychopharmacology Algorithm for PTSD 2) Clinical Guidelines for PTSD (United States Department of Veteran's Affairs and Department of Defense) 3) This American Life: Ten Sessions

Dr. John Walkup, Chair of the Pritzker Department of Psychiatry and Behavioral Health at Ann and Robert H. Lurie Children's Hospital of Chicago, Professor of Psychiatry at Northwestern Feinberg School of Medicine, and president-elect of the American Academy of Child and Adolescent Psychiatry, introduces us to anxiety disorders. We discuss the phenomenon of normal, adaptive anxiety and contrast this with symptomatology that may warrant a diagnosis of an anxiety disorder. We learn to appreciate anxiety disorders from a developmental lens, discuss clinical pearls for building a therapeutic alliance with anxious patients, and explore psychotherapies for anxiety disorders. We also discuss psychopharmacological considerations for both SSRIs and benzodiazapines.

Dr. Roger McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, Canada, returns to introduce depressive disorders. We differentiate normal "low mood" from conditions that warrant a psychiatric diagnosis. We discuss historical subtypes of depression and the current DSM specifiers for major depressive disorder. We review epidemiology, discuss the neurophysiology of depressive disorders, and then dive into treatment options.

Dr. Roger McIntyre,  Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit at the University Health Network in Toronto, Canada, introduces us to bipolar disorders. We discuss the key clinical features of bipolar disorders, the relationship between bipolar disorders and circadian rhythm, known pathogenesis, and some first line treatment options. We also contextualize the difference between "type I" and "type II" bipolar disorder, and explore the relationship between bipolar disorder and traumatic life experiences. For more: Bipolar Disorders (Lancet Seminar)

Dr. Lois Choi-Kain, Director of the Gunderson Personality Disorders Institute at McLean Hospital and Associate Professor of Psychiatry at Harvard Medical School, introduces us to borderline personality disorder (BPD). We discuss the prevalence, naturalistic course, and treatments for BPD. We explore BPD using the “Good Psychiatric Management” (GPM) model, which is intended to empower clinicians of all disciplines to manage patients with BPD effectively. We discuss the principles of GPM and walk through some examples of how it might be used in the clinical setting.  Book: Applications of Good Psychiatric Management for Borderline Personality Disorder: A Practical Guide (Check your academic library!)  References:  (11:30) Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533-545.  (12:30) Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord. 2010;24(4):412-426.  (15:00) Gregory R, Sperry SD, Williamson D, Kuch-Cecconi R, Spink GL Jr. High Prevalence of Borderline Personality Disorder Among Psychiatric Inpatients Admitted for Suicidality. J Pers Disord. 2021;35(5):776-787.  (20:45) Kernberg O. Borderline personality organization. J Am Psychoanal Assoc. 1967;15(3):641-685.  (29:30) Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30.  (33:00) Skodol AE, Gunderson JG, Shea MT, et al. The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. J Pers Disord. 2005;19(5):487-504. (33:00) Temes CM, Zanarini MC. The Longitudinal Course of Borderline Personality Disorder. Psychiatr Clin North Am. 2018;41(4):685-694.   

Dr. Steve Delisi, Chief Medical Officer at YourPath Inc., Co-Associate Director at UC-Irvine School of Medicine's "Train New Trainers" Primary Care - Training and Education in Addiction Medicine Fellowship, Adjunct Professor at Hazelden Betty Ford Graduate School of Addiction Studies, walks through the fundamentals of substance use disorder. We discuss the neurobiology of substance use disorder and explore the clinical use of "translational neuroscience." You'll also learn about the relationship between trauma and substance use, hear best practices for building a therapeutic alliance with this patient population, and catch a glimpse into future research on substance use disorders.

Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, takes us through a deep dive on delirium. This episode covers an enormous amount of material. We contrast encephalopathy and delirium before diving into the dangerousness of delirium and prevention strategies. We explore the neurobiology of delirium and tie it to validated assessment tools and treatment approaches. We also discuss areas for future research and learn to appreciate the evolutionary function that delirium serves. References can be found on the episode website.

Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, takes us through a deep dive on delirium. This episode covers an enormous amount of material. Contrast  encephalopathy and delirium before diving into the dangerousness of delirium and prevention strategies. Explore the neurobiology of delirium and tie it to validated assessment tools and treatment approaches. We also discuss areas for future research, and learn to appreciate the evolutionary function that delirium serves.This episode also deserves some references! (3:38) Lipowski ZJ. Delirium: Acute Brain Failure in Man. Springfield, IL: Charles C Thomas, 1980.  (7:55) Slooter AJC, Otte WM, Devlin JW, et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020;46(5):1020-1022.  (21:46)  Marcantonio ER, Ngo LH, O'Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study [published correction appears in Ann Intern Med. 2014 Nov 18;161(10):764]. Ann Intern Med. 2014;161(8):554-561.   (29:50) Kunicki ZJ, Ngo LH, Marcantonio ER, et al. Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium. JAMA Intern Med. 2023;183(5):442-450.   (41:40) Mews MR, Tauch D, Erdur H, Quante A. Comparing consultation-liaison psychiatrist's and neurologist's approaches to delirium - A retrospective analysis. Int J Psychiatry Med. 2016;51(3):284-301. = (1:08:08) Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med. 2018;379(26):2506-2516.   (1:09:33) Hui D, Frisbee-Hume S, Wilson A, et al. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. JAMA. 2017;318(11):1047-1056.   (1:31:36) By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.  (1:33:54) Burton JK, Craig LE, Yong SQ, et al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2021;7(7):CD013307. Published 2021 Jul 19.   (1:35:41) Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial. Am J Respir Crit Care Med. 2018;197(9):1147-1156.   (1:36:00) Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial [published correction appears in JAMA. 2019 Jul 16;322(3):276]. JAMA. 2019;321(7):686-696. 

