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Social determinants of health, including housing, food access, insurance status, and structural inequities, significantly influence stroke prevention, recovery, and long term outcomes. These factors affect biological risk, treatment adherence, and disparities in care, even when traditional clinical measures are addressed. This episode highlights practical strategies for integrating screening, leveraging multidisciplinary teams, and identifying opportunities for advocacy to improve patient outcomes. In this episode, Teshamae Monteith, MD, FAAN, speaks with Nneka L. Ifejika, MD, MPH, author of the article "Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Ifejika is an adjunct professor of physical medicine and rehabilitation at UT Southwestern Medical Center in Dallas, Texas, and the chief scientific officer of the Division of Academics at Ochsner Health System in New Orleans, Louisiana. Additional Resources Read the article: Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Monteith: Two patients have the same stroke, but when they return, they have very different outcomes. We can look into some of their comorbidities, but something we don't spend enough time talking about is the social determinants of health. Stay tuned to this discussion. I promise you, you'll become a better neurologist. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr. Teshamae Monteith. Today I'm interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. How are you? Welcome to our podcast. Dr Ifejika: Thanks for having me. I'm doing great. Dr Monteith: Great. So, can you introduce yourself to our audience? Dr Ifejika: Sure. I'm Dr. Nneka Ifejika. I am the Chief Scientific Officer of Ochsner Health System in New Orleans, Louisiana. But I'm also a cerebrovascular rehabilitation doctor. I've been practicing for about nineteen years, and am happy and honored to be a contributor to this Continuum Neurology article. It's a really important topic. Dr Monteith: Great. So, what got you into this field, first of all? Dr Ifejika: Well, I was deciding between PM&R and neurology, and I was putting in both match lists. And I thought about it and I leaned toward PM&R, but stroke still had a grasp on my heart and my mind. And so, after I finished my residency, I joined the UT Houston stroke team, and I did a, thankfully did a two-year fellowship and became cross-trained in stroke as well as physical medicine rehab. So, I am a jack of both trades. Dr Monteith: So, you got your way in a way. Dr Ifejika: I did. Dr Monteith: You know, we have a lot of learners that are listening, so it's always, uh, nice for them to be inspired, I think, by people's career paths. So why don't we talk about the objectives of your article? Dr Ifejika: Sure. So, one of the most important things that we wanted to do was make sure that medical students, residents, faculty, and fellows understood the impact of social determinants of health on stroke recovery and stroke rehabilitation. It's not as simple as you have hypertension, hyperlipidemia, we're going to manage your stroke risk factors. Oh, you had an ischemic stroke. You presented in time for the window. We're going to give you endovascular therapy and then modified Rankin scale at hospital discharge in ninety days. No, no, no. The stroke survivor and their caregivers and their family have a lot more to deal with outside of what we look at during the acute stroke hospitalization and post-acute rehabilitation. Things like, can they afford the medication that we're prescribing? Antiplatelet agents or anticoagulation can be extremely expensive. Do they have housing insecurity? Is there food insecurity? What's going on behind the scenes that we are not addressing that can directly impact the admission rate and the readmission rate after we take care of a stroke survivor? Dr Monteith: I love the article because you took a real deep dive into social determinants of health, what they are, why they matter, and what we can do about them. And so why don't we talk a little bit about the NINDS framework for social determinants of health? I think many of us might not be familiar with the framework per se. Dr Ifejika: So, the framework consists of multiple domains specifically that relate to social determinants of health that were published in Neurology a couple of years ago. So, I do hope that people who are hearing this recording actually read them. There are interpersonal domains, there are classic medical domains, there are indeterminate domains, and there are six total domains. And health domains are the last domain. So, things like when it comes to housing insecurity, food insecurity, that's a domain of social determinants of health. When it comes to chronic racism, when it comes to biases that patients experience, those actually impact outcomes. So, there are six separate indices that we're going to get into in detail and how we address them as clinicians, whether it be at the medical student level, resident level, faculty level, to integrate the social determinants of health in our care plans, because we could be doing a much better job. And I think it'll be really important from the interpersonal perspective when we really relate to our patients and their families that we ask these questions. For example, if we're prescribing someone to have treatment for their diabetes mellitus and ha- and, and be taking insulin, if they have housing insecurity and they're in a homeless shelter, they have to leave the homeless shelter during the day. So, what happens to the insulin that we prescribe? These are variables that we are not considering on a regular basis, but they directly relate to compliance. Dr Monteith: Great. So that was one thing I wanted to bring up. We're very good at measuring blood pressure and trying to determine, uh, the association between stroke outcomes and things that we can measure, glucose, lipids, blood pressure. What is the evidence for social determinants of health and stroke outcome? Dr Ifejika: The evidence is growing, and there have been many publications that have come out that are, are going to be highlighted in this article related to structural determinants of health inequities, like structural racism, as well as disparities related to ethnicity and race. There's geographical disparities. For example, a lot of patients are, are primarily concerned about rural versus urban, whether you have access to different post-acute rehabilitation, whether you have access to secondary stroke prevention because you simply don't have the transportation from a, a rural area to get to a drugstore to get things available to you. Social status. There are actually publication related to socioeconomic status and the concerns when it comes to air pollution. So particulate matter 2.5, we know that that has a direct impact on stroke outcomes and health overall, but we don't really think about it as a structural determinant of health inequity. There's several multiple layers of research that have gone on specifically that have been cited in the literature that relate directly to social determinants of health and how we can address them moving forward. Dr Monteith: And what I found interesting in your article in that you gave at least a few examples where social factors like income, education were controlled for, and maybe in large part it is, but even when you control for some of these very obvious social risk factors, you still have inequities. Dr Ifejika: Absolutely. And I think it was really important to show that we had strong peer review evidence behind this, as it wasn't just something that we were creating or hypothesizing about. There have been studies that have been done over this over decades of time, showing the impacts of social determinants of health on outcomes. But the question and concern that we have is we know this growing body of literature continues to expand. What are we doing about it when it comes to education of the future generations of providers who will be caring for this population? Dr Monteith: Before we get into how, you know, what we're going to do about that, let's just kind of put that link, cause the evidence is there. How does it drive biology? Dr Ifejika: It's a great question. So, for example, particulate matter 2.5 in air pollution has been shown to have an existing impact on hypertension, raising your blood pressure. So that's a direct effect of a social determinant of health related to socioeconomic status because people who live in areas with higher air pollution are... They're not green spaces. They live near highways. Those are areas that unfortunately are also impacted by food deserts. Food deserts, if you're not able to get fresh fruits, vegetables, whole foods, increases your risk of developing diabetes, hyperlipidemia, also increases your sodium intake, again, increasing hypertension. These things are all connected to biological determinants. It's just that we're not asking about them necessarily within the social history when we're taking people into the hospital, but they have direct effects. Dr Monteith: Great. Neurologists tend to be busy and, you know, we're... have all of these things that we're being asked to do and chart and click and all of that stuff. And so how can we more readily integrate screening for social determinants of health and that conversation into the work we do? We recognize it's important. We recognize it's an important risk factor. There's a lot of these determinants. So, what is a good way to do so? And I, I know that in the paper you've, you've given different roles to different team players, so I want you to talk about that too, but just kind of even a regular routine office visit. Walk us through a way we can more easily integrate that kind of conversation. Dr Ifejika: It's an excellent question, and what I've recommended that we do in a standard office visit is utilize the time before the visit to send out screeners. So, for example, usually with an electronic medical record, you can send documents before the visit even starts, where people can check off whether they have any concerns regarding housing, food insecurity. They can check out their location of where they live, whether they live near a highway or not near a highway. It's specifically related to socioeconomic status. We can ask about insurance status, whether they have insurance, insured versus uninsured, but then also types of insurance, whether they have Medicaid insurance versus Medicare insurance. Then even drilling even further, type of Medicare insurance, Medicare Advantage versus traditional Medicare, cause all of those things actually play a role in this. Dr Ifejika: And evaluate these things and don't take time during your office visit. Send these screeners out beforehand. Have them be assimilated by your medical staff. Make sure you're utilizing every resource that you have at your disposal to help streamline things, so by the time the person comes in for the visit, you've primed the pump. You have this information already in your hands at your fingertips cause it was sent out in advance, and you have your medical staff already have an understanding of. If they didn't fill it out electronically, give it to them in the lobby. Make sure they have a handwritten copy in the lobby so that when they come into the office visit, you have the information at your fingertips. Dr Monteith: Are there any particular resources that you recommend for those types of screeners? Dr Ifejika: What I've used in the past, if you have patient-reported outcomes, so the PROMIS instruments, that's a good start. It doesn't get into the details of housing insecurity, food insecurity, but it's a good start to help prime questions and to start the conversation during your office visit. In my clinics, I do a PROMIS 27 on every patient, as well as a PHQ-9 for depression on everyone. And then I collect data longitudinally, and I can always drill down on factors that I noticed that could become a problem moving forward. Dr Monteith: Yeah. And then also in your article, you spoke a bit about this impact from the acute presentation in the hospital to rehab. Dr Ifejika: Yeah. Dr Monteith: So why don't you talk about these different entry points where we can really engage our patients and try and help reduce their burden? Dr Ifejika: Sure. So, healthcare can be quite fragmented, and the stroke patient, stroke survivor, and their family member have no grasp of that. They've had a stroke, and they may be going from the ER to the ICU to the stroke unit to the floor to the rehab unit, and we see it as multiple levels of care, multiple types of providers. They see it as one hospital. And the concern that we have is, at those branch points, things get dropped, and we have the opportunity to pick things up at those branch points. So, during the acute care hospitalization-Primarily, that's the establishment of what has happened, how we're gonna treat it, what are the variables that we can control for right now to address those determinants of health moving forward, and to specifically looking at whether they were taking medications before, whether they could afford medications before, what that looks like at hospital discharge. Is there any duplication of medications? If a person is taking Coreg and you prescribe metoprolol, but they still have the Coreg at home, should we have really prescribed the metoprolol? We're just spending money that they may have concerns when it comes to access to care and the cost