Podcasts about am j psychiatry

In dieser Folge spreche ich mit Florent Crépin, Geschäftsführer von Neurolite. Er stellt eine Depressions-Behandlung vor, die ohne Medikamente auskommt.Links :LinkedIn Instagram NeuroliteYoutube Instagram FlowFacebook FlowÜBER DEPRESSIONDepressionen.ch Stiftung Deutsche DepressionshilfeREFERENZENBarker et al. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985 May. Zur PublikationRush et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006 Nov. Zur PublikationFregni et al. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol. 2021 Apr. Zur PublikationWoodham et al. Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial. Nat Med. 2025 Jan. Zur PublikationCipriani et al. Comparative Efficacy and Acceptability of 21 Antidepressant Drugs for the Acute Treatment of Adults With Major Depressive Disorder: A Systematic Review and Network Meta-Analysis. Focus (Am Psychiatr Publ). 2018 Oct. Zur PublikationSaelens et al. Relative effectiveness of antidepressant treatments in treatment-resistant depression: a systematic review and network meta-analysis of randomized controlled trials. Neuropsychopharmacology. 2024 Dec. Zur PublikationGriffiths et al. Self-Administered “Flow” Transcranial Direct Current Stimulation (tDCS) Depression Treatment in a Crisis Resolution & Home Treatment (CRT) Service: Functioning, and Health-Related Quality of Life Outcomes. Open Journal of Psychiatry. 2024 Nov. Zur PublikationTomonaga et al. The economic burden of depression in Switzerland. Pharmacoeconomics. 2013 Mar. Zur PublikationDeutsche S3-Leitlinie und Nationale VersorgungsLeitlinie (NVL)  Kurzfassung – Lass mir Feedback da :)Hat dir die Folge gefallen? Ich würde mich über eine 5-Sterne-Bewertung sehr freuen! :)Webseite: https://www.psychologieunddenn.ch/Whatsapp-Gruppe (offen für alle): https://chat.whatsapp.com/JBcjpAaIaSeCRxmQMQWGXuMöchtest du Werbung schalten oder mit mir zusammenarbeiten. Dann schau hier vorbei.

Les troubles psychotiques, qui débutent le plus souvent chez les adolescents et les jeunes adultes, peuvent avoir des répercussions importantes sur la santé des patients qui en sont atteints. Toutefois, ils peuvent aussi affecter leur fonctionnement et leur qualité de vie de façon significative. Pour discuter des premiers épisodes psychotiques avec nous, Trait pharmacien reçoit Nadia Akliouat, pharmacienne au CIUSSS du Nord-de-l'Île-de-Montréal et la première diplômée du programme de troisième cycle en soins pharmaceutiques de la Faculté de pharmacie de l'Université Laval. Références : Publications du Dr Patrick McGorry sur les premiers épisodes psychotiques : https://pubmed.ncbi.nlm.nih.gov/?term=McGorry+PD&cauthor_id=37378974 Kane JM, Robinson DG, Schooler NR et coll. Comprehensive versus usual community care of first-episode psychosis: two-year outcomes from the NIMH RAISE Early Treatment Program. Am J Psychiatry 2016;173(4):362-72. Béchard L, Corbeil O, Malenfant E et coll. Une approche de la psychopharmacologie des premiers épisodes psychotiques axée sur le rétablissement. Santé Ment Que 2021;46(2):113-37.

Kochani dzisiaj porozmawiamy sobie o emocjach a dokładniej o ich regulacji :) źródła i dodatkowe materiały : Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014, 171(3) 276-93. doi: 10.1176/appi.ajp.2013.13070966. https://pmc.ncbi.nlm.nih.gov/articles/PMC4282137/pdf/nihms646954.pdf https://www.additudemag.com/emotional-dysregulation-adhd-video/ https://www.youtube.com/watch?v=2kew2JhKq3Y https://psychiatraplus.pl/zaburzenie-regulacji-emocji-brakujace-ogniwo-w-rozumieniu-adhd/ podcast : kurs na DBT https://www.youtube.com/@kursnadbt/videos

This episode of the Ketamine Startup Podcast, comes from a presentation Sam gave at the American College of Emergency Physicians Scientific Assembly on October 1, 2024. Discover the journey of opening a ketamine clinic, the efficacy of IV ketamine for depression, anxiety, PTSD, and chronic pain, and the mechanism behind its success. You will learn about the growing mental health crisis, high burnout rates among emergency physicians, and why ketamine therapy can be a rewarding alternative career path. Sam also shares the emotional and financial realities of running a ketamine clinic, emphasizing the importance of motivation, purpose, and personal fulfillment. Hear powerful testimonials from patients and gain practical advice for starting your own clinic. Don't miss this comprehensive guide filled with scientific studies, real-life experiences, and expert insights.What You'll Learn In This Episode:• Career Transition: Discover how emergency physicians can pivot into running ketamine clinics and find greater autonomy and purpose.• Clinical Evidence: Explore key studies supporting the use of ketamine therapy for depression, anxiety, PTSD, and chronic pain.• Overcoming Challenges: Understand the financial and emotional challenges of running a ketamine clinic and how to stay motivated by focusing on your "why."Episode 22 show notes:00:00 Teaser - The Swimming Pool Dilemma00:35 Introduction01:10 Sam's Journey and Niche in Ketamine Therapy03:12 The Mental Health Crisis05:05 Challenges Faced by Emergency Physicians06:13 Scientific Studies on IV Ketamine Therapy08:45 Ketamine for Anxiety and PTSD10:47 Ketamine for Chronic Pain12:13 How Does Ketamine Work?12:17 Ketamine's Impact on Neurotransmitters13:11 Ketamine and Chronic Stress14:06 Hallucinogenic Effects of Ketamine14:57 Emergency Medicine and Ketamine16:16 Starting a Ketamine Clinic17:19 The Importance of Your 'Why'18:33 Challenges and Rewards of a Ketamine Clinic20:12 Patient Testimonials and Impact21:34 ConclusionThanks for listening

Send us a textDescription: An immersive reading of On Being Ill by Virginia Woolf with reflection on language, health humanities and bipolar disorder.Website:https://anauscultation.wordpress.comWork:Excerpts from On Being Ill by Virginia WoolfFinally, to hinder the description of illness in literature, there is the poverty of the language. English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache. It has all grown one way. The merest schoolgirl, when she falls in love, has Shakespeare or Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry. There is nothing ready made for him. He is forced to coin words himself, and, taking his pain in one hand, and a lump of pure sound in the other (as perhaps the people of Babel did in the beginning), so to crush them together that a brand-new word in the end drops out. Probably it will be something laughable. […] Yet it is not only a new language that we need, more primitive, more sensual, more obscene, but a new hierarchy of the passions; love must be deposed in favour of a temperature of 104; jealousy give place to the pangs of sciatica; sleeplessness play the part of villain, and the hero become a white liquid with a sweet taste—that mighty Prince with the moths' eyes and the feathered feet, one of whose names is Chloral.References:On Being Ill: https://www.gutenberg.net.au/ebooks15/1500221h.html#ch3 Bantel C, Sörös P. On pain - Virginia Woolf and the language of poets and patients. Br J Pain. 2021 Nov;15(4):497-500.Munday I, Kneebone I, Newton-John T. The language of chronic pain. Disabil Rehabil. 2021 Feb;43(3):354-361. Pett S. Rash Reading: Rethinking Virginia Woolf's On Being Ill. Lit Med. 2019;37(1):26-66. Dalsimer K. Virginia Woolf (1882-1941). Am J Psychiatry. 2004 May;161(5):809. Koutsantoni K. Manic depression in literature: the case of Virginia Woolf. Med Humanit. 2012 Jun;38(1):7-14.Bazin, N. T. (1994). Postmortem diagnoses of Virginia Woolf's 'madness': The precarious quest for truth. In B. M. Rieger (Ed.), Dionysus in literature: Essays on literary madness (pp. 133-147). Bowling Green State University Popular Press. 

Articles that Changed Our Practice-Part 1    In this episode we discuss 5 articles that changed our addiction medicine practice.    Mahdi Sheikh, et al. Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality: A Prospective Cohort Study. Ann Intern Med.2021;174:1232-1239. [Epub 27 July 2021]. (Episode 4)    Santos GM, et al. Targeted Oral Naltrexone for Mild to Moderate Alcohol Use Disorder Among Sexual and Gender Minority Men: A Randomized Trial. Am J Psychiatry. 2022 Dec 1;179(12):915-926. Epub 2022 Oct 26. (Episode 20)    Perry, Briana N. MD; et al. Buprenorphine-naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy. Journal of Addiction Medicine 16(6):p e399-e404, 11/12 2022. (Episode 17)  Biddinger KJ, Emdin CA, Haas ME, et al. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Netw Open. 2022;5(3):e223849. (Episode 1)    Reed, M.K., et al. Sorting through life: evaluating patient-important measures of success in a medication for opioid use disorder (MOUD) treatment program. Subst Abuse Treat Prev Policy 18, 4 (2023). (Episode 19)  ----------  This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go to this link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, please visit MI CARES.  ----------  Episode Credits:  Original theme music: composed and performed by Benjamin Kennedy  Audio production: Erin McCue  Executive Producer: Dr. Patrick Beeman  A podcast from Ars Longa Media  ----------  This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice.     The best part of any journal club is the conversation. Send us your comments on social media or join our Facebook group.    Email: addictionmedicinejournalclub@gmail.com   Facebook: @AddictionMedJC  Facebook Group: Addiction Medicine Journal Club  Instagram: @AddictionMedJC   Threads: @AddictionMedJC  Twitter/X: @AddictionMedJC   YouTube: addictionmedicinejournalclub    Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities. 

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 10, 2018 There is a nationwide epidemic happening right now. And it's not some terrible virus, it's not because of anything we've had to eat or drink. It is an occupational hazard of the hospital environment: Physician suicide. Dr. Pamela Wible, Founder of the Ideal Medical Care Movement, shares her unique approach to this preventable plague. Produced by James E Siegler. Music by Andrew Sacco, Damiano Baldoni, Kevin McLeod, Jason Shaw, and Rafael Archangel. Voiceover by Patrick Green. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015 May;72(5):411-2. doi: 10.1001/jamapsychiatry.2014.3050. PMID 25738529Kesselheim AS, Austad KE. Residents: workers or students in the eyes of the law? N Engl J Med 2011;364(8):697-9. PMID 21226569Schernhammer E. Taking their own lives -- the high rate of physician suicide. N Engl J Med 2005;352(24):2473-6. PMID 15958803Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161(12):2295-302. PMID 15569903Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry 2010;67(6):557-65. PMID 20368500Witte TK, Fitzpatrick KK, Joiner TE Jr, Schmidt NB. Variability in suicidal ideation: a better predictor of suicide attempts than intensity or duration of ideation? J Affect Disord 2005;88(2):131-6. PMID 16054227  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: June 7, 2018 Depression and dementia are, unfortunately, two very common disorders in mental health. But the fact that they occur together is not explained by their overall prevalence. The relationship is a bit more complicated. Joan Dietz joins Jim Siegler in a discussion on how she counters these common conditions. Produced by James E Siegler. Music by Lee Rosevere, Jason Shaw, Chris Zabriskie, Kai Engel, and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Alexopoulos GS, Murphy CF, Gunning-Dixon FM, et al. Microstructural white matter abnormalities and remission of geriatric depression. Am J Psychiatry 2008;165(2):238-44. PMID 18172016Byers AL, Yaffe K. Depression and risk of developing dementia. Nat Rev Neurol 2011;7(6):323-31. PMID 21537355Dotson VM, Beydoun MA, Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 2010;75(1):27-34. PMID 20603482Korczyn AD, Halperin I. Depression and dementia. J Neurol Sci 2009;283(1-2):139-42. PMID 19345960Lee CW, Lin CL, Sung FC, Liang JA, Kao CH. Antidepressant treatment and risk of dementia: a population-based, retrospective case-control study. J Clin Psychiatry 2016;77(1):117-22; quiz 122. PMID 26845268Sachdev PS, Smith JS, Angus-Lepan H, Rodriguez P. Pseudodementia twelve years on. J Neurol Neurosurg Psychiatry 1990;53(3):254-9. PMID 2324757Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA, Au R. Depressive symptoms and risk of dementia: the Framingham Heart Study. Neurology 2010;75(1):35-41. PMID 20603483  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Fish oils:Parker G, Gibson NA, Brotchie H, Heruc G, Rees AM, Hadzi-Pavlovic D. Omega-3 fatty acids and mood disorders. Am J Psychiatry. 2006 Jun;163(6):969-78. doi: 10.1176/ajp.2006.163.6.969. Erratum in: Am J Psychiatry. 2006 Oct;163(10):1842. PMID: 16741195. B Vitamins:Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy--A Review. Nutrients. 2016 Jan 27;8(2):68. doi: 10.3390/nu8020068. PMID: 26828517; PMCID: PMC4772032. Magnesium:Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2):362-70. doi: 10.1016/j.mehy.2006.01.047. Epub 2006 Mar 20. PMID: 16542786. Vitamin D:Penckofer S, Kouba J, Byrn M, Estwing Ferrans C. Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 2010 Jun;31(6):385-93. doi: 10.3109/01612840903437657. PMID: 20450340; PMCID: PMC2908269.

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 psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

20. Targeted Naltrexone for Binge Drinking In episode 20 we discuss an article about taking naltrexone as needed to reduce binge drinking among sexual and gender minority men. Santos GM, Ikeda J, Coffin P, Walker J, Matheson T, Ali A, McLaughlin M, Jain J, Arenander J, Vittinghoff E, Batki S. Targeted Oral Naltrexone for Mild to Moderate Alcohol Use Disorder Among Sexual and Gender Minority Men: A Randomized Trial. Am J Psychiatry. 2022 Dec 1;179(12):915-926. Epub 2022 Oct 26.  We also discuss the recent reduction in the number of overdose deaths in the United States. Take a look at the White House Briefing on the CDC rolling 12-month overdose data.  California wants to phase out smoking. --------- Episode 20 Credits: Original theme music: composed and performed by Benjamin Kennedy Audio production: Erin McCue Video production: Paul Kennedy Executive Producer: Dr. Partick Beeman A podcast from Ars Longa Media ---------- This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice.  The best part of any journal club is the conversation. Send us your comments on Twitter, Facebook, YouTube, Spotify, email, or join our Facebook group. Email: addictionmedicinejournalclub@gmail.com  Twitter: @AddictionMedJC  Facebook: @AddictionMedJC Facebook Group: Addiction Medicine Journal Club YouTube: addictionmedicinejournalclub Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.

