Psychiatry Explored

Dive into an informative conversation with Developmental and Behavioral Pediatricians Dr. Randall Phelps & Dr. Amelia Roth as we discuss multimodal evaluation for Autism Spectrum Disorder in children, as well as existing supports for patients with ASD and their families and further psychiatric considerations for neurodiverse youth. As a note, we acknowledge that ASD does not solely affect children as more and more individuals are being diagnosed at older ages, partly due to systemic injustice in the medical system. The scope of this episode is limited to workup in a pediatric population. Hosted by Maya Singh Sharkey (she/her) and Harland Harrison (they/them)Questions? Reach out to us at: psychiatryexplored@gmail.com

Join us as psychiatrists Dr. Julie Anderson and Dr. Sean Stanley unravel the complexities of Bipolar Disorder. In the second and final part of our series on mood disorders, they discuss the diagnosis of Bipolar disorder, including the distinctions between Bipolar I and II,  as well as pharmacologic and psychosocial therapies for patients with bipolar disorder. This discussion of Bipolar disorder is ideal for medical learners, physicians, and anyone curious about the subject. We will be discussing manic, hypomanic, and major depressive episodes in our discussion of Bipolar Disorders. Full diagnostic criteria for those episodes can be found in Section 2 of the DSM-V under Bipolar and related disorders. References: 1. The Sydney Bipolar Screener 2. VVA/DOD Clinical Practice Guidelines for Management of Bipolar Disorder 3. National Collaborating Centre for Mental Health (UK). Bipolar Disorder: The NICE Guideline on the Assessment and Management of Bipolar Disorder in Adults, Children and Young People in Primary and Secondary Care. London: The British Psychological Society and The Royal College of Psychiatrists; 2014 Sep. PMID: 29718639. (2014, some updates 2023)  4. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk 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 Disord. 2018 Mar;20(2):97-170.

Tag along as psychiatrists Dr. Julie Anderson and Dr. Sean Stanley unravel the complexities of Major Depressive Disorder (MDD). In this first of two podcasts on mood disorders, they explain MDD's neurological basis, diagnosis, suicide risk assessment, and treatments ranging from medications to psychotherapy to lifestyle changes. A thoughtful discussion of MDD's multifaceted impacts ideal for medical learners, physicians, and interested minds alike. References: Patient Health Questionnaire (PHQ-9 & PHQ-2) Collaborative Care Model Columbia-Suicide Severity Rating Scale (C-SSRS) My Resilience in Adolescence (MYRIAD) Project   Barbui, C., Cipriani, A., & Geddes, J. R. (2008). Antidepressants and suicide symptoms: compelling new insights from the FDA's analysis of individual patient level data. BMJ Ment Health, 11(2), 34-35. Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. Jama, 303(1), 47-53.

Join Psychiatrists, Dr. Brandon Cornejo & Dr. Justin Laporte, for a stimulating talk about all things Transcranial Magnetic Stimulation (TMS). Hosts: Candace Chan, MS4 & Devon Boorstein-Holler, MS4 Have Questions? Feel free to reach out to us at: psychiatryexplored@gmail.com References: rTMS for Craving in Methamphetamine Use Disorder, a clinical trial Carmi, L., Tendler, A., Bystritsky, A., Hollander, E., Blumberger, D. M., Daskalakis, J., ... & Zohar, J. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry, 176(11), 931-938. Roth, Y., Tendler, A., Arikan, M. K., Vidrine, R., Kent, D., Muir, O., ... & Zangen, A. (2021). Real-world efficacy of deep TMS for obsessive-compulsive disorder: post-marketing data collected from twenty-two clinical sites. Journal of psychiatric research, 137, 667-672. Voigt, J. D., Leuchter, A. F., & Carpenter, L. L. (2021). Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis. Translational psychiatry, _11_(1), 330.