of these prescriptions. So, it's the responsibility of the acute care physician to kind of look at that. Those are subtle things that we think are subtle, but they add up quickly for the family when it comes to having one group of medications that's the same class and having to buy another type. When it comes to post-acute rehabilitation, it's really an important time to screen for whether the caregiver can handle what's occurring. So specifically, if the caregiver is already burning out and the average length of stay for a stroke patient is five days and they've come to rehab for two weeks, what's gonna happen in the next two years or the next four years? So, during the post-acute rehabilitation phase, it's time to kind of look at that and drill down on those kind of questions. Also, the levels of care, Dr Ifejika: it's really important to look at other levels of rehabilitation, so skilled nursing facilities, making sure people have access to that if they need to, if the caregiver is burned out and they don't have the ability to go straight home. Because acute inpatient rehab, the goal of it afterwards, is to go straight home. It's not to go to another facility. So, you need to have that screener in place when it comes to whether the family can take care of this person, and whether the family can do it in an effective way to prevent them being readmitted. Dr Monteith: Great. I also like that you spoke about kind of the team approach and different roles, both for screening and for intervention, both being very important, especially the intervention. And so why don't you give us a few examples how the team could break up the responsibility and how also for the intervention component that can be done. Dr Ifejika: Sure. So, I broke up the team into several levels. So, the team medically is the medical student, resident, and faculty physician. However, the team also includes the support staff, so your case manager, your social worker, the therapist, physical therapy, occupational therapy, speech therapy, the pastoral services, all these members of the team. You know, sometimes as physicians, we don't read those notes. There's a lot of information in the notes from social work, care coordination, and the therapist. They get down to subtleties cause they're asking questions, for example, "What kind of equipment do you have at home? How many stairs do you have at home? What level of house do you have, one story, two story? If you live in an apartment, do you have an elevator access?" That's important for someone with hemiparesis. When it comes to medications, when it comes to insurance status, when it comes to your ability to have the mechanisms to pay for care as an outpatient, social workers are required to ask these questions cause they have to figure out resources for the patient and their family to help facilitate improved outcomes. So, they have to ask questions regarding these tasks. The concerns are, do we read what they're saying? So, it's really important to interact with them, and if it's not something that you're looking at in the chart, cause we're all so tied to our computers, find where they are in the hospital. Walk by their office and have a chat. Run your list with them, especially for people who you're concerned have vulnerabilities, and make sure that you're setting an example for your medical students with your faculty doing so. If you're looking at it from the medical student, resident, faculty perspective, medical students, listen. This is your opportunity to really contribute to the team as well as learn about social determinants of health and research in their fields. You are the boots on the ground for the medical team. You are the ones who should be priming the pump and asking these questions of the family members. We're sending you into the rooms to do a history and physical. Social determinants of health should be a part of your history and physical, and you should be taking what we're saying in this article and asking these questions and tying it into your resident. Now, the resident is the work person of the hospital. We all know this. Things run through the resident. Things run through the fellow. It's really important that they have this information in a manner that is negotiable. The list keeps getting longer, and a resident doesn't need to be overburdened. It needs to be synthesized in a manner that can help facilitate the resident being able to act as well as communicate any concerns to the faculty. And at the faculty level, we are the voices that can affect change. So, if there's any concerns when it comes to advocacy, research, making sure that people are accessing care in a way that makes sense, particularly when it comes to the ability for us to galvanize change on a national level, that's kind of our job. Dr Monteith: Great, and so let's talk about intervention. What are things that, let's say, the neurologist can do to deal with some of these social factors? Dr Ifejika: From the neurology perspective, I think it's really important to identify missed opportunities and making sure that we address them. For example, the conversations around the ability to have access to care related to insurance versus no insurance. There are many, many ways that neurologists are able to advocate for a person being able to get to Medicare insurance, particularly in the outpatient setting. When we see patients in clinic, it takes two years, them, to qualify for Medicare, two years at a minimum. But there's a gap there that can be filled by us making sure that we document what's happened, contact their providers, facilitate communication with their employers, if they're employees, they can get some short-term disability benefits to help bridge that gap prior to receiving Medicare insurance. It behooves us to do this because if we do not, they fall into the gap and they get readmitted and they're back on service anyway. So, what's important is the outpatient that we really kind of focus on things that we can impact and things like insurance and getting people transitioned from having employer-based insurance versus getting to Medicare is a really important way that we can effect change in a, in a way that's viable and, and replicable. So, in the outpatient setting, neurologists have a wonderful opportunity to effect change in social determinants of health. When it comes to employed persons, who had a stroke transitioning to Medicare, it takes two years to do so. So, in the outpatient clinic, if you have an employed person, make sure that you fill out their short-term disability benefits forms, their long-term disability benefits form. Bridge the gap. Get that information to their employer so they can maintain constant coverage. Because if they do not, if they have to choose between refilling medications and putting food on the table, they're going to choose putting food on the table, and that's going to directly impact their outcomes if they're not taking the medication that we recommend. Dr Monteith: I think that's a great point. I mean, there's a lot that we can do, and in some ways, it may not take that much to document and to be able to ask the questions and to include some of that information into the assessment and plan is really a, a great idea. Dr Ifejika: And you know, if we don't bring these things up and have these conversations, it doesn't get addressed. And that's why I'm very, very thankful that I had the opportunity to do so, cause this is a part of what I do all day. I think that if I wasn't integrating these kind of conversations into my practice, I wouldn't have the ability to share these tips and these abilities to move things forward in a manner that will be constructive for our field overall and for our patients. Dr Monteith: And towards the end of the article, you brought up something I think we don't see in many articles, and that's the role of advocacy and getting involved in health policy. So, can you talk a little bit about that? Dr Ifejika: You know, it's really important to facilitate change when you see that there are things that need to be changed. And the best way to do that is through advocacy at the local or state or federal level. A lot of these variables that we're dealing with can be addressed through legal changes. I'll give you an example. End-stage renal disease, if you have immediate hemodialysis and you have that requirement upon hospital discharge, you qualify for Medicare immediately. Immediately. Before you even leave the hospital. Why wouldn't something be similar for a stroke? Well, the reason why is because there was a level of advocacy that came around end-stage renal disease and a member of Congress's wife had hemodialysis requirements. And so, a law was passed to make sure Medicare covered it immediately after hospital discharge. So, it requires advocacy in some significant ways to get things done, but we have the bandwidth to do this. We take care of a population that has some of the highest rates of preventable disability. That's not going away. We need to make sure that we're effecting change for this group to make sure that they have the best possible outcomes they can experience. Dr Monteith: So, any final messages for our listeners? Dr Ifejika: I look forward to hearing everyone's feedback about our issue. I am thankful for the opportunity to talk about, address, and write about this important topic, and look forward to everyone's feedback. Dr Monteith: Well, thank you so much for being on our podcast. It was a really wonderful summary and we had a very thorough conversation, but you didn't give away too much, so I think they're going to have to read the article. Dr Ifejika: You're going to have to read the article. And we want medical students, residents, fellows, faculty, all of our ancillary staff within the hospitals, please read this article. We really appreciate it. Dr Monteith: Again today, I've been interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this episode of The Health Literacy 2.0 Podcast, host Seth Serxner welcomes Brian Oss, Head of Solutioning at Calm, for a deep dive into the evolving landscape of workforce health literacy, behavioral health, and digital mental health solutions.Calm is a leading mental health company on a mission to support everyone on every step of their mental health journey. Our flagship consumer app - ranked #1 in its category with over 180 million downloads and available in seven languages across nearly 190 countries - helps people sleep better, stress less, and live more mindfully through content and tools from experts and beloved celebrity voices.Since their launch, they've expanded their offerings with Calm Sleep, an app providing deeper, personalized sleep support, and Calm Health, an evidence-based digital solution offered through employers, health plans, and providers to expand access, boost benefits engagement, and drive positive health outcomes.Today, Calm supports more than 3,500 organizations and reaches over 26 million covered lives through Calm Health.Brian leads solutioning to address some of the toughest challenges in behavioral health.Brian and Seth discuss:Career Paths Are Not Linear: Both Brian and Seth highlight the importance - and inevitability - of nontraditional career journeys in health and wellness leadership.Cost and Access as Top Challenges: Controlling costs while increasing access to mental and behavioral health care remains a leading concern for employers and health plans.Digital Content as a Scalable Solution: For roughly 75% of a given population, high-quality digital content can be a first line of support, offering tools for episodic needs and keeping people out of higher-acuity care.Data-Driven Personalization: Calm Health leverages PHQ and GAD scores to curate programs tailored to each user's unique needs, including specialized tracks for those with chronic conditions like diabetes.Clinical Expertise Meets Engaging Delivery: Calm collaborates with top psychologists to create evidence-based programs, then crafts them into highly engaging audio-visual experiences featuring trusted voices.Proof of Outcomes: A recent payer-led study of 70,000 users showed significant reductions in anxiety and depression scores - demonstrating that digital tools can make a real impact.Health Literacy = Access + Navigation: True health literacy goes beyond reading level - it includes providing clear pathways and referrals to the right care, tailored to each user's situation and acuity.Supporting the Full Continuum: Calm Health's offerings help users at every point in the journey, from “green” users needing only light support to those who require referral to therapy or crisis services.Cautious Approach to AI: While Calm Health utilizes AI to help users articulate their goals, they are conservative about using AI for actual clinical care - mindful of both ethical concerns and payer requirements.Brian closes with a reminder of the human side of mental health - urging listeners to check in, offer a smile, and truly see one another, as small moments of connection can be transformative.Discover how digital innovation and compassionate leadership are reshaping mental health support in the workplace - one small step, and one smile, at a time.Learn About EdLogicsWant to see how EdLogics' gamified platform can boost health literacy, drive engagement in health and wellness programs, and help people live happier, healthier lives?Visit the EdLogics website: www.edlogics.com.Get Seth's BookCheck out The Wellbeing Effect by Seth Serxner.