Nessa semana o Clube dos Generais recebe José Antonio Mariano, psicanalista e membro do CG, para conversar sobre o que é a PTSD (síndrome de stress pós-traumático), como ela foi estudada e como se manifesta. O Clube dos Generais é associado Amazon.com.br - compre com nossos links e ajude o CG!- Military Psychology: Clinical and Operational Applications: https://amzn.to/40IBeHJ- Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War: https://amzn.to/3KxTEp1- Things they cannot say: https://amzn.to/3K9GIUX- Fields of combat: https://amzn.to/40xfej7- Achilles in Vietnam: https://amzn.to/3ZHWeNH- Odysseus in America: https://amzn.to/3U5fuUdArtigos recomendados:- Jones, E; Fear, N; e Wessely, S. "Shell Shock and Mild Traumatic Brain Injury: A Historical Review". Am J Psychiatry 2007; 164:1641–1645- Horrocks, J. (2018). The limits of endurance: Shell shock and dissent in World War one. The Journal of New Zealand Studies, (NS27).- MacLeod, A. D. (2004). "Shell shock, Gordon Holmes and the Great War". Journal of the Royal Society of Medicine. 97 (2): 86–89.- Myers, C.S. "A contribution to the study of shell shock". Lancet, 1, 1915, pp. 316–320- Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists, 1914–1994. London, Jonathan Cape, 2000. Outros livros que passam pelo tema:- Os 900 dias, o cerco de Leningrado, de Harrison E. Salisbury- A Batalha de Sarajevo, de Leão Serva- Bagdá ao alvorecer, de Peter R. Mansoor- Crer & destruir, de Christian Ingrao- De casa em casa em Fallujah, de David Belavia- Gostaríamos de informá-lo... mortos com nossas famílias, Philip Gourevitch- Stasilândia, de Anna Funder- Sussuros, de Orlando Figes- Tu carregas meu nome, de Norbert e Stephan Lebert- Uma mulher em Berlim, de Martha Hillers- Uma temporada de facões, de Jean Hatzfeld Episódio em áudio e vídeo, consuma como preferir! Ouça Podcasts - conteúdo interessante onde, como e quando você quiser! Assine o Clube dos Generais pelo seu aplicativo de podcasts favorito.Nosso agradecimento aos membros do nosso canal no YouTube!Categoria Capitão: Rafael AndradeCategoria Sargento: Felipe Veiga Ramos, Claudio Calaza, Anderson Püttow, Breno Achete MendesCategoria Cabo: Paulo Fernandes, Vinícius, João Felipe Müller, Pablo Maicá, Fabiano Bitterncourt, Márcio Leandro "Wood" Montanha, Rogério Batista, Mauro Rached, Gustavo Grossi, Dani Dani, Paulo RobertoCategoria Hater: Cristiano FerreiraCategoria Recruta: Iago "BT-7" Bovi, Fabrizio "Valkoinen Kuolema" Messetti, Goodpaster, Vader Brasil, Lyndon Johnson, Carlos Eduardo Perez de Moraes, Marcio MatiasAcompanhe as atividades do Clube dos Generais direto no nosso site!https://clubedosgenerais.com.br/Cansado do YouTube? Dá uma olhada na Odysee:https://odysee.com/@ClubedosGenerais:cQuer contribuir direto, sem intermediários?Pix para estadomaiorcg@gmail.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/clubedosgenerais/message

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 28, 2020 Lewy body dementia may be the second most common neuropathologic cause of dementia behind Alzheimer disease, but it remains largely a clinical diagnosis with limited treatment options. This week on BrainWaves, Dr. Amy Colcher (Cooper University Hospital) reviews the diagnostic criteria and management strategies for patients and their caregivers who suffer from this condition. Plus, a sort of tribute to Robin Williams. Produced by James E Siegler and Amy Colcher. Music courtesy of Andrew Sacco, Axletree, Damiano Baldoni, Josh Woodward, and Julie Maxwell. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Armstrong MJ. Lewy body dementias. Continuum (Minneap Minn) 2019;25(1):128-46. PMID 30707190 Desmarais P, Massoud F, Filion J, Nguyen QD, Bajsarowicz P. Quetiapine for psychosis in Parkinson disease and neurodegenerative parkinsonian disorders: a systematic review. J Geriatr Psychiatry Neurol 2016;29(4):227-36. PMID 27056066 Frieling H, Hillemacher T, Ziegenbein M, Neundörfer B, Bleich S. Treating dopamimetic psychosis in Parkinson's disease: structured review and meta-analysis. Eur Neuropsychopharmacol 2007;17(3):165-71. PMID 17070675 Galvin JE, Duda JE, Kaufer DI, Lippa CF, Taylor A, Zarit SH. Lewy body dementia: the caregiver experience of clinical care. Parkinsonism Relat Disord 2010;16(6):388-92. PMID 20434939 Koga S, Aoki N, Uitti RJ, et al. When DLB, PD, and PSP masquerade as MSA: an autopsy study of 134 patients. Neurology 2015;85(5):404-12. PMID 26138942 McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium. Neurology 2017;89(1):88-100. PMID 28592453 McKeith IG. Spectrum of Parkinson's disease, Parkinson's dementia, and Lewy body dementia. Neurol Clin 2000;18(4):865-902. PMID 11072265 Stinton C, McKeith I, Taylor JP, et al. Pharmacological management of Lewy body dementia: a systematic review and meta-analysis. Am J Psychiatry 2015;172(8):731-42. PMID 26085043 Taylor JP, McKeith IG, Burn DJ, et al. New evidence on the management of Lewy body dementia. Lancet Neurol 2020;19(2):157-69. PMID 31519472  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

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 psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.  

In this episode, we discuss the evidence, safety, and place in therapy of Auvelity® (dextromethorphan-bupropion), a newly approved antidepressant with a unique mechanism of action and interesting pharmacokinetic considerations. Key Concepts Auvelity® (bupropion-dextromethorphan) was FDA approved in 2022 for major depressive disorder (MDD). The bupropion component inhibits CYP2D6 metabolism and increases serum concentrations of dextromethorphan. The proposed mechanism of benefit in MDD is via dextromethorphan (as an NMDA antagonist) and possibly with bupropion (as a dopamine/norepinephrine reuptake inhibitor). Although the bupropion component in Auvelity® is being used for its drug interaction, the dose is a therapeutic dose and carries several warnings and precautions, including the risk of seizure and hypertension. In short (6-week) clinical trials, Auvelity® improved depression symptoms quickly (within 1-2 weeks), which is faster than many other antidepressants. Auvelity® is associated with dizziness, anxiety, hyperhidrosis, nausea, headache, diarrhea, and dry mouth. As a CYP2D6 inhibitor, the bupropion component of Auvelity® will cause drug interactions with many other medications, including some antidepressants, antipsychotics, and opioid analgesics (among others). References Iosifescu DV, Jones A, O'Gorman C, et al. Efficacy and Safety of AXS-05 (Dextromethorphan-Bupropion) in Patients With Major Depressive Disorder: A Phase 3 Randomized Clinical Trial (GEMINI). J Clin Psychiatry. 2022;83(4):21m14345. Published 2022 May 30. doi:10.4088/JCP.21m14345 Tabuteau H, Jones A, Anderson A, Jacobson M, Iosifescu DV. Effect of AXS-05 (Dextromethorphan-Bupropion) in Major Depressive Disorder: A Randomized Double-Blind Controlled Trial. Am J Psychiatry. 2022;179(7):490-499. doi:10.1176/appi.ajp.21080800 Kotlyar M, Brauer LH, Tracy TS, et al. Inhibition of CYP2D6 activity by bupropion. J Clin Psychopharmacol. 2005;25(3):226-229. doi:10.1097/01.jcp.0000162805.46453.e3

Content Warning: Mental health and suicide  What's going down:  An in-depth analysis of hormonal birth control usage in the United States    A close look at the limited data on hormonal birth control use in people who have previously been diagnosed with mental health struggles    Exposing whether starting hormonal birth control will jump-start mental health issues    Clitorally STOP making content based on studies that are dated and inaccurate - Find out why "they" call birth control the divorce pill here.    Breaking down why we even think birth control could affect our mental health   Understanding the difference between correlation and causation   The reason birth control can actually minimize anxiety and increase your mood   Revealing the most (surprisingly) popular form of birth control in the United States  Thank you for continuing the conversation and calling into the Viva la Vulva Voicemail at (503) 893-2016! Please be sure to rate, follow, review, and remember that nothing is considered TMI around here.   Social & Website  Tiktok: @drjenniferlincoln  Instagram: @drjenniferlincoln  YouTube: @drjenniferlincoln  Website: www.drjenniferlincoln.com    Resources   Grab a copy of my book HERE!  Obstetricians For Reproductive Justice    References  https://www.guttmacher.org/fact-sheet/contraceptive-method-use-united-states  https://www.mhanational.org/depression-women  Pagano HP, Zapata LB, Berry-Bibee EN, Nanda K, Curtis KM. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016 Dec;94(6):641-649. doi: 10.1016/j.contraception.2016.06.012. Epub 2016 Jun 27. PMID: 27364100.  McCloskey LR, Wisner KL, Cattan MK, Betcher HK, Stika CS, Kiley JW. Contraception for Women With Psychiatric Disorders. Am J Psychiatry. 2021 Mar 1;178(3):247-255. doi: 10.1176/appi.ajp.2020.20020154. Epub 2020 Nov 10. PMID: 33167674.  https://ideas.ted.com/how-the-birth-control-pill-affects-your-mood/  Mu E, Kulkarni J. Hormonal contraception and mood disorders. Aust Prescr. 2022 Jun;45(3):75-79. doi: 10.18773/austprescr.2022.025. Epub 2022 Jun 1. Erratum in: Aust Prescr. 2022 Aug;45(4):147. PMID: 35755988; PMCID: PMC9218393.  Roberts S.C., Gosling L.M., Carter V., Petrie M.: MHC-correlated odour preferences in humans and the use of oral contraceptives. Proc. R. Soc. Lond. B: Biol. Sci. 2008; 275: pp. 2715-2722.  Jones, B. C., Hahn, A. C., Fisher, C. I., Wang, H., Kandrik, M., Han, C., Fasolt, V., Morrison, D., Lee, A. J., Holzleitner, I. J., O'Shea, K. J., Roberts, S. C., Little, A. C., & DeBruine, L. M. (2018). No Compelling Evidence that Preferences for Facial Masculinity Track Changes in Women's Hormonal Status. Psychological Science, 29(6), 996–1005. https://doi.org/10.1177/0956797618760197  Learn more about your ad choices. Visit megaphone.fm/adchoices

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 psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

How many serial killers have a medical illness that drives them to kill? How many innocent  people are sent to death row each year? Answers to these questions and more await you in this episode that is all about homicide.  Check out the instagram page the_z_files_podcast for weekly crime fact drops! email questions to: thezfilespodcast@gmail.comChild abuse info sheet: https://www.childwelfare.gov/pubpdfs/whatiscan.pdfSources:https://www.domesticshelters.org/articles/in-the-news/women-serve-longer-prison-sentences-after-killing-abusershttps://everytownresearch.org/report/guns-and-violence-against-women-americas-uniquely-lethal-intimate-partner-violence-problem/Friedman, Susan H. , Sarah McCue Horwitz, and Phillip J. Resnick.  2005. “Child Murder by Mothers: A Critical Analysis of the Current State of Knowledge and a Research Agenda.” Am J Psychiatry; 162:1578-1587FBI.govhttps://projects.voanews.com/mass-shootings/https://documents.deathpenaltyinfo.org/pdf/FactSheet.pdf

《美國醫學會神經學期刊》（JAMA Neurology）的短文介紹美國的神經內科醫師訓練過程中，必須要有1個月的時間全職到精神科外訓；而精神科醫師的訓練過程中，也有2個月的神經內科訓練。台灣住院醫師訓練也是類似的時程。 神經內科醫師來到精神科的短短一個月中，哪些是可以優先學習的重點呢？這篇短文提到了一個可能是全世界的醫院外訓都常見的現象 — 不要把外訓醫師作為人力考量，是外訓能夠有好的學習環境最重要的一項條件。例如這篇論文認為神經內科醫師的精神醫學訓練中，門診可能是比照顧住院病患還要更重要的環節，如果在病房人力不足的情況下，這項門診的學習很可能就會因此被犧牲了。 更多的內容，歡迎參考本集的podcast!

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 psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Contributor: Aaron Lessen, MD Educational Pearls: Firearms are a dangerous potential method of committing suicide Death occurs in about 5-15% of suicide attempts overall, but death in suicide attempts using firearms occurs in 85-90% of cases In some states, families can petition a judge to remove firearms from a house although healthcare providers cannot do this References Sarai SK, Abaid B, Lippmann S. Guns and Suicide: Are They Related? Prim Care Companion CNS Disord. 2017 Dec 21;19(6):17br02116. doi: 10.4088/PCC.17br02116. PMID: 29272571. Anestis MD, Bandel SL, Butterworth SE, Bond AE, Daruwala SE, Bryan CJ. Suicide risk and firearm ownership and storage behavior in a large military sample. Psychiatry Res. 2020 Sep;291:113277. doi: 10.1016/j.psychres.2020.113277. Epub 2020 Jul 2. PMID: 32886959. Mann JJ, Michel CA. Prevention of Firearm Suicide in the United States: What Works and What Is Possible. Am J Psychiatry. 2016 Oct 1;173(10):969-979. doi: 10.1176/appi.ajp.2016.16010069. Epub 2016 Jul 22. PMID: 27444796. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Você já se sentiu ansioso? Estes sentimentos são constantes e te atrapalham numa prova, trabalho, ou em um relacionamento? A emoção ansiedade é normal, pois ajuda a preparar o indivíduo para enfrentar ou escapar de um perigo no futuro. Porém, em alguns casos a ansiedade experimentada pelo indivíduo é tão intensa e constante, que prejudica o seu funcionamento ou causa sofrimento intenso. Neste episódio, comentamos sobre a emoção ansiedade, seus principais sintomas e também sobre os Transtornos de Ansiedade, que segundo o DSM-V são: Transtorno de Ansiedade de Separação; Mutismo Seletivo; Fobia Específica; Fobia Social; Transtorno de Pânico; Agorafobia; Transtorno de Ansiedade Generalizada; Transtorno de Ansiedade Induzido por Substância; Transtorno de Ansiedade Devido à Outra Condição Médica; Outro Transtorno de Ansiedade Especificado; e Transtorno de Ansiedade Não Especificado. A boa notícia é que existem tratamentos psicológicos e farmacológicos efetivos para todos estes casos. Então, diminui essa ansiedade cienciando conosco em mais este episódio! *Reproducible Genetic Risk Loci for Anxiety: Results From ~200,000 Participants in the Million Veteran Program. Am J Psychiatry. 2020 March 01; 177(3): 223–232. doi:10.1176/appi.ajp.2019.19030256. *Samba = Pré carnaval anti-nazi. Paródia de “Aquarela brasileira” (Silas de Oliveira), por Edu Krieger no Voz e cavaco – @edukrieger

本集導讀《新英格蘭醫學期刊》刊登麻州總醫院的病例討論會，探討一位54歲的男性，出現易怒、意識混亂以及怪異行為。而從這則案例，讀者也可以同時複習《會談地圖》中：鴉片類藥物過量的臨床症狀與處置（第11章）、自殺評估（第1章）、缺氧傷及哪些大腦的區域（第5章）、各種認知功能障礙的鑑別診斷（第9章）等重要的知識。而這篇病例討論所描述的行為與精神狀態的細膩之處，也非常值得學習。  

As many as 80% of people with ADHD will have at least one other psychiatric condition in their lifetime. Just as untreated ADHD can lead to unnecessary problems in everyday life, comorbid conditions can cause a tremendous amount of harm in those with ADHD if left undiagnosed and untreated. On the surface, SAD and ADHD can sometimes look alike. We will discuss The following and few ways symptoms of ADHD and SAD overlap. As always this episode will include tips and ways to help minimize the suffering of Social Anxiety! If you would like to become a patreon you can at www.patreon.com/theneurodivergentnurse References used to help create this podcast: Sobanski E, Brüggemann D, Alm B, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2007;257(7):371-377. doi:10.1007/s00406-007-0712-8 Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716 Koyuncu A, Alkın T, Tükel R. Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis). Early Interv Psychiatry. 2018;12(2):269-272. doi:10.1111/eip.12372 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, DC. 2013 --- Send in a voice message: https://anchor.fm/theneurodivergentnurse/message

Dr. Autumn Walkerly provides an overview of Spravato (esketamine) nasal spray for treatment resistant depression. References: Gaynes BN, Lux L, Gartlehner G, et al. Defining treatment-resistant depression. Depress Anxiety. 2020;37(2):134-45. Irwin MN, VandenBerg A. Retracing our steps to understand ketamine in depression: A focused review of hypothesized mechanisms of action. Ment Health Clin. 2021;11(3):200-10. Rush AJ, Trivedi MH, Wisniewski SR, et al. "Acute and longer-term outcomes in depressed outpatient requiring one or several treatment steps: A STAR*D report". Am J Psychiatry. 2006. 163(11):1905-17. Daly EJ, Trivedi MH, Janik A, et al. Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA Psychiatry. 2019;76(9):893-903. Fu DJ, Ionescu DF, Li X, et al. Esketamine nasal spray for rapid reduction of major depressive disorder symptoms in patients who have active suicidal ideation with intent: double-blind, randomized study (ASPIRE I). J Clin Psychiatry. 2020;81(3):19m13191. Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. Am J Psychiatry. 2019;176(6):428-38.