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Dr. Erick Messias, Chair of Psychiatry at Saint Louis University, introduces us to the world of psychiatric epidemiology. Learn how epidemiological figures (that show up on training exams) are derived, and explore how epidemiology can help us to understand the naturalistic course of psychiatric illness. We also delve into the history of our diagnostic system  and how it developed into the current model, and run through some of the most important findings to date in psychiatric epidemiology. Dr. Messias also explains how to approach every situation in life "as a 2 by 2 table," and we conclude with some wisdom about inserting meaning into daily psychiatric practice. 

Dr. Kimberly Nordstrom, Past President of the American Association for Emergency Psychiatry and Associate Clinical Professor of Psychiatry at the University of Colorado, discusses the process of considering medical contributions to psychiatric illness.  We discuss red flags that should guide clinicians to start thinking medically, explain the importance of systematically approaching a differential diagnosis, and provide a brief introduction to a few common medical-psychiatric conditions including autoimmune encephalitis, neuroleptic malignant syndrome (NMS), and serotonin toxicity ("serotonin syndrome").Book: Quick Guide to Psychiatric Emergencies: Tools for Behavioral and Toxicological Situations (Check your academic library!!!)

Dr. Allen Frances, Chair of the DSM-IV Task Force and Chair Emeritus at Duke, returns to orient listeners to psychiatric diagnosis. Explore diagnostic principles including "stepped diagnosis" and understand the importance of nuance when making and communicating a psychiatric diagnosis. You'll also learn about how these diagnoses are  derived, and hear tips for making an accurate and meaningful diagnosis to improve a patient's quality of life.

Welcome to Psychiatry Boot Camp Season 2: Hoofbeats on Broadway! We are basing this season around the axiom, "When you hear hoofbeats on Broadway, think horses, not zebras." Our global experts will introduce the fundamentals of psychiatric diagnosis before walking  us diagnosis-by-diagnosis through the psychiatric stables. Stay tuned!

Dr. Amy Barhnorst, Associate Professor of Psychiatry and Vice Chair for Community Mental Health at U C Davis,  explains various ways to characterize violence, violence prevention strategies, best practices for documentation, firearms, and more.For more: https://www.bulletpointsproject.org/

Dr. Donna Sudak,  Professor of Psychiatry and Vice Chair for Education at Drexel University College of Medicine, and Past President of the American Association of Directors of Psychiatric Residency Programs, introduces us to psychotherapy.  We explore the role of psychotherapy in psychiatric practice, discuss "common factors" in psychotherapy, and learn to incorporate psychotherapy into each patient encounter.

Dr. Rajesh Tampi, Editor-in-Chief of the World Journal of Psychiatry, Past President of the American Association for Geriatric Psychiatry, and Chairman of Psychiatry at Creighton University, walks us through capacity assessments and shares his hard won wisdom for navigating difficult cases.

Dr. Jyotsna Ranga, Program Director for the Adult Psychiatry Residency and Child and Adolescent Psychiatry Fellowship at Creighton University, teaches how to construct case formulations using the biopsychosocial model and the "five Ps."

Dr. Tony Thrasher, President of the American Association for Emergency Psychiatry and medical director of crisis services in Milwaukee county, discusses best practices for management of the agitated patient. Learn key safety points, verbal de-escalation techniques, medical-legal principles, and pharmacotherapy options.

Dr. Tyler Black, a suicidologist and child psychiatrist at British Columbia Children's Hospital, walks through common suicide myths, structuring the suicide risk assessment interview, common motivations for suicide, clinical decision making, best practices for documentation, and what works in preventing suicide.

Dr. Rajesh Tampi, Editor-in-Chief of the World Journal of Psychiatry, Past President of the American Association for Geriatric Psychiatry, and Chairman of Psychiatry at Creighton University, walks us through the mental status examination.

Dr. Dana Raml, Assistant Professor of Psychiatry at the University of Nebraska Medical Center, walks through interviewing do's and don'ts, techniques for building a therapeutic alliance, and teaches us how to ask for and organize the information gleaned during an initial psychiatric encounter.

Dr. Allen Frances, Chair of the DSM-4 Task Force and Chair Emeritus at Duke, discusses our profession's identity and provides pearls for developing psychiatrists. Dr. Awais Aftab, Clinical Professor of Psychiatry at Case Western University, discusses the validity of the DSM and psychiatric harm. More from Dr. Frances: https://www.psychiatrictimes.com/view/advice-young-psychiatrists-very-old-one

An introduction to Psychiatry Boot Camp Season 1!