American psychiatry has built a sociological armor around itself that protects it from reform. The armor has two parts. Reverence and complexity. Together they form the most effective institutional defense system in American professional life. And the apparatus, in 2026, has evolved its most refined defensive move yet, the DSM-6 roadmap, which absorbs the entire body of structural critique against the field by publishing thoughtful documents acknowledging the critique is correct, while channeling an entire generation of reform energy into bureaucratic processes that will conclude, eventually, with the publication of a new manual that incorporates the language of the critique without changing what the manual does. Why the apparatus persists despite forty years of evidence it is failing. How residency capture, modality capture, and credentialing capture work together to produce a workforce whose tolerance for the mystery of the work has been systematically lowered. What would have to change. And why none of the obvious answers are actually answers. This episode covers: Of Two Minds. Tanya Luhrmann's anthropology of American psychiatric residency. How young doctors who enter training wanting to think across biological and psychological registers get formed, by the reward structure of training itself, into single-register practitioners. Why this is happening right now to the residents who started in 2025, and why the AI replacement is going to be welcomed by the field that has been preparing for it for a generation. How Aaron Beck got eaten. The careful, curious clinician who let his data change his mind. The three properties of cognitive therapy that made it perfectly compatible with the emerging managed care apparatus. Why Beck himself was not the version of Beck that got reproduced in the training programs. The selection pressure that captures every modality with the same properties, regardless of the founder's intent. The ABA parallel. Ivar Lovaas, the 1987 study, the autism insurance mandates, the BACB explosion. Why Applied Behavior Analysis became mandatory standard of care despite extensive evidence of harm from the autistic community. Henny Kupferstein on PTSD outcomes. The Autistic Self Advocacy Network. Private equity acquisition of ABA chains and what the moral crumple zone looks like at scale. Measurement as the real religion. The PHQ-9 and GAD-7 as Pfizer-funded screening instruments that became, by capture and convenience, the definitions of depression and anxiety in American clinical practice. Campbell's Law. Goodhart's Law. Theodore Porter on quantification as defense against weak internal authority. The IAPT case study from England, Layard's economic argument, David Clark's CBT rollout, Michael Scott's outcome research, Farhad Dalal's cognitive-behavioral tsunami. Why the entire international model of measurement-based care produces excellent statistics and very little durable change. The critics the apparatus could not absorb. Robert Whitaker on long-term outcomes and Anatomy of an Epidemic. Joanna Moncrieff and the 2022 serotonin meta-analysis that should have ended the chemical imbalance theory and didn't. Lisa Cosgrove on DSM-5-TR financial conflicts of interest. Why each of them produced exactly the kind of evidence that should have triggered structural reform, and why the apparatus dismissed each of them through credentialing arguments that were really about boundary policing. The DSM-6 trap. The closure-of-the-trap argument. Why the DSM-6 roadmap, which concedes the entire structural critique, is the apparatus's most sophisticated defensive move yet. Why being invited to participate in the DSM-6 working groups is the mechanism by which the next decade of reform energy gets neutralized. Why the manual is downstream of the apparatus and reforming the manual cannot reform the apparatus. Enshittification of care. Cory Doctorow's framework applied to American mental health. The four constraints that should have prevented it. How each was eliminated. Madeleine Clare Elish on moral crumple zones. Why clinicians absorb the moral and financial cost of an apparatus they did not design. The diploma mill. The accreditation conflict of interest. Why MSW programs, counseling programs, and PsyD programs have doubled their output without any accountability for what they produce. The accountability inversion. The structural fix. Why schools and boards should be liable for the clinicians they produce. Why the field needs both rigorous selection and rigorous accountability, and how the current system has neither. What would change if the field stopped being a diploma mill. Why this is not a return to Freud's priest class. Disagreement was the wisdom. Why the productive conflict between schools of thought was where psychology was actually thinking, and why the DSM-III atheoretical move killed the conversation that produced wisdom. Neither side wins. Why the cold machine and the warm ghost both need each other. Why the answer is not to defeat the apparatus but to stop mistaking it for the work. The coda. The Machines Will Start to Dream. The actual ending of the series. Why you do not need a conspiracy theory for any of this. The cold machines are nothing, the warm ghost is everything. The microcosm is the macrocosm because the systems are human. The AI threat as reality splitting, where the simulated layer becomes thick enough that the substrate underneath stops being accessible. Freud's permanent problem. Bureaucracy as the most successful avoidance technology humans have ever invented. The disbelief at the root. The question of whether you are more scared of yourself than of not seeing life clearly. The wager that even if humans always refuse, professional psychology should stop being the most refined refusal in the culture. About the host: Joel Blackstock is a Licensed Independent Clinical Social Worker and Clinical Supervisor, the Clinical Director of Taproot Therapy Collective in Hoover, Alabama, and the author of work on Brainspotting, Emotional Transformation Therapy, qEEG neurofeedback, somatic and depth approaches to trauma. Find more at gettherapybirmingham.com. This is the final episode of a nine-part series. #PsychotherapyOnTheCouch #AmericanConfession #DSMReform #DSM6 #DSMCritique #DiagnosticAndStatisticalManual #APA #AmericanPsychiatricAssociation #PsychiatryReform #MentalHealthReform #PsychotherapyReform #TanyaLuhrmann #OfTwoMinds #PsychiatricResidency #AaronBeck #CognitiveTherapy #CBT #CognitiveBehavioralTherapy #ABA #AppliedBehaviorAnalysis #IvarLovaas #BACB #AutismRights #AutisticSelfAdvocacy #ASAN #HennyKupferstein #PHQ9 #GAD7 #MeasurementBasedCare #CampbellsLaw #GoodhartsLaw #TheodoreporPorter #TrustInNumbers #IAPT #RichardLayard #DavidClark #MichaelScott #FarhadDalal #CognitiveBehaviouralTsunami #RobertWhitaker #AnatomyOfAnEpidemic #MadInAmerica #JoannaMoncrieff #SerotoninHypothesis #ChemicalImbalance #SSRIs #Antidepressants #LisaCosgrove #PsychiatryUnderTheInfluence #ConflictOfInterest #PharmaInfluence #BigPharma #Enshittification #CoryDoctorow #RotEconomy #EdZitron #MoralCrumpleZone #MadeleineCElish #InsuranceMentalHealth #GhostNetworks #MentalHealthParity #DiplomaMill #SocialWorkEducation #MSWPrograms #PsyD #CounselingEducation #CACREP #CSWE #APAAccreditation #LicensingBoards #ClinicalSupervision #AccountabilityInversion #PsychotherapyTraining #PsychiatricTraining #PsychologyHistory #PsychiatryHistory #FreudCivilizationDiscontents #JungianTherapy #DepthPsychology #SomaticTherapy #TraumaTherapy #ComplexTrauma #AITherapy #AIReplacingTherapists #ChatGPTTherapy #FutureOfTherapy #PsychotherapyPodcast #PsychiatryPodcast #PsychologyPodcast #MentalHealthPodcast #ClinicalSocialWork #JoelBlackstock #LICSW #TaprootTherapy #BirminghamAlabama #AlabamaTherapy #HooverAlabama #ColdMachinesWarmGhosts #TheMostSacredThingWeHave #TheMachinesWillStartToDream #WarmGhost #ReverenceAndComplexity #ProfessionalCapture #InstitutionalCapture #RegulatoryCapture #EvidenceBasedPractice #EvidenceBasedCritique #BiologicalPsychiatry #PsychiatryEpistemology