Episode 27: In this episode, host Angie Gust, talks about some amazing aspects of mushrooms.  In addition to being able to break down plastics and other pollutants, many mushrooms are good for your health.  Some of the edible mushrooms with health benefits are Lion's Mane, Reishi, Chaga, Cordyseps, and Turkey Tail.  In terms of the environment, in May, the International Energy Agency (IEA) published its first-ever detailed blueprint for reaching net-zero emissions by 2050, which it said was “compatible” with the 1.5C limit. They said, “Beyond projects already committed as of 2021, there are no new oil and gas fields approved for development in our [NZE] pathway, and no new coal mines or mine extensions are required.”  Post-pandemic plans aimed at a greener recovery have been moving forward in several European countries, with Germany and France applying for funds under an EU scheme.  References Jones, ST. Feb 23, 2021. Plastic industry's fake tears. Medium. https://medium.com/center-for-biological-diversity/plastic-industrys-fake-tears-2d45c2e0c4cb Liu J, Raine A, Venables PH, Mednick SA. Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11, and 17 years. Am J Psychiatry. 2004 Nov;161(11):2005-13. doi: 10.1176/appi.ajp.161.11.2005. PMID: 15514400; PMCID: PMC1570126 MacFarlane, S. May 27, 2021. Climate Ruling Could Force Big Change at Shell. The Wall Street Journal. https://www.wsj.com/articles/climate-ruling-could-force-big-change-at-shell-11622131737?mod=hp_lead_pos7 Mathews, CM. May 26, 2021. Activist Wins Exxon Board Seats After Questioning Oil Giant's Climate Strategy. The Wall Street Journal. https://www.wsj.com/articles/activist-wins-exxon-board-seats-after-questioning-oil-giants-climate-strategy-11622050087?mod=hp_lead_pos1&mod=article_inline Ozdemir, D. Apr 14, 2021. Could Plastic-Eating Mushrooms Solve Humanity's Plastic Problem? https://interestingengineering.com/could-plastic-eating-mushrooms-solve-humanitys-plastic-problem Park, K. Mushrooms can save the world. We are Wildness. https://wearewildness.com/mushrooms-can-save-world/#:~:text=Here's%20a%20great%20quote%20from,understand%20the%20language%20of%20Nature The Ultimate Beginner's Guide to Medicinal Mushrooms. Jan 21, 2020. Natural Force. https://naturalforce.com/blogs/nutrition/medicinal-mushrooms UN Climate Change. Apr 30, 2021. Urgent Climate Action Is Needed to Safeguard the World's Oceans https://unfccc.int/news/urgent-climate-action-is-needed-to-safeguard-the-world-s-oceans Williams, J. May 29, 2021. As protected bike lanes arrive in New Orleans, cyclists happy, some other residents not so much. Nola. https://www.nola.com/news/politics/article_aa133616-bfc1-11eb-8cb4-930c9c00f9b7.html

The article we discuss is MA Raskind et al. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans. New England Journal of Medicine 2018; 378(6):507-517For an  example of an earlier study that DID find benefit of prazosin for PTSD, check out Raskind, MA et al. A Trial of Prazosin for Combat Trauma PTSD with Nightmares in Active-Duty Soldiers Returned from Iraq and Afghanistan. Am J Psychiatry 2013; 170: 1003-1010.Recent meta-analyses of the efficacy of prazosin for PTSD can be found here and here. A brief review on the ethical principles of equipoise in research.

Join us in this episode's case study about Luka Mahnoggta. Find out how his story can be possibly linked to Narcissism Personality Disorder (NPD) according to Alexander Lowen's Theory. In this episode, we also talk about what the basic traits for NPD are according to the DSM-V criteria,  and the different types of Narcissism.Script-Writer: Cheryl AnthonyCo-hosts: Cheryl Anthony and Niranjan Vinayakrishnan References Akhtar, S. (1989). Narcissistic personality disorder: Descriptive features and differential diagnosis. Psychiatric Clinics of North America, 12(3), 505-529.Campbell, W. K., & Miller, J. D. (2011). The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. John Wiley & Sons.Cooper, A. M., & Ronningstam, E. (1992). Narcissistic personality disorder. American psychiatric press review of psychiatry.Freud, S. (1957). On narcissism: An introduction. In The Standard Edition of the Complete Psychological Works of Sigmund Freud: On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, 67-102.Gabbard, G. O. (1989). Two subtypes of narcissistic personality disorder. Bulletin of the Menninger Clinic.Kohut, H. (1966). Forms and transformations of narcissism. Journal of the American Psychoanalytic association, 14(2), 243-272.Lasch, C. (1980). The culture of narcissism. Bulletin of the Menninger Clinic, 44(5), 426.Levy, K. N., Reynoso, J. S., Wasserman, R. H., & Clarkin, J. F. (2007). Narcissistic personality disorder.M. D., & Thomson Jr, J. A. (1982). Overview: Narcissistic personality disorder. Am J Psychiatry, 139(1).Miller, J. D., Widiger, T. A., & Campbell, W. K. (2010). Narcissistic personality disorder and the DSM-V. Journal of Abnormal Psychology, 119(4), 640.Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual review of clinical psychology, 6, 421-446.Pulver, S. E. (1970). Narcissism: The term and the concept. Journal of the American Psychoanalytic Association, 18(2), 319-341.Raskin, R. N., & Hall, C. S. (1979). A narcissistic personality inventory. Psychological reports.Rhodewalt, F., & Peterson, B. (2009). Narcissism.Shoshani, M., & Shoshani, B. (2003). Chapter 7 Psychic Survival versus Psychic Freedom: Reflections on Symington's Theory of Narcissism. Progress in self psychology, 19, 133-151.Wink, P. (1991). Two faces of narcissism. Journal of personality and social psychology, 61(4), 590.Winnicott, D. W. (1960). "Ego distortion in terms of true and false self". The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development. New York: International Universities Press, Inc: 140–57.Winnicott, D. W. (1965). A clinical study of the effect of a failure of the average expectable environment on a child's mental functioning. International Journal of Psycho-Analysis, 46, 81-87.

For nearly 17 years, since the FDA black box warning about suicidality with antidepressants, our community has been quoting data that downplays this concern. We were wrong. We were deceived. Antidepressants can be lifesaving, but there really is a duty to warn. In this episode, Doctors Martha Ignaszewski and Glen Spielmans talk with us about what went on and how to talk about it with our families. Guests: Dr. Glen Spielmans, professor of psychology at Metropolitan State University in Saint Paul, Minnesota Dr. Martha Ignaszewski, staff psychiatrist at BC Children’s Hospital and a clinical instructor at the University of British Columbia Published On: 3/1/2021 Duration: 24 minutes, 36 seconds Related Articles: "Duty to Warn? Debating Antidepressant Suicidality," The Carlat Child Psychiatry Report, Oct/Nov/Dec 2020 Spielmans GI, Spence-Sing T, Parry P. Duty to Warn: Antidepressant Black Box Suicidality Warning Is Empirically Justified. Front Psychiatry. 2020 Feb 13;11:18. doi: 10.3389/fpsyt.2020.00018. PMID: 32116839; PMCID: PMC7031767. [Link] Ignaszewski MJ, Waslick B. Update on Randomized Placebo-Controlled Trials in the Past Decade for Treatment of Major Depressive Disorder in Child and Adolescent Patients: A Systematic Review. J Child Adolesc Psychopharmacol. 2018 Dec;28(10):668-675. doi: 10.1089/cap.2017.0174. Epub 2018 Jul 31. PMID: 30063169. [Link] Links and References: Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, Herings RM, Mann JJ. Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 2007 Sep;164(9):1356-63. doi:" [Link] Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry. 2012 Jun;69(6):580-7. doi: 10.1001/archgenpsychiatry.2011.2048. Erratum in: Arch Gen Psychiatry.2013 Aug;70(8):881. PMID: 22309973; PMCID: PMC3367101. [Link] Findling RL, Robb A, Bose A. Escitalopram in the treatment of adolescent depression: a randomized, double-blind, placebo-controlled extension trial. J Child Adolesc Psychopharmacol. 2013 Sep;23(7):468-80. doi: 10.1089/cap.2012.0023. PMID: 24041408; PMCID: PMC3779002. [Link] Healy D, Cattell D. Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatry. 2003 Jul;183:22-7. PMID: 12835239. [Link] Phase Five Website [Link] Phase Five Marketing Document [Link]

The paper we discuss is BA Clementz et al. Identification of Psychosis Biotypes Using Brain-Based Biomarkers. Am J Psychiatry  2016; 173(4): 373-384.Here's the paper Dr Toups mentions about depression, biotypes, and treatment response:  AT Drysdale et al. Resting-state connectivity biomarkers define neurophysiological subtypes of depression. Nature Medicine 2017; 23: 28-28.The  discussion about psychiatric nosology has led to some heated discussions and received a bit of attention in the popular press.  The New Yorker's take is here.We are not the only the psychiatry podcast that has discussed these questions. There's also an excellent discussion on the first episode of the podcast Ten to the Fifteenth, which is produced by the National Neuroscience Curriculum Initiative.

The paper we discuss in this episode is V Popova et al. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined with a Newly Initiated Oral Antidepressant in Treatment Resistant Depression: A Randomized Double-Blind Active-Controlled Study. Am J Psychiatry  2019; 176(6): 428-438.For a deeper understanding of the factors that contribute to placebo response, check out  BR Rutherford and SP Roose. A Model of Placebo Response in Antidepressant Clinical Trials. Am J  Psychiatry  2013; 170:723-733.Lots of data about the placebo response in antidepressant clinical trials:BT Walsh et al. Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing. JAMA 2002; 287(14):1840-1847.W Rief et al . Meta-analysis of the Placebo Response in Antidepressant Trials. Journal of Affective Disorders 2009; 118:1-8.TA Furukawa et al. Placebo Response Rates in Antidepressant Trials: A Systematic Review of Published and Unpublished Double-Blind Randomised Controlled Studies. Lancet Psychiatry 2016; 3:1059-1066.     

Lecture SummaryKetamine is a small molecule that works mainly through inhibition of the NMDA receptor in brain and nerve tissue. It has varying effects at different doses and can be used for a number of medical indications including depression, suicidal ideation, acute and chronic pain, sedation, and anesthesia. Ketamine is a very safe drug when used intermittently and appropriately. However, it can cause both harm and addiction. Many clinicians fear ketamine. This fear is misplaced as ketamine is very forgiving in the clinical setting and safer than other alternatives like opiates.References- Olson KR et al. Poisoning and drug Overdose, 6th ed. Arminian P. Phencyclidine and Ketamin. 2012. McGraw Hill. 325-327- Nelson LS et al. GoldFrank’s Toxicological Emergencies, 11th ed. Olmedo RE. Phencyclidine and Ketamin, chapter 83. 2019. McGraw Hill. 1210-1221. (NMDA receptor information from other chapters as well)- George D et al. Pilot randomized controlled trial of titrated subcutaneous ketamine in older patients with treatment-resistant depression. Am J Geriatr Pscychiatry. 2017; 25(11): 1199-1209.- Murrough JW et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013; 170(100): 1134-1142.- Rodriguez CI et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology. 2013; 38:2475-2483.- Michelet D et al. Ketamine for chronic non-cancer pain: A meta-analysis and trial sequential analysis of randomized control trials. Eur J Pain. 2018; 22:632-646.- Price RB et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014; 31(4): 335-343.- Lapidus KAB et al. A randomized controlled trial of intrasal ketamine in major depressive disorder. Biol Pscyhiatry. 2014; 76(12): 970-976.- Zanos P, Gould TD. Mechanisms of Ketamine Action as an Antidepressant. Mol Psychiatry. 2018; 23(4): 801-811.- Orhurhu VJ et al. Ketamine Toxicity. StatPearls. 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541087/- Wikipedia – Ketamine, Enantiomers, NMDA, etc.