Join Neuropsychiatrist Dr. Jordan Anderson and Psychiatrist Dr. Joel Mack in an expansive discussion on the fascinating world of Functional Neurological Disorders. Questions? psychiatryexplored@gmail.com References: ⁠https://neurosymptoms.org⁠ (Signs and symptoms of FND's including functional tremor & examples of entrainment) Baslet, G., Seshadri, A., Bermeo-Ovalle, A., Willment, K., & Myers, L. (2016). Psychogenic non-epileptic seizures: an updated primer.⁠ _Psychosomatics_, _57_(1), 1-17 LaFrance WC Jr, Miller IW, Ryan CE, Blum AS, Solomon DA, Kelley JE, Keitner GI. Cognitive behavioral therapy for psychogenic nonepileptic seizures.⁠ Epilepsy Behav. 2009 Apr;14(4):591-6. doi: 10.1016/j.yebeh.2009.02.016. Epub 2009 Feb 20. PMID: 19233313. Perez DL, Edwards MJ, Nielsen G, Kozlowska K, Hallett M, LaFrance WC Jr. Decade of progress in motor functional neurological disorder: continuing the momentum. J Neurol Neurosurg Psychiatry. 2021 Mar 15:jnnp-2020-323953. doi: 10.1136/jnnp-2020-323953 The Dancing Plague of 1518⁠

Dive into an enlightening conversation with Dr. David Do & Dr. James Koved as they shed light on the specialized realm of psychiatric emergency rooms, the challenges faced in modern mental health care, and the evolving landscape of emergency psychiatry. Hosted by Candace Chan & Devon Boorstein-Holler Questions? Reach out to us at: psychiatryexplored@gmail.com

Join Psychiatrists Dr. Anne Fang, Dr. Veronica Rita Hocker, and Anaesthesiologist Dr. Natalia Guzman-Seda as they explore the electrifying clinical landscape of Electroconvulsive Therapy. Hosted by Candace Chan & Kathleen Daily-Jensen Questions? psychiatryexplored@gmail.com

Sleep Psychiatrist Dr. John Emens takes on the topic of cognitive behavioral therapy for insomnia. Hosted by Allison Zhou and Nakai Corral Questions? psychiatryexplored@gmail.com Topics covered: Introduction to cognitive behavioral therapy for insomnia Sleep education Stimulus control Sleep restriction therapy Circumstances in which medication may be indicated Contraindications to sleep restriction Alternatives Studies Mentioned: Review of CBTI vs. medications: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481424/ Overview of the pharmacology of sleep: https://aasm.org/resources/pdf/pharmacologictreatmentofinsomnia.pdf Study on two groups with insomnia or not, odds to develop depression: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108260/ Resource for online CBTi: https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia CBTI for depression: https://academic.oup.com/sleep/article/31/4/489/2454177?login=true IRT vs. IRT + CBT vs. Prazosin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265653/

Third-year OHSU medical students, Candace Chan and Devon Boorstein-Holler rehash the information from our first sleep medicine & psychiatry talk in a question-and-answer format. This episode is part of a project to help determine optimal podcast formats for student learning. Hosted by: Devon Boorstein-Holler, MS3 & Candace Chan, MS3 Questions? psychiatryexplored@gmail.com Studies Mentioned: Overview on the pharmacology of sleep: https://aasm.org/resources/pdf/pharmacologictreatmentofinsomnia.pdf Study on melatonin in OTC: https://jcsm.aasm.org/doi/full/10.5664/jcsm.6434 NEJM Bob Sack review melatonin for jet lag: https://www.nejm.org/doi/10.1056/NEJMcp0909838?url_ver=Z39.88-%202003&rft_id=ori:rid:crossref.org&rfr_dat-cr_pub%20%200pubmed Study on two groups with insomnia or not, odds to develop depression: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108260/ Resource for online CBTI: https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia CBTI for depression: https://academic.oup.com/sleep/article/31/4/489/2454177?login=true IRT vs. IRT+CBT vs. Prazosin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265653/