Text Dr. Lenz any feedback or questions Cohort Study Links ADHD to Earlier and More Severe Perimenopausal SymptomsThe episode reviews a population-based cohort study using the Icelandic SAGA cohort (women aged 35–55; n=5,392) examining perimenopausal symptom severity in women with versus without self-reported ADHD (9.9%). Using the Menopause Rating Scale (MRS), Adult ADHD Self-Report Scale v1.1, and PHQ-15, researchers found higher overall perimenopausal symptom burden in women with ADHD (mean MRS 18 vs 13) across psychological, somatic, and urogenital domains, and higher prevalence of severe symptoms (overall PR 1.8; somatic PR 2.2; psychological PR 1.63; urogenital PR 1.57) plus severe general symptoms (PR 1.94). Symptoms peaked earlier in ADHD (ages 35–39 vs 45–49), suggesting onset up to 10 years earlier. Adjustments for sociodemographics, smoking, binge drinking, and PTSD (more common in ADHD) did not remove associations. Limitations include cross-sectional measures, self-reported ADHD, symptom overlap, and lack of treatment data; the script calls for tailored guidelines for perimenopausal women with ADHD.00:00 ADHD Meets Perimenopause00:23 Study Purpose And Rationale01:16 Cohort And Measurement Tools02:33 Menopause Rating Scale Breakdown03:17 Overall Symptom Burden Results04:11 Severe Symptoms And Ratios05:26 Earlier Onset By Age06:23 Confounders And PTSD Analysis07:38 Clinical Takeaways And Guidance08:39 Limitations And Future Research10:00 Wrap Up And Call To Action Support the showWhen I started this podcast and YouTube Channel—and the book that came before it—I had my patients in mind. Office visits are short, but understanding complex, often misunderstood conditions like fibromyalgia takes time. That's why I created this space: to offer education, validation, and hope.  If you've been told fibromyalgia “isn't real” or that it's “all in your head,” know this—I see you. I believe you. This podcast aims to affirm your experience and explain the science behind it. Whether you live with fibromyalgia, care for someone who does, or are a healthcare professional looking to better support patients, you'll find trusted, evidence-based insights here, drawn from my 29+ years as an MD.Please remember to talk with your doctor about your symptoms and care. This content doesn't replace per...