Sanjay Gupta, MD, conducts a Masterclass on treating geriatric patients with symptoms of dementia, particularly amid the restrictions tied to COVID-19. Dr. Gupta is chief medical officer at BryLin Hospital in Buffalo, N.Y. He is also is a clinical professor in the department of psychiatry at the State University of New York, Syracuse, and is affiliated with SUNY at Buffalo. Dr. Gupta attends at 8-10 nursing homes. He disclosed serving on the speakers’ bureaus of AbbVie, Acadia, Alkermes, Intra-Cellular Therapies, Janssen, and Otsuka. Take-home points Common neuropsychiatric symptoms in patients with dementia include agitation, aggression, delusions, insomnia, anxiety, and depression. One-third of community-dwelling elders and between 60%-80% of nursing facility patients have these neuropsychiatric symptoms. The most common medication class Dr. Gupta uses is antipsychotics. The use of these medications in individuals with dementia is off label. The Food and Drug Administration maintains a black-box warning on the use of antipsychotics for geriatric patients because of the increased risk of sudden death. Risperidone is supported by the most data, then olanzapine, then aripiprazole, and finally quetiapine. Quetiapine has very limited data to support its efficacy. Most antipsychotics have modest efficacy data for their use in this population. The riskiest adverse effects are cardiovascular adverse events, which are higher in risperidone. Dr. Gupta starts risperidone at a low dose of 0.25 mg taken by mouth b.i.d. and titrates to a maximum dose of 2 mg/24 hours. The starting dose for olanzapine is 2.5 mg up to a maximum dose of 10 mg. The starting dose of aripiprazole is 1 mg, and maximum dose 5 mg or less. Selective serotonin reuptake inhibitors (most commonly sertraline or citalopram), the atypical antidepressant mirtazapine, and anticonvulsants (valproic acid) are also used for agitation in dementia but there is limited evidence for their efficacy. Melatonin and trazodone have a positive effect on sleep that can have downstream improvement on aggressive behaviors. Summary To choose an effective treatment, it’s essential to obtain a detailed history of the symptoms from patients and collateral, such as relatives and staff members from the facility. Staff members can be educated about what information is most important to the clinician, or they may provide vague information, such as “the patient is confused.” Specific symptoms that can be used guide treatment include the presence of disorganized thoughts, delusions and paranoia, or visual and/or auditory hallucinations; the timing of the behavior (day vs. night); and patterns of aggressive behaviors. Dr. Gupta emphasizes that it’s important to rule out delirium as the cause of agitation by evaluating underlying medical issues with laboratory evaluations, and when possible, a physical exam. Antipsychotics work best in the context of aggression driven by paranoia and/or delusions of persecution. Antipsychotics seem to work less well for general agitation that may be driven by triggers that need to be uncovered through investigation of the history and environment. Reasons for agitation and aggression might include sensory or activity deprivation, difficulty emptying bladder or bowels, or depression and loneliness, both of which are prevalent during the pandemic. Adverse effects of antipsychotics will be greater in older adults, and include sedation, gait problems that increase the risk of falls, and extrapyramidal or Parkinsonian symptoms. In a geriatric patient, tardive dyskinesia can occur with as little as 1 month of exposure to an antipsychotic, compared with 3 months in younger adults. Before starting an antipsychotic, the clinician must obtain informed consent from the health-care proxy and inform them that using antipsychotics in a patient with dementia is a non–FDA-approved treatment with a black-box warning. Gradual dose reduction, a Medicare policy about the use of psychotropic medications within nursing homes, is defined as “stepwise tapering of a dose to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or medication can be discontinued.” Dr. Gupta addresses this policy by assessing which medications are essential and often stopping some medications once the patient is started on antipsychotics. References Steinberg M, Lyketsos CG. Am J Psychiatry. 2012 Sep;169(9):900-6. Maher AR et al. JAMA. 2011 Sep 28;306(12):1359-69. Schneider LS et al. JAMA. 2005 Oct 19;294(15):1934-43. Seitz DP et al. Cochrane Database Sys Rev. 2001 Feb 16;(12):CD0089. Ballard C et al. Cochrane Database Sys Rev. 2006 Jan 25. doi: 10.1002/14651858. Ballard C, Waite J. Cochrane Database Sys Rev. 2006 Jan 25;(1):CD003476. Department of Health & Human Services. State Operations Manual Surveyor Guidance Revisions Related to Psychosocial Harm in Nursing Homes. CMS.gov. 2016 Mar 25. *  *  * Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Alex Murray is a Canberra based Podiatrist working in private practice and the founder of the website Making Sense in Podiatry. He's passionate about helping other clinicians make sense of evidence and clinical practice with a core philosophy of exploring the complexity of human beings, embracing the uncertainty of clinical practice, and avoiding overly reductionist thinking. He has experience with both national and international athletes and recently transitioned to focusing primarily on helping the general population, and local athletes manage their pain and achieve their goals. On this episode we discuss: The paradigm shift and changing the ways we think about not only our failures but also our successes. Reductionism & Complexity Guided problem solving: why different problems can be managed successfully in many ways Having more treatment options make us better. Pain Management and managing athletes. Patient beliefs and previous experiences will determine their behaviours.  The long-term benefits of understanding and listening to your patient's goals and how to encourage them back into their activity  "Reassurance is a great pain killer." Final Tip Listen: You need to listen before you begin to educate your patient. If you listen, you'll know everything that you need to address. You'll know what the patient's goal is, and you can take that information and apply it to them. With listening, we'll know what they're looking for, expecting, and what makes them fearful. Only then can we can reassure our patients.  Reflective Listening: Reflect what they're saying, so they can either correct us or agree with us. There needs to be a sense of collaboration.  If you have any questions after listening to this episode, please send me an email at tf@tysonfranklin.com, or you can contact Alex Murray via his website Making Sense in Podiatry, or his Facebook Page.  You'll find a list of  Alex's Reference Articles at the bottom of this page.  Podiatry Business Coaching & Mentoring If you want to own and operate a Thriving Podiatry Business, there are four vital pieces to the business puzzle.   Marketing - You need a well thought out marketing strategy, not just more tactics.  Systems - You need systems that will support your marketing strategy and your team. Team - You need to develop a team culture that makes your work-life balance easier, not harder.  Diary - Your diary needs to be structured in a way that maximises patient numbers and increases daily profits.  You have two choices: There's the slow approach, where you learn by trial and error and do everything yourself, or you can fast-track your education and business success with one-on-one business coaching and mentoring, or group coaching.  If you want to know more, please email me at tf@tysonfranklin.com, and we can set up a Zoom Call and have a quick chat to see if I can be of assistance.   ALEX'S REFERENCES THE ESSENTIAL PAIN PAPER Moseley, G. L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12(3), 169-178. doi: 10.1179/108331907X223010   Pain papers: Atlas, L. Y., & Wager, T. D. (2012). How expectations shape pain. Neuroscience Letters, 520(2), 140-148. doi: https://doi.org/10.1016/j.neulet.2012.03.039   Hainline, B., Turner, J. A., Caneiro, J. P., Stewart, M., & Lorimer Moseley, G. (2017). Pain in elite athletes—neurophysiological, biomechanical and psychosocial considerations: a narrative review. Br J Sports Med, 51(17), 1259-1264. doi: 10.1136/bjsports-2017-097890   Harvie, D. S., Broecker, M., Smith, R. T., Meulders, A., Madden, V. J., & Moseley, G. L. (2015). Bogus visual feedback alters onset of movement-evoked pain in people with neck pain. Psychol Sci, 26(4), 385-392. doi: 10.1177/0956797614563339   Rio, E., Moseley, L., Purdam, C., Samiric, T., Kidgell, D., Pearce, A. J., . . . Cook, J. (2014). The pain of tendinopathy: physiological or pathophysiological? Sports Med, 44(1), 9-23. doi: 10.1007/s40279-013-0096-z   Testa, M., & Rossettini, G. (2016). Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Man Ther, 24, 65-74. doi: 10.1016/j.math.2016.04.006   Understanding complexity/complex systems theory: Bittencourt, N. F. N., Meeuwisse, W. H., Mendonça, L. D., Nettel-Aguirre, A., Ocarino, J. M., & Fonseca, S. T. (2016). Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept. Br J Sports Med, 50(21), 1309-1314. doi: 10.1136/bjsports-2015-095850   Stern, B. D., Hegedus, E. J., & Lai, Y. C. (2020). Injury prediction as a non-linear system. Phys Ther Sport, 41, 43-48. doi: 10.1016/j.ptsp.2019.10.010   Biopsychosocial model of health Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136. doi: 10.1126/science.847460 Engel, G. L. (1980). The clinical application of the biopsychosocial model. Am J Psychiatry, 137(5), 535-544. doi: 10.1176/ajp.137.5.535     Muscloskeletal Pain/Injury: Caneiro, J. P., Roos, E. M., Barton, C. J., O'Sullivan, K., Kent, P., Lin, I., . . . O'Sullivan, P. (2020). It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice. Br J Sports Med, 54(8), 438-439. doi: 10.1136/bjsports-2018-100488   Lewis, J., & O’Sullivan, P. (2018). Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med, 52(24), 1543-1544. doi: 10.1136/bjsports-2018-099198 Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., . . . O’Sullivan, P. P. B. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med, 54(2), 79-86. doi: 10.1136/bjsports-2018-099878   Shared Decision Making: Hoffmann, T. C., Lewis, J., & Maher, C. G. (2020). Shared decision making should be an integral part of physiotherapy practice. Physiotherapy, 107, 43-49. doi: https://doi.org/10.1016/j.physio.2019.08.012   Clinical Decision Making: Simpkin, A. L., & Schwartzstein, R. M. (2016). Tolerating Uncertainty - The Next Medical Revolution? N Engl J Med, 375(18), 1713-1715. doi: 10.1056/NEJMp1606402   Walton, D. M. (2019). The critical skill of asking why? An endorsement of critical reflection in physiotherapy research and practice. Musculoskelet Sci Pract, 41, iv-v. doi: 10.1016/j.msksp.2019.04.005   Zou, K., Wong, J., Abdullah, N., Chen, X., Smith, T., Doherty, M., & Zhang, W. (2016). Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis, 75(11), 1964-1970. doi: 10.1136/annrheumdis-2015-208387   Communication:   Soklaridis, S., Hunter, J. J., & Ravitz, P. (2014). Twelve tips for asking and responding to difficult questions during a challenging clinical encounter. Med Teach, 36(9), 769-774. doi: 10.3109/0142159x.2014.916782   Zolnierek, K. B. H., & Dimatteo, M. R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical care, 47(8), 826-834. doi: 10.1097/MLR.0b013e31819a5acc

Roger S. McIntyre, MD, returns the Psychcast, this time to talk with host Lorenzo Norris, MD, about the mental health hazards of COVID-19 and what clinicians can do to help protect patients. Dr. McIntyre is professor of psychiatry and pharmacology, and head of the mood disorders psychopharmacology unit at the University Health Network at the University of Toronto. He disclosed receiving research or grants from the Stanley Medical Research Institute and the CIHR/GACD/National Natural Science Foundation of China. Dr. McIntyre also disclosed receiving consultation/speaker fees from several pharmaceutical companies. Dr. Norris has no disclosures.  Take-home points Uncertainty tied to the COVID-19 pandemic threatens to undermine mental health and exacerbate problems for those with mental illness. U.S. suicide rates, which were already rising after the Great Recession of 2007-2009, are likely to climb further because of the impact of COVID-19. Clinicians can take steps to prevent some of the negative mental health outcomes tied to the pandemic. Summary COVID-19 presents a triple threat to patients' mental health. The fear of viral infection is a mental health hazard. The financial shock that COVID-19 has had on the economy has not been seen since the Great Depression. Links between suicide and unemployment are powerful. In a study published in World Psychiatry, McIntyre and colleagues found associations between COVID-19 and major depression, PTSD, binge alcohol use, and substance use disorders. French social scientist Emile Durheim, PhD described the link between suicide and unemployment. Quarantining affects mental health, and there is nothing like COVID-19 in the history books. The Toronto experience with severe acute respiratory syndrome in 2003 offers lessons about the devastating impact of quarantining on mental health. “Deaths of despair” in the form of suicides have been on the increase in the United States. From the Great Recession, researchers found that for every 1% increase in unemployment, there is a commensurate 1% increase in suicide. U.S. unemployment stood at 8%-9% during the Great Recession, and now those percentages are much higher. Dr. McIntyre and his team projected that an unemployment rate of 14%-20% would lead to an additional 8,000-10,000 suicides could occur each year for the next 2 years. That’s in addition to the current number of approximately 50,000 suicides annually. Express Scripts, a pharmacy benefits manager, recently reported a 40% increase in prescriptions for anxiety-related medications. This suggests that people are distressed. Clinicians should take an aspirational approach to addressing these issues by pivoting to virtual platforms to increase patients’ access to care. Create medical homes that are HIPAA compliant. Look toward evidence-based models such as those found in Japan. That country found that, for every 0.2% increase in GDP spending on mental health care right after the Great Recession, the suicide rate fell by 1%. Encourage patients to structure the day and avoid consuming too much news or participating on social media. Two studies conducted in China found that people who spent more than 2-3 hours a day on news consumption were more likely to report clinical levels of depression, anxiety, and insomnia. Social media consumption has been associated with many adverse mental health outcomes, including loneliness. People who spent more than 3 hours a day were more likely to experience depression. Support programs for small-business people; jobs enhance resilience. Target the “basics” of self-care, such as getting enough sleep and engaging with others. References McIntyre RS, Lee Y. Psychiatry Res. 2020 May 19. doi: 10.1016/j.psychres.2020.113104. McIntyre RS, Lee Y. World Psychiatry. 2020 Jun;19(2):250-1. Shanahan L et al. Am J Public Health. 2012 Jun;109(6):854-8. Kang S, Chua HC. CMAJ. 2004 Mar 2;170(5):811-2. Express Scripts. America’s State of Mind Report. 2020 Apr 16. Lee Y et al. Psychiatry Clin Neurosci. 2020 Jul 1. doi: 10.1111/pch.13101. Hao F et al. Brain Behav Immun. 2020 Jul;87:100-6. Tan W et al. Brain Behav Immun. 2020 Jul;87:84-92. Wang C et al. Brain Behav Immun. 2020 Jul;87:40-8. Harvey SB et al. Am J Psychiatry. 2018 Jan 1;175(1):28-36. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Lewy Body Dementia may be the second most common neuropathologic cause of dementia behind Alzheimer disease, but it remains largely a clinical diagnosis with limited treatment options. This week on BrainWaves, Dr. Amy Colcher (Cooper University Hospital) reviews the diagnostic criteria and management strategies for patients and their caregivers who suffer from this condition. Plus, a sort of tribute to Robin Williams. ** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. ** Produced by James E. Siegler and Amy Colcher. Music courtesy of Andrew Sacco, Axletree, Damiano Baldoni, Josh Woodward, and Julie Maxwell. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES McKeith IG. Spectrum of Parkinson's disease, Parkinson's dementia, and Lewy body dementia. Neurol Clin. 2000;18:865-902. Frieling H, Hillemacher T, Ziegenbein M, Neundorfer B and Bleich S. Treating dopamimetic psychosis in Parkinson's disease: structured review and meta-analysis. Eur Neuropsychopharmacol. 2007;17:165-71. Galvin JE, Duda JE, Kaufer DI, Lippa CF, Taylor A and Zarit SH. Lewy body dementia: the caregiver experience of clinical care. Parkinsonism Relat Disord. 2010;16:388-92. Koga S, Aoki N, Uitti RJ, van Gerpen JA, Cheshire WP, Josephs KA, Wszolek ZK, Langston JW and Dickson DW. When DLB, PD, and PSP masquerade as MSA: an autopsy study of 134 patients. Neurology. 2015;85:404-12. Stinton C, McKeith I, Taylor JP, Lafortune L, Mioshi E, Mak E, Cambridge V, Mason J, Thomas A and O'Brien JT. Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2015;172:731-42. Desmarais P, Massoud F, Filion J, Nguyen QD and Bajsarowicz P. Quetiapine for Psychosis in Parkinson Disease and Neurodegenerative Parkinsonian Disorders: A Systematic Review. J Geriatr Psychiatry Neurol. 2016;29:227-36. McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, Aarsland D, Galvin J, Attems J, Ballard CG, Bayston A, Beach TG, Blanc F, Bohnen N, Bonanni L, Bras J, Brundin P, Burn D, Chen-Plotkin A, Duda JE, El-Agnaf O, Feldman H, Ferman TJ, Ffytche D, Fujishiro H, Galasko D, Goldman JG, Gomperts SN, Graff-Radford NR, Honig LS, Iranzo A, Kantarci K, Kaufer D, Kukull W, Lee VMY, Leverenz JB, Lewis S, Lippa C, Lunde A, Masellis M, Masliah E, McLean P, Mollenhauer B, Montine TJ, Moreno E, Mori E, Murray M, O'Brien JT, Orimo S, Postuma RB, Ramaswamy S, Ross OA, Salmon DP, Singleton A, Taylor A, Thomas A, Tiraboschi P, Toledo JB, Trojanowski JQ, Tsuang D, Walker Z, Yamada M and Kosaka K. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017;89:88-100. Armstrong MJ. Lewy Body Dementias. Continuum (Minneap Minn). 2019;25:128-146. Taylor JP, McKeith IG, Burn DJ, Boeve BF, Weintraub D, Bamford C, Allan LM, Thomas AJ and O'Brien JT. New evidence on the management of Lewy body dementia. The Lancet Neurology. 2020;19:157-169.

In episode two of the third season of The Psych Review the focus is on psychological trauma. Alanna and Shakira explore the consequences of childhood trauma, in both clinical and non-clinical contexts. Mazz looks globally into the mental health outcomes of protests, riots and revolutions.Warning: this episode may contain trauma-related content that could be distressing for some listeners. The articles covered in this month's episode are:- Alanna: Lippard, et. al. The Devastating Clinical Consequences of Child Abuse and Neglect:Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders. Am J Psychiatry 2020; 177:20–36; doi: 10.1176/appi.ajp.2019.19010020- Shakira: Beilharz, J. E., Paterson, M., Fatt, S., Wilson, C., Burton, A., Cvejic, E., … Vollmer-Conna, U. (2020). The impact of childhood trauma on psychosocial functioning and physical health in a non-clinical community sample of young adults. Australian & New Zealand Journal of Psychiatry, 54(2), 185–194. https://doi.org/10.1177/0004867419881206- Mazz: Ni, MY. et colleagues. (2020). Mental health during and after protests, riots and revolutions: A systematic review. Australian and New Zealand Journal of Psychiatry, 1-12 00(0).The Psych Review was brought to you by Call to Mind, a telepsychiatry service that you can learn more about at www.calltomind.com.au. The original music in our podcast was provided by the very talented John Badgery, and our logo was designed by the creative genius of Naz.