Surgeon Dr. Andrea Stroud and psychologist Dr. Thomas Kern take on the topic of Bariatric Surgery. Hosted by Sheuli Chowdhury and Nakai Corral Questions? psychiatryexplored@gmail.com Topics covered: Indications for bariatric surgery Psychological implications: pre and post Studies Mentioned: Some recent obesity statistics: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493650/ Obesity and diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066828/ Depression and suicide after bariatric surgery: https://pubmed.ncbi.nlm.nih.gov/31410656/ Long-term depression/anxiety review: https://pubmed.ncbi.nlm.nih.gov/30795495/ Disordered eating and impulsivity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538470/

Host: Avery Ballato Part 1: The presentation and evolution of methamphetamine use in the clinical setting with Dr. Jordan Laub, MD MPH FACEP Part 2: The management and impact of methamphetamine use in and out of the clinical setting with Curtis Johnson, LCSW Sources: https://www.samhsa.gov/data/data-we-collect/dawn-drug-abuse-warning-network This episode is not affiliated with OHSU.

Psychologist Dr. Joel Nigg takes on the topic of ADHD. Hosted by Nakai Corral Questions? psychiatryexplored@gmail.com Topics covered: How to speak to patients/parents about the diagnosis Emotional dysregulation Genetic basis of ADHD Nutritional treatments Impact of stimulants Trends in diagnosis and treatment Media, the internet, and our kids' attention Studies Mentioned: Study on stimulants and impact on grades: https://pubmed.ncbi.nlm.nih.gov/35604744/ Study on stimulants and addiction: https://www.sciencedirect.com/science/article/abs/pii/S0306460313002608?casa_token=jwUw58PypHoAAAAA:W0SbeZ6OmxvAM5WJmSnxtsW5_WBh0ZFjq-vrin_cR9wUWdJjeYpQKSqDq7SEBFvHCprbA1KOtxI Reduction in height with stimulants: https://www.sciencedirect.com/science/article/abs/pii/S0890856708600763?casa_token=eg8stVhUO28AAAAA:65KbhBjbeOuh0pjiaGout3k8NRI1wURGXMSUtWVKTIc_XiLbXk0TTDs-unQ4jqpqaDZdVlOdUPg Brain growth and stimulants: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183380/, https://pubmed.ncbi.nlm.nih.gov/23247506/ Correction from Dr. Nigg: There's actually not a clear conclusive finding here that I can see after more studies have come out. Only correlational studies. The main MRI finding on structure is no evidence of harm. When we do see structural changes over time (e.g., one randomized controlled trial) it's unclear what it means. Animal model of stimulant use and neuronal damage: https://pubmed.ncbi.nlm.nih.gov/27575717/ Omega 3 supplements and ADHD symptoms: https://www.tandfonline.com/doi/full/10.1080/09540260600583031?casa_token=IvSUmSWkf6gAAAAA:u8lp26TFqEsj5KIQQdTKw4vpcqXXodm612ikG9sSg742FbSeYYl3TK4frxgoDwDPXdBiUbNMJTjpXw Vitamin D supplementation and ADHD symptoms: https://www.tandfonline.com/doi/full/10.1080/1028415X.2016.1262097?casa_token=WHfv4XoZMZYAAAAA:Wwcjgg8dpNsp1k9Je1oMVI9W7GRhhgWuVZT2WuqaKrgyUq7uVsZwPAuLUQnTa-gb0LgzsJlbxn8PfA Multi-nutrient supplements and ADHD symptoms: https://pubmed.ncbi.nlm.nih.gov/34303786/ Mindfulness w/ parents and kids with ADHD: https://pubmed.ncbi.nlm.nih.gov/35847187/ MTA trials: https://journals.lww.com/jrnldbp/Abstract/2001/02000/Findings_from_the_NIMH_Multimodal_Treatment_Study.8.aspx