Residential treatment gets talked about like a single thing, but most people have no idea what they are walking into until they arrive. I sit down with Rachel Docekal, CEO of the Hanley Foundation in Florida, to open up the “black box” of residential addiction treatment and partial hospitalization (PHP), from how programs are structured to what patients actually do hour by hour.We dig into what separates a quality rehab program from one that is all marketing. Rachel explains measurement based care, why repeat assessments like PHQ 9 and GAD 7 style tools matter, and how teams should adjust treatment based on data instead of vibes. We also address a hard topic: predatory rehab practices, including unethical pressure to relapse to meet ASAM criteria so insurance will pay again, and what ethical, patient centered care should look like instead.Then we get practical. We talk length of stay, why discharge planning must start on day one, and how step down care, sober living, family involvement, and alumni support can make the difference between momentum and relapse. Rachel also walks through a real residential daily schedule including medical and psychiatric care, cohort based groups, nutrition and fitness, and why many programs restrict smartphones to improve engagement and outcomes.If you want a clearer map for choosing a residential treatment center and building an aftercare plan that holds up in real life, press play. Subscribe, share this with someone who needs it, and leave a rating or review so more people can find the show.To learn more about Rachel's program: https://hanleyfoundation.org/To contact Dr. Grover: ammadeeasy@fastmail.com

May is Mental Health Awareness Month!Mental Health Mississippi was developed to make that process easier and to serve as a hub of information for all mental health resources available in our state.Hinds Behavioral Health Services (Region 9)specializes in outpatient community mental health services for adults, children and youth, families, elderly, and those with chemical dependencies and substance use disorders. Our mission is to provide quality, effective mental health services to the citizens of Hinds County.In a mental health crisis you need help fast. Call us and we will come to you. 601-321-2400 24/7Mobile Crisis Response Team 601-955-6381. Mobile Crisis Teams provide guidance and support to adults and children who are experiencing a mental health crisis. The teams work closely with law enforcement to reduce the likelihood that a person experiencing a mental health crisis is unnecessarily placed in a more restrictive environment, like jail, a holding facility, hospital, or inpatient treatment.Region 8 Mental Health Services provides services in five central Mississippi counties, but if you need immediate crisis assistance, contact your Mobile Crisis Response Team.PHQ-9 (Patient Health Questionnaire-9)Psychology Today: Find a Therapist, Psychologist, Counselor Hosted on Acast. See acast.com/privacy for more information.

Uh oh, your patient answered yes to Question #9 on the PHQ-9? We join John Ackerman, PhD, ABPP and Elizabeth Kleinhenz, MSW, MPH, LISW from the Center for Suicide Prevention and Research at Nationwide Children's Hospital to shed light on non-suicidal self-injury, suicide risk assessment, and safety planning in adolescents. From universal screening to individualized safety plans, this episode will leave you feeling more confident and equipped to handle mental health crises.

Rebecca Benghiat holds a JD, passed the bar, and skipped corporate law to build mental health systems instead. She now serves as Chief of Staff and Head of Impact at Inner Foundation, where she helps direct capital toward emerging adults ages 18 to 30 and asks a hard question every day: Is this actually working?In this conversation, she dismantles the myth of easy fixes. She explains why mental health measurement resists clean metrics, why a PHQ 9 score starts a conversation but never finishes one, and why “scale” often flatters institutions more than it helps people. She breaks down how impact investing shapes care delivery, why schools need networked systems not slogans, and why friction might be developmentally necessary.The stakes are real. Vulnerable families navigate snake oil, glossy apps, and pay to play algorithms while carrying the burden of choice in crisis. Benghiat lives inside that complexity and refuses to simplify it.RELATED LINKSRebecca BenghiatInner FoundationAspen Ideas HealthThe Jed FoundationFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The perinatal period — from the start of pregnancy until the baby's first birthday — is a time of significant change for women and, while much of this can be positive, for some, it brings major challenges. Mental health disorders, including anxiety, depression, OCD and PTSD, can have significant and long-lasting effects on both mothers and children. But, in this episode of the Clinical Update podcast, MIMS Learning editors Rhiannon and Pat remind us of the positive impact that primary care can have in identifying at-risk women and offering prompt intervention or referral.  They explore the biopsychosocial factors that contribute to risk of perinatal mental health disorders, including the impact of previous pregnancy loss, health inequalities, and complex social factors, and provide practical advice from experts on distinguishing postnatal depression from ‘baby blues'.Content warning: This podcast contains a brief mentions of maternal suicide, domestic violence and birth trauma, but focuses more broadly on how GPs can help patients experiencing mental health disorders. The Samaritans helpline is 116 123.Educational objectivesAfter listening to this podcast, healthcare professionals should be better able to:Apply the biopsychosocial model to identify biological, psychological, and social risk factors for perinatal mental health disordersUse screening tools such as the Whooley questions, PHQ-9, and GAD-2 to assess for depression and anxietyBe aware of red flags that may indicate a psychiatric emergency, such as postpartum psychosis, requiring immediate referralRecognise the signs of perinatal OCD, and understand how these differ from postnatal depressionDiscuss management options, including the risk-benefit profile of prescribing while breastfeeding Recall the prevalence of birth trauma and the importance of providing trauma-informed careYou can access the website version of this podcast, along with a list of key learning points, on MIMS Learning - and make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.Useful resourcesManaging perinatal mental health disorders in primary careA guide to providing trauma-informed maternity carePodcast: navigating medication safety in breastfeeding with Rachel PilgrimEquity in maternity care - lessons from MBRRACE-UKRegister for a FREE accountMIMSAntidepressants, a guide to switching and withdrawingTreatment options in pregnancy Hosted on Acast. See acast.com/privacy for more information.