In episode 99 of the Psychcast, Frank Yeomans, MD, PhD, clinical associate professor of psychiatry at the Weill Medical College of Cornell University, Ithaca, N.Y., spoke with Dr. Norris at the Group for the Advancement of Psychiatry (GAP) fall 2019 meeting about treating patients with personality disorders. Characteristics of personality disorders A personality disorder affects the quality of a person’s experience and his or her ability to deal with challenges in life, including comorbid psychiatric disorders. A personality disorder is not based on symptoms alone and determines how people engage with their environment; it is a part of the biological side of psychiatry. The DSM traditionally relied on a traits-based definition of personality disorders. Yet, in the “emerging measures and models” section, the DSM-5 describes a dimensional/categorical model of personality disorders, which looks at personality disorders as combinations of core impairments in personality functioning with specific configurations of problematic personality traits. This harkens back to the concept of borderline personality organization as outlined by Otto F. Kernberg, MD. The dimensional model suggests that individuals with personality disorders benefit from behavioral therapies, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), to treat problematic traits. Exploratory and insight-focused psychotherapies can help individuals understand their personality organization. Ideally, the treatments for personality disorders would be sequenced, starting with CBT or DBT and transitioning into exploratory therapy. Much like borderline personality disorder, at the core of narcissistic personality disorder is a fragmented sense of self, but in the latter disorder, a self-centered narrative exists that is coherent to the person but does not support reality. If mental health is defined as the ability to adapt to the different circumstances of life, people with narcissism cannot adapt and instead, develop a grandiose narrative to soothe the fragmented self. Therapeutic interventions for narcissism focus on disrupting the narrative in a gentle way that allows patients to understand the model in which they currently experience the world and then reconstitute an adaptive narrative. An effective treatment approach is psychodynamic therapy, with a focus on a treatment contract and specific, explicitly agreed-upon goals. Try to focus more on the interaction with the patient than on the narrative content of the session. The therapy must focused on how the patient acts in therapy, and their adaptations and reactions, because these are the actions that negatively affect their relationships and daily lives. The biological part of a person is processed at the psychological level, so psychiatrists must be interested in psychological aspects of treatment. References Sharp C et al. The structure of personality pathology: Both general ('G') and specific ('S') factors? Abnorm Psychol. 2015 May;124(2):387-98. Gunderson JG. Borderline personality disorder: Ontogeny of a diagnosis. Am J Psychiatry. 2009 May 1;166(5):530-9. Caligor E et al. Narcissistic personality disorder: Diagnostic and clinical challenges. Am J Psychiatry. 2015 May;172(5):415-22. Morey LC et al. Personality disorders in DSM-5: Emerging research on the alternative model. Curr Psychiatry Rep. 2015 Apr;17(4):558. *  *  *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych    

Barbara Daly Baekeland was a New York socialite, model, and heiress.  She had many friends, beauty, and a personality like a force of nature, so why would someone want her dead? Sources – The Fall of the House of Baekeland. Sept. 15, 1985 - by Christopher Schemering, The Washington Post https://www.washingtonpost.com/archive/entertainment/books/1985/09/15/the-fall-of-the-house-of-baekeland/41da760f-dba9-4ac8-bf81-c2469642d657/?noredirect=on  Barbara Baekeland: The Incestuous Socialite Who Was Murdered by Her Son. Feb 9, 2018 By Laura Kelley, Rebel Circus, https://www.rebelcircus.com/blog/barbara-baekeland-wealthy-glamorous-socialite-incestuous-murdered/  He will kill you: Shrink warned mother of Baekeland plastics heir. Jul 15, 2012 By DAVID J. KRAJICEK, New York Daily News. https://www.nydailynews.com/news/justice-story/kill-shrink-warned-mother-baekeland-plastics-heir-article-1.1114966  Bakelite – Wikipedia - https://en.wikipedia.org/wiki/Bakelite  Kennedy, F. Sterilization and eugenics. Am. J. Obstet. Gynecol. 1937;34:519-520. Kennedy, F. The problem of social control of the congenital defective: education, sterilization, euthanasia. Am J Psychiatry 1942;99:13-16. Savage Grace: The True Story of Fatal Relations in a Rich and Famous American Family, book by Natalie Robins & Steven M. L. Aronson, © 1985 Fatal Seduction: How a society millionairess seduced her own son to “cure” him of being gay…and paid with her life. June 27, 2008 by David Leafe for The Daily Mail, https://www.dailymail.co.uk/femail/article-1030028/Fatal-Seduction-How-society-millionairess-seduced-son-cure-gay--paid-life.html  Fatal Seduction: How a society millionairess seduced her own son to “cure” him of being gay…and paid with her life. June 30, 2008 by David Leafe for The Daily Mail, https://www.dailymail.co.uk/femail/article-1030330/How-society-beauty-finally-murdered-gay-son-tried-cure-homosexuality.html  Murderpedia - Antony Baekeland: https://murderpedia.org/male.B/b/baekeland-anthony.htm  Wikipedia – Barbara Daly Baekeland: https://en.m.wikipedia.org/wiki/Barbara_Daly_Baekeland 

  Show Notes Roger McIntyre, MD, joins Lorenzo Norris, MD, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, to talk about obesity, inflammation, and treatment implications for mental health conditions. They spoke at the Focus on Neuropsychiatry 2019 meeting, sponsored by Current Psychiatry and Global Academy for Medical Education.  Dr. McIntyre is a professor of psychiatry and pharmacology at the University of Toronto, and head of the mood disorders psychopharmacology unit at the University Health Network, also in Toronto. For a complete video of this interview, please visit the vodcast. Don’t miss the “Dr. RK” segment by Renee Kohanski, MD, who discusses how to think through whether sharing personal information with patients helps move their therapy forward. Dr. Kohanski, a member of the MDedge Psychiatry Editorial Advisory Board, is a psychiatrist in private practice in Mystic, Conn. Show notes by Jacqueline Posada, MD, consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.   Reconceptualizing mental illness by looking at inflammation Mental illness should be viewed as a disease involving many organs – including the brain – and psychiatry should expand its understanding of the etiology of mental illness. Increasingly, research suggests that a subgroup of people with mental disorders, including those with a variety of diagnoses, have symptoms related to alterations in their immune system and inflammation. Inflammation plays a role in disparate psychiatric diagnoses, including childhood disorders such as obsessive-compulsive disorder, ADHD, and autism, and adult disorders such as schizophrenia, depression, and Alzheimer’s disease. Currently, psychiatry uses the monoamine paradigm to explain psychiatric diagnosis, and most medications were developed using that paradigm. A subgroup of people is not sufficiently helped by current medications, so looking at inflammation as a driver of mental illness provides another biological avenue to pursue drug development. Role of obesity and chronic health conditions in worsening inflammation Obesity, particularly abdominal obesity, is overrepresented in people with mental illness and is not fully explained by either social determinants of health or medication side effects. Obesity and mental illness have a bidirectional relationship; each affects the body as multiorgan system diseases. Mental illness can be conceptualized as a kind of “metastasis to the brain.” Adipose tissue releases a surfeit of neurochemicals hazardous to brain function and that disrupt neurocircuitry. For example, compared with an individual with major depressive disorder (MDD) only, an individual with MDD and obesity is more likely to have symptoms driven by inflammation, such as anhedonia, cognitive impairment, limited motivation, and a dysregulated reward system. Obesity should also be a target symptom worthy of a focused treatment plan. Heart disease is the leading cause of death in schizophrenia, and coronary artery disease is an inflammatory illness. Research is identifying connections between psychiatric illness such as schizophrenia and potentially inflammatory driven symptoms, often called “sickness behaviors,” such as low motivation, anhedonia, and cognitive impairment. Clinical implications of obesity and inflammation Alterations in inflammation and metabolism are not just a consequence of obesity. For example, patients will bipolar disorder who report sexual or physical trauma are more likely to be in a proinflammatory neurochemical state and benefit from anti-inflammatory interventions. Are patients with early trauma who do not respond fully to “traditional” monoamine medications part of the subpopulation who respond to anti-inflammatory interventions because trauma is driving inflammation? The genetics of mental illness already are complicated and will be influenced by the environment and a “proinflammatory milieu.” Which tests show inflammation? Current inflammatory markers, such as erythrocyte sedimentation rate and C-reactive protein, are not specific enough to direct treatment of inflammation in mental illness. Elements of a patient’s history, including history of trauma, disrupted sleep and circadian disturbances, cigarette smoking, poverty, housing dislocation, and exposure to racism, can indicate inflammation. We can conceptualize as anti-inflammatory several current treatments, such as mindfulness-based therapy, electroconvulsive therapy, and selective serotonin reuptake inhibitors. Alternative treatments to treat inflammation exist; however, specific anti-inflammatory treatments, such as NSAIDs, cyclooxgenase-2 inhibitors, and minocycline, are not yet recommended for patients with mental illness. Targeting inflammation as prevention of psychiatric illness Clinicians can target drivers of inflammation as a means of treatment and prevention of mental illness. They can also target the basics, such as sleep, diet, exercise, and socializing, as preventive measures that also target inflammation. The incidence of depression can be decreased by targeting lifestyle changes and metabolic illness with treatments such as exercise and statins. Interventions focused on inflammation are being investigated as a means of prevention for people at risk of mental illness. For example, a study in China in which Dr. McIntyre was involved explored whether exercise can decrease the development of bipolar disorder in children who have a genetic predisposition to the illness. Caloric restriction can reduce inflammation and improve cognition.  Inflammation and the absence of ‘meaningful connections’ In social baseline theory, human beings allocate energy in proportion to their social connectivity. People with fewer social connections are more likely to be in a proinflammatory state and more likely to consume high-carbohydrate food. Loneliness can be conceptualized as an epidemic associated with serious health outcomes, such as suicide, addiction, and other chronic mental and physical health problems. We are living in a society of anxious despair. Psychiatry needs to broaden its understanding of mental illness by investigating a variety of underlying causes, from inflammation to the monoamine theory.   References Rosenblat JD et al. Inflamed moods: A review of the interactions between inflammation and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2014 Aug 4;53:23-34. Harvey SB et al. Exercise and prevention of depression: Results of the HUNT cohort study. Am J Psychiatry. 2018 Jan 1;175(1):28-36. Redlich C et al. Statin use and risk of depression: A Swedish national cohort study. BMJ Psychiatry. 2014 Dec 4;14:348. doi: 10.1186/s12888-014.0348-y. Leclerc E et al. The effect of caloric restriction on working memory in healthy non-obese adults. CNS Spectr. 2019 Apr 10:1-7. doi: 10.1017/S1092852918001566. Schwabel D. “Vivek Murthy: How to solve the work loneliness epidemic.” Forbes.com. Oct 7, 2017. Ho RCM et al. Factors associated with risk of developing coronary artery disease in medical patients with major depressive disorder. Int J Environ Res Public Health. 2018 Oct;15 (10): 2073. doi: 10.33901/ijerph1510102073. Dantzer R. Cytokine, sickness behavior, and depression. Immunol Allergy Clin North Am. 2009 May;29(2): 247-64.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych                

La questione se sia corretto utilizzare farmaci antidepressivi (e di che tipo...) nell'ambito del Disturbo Bipolare è aperta ormai da anni e ci sono varie scuole di pensiero ed orientamenti al riguardo. Le domande a cui voglio provare a rispondere in questo video sono le seguenti: ci sono regole circa la prescrizione di antidepressivi nel disturbo bipolare? Come si tratta la depressione bipolare? Nel caso si somministrino antidepressivi al paziente bipolare, per quanto tempo vanno usati? E molte altre, tutte inerenti alla psicofarmacologia del disturbo bipolare....Vi porto di seguito le voci di bibliografia a cui faccio riferimento nel video.#disturbobipolare #antidepressiviBibliografia consigliata:1. Sidor MM, MacQueen GM. antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry 2011;72:156–67.2. Vazquez G, Tondo L, Baldessarini R. Comparison of antidepressant responses in patients with bipolar versus unipolar depression: a meta-analytic review. Phamracopsychiatry 2011;44:21–6.3. Pacchiarotti I, Bond DJ, Baldessarini RJ, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013;170:1249–62.4. Amsterdam JD, Lorenzo-Luaces L, Soeller I, et al. Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: a randomized, double-blind, parallel-group, prospective study. J Affect Disord 2015;185:31–7.5. El-Mallakh RS, Vöhringer PA, Ostacher MM, et al. Antidepressants worsen rapid-cycling course in bipolar depression: a STEP-BD randomized clinical trial. J Affect Disord 2015;184:318–21.Malhi G, Berk M. Diagnosing bipolar disorder: defining thresholds and setting boundaries. Aust N Z J Psychiatry2014;48:500–4.6. Malhi GS. Diagnosis of bipolar disorder: who is in a mixed state? Lancet 2013;381:1599–600.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th Edn. American Psychiatric Association, 2013.7. Tohen M, Frank E, Bowden CL, et al. The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009:11:453–73.8. Malhi GS, Masson M, Bellivier F. Teasing apart Bipolar III: The causes and consequences of a Treatment-Emergent Affective Switch (TEAS) into mania. Aust N Z J Psychiatry 2015;49:866–8. ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria, la Psicofarmacologia e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

La questione se sia corretto utilizzare farmaci antidepressivi (e di che tipo...) nell'ambito del Disturbo Bipolare è aperta ormai da anni e ci sono varie scuole di pensiero ed orientamenti al riguardo. Le domande a cui voglio provare a rispondere in questo video sono le seguenti: ci sono regole circa la prescrizione di antidepressivi nel disturbo bipolare? Come si tratta la depressione bipolare? Nel caso si somministrino antidepressivi al paziente bipolare, per quanto tempo vanno usati? E molte altre, tutte inerenti alla psicofarmacologia del disturbo bipolare....Vi porto di seguito le voci di bibliografia a cui faccio riferimento nel video.#disturbobipolare #antidepressiviBibliografia consigliata:1. Sidor MM, MacQueen GM. antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis. J Clin Psychiatry 2011;72:156–67.2. Vazquez G, Tondo L, Baldessarini R. Comparison of antidepressant responses in patients with bipolar versus unipolar depression: a meta-analytic review. Phamracopsychiatry 2011;44:21–6.3. Pacchiarotti I, Bond DJ, Baldessarini RJ, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013;170:1249–62.4. Amsterdam JD, Lorenzo-Luaces L, Soeller I, et al. Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: a randomized, double-blind, parallel-group, prospective study. J Affect Disord 2015;185:31–7.5. El-Mallakh RS, Vöhringer PA, Ostacher MM, et al. Antidepressants worsen rapid-cycling course in bipolar depression: a STEP-BD randomized clinical trial. J Affect Disord 2015;184:318–21.Malhi G, Berk M. Diagnosing bipolar disorder: defining thresholds and setting boundaries. Aust N Z J Psychiatry2014;48:500–4.6. Malhi GS. Diagnosis of bipolar disorder: who is in a mixed state? Lancet 2013;381:1599–600.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th Edn. American Psychiatric Association, 2013.7. Tohen M, Frank E, Bowden CL, et al. The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009:11:453–73.8. Malhi GS, Masson M, Bellivier F. Teasing apart Bipolar III: The causes and consequences of a Treatment-Emergent Affective Switch (TEAS) into mania. Aust N Z J Psychiatry 2015;49:866–8. ISCRIVETEVI AL MIO CANALE ► https://bit.ly/2zGIJorVi interessano la Psichiatria, la Psicofarmacologia e le Neuroscienze? Bene, allora iscrivetevi a questo podcast, al mio canale YouTube e seguitemi sul web tramite il mio blog https://www.valeriorosso.comInoltre andate su Amazon a dare un’occhiata ai miei libri:“Psicobiotica” - Un nuovo modo di intendere il rapporto tra la Mente ed il Corpo….andate su: https://amzn.to/2IZwjhm“Psichiatria Rock” - 50 pensieri off line dal mio blog….andate su: https://amzn.to/2IVKKmJ