Sleep psychiatrist Dr. Emens and sleep specialist Dr. Mukundan take on the topic sleep medicine through a psychiatric lens. Hosted by Tom Bartlett and Nakai Corral Questions? psychiatryexplored@gmail.com Topics covered: Importance of sleep Cognitive behavioral therapy for insomnia Melatonin Substance use and ADHD Benzodiazepines and BZRAs PTSD Studies Mentioned: Overview on pharmacology of sleep: https://aasm.org/resources/pdf/pharmacologictreatmentofinsomnia.pdf Study on melatonin in OTC: https://jcsm.aasm.org/doi/full/10.5664/jcsm.6434 NEJM Bob Sack review melatonin for jet lag: https://www.nejm.org/doi/10.1056/NEJMcp0909838?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Dr. Sack's study on blind individuals and melatonin: https://grantome.com/grant/NIH/R01-MH056874-01 Study on two groups with insomnia or not, odds to develop depression: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108260/ Resource for online CBTi: https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia CBTI for depression: https://academic.oup.com/sleep/article/31/4/489/2454177?login=true Cannabis and sleep: https://pubmed.ncbi.nlm.nih.gov/31895189/ IRT vs. IRT + CBT vs. Prazosin: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265653/

Psychiatrists Dr. Roff and Dr. D'Souza take on the topic of diagnosis and treatment of borderline personality disorder. Hosted by Dr. Vikas Mankala and Nakai Corral Questions? psychiatryexplored@gmail.com Borderline personality disorder is a complex mental health condition that is characterized by difficulty managing emotions and behavior, impulsiveness, instability of interpersonal relationships, and insecurity - which often presents as self-image issues. Most diagnoses are made during early adulthood, and the core features cause significant impairment in every day life. It is estimated that the lifetime prevalence of borderline personality disorder is 6 percent, with studies showing that the diagnosis was present in 6.4 percent of urban primary care patient, 9.3 percent of psychiatric outpatients, and a staggering 20 percent of psychiatric inpatients. The ratio of females to males is approximately 3:1 in clinical settings, however the lifetime prevalence does not differ significantly between men and women. Co-occuring psychiatric disorders are common including mood, anxiety, substance-use, eating and somatoform disorders. Borderliner notes: https://www.youtube.com/c/BorderlinerNotes What is Dialectical behavior therapy for adolescents (DBT)?: https://youtu.be/Stz--d17ID4

Addiction specialists Dr. Thomas Meeks and Dr. Honora Englander take on the topic of opioid use disorder. Hosted by Lenora Waconda and Nakai Corral Questions? psychiatryexplored@gmail.com Fentanyl Concentrations in Canada: https://drugcheckingbc.ca/wp-content/uploads/sites/2/2022/04/Drug_Checking_BC_Mar_2022.pdf Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2760032 Opioid Agonist Discontinuation: https://pubmed.ncbi.nlm.nih.gov/35489179/ Microinduction of Buprenorphine/Naloxone: A Review of the Literature: https://pubmed.ncbi.nlm.nih.gov/33378137/

Psychiatrists Dr. Asha Jetmalani and Dr. Craigan Usher take on the topics of gender dysphoria, transgender psychiatric care, and pediatric management. Hosted by Corey Gallet de Saint-Aurin and Nakai Corral Questions? psychiatryexplored@gmail.com Let's Talk Gender: Ten Things Transgender and Nonbinary Youth Want All Researchers to Know - https://www.jaacap.org/article/S0890-8567(21)02095-5/fulltext Ten Things Transgender and Gender Nonconforming Youth Want Their Doctors to Know - https://www.jaacap.org/article/S0890-8567(17)30027-8/fulltext

Psychiatrists Dr. Sean Stanley and Dr. Mikaela Rodriguez take on adult ADHD treatment and diagnosis. Hosted by Nakai Corral and Devon Holler