The episode moves through three connected ideas. First: clinical trials have a UX problem. One in five trials recruits zero patients. Half under-recruit. Paul's early work was understanding why – and fixing it. The answer was almost never the science. It was that patients had no parking, caregivers had no wifi (or babysitting!), and the protocol assumed everyone could get to Mass General by 9 AM on a Friday via public transit. Solving that required showing trial designs to actual patients before locking them, and listening to their recorded reactions rather than just summarizing their survey scores. Second: measuring patient experience is genuinely hard. There are no inches of insomnia. No pounds of pain. Patient Reported Outcomes – PROs – exist because the most burdensome chronic conditions don't have actual units that can be measured. There are thousands of PROs, many are outdated (the fibromyalgia questionnaire from the early 2000s asks how well you can vacuum and cook for your family), and most were designed for clinical trials, not for weekly check-ins on a mobile screen. So for you, Product Manager/Engineer/Builder: how are you going to measure whether your Care Model actually improves patient health? Third: building PROs into a product creates specific traps. Paul runs through the ones he has seen firsthand: copyright violations (most scales are licensed and litigation can cost millions), engagement drop-off (5–10% of users is a good day for consistent tracking), incentive fraud (cash rewards attract bot farms), the nocebo effect (asking about pain can worsen it: hey, 1-10 scale, how itchy are you right now?), and the regulatory ceiling – go too far with your tracker and you've crossed into medical device territory, with all the compliance that comes with it. The Five Things to Know Before You Build 1. You probably don't have permission to use that questionnaire. Most validated scales are owned by universities and licensed for a fee. Saying you found it published online doesn't mean it's free. The database PROQOLID lists rights holders, and some of them are quite litigious  2. Only about 5–10% of patients will track at the cadence you're planning. The ones who do are not representative of your broader user base. Obsessive trackers skew your data. Users with executive dysfunction may not be able to log in, let alone complete a questionnaire. 3. Cash incentives destroy your data. If you offer a financial reward for completion, expect an avalanche of bots and fraudulent responses. Survey researchers report 80–90% fraud rates in incentivized studies. Things that seem to work better: setting group goals, an AMA with the scientists behind the study, and giving users a summary of what their data revealed. 4. Asking about symptoms can worsen them. The nocebo effect is real (for example: scale of 1-10, how itchy do you feel right now?). Paul's team designed positively-framed questions ("how well are you sleeping?") rather than deficit-focused ones ("how bad is your insomnia?") specifically to reduce iatrogenic harm. 5. Interpreting a score triggers regulation. Tracking is fine. Saying that a score of 5/5 means "severe" COULD make your app a medical device and suddenly make you beholden to a lot more regulation Resources Paul Wicks on LinkedIn — linkedin.com/in/paulwicks Paul's newsletter, ProofPoints Paul's podcast, Prove It! Paul's website, ProofStack Health https://www.meetnirvana.com/oop RAAPID Inc course on Risk Adjustment: V28, AI, and multi-million dollar settlements. Apr 7-9 Sponsor the Hardware Hackathon! Apr 17-19 in SF! PROQOLID — eprovide.mapi-trust.org — find the rights holder for any validated PRO scale PHQ-9: free, validated, widely used depression screener GAD-7: free, validated anxiety scale Timestamps 00:00 — Paul's origin story: ALS research, patient communities, and clinical trial ethics 03:00 — PatientsLikeMe and showing trial protocols to patients before locking them can actually INCREASE recruitment 11:00 — What PROs (Patient Reported Outcomes) are, why there are so many, and why none of them agree 18:00 — Pharma, payers, providers, patients – and who actually cares about PRO data 26:00 — The fifth stakeholder: scale developers. Beware for license fees and lawsuit risk 30:00 — Which patients actually track data, and what to do about everyone else 33:00 — False starts: psoriasis body maps, crab-to-clam scales, and positive framing 38:00 — The regulatory ceiling and pharmacovigilance

Join us for this episode which is a fast, honest tour through what ketamine can actually do for mental health—without the hype. We sit down with addiction psychiatrist Dr. Mark Hrymoc to unpack where the evidence is strongest, who qualifies, and why IV ketamine often produces quicker relief than nasal esketamine when depression won't budge. From treatment-resistant depression and acute suicidality to anxiety and PTSD, we dig into the protocols that matter: six-session inductions, customized maintenance, and practical strategies for measuring progress with tools like the PHQ-9.We pull back the curtain on how ketamine works at the receptor level—NMDA antagonism, downstream dopamine effects, and BDNF-driven neuroplasticity—and explain why dissociation may help some patients but isn't required for benefit. You'll hear how we screen candidates, manage blood pressure, reduce nausea, and set up sessions with eye masks, ambient music, and a nurse at the bedside so the experience is safe, focused, and grounded. We also get real about addiction risk, clarifying the difference between recreational use and a carefully monitored medical protocol, and how stable recovery timelines factor into clinical decision-making.For PTSD and anxiety, we explore pairing ketamine with psychotherapy and post-session integration to turn insights into change. We compare IV ketamine's dosing flexibility with Spravato's structured pathway, talk costs and coverage, and outline how to taper other meds only after sustained stability. Looking ahead, we spotlight promising research directions—from extending response with adjuncts to early signals for substance use disorders—and why interventional psychiatry is opening a much-needed chapter beyond traditional antidepressants. If you've wondered whether ketamine is a bridge or a destination, this conversation gives you a clear, practical map. Subscribe, share with a clinician friend, and leave a review to help others find evidence-based mental health care.To contact Dr. Grover - ammadeasy@fastmail.com

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, "Mood, Behavior, and Quality of Life in Parkinson Disease," Sneha Mantri, MD, MS, Chief Medical Officer at the Parkinson's Foundation, discusses how mood and behavioral symptoms shape the lived experience of people with Parkinson disease across the disease course. Mantri, a practicing movement disorders specialist with extensive training and experience, explains why depression and anxiety often precede motor symptoms, how these issues evolve with cognitive change, and why they remain key drivers of quality of life. Mantri reviews commonly used screening tools – including the PHQ-2/9, Geriatric Depression Scale, GAD-7, and emerging measures like the HOPE questionnaire – emphasizing their role in opening deeper clinical conversations. She also highlights Parkinson's Foundation initiatives that support both clinicians and patients, from PD Health at Home programming to team-based care models. The conversation concludes with ongoing challenges, including cultural barriers to mental health care, access limitations, and the continued need for true mental health parity in Parkinson disease management. Looking for more Movement disorder discussion? Check out the NeurologyLive® Movement disorder clinical focus page. Episode Breakdown: 1:10 – How mood and behavior symptoms shape Parkinson disease quality of life 5:30 – How conversations about mental health in Parkinson disease have evolved 9:25 – Screening tools and practical assessment strategies for mood and anxiety 13:40 – Neurology News Minute 15:50 – Foundation and community initiatives supporting mood and behavior care 19:50 – Remaining gaps, cultural barriers, and mental health parity challenges The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: CTAD Presentation Lays Insights Into Disappointing Phase 3 EVOKE Trial of GLP-1 Semaglutide in Alzheimer Disease Gene Therapy ETX101 Demonstrates Significant Effects on Seizure Reduction, Neurodevelopmental Outcomes in POLARIS Phase 1/2 Program FDA Accepts NDA for Low-Sodium Oxybate TRN-257 in Narcolepsy and Idiopathic Hypersomnia Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