Ep. 70 Show Notes By Jacqueline Posada, MD, 4th-year resident in the department of psychiatry & behavioral sciences at George Washington University, Washington. In this episode, Richard Balon, MD, returns to the MDedge Psychcast to discuss benzodiazepines. This time, Lorenzo Norris, MD, host of the MDedge Psychcast and editor in chief of MDedge Psychiatry, interviewed Dr. Balon about prescribing benzodiazepines for patients with serious medical illnesses. They also examine some of the controversies around benzodiazepines and common mistakes that some clinicians make when prescribing these drugs. Dr. Balon is professor of psychiatry at Wayne State University in Detroit. And later, in the “Dr. RK” segment, Renee Kohanski, MD, explores the need for psychiatrists to challenge the distorted thinking patterns of patients, particularly in light of the growing influence of social media. Dr. Kohanski, a member of the MDedge Psychiatry Editorial Advisory Board, is a psychiatrist in private practice in Mystic, Conn. Benzodiazepines can be used for patients with serious mental illness across several areas of medical illness, including those with cardiovascular, gastrointestinal, and sleep disorders, as well as for those with generalized anxiety disorder (GAD) and panic disorder. Cardiovascular illness Patients with cardiovascular illness might have just encountered a near-death experience and present with somatic symptoms of their cardiovascular illness and anxiety. This overlap of symptoms makes cardiovascular illness a reasonable comorbidity in which to use benzodiazepines for anxiety. A naturalistic study of patients with heart failure showed patients on benzodiazepines had a small decrease in mortality. The reason is unknown, but it could be from a decrease in anxiety and stress, both of which affect the heart. Older studies show that some benzodiazepines can be used in addition to antihypertensives. Gastrointestinal illness Benzodiazepines also are useful for such gastrointestinal (GI) illnesses as peptic ulcer disease, inflammatory bowel disease, irritable bowel syndrome, etc. The symptoms of GI illness, such as constipation, diarrhea, and nausea, can complicate the use of SSRIs or tricyclic antidepressants for anxiety. Older studies suggest that adding benzodiazepines to the regimen of these patients, especially those without substance use disorder, can improve outcomes. Sleep disorders Five benzodiazepines have been approved for sleep disorders: triazolam, flurazepam, temazepam, estazolam, and quazepam. These medications are used infrequently despite having a long half-life, which is useful for sleep initiation and maintenance. Quazepam is designed specifically for insomnia and has activity at a different part of the alpha subunit on the GABA receptor. Clonazepam also is useful, especially for patients with comorbid anxiety and sleep issues, because it contributes to sedation, and as a result of its long half-life, it continues to relieve anxiety throughout the day. Generalized anxiety disorder (GAD) and panic disorder Many clinicians are leery about using alprazolam for several reasons. The medication’s short half-life contributes to patients using the drug several times a day. Immediate relief of anxiety has a reinforcing effect, which in turn, increases the risk of abuse. There are no well-designed trials comparing benzodiazepines with SSRIs. Many of the recommendations about how to use benzodiazepines come from clinical experience. Some patients with GAD without substance use benefit from benzodiazepines such as clonazepam. It is possible for some patients to stay on long-term treatment with benzodiazepines and not need higher doses because of tolerance. Clarity is needed about the true impact of benzodiazepines on patients  Benzodiazepines are an integral part of the psychopharmacology armamentarium yet are underused. Their use is increasingly discouraged, and trainees are not getting enough experience with prescribing benzodiazepines. Benzodiazepines are rarely abused on their own. Common mistakes in using benzodiazepines Patients who might need or benefit from treatment with benzodiazepines are not adequately assessed. Dose escalation with benzodiazepines often is avoided. When patients ask for an increase in the dose, this is not necessarily sign of abuse. A dose increase might be a sign that the patient is still anxious. Trainees are not getting proper guidance in prescribing benzodiazepines; they need to be familiar with prescribing all classes of psychotropics. References Slee A et al. Pharmacological treatments for generalised anxiety disorder: A systematic review and network meta-analysis. Lancet 2019 Feb 23;393(10173):768-77. Guina J, Merrill B. Benzodiazepines I: Upping the care on downers: The evidence of risks, benefits, and alternatives. J Clin Med. 2018 Jan 30. doi: 10.3390/jcm7020017. Salzman C. The APA task force report on benzodiazepine dependence, toxicity, and abuse. Am J Psychiatry. 1991 Feb;148(2):151-2. Fava GA et al. Benzodiazepines in anxiety disorders. JAMA Psychiatry. 2015;72(7):733-4. Tully PJ et al. The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment, and morbidity risk in coronary heart disease. J Psychosom Res. 2014 Dec;77(6):439-48. Colussi GL et al. Benzodiazepines: An old class of new antihypertensive drugs? Am J Hypertension. 2018 Apr;31(4):402-4.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych          

In 1495, a mysterious and deadly plague struck the city of Naples. Over the next 500 years, the medical attempts to understand and treat this new disease -- syphilis -- would mold and shape medicine in surprising ways. In this episode, Tony Breu and I will perform an historical and physiological biography of syphilis, covering the development of germ theory, epic poetry, mercury saunas, intentionally infecting patients with malaria, magic bullets, and lots and lots of experiments on poor rabbits. This presentation was performed live at the American College of Physicians’ national meeting in Philadelphia on April 11, 2019.   Sources (WARNING -- LONG LIST):   Swain, K. ‘Extraordinarily arduous and fraught with danger’: syphilis, Salvarsan, and general paresis of the insane. Lancet Psychiatry 5, (2018).   Kępa, M. et al. Analysis of mercury levels in historical bone material from syphilitic subjects – pilot studies (short report). Kępa Małgorzata 69, 367-377(11) (2012).   Forrai, J. Syphilis - Recognition, Description and Diagnosis. (2011). doi:10.5772/24205   Parascandola, J. From mercury to miracle drugs: syphilis therapy over the centuries. Pharm Hist 51, 14–23 (2009).   Eisler, C. Who Is Dürer’s ‘Syphilitic Man’? Perspect Biol Med 52, 48–60 (2009).   Rothschild, B. M. History of Syphilis. Clin Infect Dis 40, 1454–1463 (2005).   Schwartz, R. S. Paul Ehrlich’s Magic Bullets. New Engl J Medicine 350, 1079–1080 (2004).   Fee, E. The wages of sin. Lancet 354, SIV61 (1999).   O’Shea, J. ‘Two Minutes with Venus, Two Years with Mercury’-Mercury as an Antisyphilitic Chemotherapeutic Agent. J Roy Soc Med 83, 392–395 (1989).   Mahoney, J., Arnold, R., Sterner, B. L., Harris, A. & Zwally, M. Penicillin Treatment of Early Syphilis: II. Jama 251, 2005–2010 (1984).   Waugh, M. Role played by Italy in the history of syphilis. Sex Transm Infect 58, 92–95 (1982).   Thorburn, A. Fritz Richard Schaudinn, 1871-1906: protozoologist of syphilis. Sex Transm Infect 47, 459–461 (1971).   CROSBY, A. W. The Early History of Syphilis: A Reappraisal. Am Anthropol 71, 218–227 (1969).   Clark, E. G. & Danbolt, N. The Oslo study of the natural history of untreated syphilis An epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material a review and appraisal. J Chron Dis 2, 311–344 (1955).   MUNGER, R. S. Guaiacum, the Holy Wood from the New World. J Hist Med All Sci IV, 196–229 (1949).   Thomas, E. & r, W. Rapid Treatment of Early Syphilis with Multiple Injections of Mapharsen. J Nerv Ment Dis 99, 88 (1944).   WIEDER, L., FOERSTER, O. & FOERSTER, H. MAPHARSEN IN THE TREATMENT OF SYPHILIS: FURTHER EXPERIENCES. Arch Dermatol Syph 35, 402–413 (1937).   THON, L. SHOULD THE INTERNIST KNOW SYPHILIS? J Amer Med Assoc 97, 994–996 (1931).   Sarton, G. The Earliest Printed Literature on Syphilis, being Ten Tractates from the Years 1495-1498. Karl Sudhoff , Charles Singer , Henry E. Sigerist. Isis 8, 351–354 (1926).   COLE, H., GERICKE, A. & SOLLMANN, T. THE TREATMENT OF SYPHILIS BY MERCURY INHALATIONS: HISTORY, METHOD AND RESULTS. Arch Dermatol Syph 5, 18–33 (1922).   Mason, U. Observation: Use and Abuse of Salvarsan. J Natl Med Assoc 3, 340–3 (1911).   Fleming, A. & Colebrook, L. ON THE USE OF SALVARSAN IN THE TREATMENT OF SYPHILIS. Lancet 177, 1631–1634 (1911).   Evans, A. The Treatment of Syphilis by Salvarsan (Dioxy-diamido-arseno-benzol). Brit Med J 1, 617 (1911).   Boeck, W. History, Theory and Practice of Syphilisation. New Engl J Medicine 73, 20–25 (1865).   Veale, H. Remarks on Syphilis and Its Treatment. Edinb Medical J 10, 10–26 (1864).   LaFond RE and Lukehart SA, Biological Basis for Syphilis. Clinical Microbiology Reviews 2006.   Secher L et al, Treponema pallidum in peripheral nerve tissue of syphilitic chancres. Acta dermato-venereologica 1982.  Hollander DH, Turner TB, The role of temperature in experimental treponemal infection. American journal of syphilis, gonorrhea, and venereal diseases, 1954   Eagle H, et al. The effect of hyperpyrexia on the therapeutic efficacy of penicillin in experimental syphilis. American journal of syphilis, gonorrhea, and venereal diseases, 1947.   Kampmeier RH, Syphilis therapy: an historical perspective. Journal of the American Venereal Disease Association 1976.   Pachner AR, Spirochetal Diseases of the CNS. Neurologic clinics, 1986.   Sell S et al, Experimental syphilitic orchitis in rabbits: ultrastructural appearance of Treponema pallidum during phagocytosis and dissolution by macrophages in vivo. Laboratory investigation; a journal of technical methods and pathology, 1982.   Taylor SH, Diuretics in cardiovascular therapy. Perusing the past, practising in the present, preparing for the future. Zeitschrift für Kardiologie, 1985.   Ovchinnikov NM, [Treponema pallidum in peripheral nerves of rabbit syphiloma]. Vestnik dermatologii i venerologii, 1975.   Cheek DB, Wu F, The Effect of Calomel on Plasma Epinephrine in the Rat and the Relationship to Mechanisms in Pink Disease, Archives of Disease in Childhood, 1959   Vogl A, The discovery of the organic mercurial diuretics, American Heart Journal, 1950   Schwemlein GX et al, Penicillin and fever therapy in early syphilis, Journal of the American Medical Association, 1948.   Stringham JS, On the Diuretic Effects of Mercury in a Case of Syphilis. The Medical and physical journal, 1807   Evanson RL et al, Effect of mercurial diuretics on tubular sodium and potassium transport in the dog. The American journal of physiology, 1972   Sell S and Salman J, Demonstration of Treponema pallidum in Axons of Cutaneous Nerves in Experimental Chancres of Rabbits, Sexually Transmitted Diseases, 1992   Penn CW, Avoidance of Host Defences by Treponema pallidum in Situ and on Extraction from Infected Rabbit Testes, Microbiology 1981.   Beutler B and Munford RS, Tumor Necrosis Factor and the Jarisch–Herxheimer Reaction, The New England Journal of Medicine 1996.   Radolf JD et al, Treponema pallidum: doing a remarkable job with what it's got. Trends in Microbiology, 1999   Tight RR, Perkins RL, Treponema pallidum infection in subcutaneous polyethylene chambers in rabbits. Infection and immunity, 1976   Salazar JC et al, Treponema pallidum Elicits Innate and Adaptive Cellular Immune Responses in Skin and Blood during Secondary Syphilis: A Flow-Cytometric Analysis. The Journal of Infectious Diseases, 2007   Azevedo BF et al, Toxic Effects of Mercury on the Cardiovascular and Central Nervous Systems. Journal of Biomedicine and Biotechnology 2012,   Clarkson TW and Magos L, The Toxicology of Mercury and Its Chemical Compounds, Critical Reviews in Toxicology 2008.   Fitzgerald TJ, The Th1/Th2-like switch in syphilitic infection: is it detrimental? Infection and immunity, 1992   Batterman RC et al, THE SUBCUTANEOUS ADMINISTRATION OF MERCAPTOMERIN (THIOMERIN®): Effective Mercurial Diuretic for the Treatment of Congestive Heart Failure. Journal of the American Medical Association, 1949   Batterman RC, The status of mercurial diuretics for the treatment of congestive heart failure. American Heart Journal, 1951   Bleich HL et al, The Role of Regional Body Temperature in the Pathogenesis of Disease, The New England Journal of Medicine, 1981   Vander Veer JB et al, The Prolonged Use of an Oral Mercurial Diuretic in Ambulatory Patients with Congestive Heart Failure. Circulation 1950   Cox DL et al, The outer membrane, not a coat of host proteins, limits antigenicity of virulent Treponema pallidum. Infection and immunity, 1992.   Fildes P, The Mechanism of the Anti-bacterial Action of Mercury. Br J Exp Pathol, 1940   Clarkson TW, THE MECHANISM OF ACTION OF MERCURIAL DIURETICS IN RATS; THE METABOLISM OF 203Hg‐LABELLED CHLORMERODRIN. British Journal of Pharmacology and Chemotherapy, 1965   Engelkens HJ et al, The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourinary Medicine, 1993   Belum GR et al, The Jarisch–Herxheimer reaction: Revisited. Travel Medicine and Infectious Disease, 2013   Arando M et al, The Jarisch–Herxheimer reaction in syphilis: could molecular typing help to understand it better? Journal of the European Academy of Dermatology and Venereology, 2018.   Butler T, The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. The American Journal of Tropical Medicine and Hygiene, 2016   Carlson JA et al, The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity. The American Journal of Dermatopathology 2011.   Aronson IK and Soltani K, The enigma of the pathogenesis of the Jarisch-Herxheimer reaction. The British Journal of Venereal Diseases, 1976   Sellato TJ et al, The Cutaneous Response in Humans to Treponema pallidum Lipoprotein Analogues Involves Cellular Elements of Both Innate and Adaptive Immunity, The Journal of Immunology 2001   Spiller HA, Rethinking mercury: the role of selenium in the pathophysiology of mercury toxicity. Clinical Toxicology 2017   Sell S et al, Reinfection of chancre-immune rabbits with Treponema pallidum. I. Light and immunofluorescence studies. The American journal of pathology 1985.    Grant SS and Hung DT, Persistent bacterial infections, antibiotic tolerance, and the oxidative stress response, Virulence 2013   Lant AF, Modern diuretics and the kidney. Journal of Clinical Pathology, 1981   Kamath SU et al, Mercury-based traditional herbo-metallic preparations: a toxicological perspective, Archives of Toxicology 2012.   Yeter et al, Mercury Promotes Catecholamines Which Potentiate Mercurial Autoimmunity and Vasodilation: Implications for Inositol 1,4,5-Triphosphate 3-Kinase C Susceptibility in Kawasaki Syndrome. Korean Circulation Journal 2013   Wöβmann W et al, Mercury intoxication presenting with hypertension and tachycardia. Archives of Disease in Childhood, 1999   Giacani L et al, Identification of the Treponema pallidum subsp. pallidum TP0092 (RpoE) Regulon and Its Implications for Pathogen Persistence in the Host and Syphilis Pathogenesis. Journal of Bacteriology 2013.   Edwards AM, From tooth to hoof: treponemes in tissue‐destructive diseases. Journal of Applied Microbiology, 2003   Wolgemuth CW, Flagellar motility of the pathogenic spirochetes. Seminars in Cell & Developmental Biology 2015.   Solomon HC and Kopp I, Fever Therapy. The New England Journal of Medicine 1937.   Rice KM et al, Environmental Mercury and Its Toxic Effects. Journal of Preventive Medicine and Public Health 2014.   Drusin LM, Electron microscopy of Treponema pallidum occurring in a human primary lesion. Journal of bacteriology 1969.   McNeely MC et al, Cutaneous secondary syphilis: Preliminary immunohistopathologic support for a role for immune complexes in lesion pathogenesis. Journal of the American Academy of Dermatology 1986.   Borenstein LA et al, Contribution of rabbit leukocyte defensins to the host response in experimental syphilis. Infection and immunity 1991.   Cabot RC et al, Case 51-1976 — Bicentennial CPC — Syphilis, Diarrhea and Death in the 1820's. The New England Journal of Medicine 1976.   Hobman JL and Crossman LC, Bacterial antimicrobial metal ion resistance. Journal of Medical Microbiology 2015   Gelpi A and Tucker JD, After Venus, mercury: syphilis treatment in the UK before Salvarsan. Sexually Transmitted Infections 2015.   MacHaffie et al, A study of the effectiveness of mercurial diuretics in treatment of cardiac decompensation. The American Journal of Cardiology 1958   Aberer W et al, Ammoniated mercury ointment: outdated but still in use. Contact Dermatitis 1990   Farhi D, Dupin N, Origins of syphilis and management in the immunocompetent patient: Facts and controversies. 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Depression and dementia are unfortunately two very common disorders in mental health. But the fact that they occur together is not explained by their overall prevalence. The relationship is a bit more complicated. Joan Dietz joins Jim Siegler in a discussion on how she counters these common conditions. Produced by James E. Siegler. Music by Lee Rosevere, Jason Shaw, Chris Zabriskie, Kai Engel, and Scott Holmes. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Byers AL and Yaffe K. Depression and risk of developing dementia. Nature reviews Neurology. 2011;7:323-31. Korczyn AD and Halperin I. Depression and dementia. Journal of the neurological sciences. 2009;283:139-42. Alexopoulos GS, Murphy CF, Gunning-Dixon FM, Latoussakis V, Kanellopoulos D, Klimstra S, Lim KO and Hoptman MJ. Microstructural white matter abnormalities and remission of geriatric depression. Am J Psychiatry. 2008;165:238-44. Dotson VM, Beydoun MA and Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology. 2010;75:27-34. Saczynski JS, Beiser A, Seshadri S, Auerbach S, Wolf PA and Au R. Depressive symptoms and risk of dementia: the Framingham Heart Study. Neurology. 2010;75:35-41. Lee CW, Lin CL, Sung FC, Liang JA and Kao CH. Antidepressant treatment and risk of dementia: a population-based, retrospective case-control study. J Clin Psychiatry. 2016;77:117-22; quiz 122. Sachdev PS, Smith JS, Angus-Lepan H and Rodriguez P. Pseudodementia twelve years on. Journal of neurology, neurosurgery, and psychiatry. 1990;53:254-9.

There is a nationwide epidemic happening right now. And it's not some terrible virus, it's not because of anything we've had to eat or drink. It is an occupational hazard of the hospital environment: Physician suicide. Dr. Pamela Wible, Founder of the Ideal Medical Care Movement, shares her unique approach to this preventable plague. Produced by James E. Siegler. Music by Andrew Sacco, Damiano Baldoni, Kevin McLeod, Jason Shaw, and Rafael Archangel. Voiceover by Patrick Green. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Kesselheim AS and Austad KE. Residents: workers or students in the eyes of the law? The New England journal of medicine. 2011;364:697-9. Witte TK, Fitzpatrick KK, Joiner TE, Jr. and Schmidt NB. Variability in suicidal ideation: a better predictor of suicide attempts than intensity or duration of ideation? J Affect Disord. 2005;88:131-6. Goldman ML, Shah RN and Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015;72:411-2. Schernhammer E. Taking their own lives -- the high rate of physician suicide. The New England journal of medicine. 2005;352:2473-6. Schernhammer ES and Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004;161:2295-302. Sen S, Kranzler HR, Krystal JH, Speller H, Chan G, Gelernter J and Guille C. A prospective cohort study investigating factors associated with depression during medical internship. Archives of general psychiatry. 2010;67:557-65.

Malariotherapy -- infecting comatose syphilis patients with malaria to cure them of the disease -- was once the cutting edge of medicine, and earned its inventor Julius Wagner-Jauregg the Nobel Prize in Medicine or Physiology in 1927. In this episode, we’re going to talk about the fascinating story behind this remarkable treatment, from the murky beginnings of syphilis through its sordid sexual connotations, to the birth of modern psychiatry and Nazi experiments. Plus, there’s a brand new #AdamAnswers about whether or not ancient doctors thought hair served to store semen (seriously).  Listen to all this and more in Episode 31 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine. Sources: Crellato E et al, “The Hippocratic treatise ‘On glands’: the first document on lymphoid tissue on lymph nodes,” Leukemia. Retrieved online at https://www.nature.com/articles/2404618 Farhi D, Dupin N, Origins of syphilis and management in theimmunocompetent patient: Facts and controversies. Clinics in Dermatology (2010) 28, 533–538 Frith J, “Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins,” Journal of Military and Veterans’ Health, 20(4), retrieved online at: http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/ Gelder MG, “Biological Psychiatry in Perspective,” British Medical Bulletin. 1996;2 (No. 3H01-4G7) Howes OD et al, “Julius Wagner-Jauregg, 1857-1940,” American Journal of Psychiatry, April 2009 Volume 166 Number 4, Volume 166, Issue 4, April, 2009, pp. 409-409. Karamanou M et al, “Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis.” Psychiatriki. 2013 Jul-Sep;24(3):208-12. Kent, ME and Romanelli F. Reexamining Syphilis: An Update on Epidemiology, ClinicalManifestations, and Management, The Annals of Pharmacotherapy. 2008 February, Volume 42 Kreston R, “Pyromania! On Neurosyphilis and Fighting Fire with Fire,” Body Horrors blog on Discover. Retrieved online at: http://blogs.discovermagazine.com/bodyhorrors/2014/05/31/pyromania-syphilis-malaria/#.WnTvHKinE2x Martin TW, “Paul’s argument from Nature for the Veil in 1 Corinthians 11:13-15: A Testicle Instead of a Head Covering,” Journal of Biblical Literature, Vol. 123, No. 1 pp 75-84. Rothschild, BM, “History of Syphilis Clinical Infectious Diseases.” 2005; 40:1454–63 Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140. Tampa M et al, “Brief History of Syphilis.” J Med Life. 2014 Mar 15; 7(1): 4–10. Tsay CJ, “Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane,” Yale J Biol Med. 2013;86(2): 245–254 Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582

The invention of dialysis -- essentially artificial kidneys for people with kidney failure -- revolutionized medicine. It also started a debate about medical rationing and ethics that rages to this day. Producer Cam Steele brings us a story about the God Squad, the group of lay people and doctors tasked with deciding who lived and who died in the early days of dialysis, and how it has informed every debate about medical rationing since. Learn about all this and more, plus a new #AdamAnswers in the latest episode of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine. Sources: Blagg CR, Development of ethical concepts in dialysis: Seattle in the 1960s. Nephrology, 1998.4, 235-238 Scheunemann L and White D, The Ethics and Reality of Rationing in Medicine, Chest, 140; 6. December 2011 White DB et al, Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009 January 20; 150(2): 132–138. Jonson AR, The God Squad and the Origins of Transplantation Ethics and Policy, Journal of Law, Medicine, and Ethics. Levine C, The Seattle “God Committee”: A Cautionary Tale; Nov 30 2009. Blagg, CR. The Early Years of Chronic Dialysis: The Seattle Contribution. Am J Nephrol 1999;19:350–354 Persad, et al. Principles for allocation of scarce medical interventions, Lancet 2009; 373: 423–31. Bryson, et al. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 Nov; 109(5): 905–917. Hughes, et al. Resident Physician Substance Use, By Specialty. Am J Psychiatry 1992; 149: 1348-1354.