In this episode, Dr. Rena Malik, MD explores the vital topic of senior mental health with Neelam Brar, founder and CEO of Total Life. Together, they address the challenges older adults face in accessing mental health care, bust common myths around therapy for seniors, and share actionable steps for fostering joy, purpose, and well-being later in life. Listeners will discover practical tips and insights to help themselves and their loved ones embrace aging as a privilege while supporting sound mental health. Become a Member to Receive Exclusive Content: renamalik.supercast.com Schedule an appointment with me: https://www.renamalikmd.com/appointments ▶️Chapters: 00:00 Introduction & Senior Mental Health 04:16 Emotional Reality of Aging 07:31 Daily Habits for Longevity 10:00 Aging as a Privilege 13:01 Tech, Scams & Social Support 16:58 Why Therapy Matters for Seniors 21:32 Results, PHQ-9 & Progress 23:42 AI Companion “Lily” & Future Care 25:59 Closing & Final Message Stay connected with Neelam Brar on social media for daily insights and updates. Don't miss out—follow her now and check out these links! INSTAGRAM - https://www.instagram.com/neelam.brar/?hl=en Let's Connect!: WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this special edition of the Counselling Tutor Podcast, Rory Lees-Oakes is joined by Dr. Liz Nicholl, Qualifications Development Manager at CPCAB, for an in-depth discussion on the newly relaunched Level 5 Diploma in Psychotherapeutic Counselling. They explore how the qualification aligns with the SCoPEd framework (specifically Column B), what it offers learners beyond Level 4, and how it supports safe, ethical, and inclusive practice in increasingly complex counselling environments. Key Takeaways: The Level 5 Diploma in Psychotherapeutic Counselling has been revised to meet SCoPEd Column B competencies, ensuring alignment with professional accreditation routes such as BACP and NCPS. The course supports a smooth transition from Level 4 to independent or senior agency practice, with a strong emphasis on ethical decision-making and professional accountability. Key learning outcomes include skills in managing complexity, recognising risk (e.g. suicide, self-harm), and developing policies and contracts for private practice. Cultural humility and awareness of social, cultural, and biological diversity are embedded through critically reflective assessment tasks and resources like the RACE Toolkit and the Churchill Framework. Outcome measures such as CORE-10 and PHQ-9 are introduced as relational tools for client assessment, with practical classroom training on how to use them ethically and effectively across modalities. Research literacy is a central theme, with learners encouraged to critically engage with peer-reviewed articles, integrate findings into practice, and consider conducting their own research to inform future client work. If you'd like to find out more about the CPCAB Level 5 Diploma in Psychotherapeutic Counselling (PC-L5), here are a few helpful links to explore: Level 5 Diploma in Psychotherapeutic Counselling (PC-L5) - CPCAB Download PC-L5 mapped to SCoPEd Column B - CPCAB Download PC-L5 Specification - CPCAB Download PC-L5 Tutor Guide - CPCAB Links and Resources Counselling Skills Academy Advanced Certificate in Counselling Supervision Basic Counselling Skills: A Student Guide Counsellor CPD Counselling Study Resource Counselling Theory in Practice: A Student Guide Counselling Tutor Training and CPD Facebook group Website Online and Telephone Counselling: A Practitioner's Guide Online and Telephone Counselling Course

Dr. Kathyrn Ridout (Kaiser Permanente Northern California) joins Dr. Dixon and Dr. Berezin to discuss implanting measurement-based care for solo and small-group practitioners. Transcript 00:33     Ridout interview 00:57     Background 02:56     Measurement-based care 04:32     Large integrated systems versus small group and solo practitioners 06:25     Evidence for the utility of measurement-based care 07:37     Communication and engagement between clinicians and patients 10:22     Edge cases that don't quite fit 13:44     Beyond just the PHQ-9 15:00     Moving beyond the measurement of just symptoms 16:04     What should providers be looking for in measurements? 17:27     Computerized adaptive testing 19:08     Artificial intelligence 22:23     When the measurement doesn't match 26:31     "Base truth" Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter.

Waddup Petty Posse! Zeus Network just dropped the official cast for Baddies USA, and you already know we had to break it down! In this episode, we go through every new face, returning favorite, and shocking addition to the lineup. Who on the cast has real beef? What storylines should we expect?  Is Zeus setting us up for the most chaotic season yet? Tune in for this week's dose of mess!  Also, we will be in Jersey City for our first Baddies Africa Reunion Watch Party! See the link below for tickets. Use code “PHQ” for $10 off your purchase! Come hang out with us this Sunday, October 19th as we watch the Reunion together!

Can any physician pivot to open a ketamine clinic, and what does it take to do it safely?In this Echo Episode, Dr. Andrea Austin continues her conversation with Dr. Kim Chan Ko, about common questions on ketamine infusions for mood disorders and chronic pain. As an ophthalmologist turned creative director for her emergency physician husband's clinic, Kim shares insights on transitioning careers, required training, and ethical considerations. She discusses building a patient-centered practice, managing risks like emergencies and addiction, and navigating business challenges while prioritizing family and values.You'll hear how they:Clarify licensing and training needs for ketamine clinics, emphasizing specialties like emergency medicine, anesthesia, and psychiatry  Address safety protocols, including emergency preparedness, patient monitoring, and addiction risk management Explore staffing requirements, from nurses to administrative roles, and marketing strategies for attracting patients Inspire physician entrepreneurs with tips on balancing business with personal life, values alignment, and avoiding burnout through intentional pivotsIf you're a physician considering ketamine therapy or entrepreneurial ventures, this episode provides honest FAQs and strategies for ethical, sustainable change.About the Guest“Action brings clarity.” – Dr. Kim Chan koDr. Kim Chan Ko is a board-certified ophthalmologist, diplomat of the American College of Lifestyle Medicine, and co-founder of Ketamine Startup, an online course teaching physicians to open ketamine infusion clinics. After years as creative director of Reset Ketamine in Palm Springs, CA, alongside her emergency physician husband, Kim stepped away from academic ophthalmology to pursue a path aligned with her passions for patient education, mentorship, and innovative healthcare. Her journey through burnout and coaching has shaped her mission to help physicians find clarity and build fulfilling careers.

Email the show at kids@mpbonline.orgHost: Dr. Morgan McLeod, Asst. Professor of Pediatrics and Internal Medicine at the University of Mississippi Medical Center.If you enjoyed listening to this podcast, please consider contributing to MPB: https://donate.mpbfoundation.org/mspb/podcastMay is Mental Health Awareness Month!Mental Health Mississippi was developed to make that process easier and to serve as a hub of information for all mental health resources available in our state.Hinds Behavioral Health Services (Region 9)specializes in outpatient community mental health services for adults, children and youth, families, elderly, and those with chemical dependencies and substance use disorders. Our mission is to provide quality, effective mental health services to the citizens of Hinds County.In a mental health crisis you need help fast. Call us and we will come to you. 601-321-2400 24/7Mobile Crisis Response Team 601-955-6381. Mobile Crisis Teams provide guidance and support to adults and children who are experiencing a mental health crisis. The teams work closely with law enforcement to reduce the likelihood that a person experiencing a mental health crisis is unnecessarily placed in a more restrictive environment, like jail, a holding facility, hospital, or inpatient treatment.Region 8 Mental Health Services provides services in five central Mississippi counties, but if you need immediate crisis assistance, contact your Mobile Crisis Response Team.PHQ-9 (Patient Health Questionnaire-9)Psychology Today: Find a Therapist, Psychologist, Counselor Hosted on Acast. See acast.com/privacy for more information.

What happens when burnout pushes physicians toward innovative, autonomous careers?In this Echo Episode, Dr. Andrea Austin continues her conversation with Dr. Kim Chan Co,  to speak about her journey from ophthalmology to launching Reset Ketamine in Palm Springs. Kim discusses supporting her husband Sam's shift from ER medicine to ketamine infusions, the clinic's focus on treatment-resistant depression, PTSD, anxiety, and chronic pain, and the business challenges of starting a private practice. She emphasizes intentional use of ketamine, collaborative care, and the importance of "set and setting" to minimize risks like emergence phenomena or addiction.You'll hear how they:Explore ketamine's evolution from ER staple to therapeutic tool for mood disorders and chronic pain ·Discuss managing patient expectations, emergencies, and addiction risks in a clinic setting  Share strategies for physicians considering their own ketamine clinics, including market research and business planning Inspire action amid burnout through small steps, clarity on values, and trying new pathsIf you're a physician facing burnout or envisioning entrepreneurial ventures in medicine, this episode offers practical advice and motivational insights for reclaiming autonomy and purpose.About the Guest:“Action brings clarity.” – Dr. Kim Chan koDr. Kim Chan Ko is a board-certified ophthalmologist, diplomat of the American College of Lifestyle Medicine, and co-founder of Ketamine Startup, an online course teaching physicians to open ketamine infusion clinics. After years as creative director of Reset Ketamine in Palm Springs, CA, alongside her emergency physician husband, Kim stepped away from academic ophthalmology to pursue a path aligned with her passions for patient education, mentorship, and innovative healthcare. Her journey through burnout and coaching has shaped her mission to help physicians find clarity and build fulfilling careers.