Myocardial infarction (MI) in children is uncommon, but underdiagnosed.  This is due to two main factors: the etiologies are varied; and the presenting symptoms are “atypical”. We need a mental metal detector!  Case examples Congenital Two main presentations of MI due to congenital lesions: novel and known.  The novel presentation is at risk for underdiagnosis, due to its uncommonness and vague, atypical symptoms.  There are usually some red flags with a careful H&P.  The known presentation is a child with a history of congenital heart disease, addressed by corrective or palliative surgery.  This child is at risk for expected complications, as well as overdiagnosis and iatrogenia.  Risk stratify, collaborate with specialists. The fussy, sweaty feeder: ALCAPA Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) is an example of what can go wrong during fetal development: any abnormality in the number, origin, course, or morphology of the coronary arteries can present as a neonate with sweating during feeds (steal syndrome), an infant in CHF, or an older child with failure to thrive or poor exercise tolerance. The stable child with chest pain: myocardial bridge Normal coronary arteries run along the epicardial surface of the heart, with projections into the myocardium.  If part of the artery’s course runs within the myocardium (i.e. the artery weaves into and/or out of the myocardium), then there is a myocardial bridge of the coronary artery.  With every systolic contraction, the artery is occluded.  Although a myocardial bridge may not cause symptoms (especially at distal portions), the area it supplies is at risk. With any minor trauma or exertion, demand may outpace supply, resulting in ischemia.  Diagnosis is made on coronary angiography. The unwell child post-cardiac surgery: Fontan problems The child with single ventricle physiology may have a Norwood procedure at birth (creation of a neoaorta, atrial septectomy, and Blalock-Taussig shunt), a Bidirectional Glenn procedure at 3-6 months (shunt removed, superior vena cava connected to pulmonary arteries), and a Fontan procedure at about 2-3 years of age (inferior vena cava blood flow is shunted into the pulmonary arteries). These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.  They are typically on an anticoagulant (often aspirin), a diuretic (e.g. furosemide), and an afterload reduction agent (e.g. enalapril).  Any disturbance in volume status (hyper- or hypovolemia), anticoagulation, or afterload may cause myocardial strain or infarction.  Take the child s/p Fontan seriously and involve his specialists early with any concerns. Autoimmune The body’s inflammatory-mediated reaction to a real or perceived insult can cause short- and long-term cardiac sequelae.  Find out how well the underlying disease is controlled, and what complications the child has had in the past. The red, hot, crispy, flaky child: acute Kawasaki disease Kawasaki disease (KD) is an acute systemic vasculitis, diagnosed by the presence of fever for five or more days accompanied by four or more criteria:  bilateral conjunctival injection, mucositis, cervical lymphadenopathy, polymorphous rash, and palmar or sole desquamation.  The criteria may occur (and disappear) at any time during the illness. Infants are under double jeopardy with Kawasaki Disease.  They are more likely to have incomplete KD (i.e. not fulfill strict criteria) and if they have KD, they are more likely to suffer the dangerous consequences of aneurysm formation (chiefly coronary arteries, but also brain, kidney).  Have a low threshold for investigation. Treatment includes 2 g/kg/day IVIG and high-dose aspirin (30-50 mg/kg/day) acutely, then low-dose aspirin (5 mg/kg/day) for weeks to months.  Regular and long-term follow-up with Cardiology is required. The aftermath: sequelae of Kawasaki disease The family and child with a history of KD may have psychological trauma and continuous anxiety about the child’s risk of MI.  Approximately 4.7% of children who were promptly diagnosed and correctly treated will go on to have cardiac sequelae. Children who have no detected cardiac sequelae by 8 weeks, typically continue to be asymptomatic up to 20 years later.  Smaller aneurysms tend to regress over time, especially those < 6 mm. Thrombi may calcify, or the lumen may become stenotic due to myofibroblast proliferation.  Children with any coronary artery dilatation from KD should be followed indefinitely. Giant aneurysms (≥8 mm) connote the highest risk for MI.  Parents often are concerned about recurrence, and any subsequent fever can be distressing.  There is a low rate of recurrence for KD: approximately 2%.  Infants who have coronary aneurysms are at the highest risk for recurrence. The older child with vague chest complaints and hypercoagulability: Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome Up to 15% of cases of SLE begin in childhood.  Adult criteria are used, with the caveat that the diagnosis of SLE in children can be challenging; many children only manifest a few of the criteria initially before going on to develop further systemic involvement. The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012.  The patient should have ≥4/17 clinical and/or immunologic criteria.  The clinical criteria are: acute cutaneous (malar); chronic cutaneous (discoid); oral; alopecia; synovitis; serositis; renal; neurologic; hemolytic anemia; leukopenia; or thrombocytopenia.  The immunologic criteria are: ANA; anti-dsDNA; anti-Sm; antiphospholipid; low complement; and/or Direct Coombs (in absence of hemolytic anemia).  At least one criterion should be clinical, and at least one should be immunologic.  Children with antiphospholipid syndrome (APS) may occur with or without SLE.  Patients are at risk for venous and arterial thrombi formation.  APS may also cause structural damage, such as valvular thickening and valvular nodes (Libman-Sacks endocarditis).  Mitral and aortic valves are at the highest risk. Although most children with chest pain will not have MI, those with comorbidities should be investigated carefully. Trauma Direct, blunt trauma to the chest can cause myocardial stunning, dysrhythmias, or an asymptomatic rise in Troponin I.  However, some children are at risk for disproportionate harm due to a previously unknown risk factor.  Clinically significant cardiac injury occurs in up to 20% of patients with non-penetrating thoracic trauma. The motor vehicle collision: blunt myocardial injury Direct trauma (steering wheel, airbag, seatbelt), especially in fast acceleration-deceleration injury, may cause compression of the heart between the sternum and the thoracic spine. Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury.  A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring. Elevation in troponin is common, but not predicted.  A solitary elevated troponin without ECG abnormality is of unclear significance.  Author’s advice: obtain troponin testing if there is an abnormal ECG, more than fleeting suspicion of BCI, and/or the child will be admitted for monitoring. Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The high-velocity object: coronary artery dissection or thrombus Direct trauma (e.g. MVC, baseball, high-velocity soccer ball) may cause damage to the left anterior descending artery or left circumflex artery, at the highest risk due to their proximity to the chest wall.  Thrombosis and/or dissection may result, often presenting in a focal pattern of ischemia on the ECG. Echocardiography may reveal valvular damage related to the injury, as well as effusion and ejection fraction.  Since there is often a need to investigate the coronary anatomy, percutaneous coronary intervention (PCI) is recommended. The minor trauma with disproportionate complaint: myocardial bridge As mentioned in the congenital section (above), a known variation of a coronary artery’s course involves weaving in and out of the myocardium, creating a baseline risk for ischemia.  Even minor trauma in a child with a myocardial bridge may cause acute thrombus, or slow stenosis from resulting edema.  Unfortunately, the presence of myocardial bridging is often unknown at the time of injury.  Approximately 25% of the population may have myocardial bridging, based on autopsy studies. Take the child seriously who has disproportionate symptoms to what should be a minor injury. Hematologic Coagulopathic and thrombophilic states may predispose children to focal cardiac ischemia.  The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The child with sickle cell disease and chest pain: when it’s not acute chest syndrome Sickle cell disease (SCD) can affect any organ system, although the heart is traditionally considered a lower-risk target organ for direct sickling and ischemia.  The major cardiac morbidity in sickle cell is from strain, high-output failure and multiple, serial increases in myocardial demand, causing left ventricular hypertrophy and congestive heart failure. However, there is mounting evidence that acute myocardial ischemia in sickle cell disease may be underappreciated and/or attributed to other causes of chest pain. Other cardiac sequelae from SCD include pulmonary hypertension, left ventricular dysfunction, right ventricular dysfunction, and chronic iron overload. Evidence of myocardial ischemia/infarction in children with SCD has been demonstrated on single-photon emission computed tomography (SPECT) scan. The puffy faced child with chest pain: nephrotic syndrome hypercoagulability Children who suffer from nephrotic syndrome lose proteins that contribute to the coagulation cascade.  In addition, lipoprotein profiles are altered: there is a rise in the very low-density lipoproteins (LDL), contributing to accelerated atherosclerosis.  Typically nephrotic patients have normal levels of high-density lipoproteins (HDL), unless there is profuse proteinuria. Children with difficult-to-control nephrotic syndrome (typically steroid-resistant) may form accelerated plaques that rupture, causing focal MI, as early as school age. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI.  However, the presence of PFO alone does not connote higher risk.  When paired with an inherited or acquired thrombogenic condition, the venous thrombus may travel from the right-sided circulation to the left, causing distal ischemia.  Many of these cases are unknown until a complication arises. The chronically worried, now with a reason: hypercholesterolemia A family history of adult-onset hypercholesterolemia is not necessarily a risk factor for early complications in children, provided the child does not have the same acquired risk factors as adults (e.g. obesity, sedentary lifestyle, smoking, etc).  Parents may seek help in the ED for children with chest pain and no risk factors, but adult parents who have poor cholesterol profiles. The exception is the child with familial hypercholesterolemia, who is at risk for accelerated atherosclerosis and MI. Infectious Myocarditis has varied etiologies, including infectious, medications (chemotherapy agents), immunologic (rheumatologic, transplant rejection), toxins (arsenic, carbon monoxide, heavy metals such as iron or copper), or physical stress (electrical injury, heat illness, radiation). In children, the most common cause of myocarditis is infectious (viruses, protozoa, bacteria, fungal, parasites).  Of these, viral causes are the most common (adenovirus, enterovirus, echovirus, rubella, HHV6). The verbal child may complain of typical chest complaints, or may come in with flu-like illness and tachycardia or ill appearance out of proportion to presumed viral illness. The most common presenting features in children with myocarditis are: shortness of breath, vomiting, poor feeding, hepatomegaly, respiratory distress, and fever. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’.  That may very well be true, but any virus can be invasive with myocardial involvement.  Infants are only able to increase their cardiac output through increasing their heart rate; they cannot respond to increased demands through ionotropy.  Look for signs of acute heart failure, such as hepatomegaly, respiratory distress, and sacral edema. The child with tachycardia out of proportion to complaint: myocarditis The previously healthy child with “a bad flu” may simply be very symptomatic from influenza-like illness, or he may be developing myocarditis.  Look for chest pain and tachycardia out of proportion to presumed illness, and constant chest pain, not just associated with cough. The “pneumonia” with suspicious chest x-ray: myocarditis Acute heart failure may mimic viral pneumonia.  Look for disproportionate signs and symptoms. Toxins Younger children may get into others’ medications, be given dangerous home remedies, take drugs recreationally, have environmental exposures (heavy metals), suffer from a consequence of a comorbidity (iron or copper overload) or have adverse events from generally safe medications. The hyperactive boy with a hyperactive precordium: methylphenidate Attention deficit hyperactivity disorder (ADHD) is growing in rate of diagnosis and use of medications.  As the only medical diagnosis based on self-reported criteria, many children are given stimulants regardless of actual neurologic disorder; with a higher proportion of children exposed to stimulants, adverse effects are seen more commonly. Methylphenidate is related to amphetamine, and they both are dopaminergic drugs.  Their mechanisms of action are different, however.  Methylphenidate increases neuronal firing rate.  Methamphetamine reduces neuronal firing rate; cardiovascular sequelae such as MI and CHF are more common in chronic methamphetamine use. Although methylphenidate is typically well tolerated, risks include dysrhythmias such as ventricular tachycardia. The child with seizure disorder and chest pain: anti-epileptics Some anti-epileptic agents, such as carbamazepine, promote a poor lipid profile, leading to atherosclerosis and early MI.  Case reports include school-aged children on carbamazepine who have foamy cells in the coronary arteries, aorta, and vasa vasorum on autopsy.  It is unclear whether this is a strong association. The spice trader: synthetic cannabinoids Synthetic cannabinoids are notoriously difficult to regulate and study, as the manufacturers label them as “not for human consumption”.  Once reports surface of abuse of a certain compound, the formula is altered slightly and repackaged, often in a colorful or mysterious way that is attractive to teenagers. The misperceptions are: are a) synthetics are related to marijuana and therefore safe and b) marijuana is inherently “safe”. Both tend to steer unwitting teens to take these unknown entities.  Some suffer MI as a result. Exposure to tetrahydrocannabinol (THC) in high-potency marijuana has been linked to myocardial ischemia, ventricular tachycardia, and ventricular fibrillation.  Marijuana can increase the heart rate from 20-100%, depending on the amount ingested. K2 (“kush 2.0”) or Spice (Zohai, Genie, K3, Bliss, Nice, Black Mamba, fake weed, etc) is a mixture of plant leaves doused in synthetic chemicals, including cannabinoids and fertilizer (JWH-108), none of which are tested or safe for human consumption.  Synthetic cannabinoids have a higher affinity to cannabinoid receptors, conferring higher potency, and therefore worse adverse effects.  They are thought to be 100 to 800 times more potent as marijuana. Bath salts (Purple Wave, Zoom, Cloud Nine, etc) can be ingested, snorted, or injected.  They typically include some form of cathinone, such as mephedrone, similar to the substance found in the naturally occurring khat plant. Hallucinations, palpitations, tachycardia, MI, and dysrhythmias have been reported from their use as a recreational drug. Chest pain with marijuana, synthetic cannabinoid, or bath salt ingestion should be investigated and/or monitored. Riding that train: high on cocaine Cocaine is a well-known cause of acute MI in young people.  In addition to the direct stimulant causes acutely, such as hypertension, tachycardia, and impaired judgement (coingestions, risky behavior), chronic cocaine use has long-term sequelae.  Cocaine causes accelerated atherosclerosis.  That, in conjunction with arterial vasospasm and platelet activation, is a recipe for acute MI in the young. Cranky: methamphetamine Methamphetamine is a highly addictive stimulant that is relatively inexpensive and widely available.  Repeated use causes multiple psychiatric, personality, and neurologic changes.  Risky behavior, violence, and motor vehicle accidents are all linked to this drug.  Like cocaine, methamphetamine may cause fatal dysrhythmias, acute MI from demand ischemia, and long-term sequelae such as congestive heart failure. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! References Congenital AboulHosn JA et al. Fontan Operation and the Single Ventricle. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. A case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. African Health Sci. 2014; 14(1): 23-227. Andrews RE et al. Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart. 2004; 90:e17. Canale LS et al. Surgical treatment of anomalous coronary artery arising from the pulmonary artery. Interactive Cardiovascaulr and Thoracic Surgery. 2009; 8:67-69. Güvenç O et al. Correctable Cause of Dilated Cardiomyopathy in an Infant with Heart Failure: ALCAPA Syndrome. J Curr Pediatr. 2017; 15:47-50. Hastings RS et al. Embolic Myocardial Infarction in a Patient with a Fontan Circulation. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634. Hoffman JIE et al. Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants. Pediatr Cardiol. 2013; 34(3):489-491. Kei et al. Rare Case of Myocardial Infarction in a 19-Year-Old Caused by a Paradoxical Coronary Artery Embolism. Perm J.2015; 19(2):e107-e109. Liu Y, Miller BW. ALCAPA Presents in an Adult with Exercise Inlerance but Preserved Cardiac Function. Case Reports Cardiol. 2012; AID 471759. Möhlenkamp S et al. Update on Myocardial Bridging.Circulation. 2002;106:2616-2622. Murgan SJ et al. Acute myocardial infraction n the neonatal period. Cardiol Young. 2002; 12:411-413. Sieweke JT et al. Myocardial infarction in grown up patients with congenital heart disease: an emergening high-risk combination. International Journal of Cardiology. 2016; 203:138-140. Schwerzmann M et al. Anomalous Origin of the Left Coronary Artery From the Main Pulmonary Artery in Adults. Circulation. 2004; 110:e511-e513. Tomkewicz-Pajak L et al. Arterial stiffness in adult patients after Fontan procedure. Cardiovasculr Ultrasound. 2014; 12:15. Varghese MJ et al. The caveats in the diagnosis of anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Images Paediatr Cardiol. 2010; 12(3): 3–8. Autoimmune Ayala et al. Acute Myocardial Infarction in a Child with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Turk J Rheumatol. 2009; 24:156-8. Nakano H et al. Clinical characteristics of myocardial infarction following Kawasaki disease: Report of 11 cases. J Pediatr. 1986; 108(2):198-203. Pongratz G et al. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. European Heart J. 1994. 15:1002-1004. Newburger JW et al.  Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747-2771. Son MB et al. Kawaski Disease. Pediatr Rev. 2013; 34(4). Yuan S. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease. Libyan J Med. 2012; 7:19796. Trauma Abdolrahim SA et al. Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection. J Clin Diagnost Res. 2016; 10(6):14-15. Galiuto L et al. Post-traumatic myocardial infarction with hemorrhage and microvascular damage in a child with myocardial bridge: is coronary anatomy actor or bystander. Signa Vitae. 2013; 8(2):61-63. Janella BL et al. Acute Myocardial Infarction related to Blunt Thoracic Trauma. Arq Bras Cardiol. 2006; 87:e168-e171. Liu X et al. Acute myocardial infarction in a child with myocardial bridge World J Emerg Med. 2011; 2(1):70-72. Long WA et al. Childhood Traumatic Infarction Causing Left Ventricular Aneurysm: Diagnosis by Two-Dimensional Echocardiography. JACC. 1985; 5(6):1478-83. Smith S. Right Bundle Branch Block after Blunt Trauma: A Tragic Case. [Blog Post] July 22, 2012. Retrievable at: http://hqmeded-ecg.blogspot.com/2012/07/right-bundle-branch-block-after-blunt.html. Hematologic Carano N et al. Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated with Heritable Thrombophilia. Pediatr. 2004; 114(2):255-258.      Chacko P et al. Myocardial Infarction in Sickle Cell Disease. J Cardiovascl Transl Res. 2013; 6(5):752-761. De Montalembert M et al. Myocardial ischaemia in children with sickle cell disease. Arch Dis Child. 2004; 89:359-362. Gladwin MT et al. Cardiovascular Abnormalities in Sickle Cell Disease. JACC. 2012; 59(13):1123-1133. Osula S et al. Acute myocardial infarction in young adults: causes and management. Postgrad Med J. 2002; 78:27-30. Silva JMP et al. Premature acute myocardial infarction in a child with nephrotic syndrome. Pediatr Nephrol. 2002; 17:169-172. Suryawanshi SP. Myocardial infarction in children: Two interesting cases. Ann Pediatr Cardiol. 2011 Jan-Jun; 4(1): 81–83. Infectious Cunningham R et al. Viral myocarditis Presenting with Seizure and Electrocardiographic Findings of Acute Myocardial Infarction in a 14-Month-Old Child. Ann Emerg Med. 2000; 35(6):618-622. De Vettten L et al. Neonatal Myocardial Infarction or Myocarditis? Pediatr Cardiol. 2011; 32:492-497. Durani Y et al. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009; 27:942-947. Erden I et al. Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza virus. Cardiol J. 2011; 552-555. Hover MH et al. Acute Myocarditis Simulating Myocardial Infarction in a Child. Pediatr. 1191; 87(2):250-252. Lachant D et al. Meningococcemia Presenting as a Myocardial Infarction. Case Reports in Critical Care. 2015; AID 953826. Laissy JP et al. Differentating Myocardial Infarction from Myocarditis. Radiology. 2005; 237(1):75-82. Miranda CH et al. Evaluation of Cardiac Involvement During Dengue Viral Infection. CID. 2013; 57:812-819. Rettig JS et al. Myocarditis in Children Requiring Critical Care Transport. In:  "Diagnosis and Treatment of Myocarditis", Milei J, Ambrosio G (Eds). DOI: 10.5772/56177. Toxins De Chadarévian JP et al. Epilepsy, Atherosclerosis, Myocardial Infarction, and Carbamazepine. J Child Neurol. 2003; 18(2):150-151. McIlroy G et al. Acute myocardial infarction, associated with the use of a synthetic adamantly-canabinoid: a case report. BMC Pharmacology and Toxicology. 2016; 17:2. Mir A et al. Myocardial Infarction Associated with Use of the Synthetic Cannabinoid K2. Pediatr. 2011; 128(6):1-6 Munk K et al. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate. Case Reports Pediatr. 2015; AID 905097. Rezkalla SH et al. Cocaine-Induced Acte Mycardial Infarction. Clin Med Res. 2007; 5(3):172-176. Schelleman H et al. Methylphenidate and risk of serious cardiovascular events in adults. Am J Psychiatry. 2012 Feb;169(2):178-85. Sheridan J et al. Injury associated with methamphetamine use: a review of the literature. Harm Reduction Journal, 2006; 3(14):1-18. Stiefel G et al. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of attention-deficit hyperactivity disorder. Drug Saf. 2010 Oct 1;33(10):821-42.   This post and podcast are dedicated to Edwin Leap, MD for his sanity and humanity in the practice of Emergency Medicine.  Thank you, Dr Leap for all that you do.

In last week’s episode, we learned that around 30,000 Americans die each year from guns. This week, we examine possible solutions. Do better background checks, buybacks, and gun registration lead to fewer shooting deaths? What happened in Australia after they got rid of all the guns? To find out, we talk to gun shop owner Bob Kostaras, former ATF special agent Mark Jones, Prof. Philip Alpers, and Prof. Peter Squires. Credits: This episode has been produced by Wendy Zukerman, Heather Rogers, Caitlin Kenney, Austin Mitchell, and Kaitlyn Sawrey. Editing by Annie Rose Strasser and Alex Blumberg. Production Assistance by Diane Wu, and Shruti Ravindran. Fact checking by Michelle Harris. Sound design and music production by Matthew Boll, mixing by Martin Peralta and Haley Shaw. Music written by Bobby Lord. Crisis Hotlines:US National Suicide Prevention Lifeline 1-800-273-TALK (2755)US Crisis Text Line Text “GO” to 741741Australia: Lifeline 13 11 14Canadian Association for Suicide PreventionUK & Ireland: Samaritans 116 123 Selected References:Background Checks for Firearms Transfers, US Bureau of Justice, 2009 Including details on federal gun purchase regulationsIssues with the current US background check system, plus recommendations for improvement Wintemute, “Background checks for firearm transfers: Assessment and recommendations.” Violence Prevention Research Program, UC Davis. 2013. States with more comprehensive background checks, including better reporting, have lower rates of gun homicide Ruddel and Mays, “State background checks and firearms homicides,” Journal of Criminal Justice, 2005. Most prisoners incarcerated for a gun-related offense did not buy their gun from a licensed dealer Harlow, C. “Firearm use by offenders”, Bureau of Justice Statistics Special Report, 2001. How much of violent crime in Sweden can be attributed to people with severe mental illness? About 5% Fazel and Grann. “The Population Impact of Severe Mental Illness on Violent Crime.” Am J Psychiatry, 2006A study of how gun laws in Australia changed gun homicide rates Chapman et al, “Association Between Gun Law Reforms and Intentional Firearm Deaths in Australia, 1979-2013”, Journal of the American Medical Association, 2016.