Dr. Joseph McCollom and Dr. Ramy Sedhom discuss precision palliative care, a new strategy that aims to align palliative care delivery with patient and caregiver needs instead of diagnosis alone. TRANSCRIPT ADN Podcast Episode 8-22 Transcript: What Is Precision Palliative Care? Rethinking a Care Delivery Problem Dr. Joseph McCollom: Hello and welcome to the ASCO Daily News Podcast. I'm your guest host, Dr. Joseph McCollom. I'm a GI medical oncologist and palliative oncologist at the Parkview Packnett Family Cancer Institute here in Fort Wayne, Indiana. So, the early benefits of palliative care for patients with cancer have been well documented, but there are challenges in terms of bandwidth to how do we provide this care, given the workforce shortages in the oncology field. So today, we'll be exploring a new opportunity known as precision palliative care, a strategy that aims to align care delivery with patient and caregiver needs and not just diagnosis alone. Joining me for this discussion is Dr. Ramy Sedhom. He is the medical director of oncology and palliative care at Penn Medicine Princeton Health and a clinical assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine. Our full disclosures are available in the transcript of this episode.  Dr. Sedhom, it's great to have you on the podcast today. Thank you so much for being here. Dr. Ramy Sedhom: Thank you, Joe. It's a pleasure to be here and lucky me to be in conversation with a colleague and friend. Yes, many of us have heard about the benefits of early palliative care. Trials have shown better quality of life, reduced symptoms, and potentially even improved survival. But as we know, the reality is translating that evidence into practice, which is really, really challenging. So Joe, both you and I know that not every patient can see palliative care, or I'd even argue should see palliative care, but that also means there are still many people with real needs who still fall through the cracks. That's why I'm really excited about today's topic, which we'll be discussing, which is precision palliative care. It's a growing shift in mindset from what's this patient's diagnosis or what's this patient's prognosis, to what matters most for this person in front of me right now and what are their individual care needs. I think, Joe, it's very exciting because the field is moving from a blanket approach to one tailored to meet people where they actually are. Dr. Joseph McCollom: Absolutely, Ramy. And I think from the early days when palliative care was kind of being introduced and trying to distinguish itself, I think one of the first models that came to clinicians' eyes was Jennifer Temel's paper in The New England Journal of Medicine in 2010. And her colleagues had really looked at early palliative care integration for patients with advanced non–small cell lung cancer. And in that era – this is a pre-immunotherapy era, very early targeted therapy era – the overall prognosis for those patients are similar to the population I serve as a GI medical oncologist, pancreatic cancer today. Typically, median overall survival of a year or less. And so, a lot of her colleagues really wanted her to track overall survival alongside quality of life and depression scores as a result of that. And it really was a landmark publication because not only did it show an improvement of quality of life, but it actually showed an improvement of overall survival. And that was really, I think, revolutionary at the time. You know, a lot of folks had talked about if this was a drug, the FDA would approve it. We all in GI oncology laugh about erlotinib, which got an FDA approval for a 2-week overall survival advantage. And so, it really kind of set the stage for a lot of us in early career who had a passion in the integration of palliative care and oncology. And I think a lot of the subsequent ASCO, NCCN, COC, Commission on Cancer, guidelines followed through with that. But I think what we realized is now we're kind of sitting center stage, there's still a lot of resource issues that if we sent a referral to palliative care for every single patient diagnosed with even an advanced cancer, we would have a significant workforce shortage issue. And so, Ramy, I was wondering if you could talk a little bit about how do we help center in on who are the right patients that are going to have the greatest benefit from a palliative care specialist intervention? Dr. Ramy Sedhom: Thanks, Joe. Great question. So you mentioned Dr. Temel's landmark 2010 trial published in the New England Journal of Medicine. And it is still a game changer in our field. The results of her work showed not only improved quality of life and mood, but I think very surprisingly at the time, a survival benefit for patients with lung cancer who had received early palliative care. That work, of course, has helped shape national guidelines, as you've shared, and it also helped define early, as within 8 weeks of diagnosis. But unfortunately, there remains a disconnect. So in clinical practice, using diagnosis or stage as the only referral trigger doesn't really match the needs that we see show up. And I think unfortunately, the other part is that approach creates a supply demand mismatch. We end up either referring more patients than palliative care teams can handle, or at the opposite extreme, we end up referring no one at all. So, I actually just wanted to quickly give, for example, two real world contrasts. So one center that I actually have friends who work in, tried as a very good quality improvement incentive, auto-refer all patients with stage IV pancreas cancer to palliative care teams. And while very well intentioned, they saw very quickly that in a two-month period, they had 30 new referrals. And on the palliative care side, there were only 15 available new patient slots. On the other hand, something that I often see in practice, is a situation where, for example, consider the case of a 90-year-old with a low-grade B-cell lymphoma. On paper, low-risk disease, but unfortunately, when you look under the microscope, this gentleman is isolated, has symptoms from his bulky adenopathy, and feels very overwhelmed by many competing illnesses. This is someone who, of course, may benefit from palliative care, but probably doesn't check the box. And I think this is where the model of precision palliative care steps in. It's not really about when was someone diagnosed or what is the prognosis or time-based criteria of their cancer, but it's really fundamentally asking the question of who needs help, what kind of help do they need, and how urgently do we need to provide this help? And I think precision palliative care really mirrors the logic and the philosophy of precision oncology. So just like we've made strides trying to match therapies to tumor biology, we also need to have the same attention and the same precision to match support to symptoms, to context of a patient situation and their caregiver, and also to their personal goals. So I think instead of a blanket referral, we really need to tailor care, the right support at the right moment for the right person to the right care teams. And I think to be more precise, there's really four core elements to allow us to do this well. So first, we really need to implement systematic screening. Let's use what we already have. Many of our centers have patient reported outcomes. The Commission on Cancer motivates us to use distress screening tools. And the EHR is there, but we do very little to flag and to surface unmet care needs. We have seen amazing work from people like Dr. Ethan Bash, who is the pioneer on patient-reported outcomes, and Dr. Ravi Parikh, who used to be my colleague at Penn, now at Emory, who show that you could use structured data and machine learning to identify some of these patient needs in real time. The second piece is after a systematic screening, we really need to build very clear referral pathways. One very good example is what the supportive care team at MD Anderson has done, of course, led by Dr. Eduardo Brera and Dr. David Huey, where they have, for example, designed condition-specific triggers. Urgent referrals, for example, to palliative care for severe symptoms, where they talk about it like a rapid response team. They will see them within 72 hours of the flag. But at the same time, if the unmet need is a caregiver distress, perhaps the social work referral is the first part of the palliative care intervention that needs to be placed. And I think this helps create both clarity and consistency but also it pays attention to that provider and availability demand mismatch. Third, I really think we need to triage smartly. As mentioned in the prior example, not every patient needs every team member of the palliative care team. Some benefit most from the behavioral health intervention. Others might benefit from chaplaincy or the clinician for symptom management. And I think aligning intensity with complexity helps us use our teams wisely. Unfortunately, the greatest barrier in all of our health care systems is time and time availability. And I think this is one strategic approach that I have not yet seen used very wisely. And fourth, I really think we need to embrace interdisciplinary care and change our healthcare systems to focus more on value. So this isn't about more consults or RVUs. I think it's really about leveraging our team strengths. Palliative care teams or supportive care teams usually are multidisciplinary in their core. They often have psychologists, social workers, sometimes they have nurse navigators. And I think all of these are really part of that engine of whole person care. But unfortunately, we still are not set up in care delivery systems that unfortunately to this day still model fee for service where the clinician or the physician visit is the only quote unquote real value add. Hopefully as our healthcare systems focus more on delivery and on value, this might help really embrace the structure to bring through the precision palliative care approach. Dr. Joseph McCollom: No, I love those points. You know, we talk frequently in the interdisciplinary team about how a social worker can spend 5 minutes doing something that I could not as a physician spend an hour doing. But does every patient need every member every time? And how do we work as a unified body to deliver that dose of palliative care, specialized palliative care to those right patients and match them? And I think that perfect analogy is in oncology as a medical oncologist, frequently I'm running complex next-generation sequencing paneling on patients' tumors, trying to find out is there a genetic weakness? Is there a susceptibility to a targeted therapy or an immunotherapy so that I can match and do that precision oncology, right patient to the right drug? Similarly, we need to continue to analyze and find these innovative ways like you've talked about, PROs, EHR flags, machine learning tools, to find those right patients and match them to the right palliative care interdisciplinary team members for them. I know we both get to work in oncology spaces and palliative and supportive spaces in our clinical practice. Share a little bit, if you could, Ramy, about what that looks like for your practice. How do you find those right patients? And how do you then intervene with that right palliative oncology dose? Dr. Ramy Sedhom: So Joe, when I first started in this space as a junior faculty, one thing became immediately clear. I think if we rely solely on physicians to identify the patients for palliative care, we're unfortunately going to be very limited by what we individually, personally observe. And I think that's what reflects the reality that many patients have real needs that go unseen. So over the past few years, I've really worked with a lot of my colleagues to really work the health system to change that. The greatest partnership I've personally had has been working with our informatics team to build a real time EHR integrated dashboard that I think helps us give us a broader view of patient needs. What we really think of as the population health perspective. Our dashboard at Penn, for example, pulls in structured data like geriatric assessment results, PHQ-4 screens, patient reported outcomes, whether or not they've been hospitalized, whether or not these hospitalizations are frequent and recurrent. And I think it's allowed us to really move from a reactive approach to one that's more proactive. So let me give you a practical example. So we have embedded in our cancer care team, psycho-oncologists. They share the same clinic space, they're right down the hall. And we actually use this shared dashboard to review weekly trends in distress scores and patient reported outcomes. And oftentimes, if they see a spike in anxiety or worsening symptoms like depression, they'll reach out to me and say, “Hey, I noticed Mrs. Smith reported feeling very anxious today. Do you think it'd be helpful if I joined you for her visit?” And I think that's how we could really use data and teamwork to offer and maximize the right support at the right time. Like many of our other healthcare systems, we also have real-time alerts for hospitalizations. And I think like Dr. Temel's most recent trial, which we'll discuss at some point, I'm sure, it's another key trigger for vulnerability. I think whenever someone's admitted or discharged, we try to coordinate with our palliative care colleagues to assess do they need follow-up and in what timeline. And we know that these are common triggers, progression of disease, hospitalizations, drops in quality-of-life. And it's actually surprisingly simple to implement once you set up the right care structures. And I think these systems don't just help patients, which is what I quickly learned. They also help us as clinicians too. Before we expanded our team, I often felt this weight, especially as someone dual trained in oncology and palliative medicine, as trying to be everything to everyone. I remember one patient in particular, a young woman with metastatic breast cancer who was scheduled for a routine pre-chemo visit with me. Unfortunately, on that day, she had a very dramatic change in function. We whisked her down to x-ray and it revealed a pretty large pathologic fracture in her femur. And suddenly what was scheduled as a 30-minute visit became a very complex conversation around prognosis, urgent need for surgery and many, many life changes. And when I looked at my Epic list, I had a full waiting room. And thankfully, because we have embedded palliative care in our team, I was able to bring in Dr. Collins, the physician who I work with closely, immediately. She spent the full hour with the patient while I was able to continue seeing other patients that morning. And I think that's what team-based care makes possible. It's not just more hands on deck but really optimizing the support the patient needs on each individual day. And I think last, we're also learning a lot from behavioral science. So many institutions like Penn, Stanford, Massachusetts General, they've experimented with a lot of really interesting prompts in the EHR. One of them, for example, is the concept of nodes or the concept of prompt questions. Like, do you think this patient would benefit from a supportive care referral? And I think these low-level nudges, in a sense, can actually really dramatically increase the uptake of palliative care because it makes what's relevant immediately salient and visible to the practicing physician. So I think the key, if I had to maybe finish off with a simple message: It's not flashy tech, it's not massive change against staffing, but it's having a local champion and it's working smarter. It's asking the questions of how can we do this better and setting up the systems to make them more sustainable. Dr. Joseph McCollom: I appreciate you talking about this because I think a lot of folks want to put the wheels on in some way and they don't know where to get started. And so I think some of the models that you've been able to create, being able to track patients, screen your population, find the right individuals, and then work within that team to be able to extend, I think when you have an embedded palliative care specialist in your clinic, they expand your practice as a medical oncologist. And so you can make that warm handoff. And that patient and that caregiver, when they view the experience, they don't view you as a medical oncologist, someone else as a palliative care specialist, they view that team approach. And they said, "The team, my cancer team took care of me." And I think we can really harness a lot of the innovative technological advancements in our EHR to be able to prompt us in this work. I know that Dr. Temel had kind of set the stage for early palliative care intervention, and you did mention her stepped palliative care trial. Where do you see some of the future opportunities as we continue to push the needle forward as oncologists and palliative care specialists? What do you see as being the next step? Dr. Ramy Sedhom: So for those who are not familiar with the stepped palliative care trial, again, work by Dr. Temel, I think it's really important to explain not just the study itself, but I think more importantly, what it's representing for the future of our field. First, I really want to acknowledge Dr. Temel, who is a trailblazer in palliative oncology. Her work has not only shaped how we think about timing and delivery, but really about the value of supportive care. And more importantly, I think for all the young trainees listening, she had shown that rigorous randomized trials in palliative care are possible and meaningful. And I think for me, one quick learning point is that you could be an oncologist and lead this impactful research. And she's inspired many and many of us. Now let's quickly transition to her study. So in this trial, the stepped palliative care trial, patients with advanced lung cancer were randomized into two groups. One group followed the model from her landmark 2010 New England Journal of Medicine paper, which was structured monthly palliative care visits, again, within eight weeks of diagnosis. The second group, which is in this study, the intervention or the stepped palliative care group, received a single early palliative care visit. Think of this as a meet and greet. And then care was actually stepped up. If one of three clinical triggers happened. One, a decline in patient reported quality of life as measured by PROs. Two, disease progression, or three, hospitalization. And the findings which were presented at ASCO 2024 were striking. Clinical outcomes, very similar between the two groups. And this included quality-of-life, end-of-life communication, and resource use. But I think the take-home point is that the number of palliative care visits in the stepped group was significantly lower. So in other words, same impact and fewer visits. This was a very elegant example of how we can model precision palliative care, right sizing patient care based on patient need. So where do we go from here? I think if we want this model to take root nationally, we really need to pull on three key levers: healthcare systems, healthcare payment, and healthcare culture. So from a system alignment, unfortunately, as mentioned too often, the solution to gaps in palliative care is we need more clinicians. And while yes, that's partly true, it's actually not the full picture. I think what we first need to do and what's more likely to be achieved is to develop systems that focus on building the infrastructure that maximizes the reach of our existing care teams. So this means investing in nurse navigation, real-time dashboards with patient-reported outcomes and EHR flags, and again, matching triage protocols where intensity matches complexity. And the goal, as mentioned, isn't to maximize consults, but to really maximize deployment of expertise based on need. The second piece is, of course, we need payment reform. So the stepped palliative care model only works when it allows continuous patient engagement. But unfortunately, current pay models don't reward or incentivize that. In fact, electronic PROs require a very high upfront financial investment and ongoing clinician time with little to no reimbursement. Imagine if we offered bundled payments or value-based incentives for teams that integrated PROs. Or imagine if we reimbursed palliative care based on impact or infrastructure instead of just fee-for-service volume. There is a lot of clear evidence that tele-palliative care is effective. In fact, it was the Plenary at ASCO 2024. Yet we're still battling these conversations around inconsistent reimbursement, and we're always waiting on whether or not telehealth waivers are gonna continue. So I think most importantly is we really need to recognize the broader scope of what palliative care offers, which is caregiver support, improving navigation, coordinating very complex transitions. To me, and what I've always prioritized as a champion at Penn, is that palliative care is not a nice to have, and neither are all of these infrastructures, but they're really essential to whole person care, and they need to be financially supported. And last, we really need a culture shift. We need to change from how palliative care is perceived, and it can't be something other. It can't be something outside of oncology, but it really needs to be embraced as this is part of cancer care itself. I often see hesitancy from many oncologists about introducing palliative care early. But it doesn't need to be a dramatic shift. I think small changes in language, how we introduce the palliative care team, and co-management models can really go a very long way in normalizing this part of patient care. And I'm particularly encouraged, Joe, by one particular innovation in this space, which is really the growth of many startups. And one startup, for example, is Thyme Care, where I've seen them working with many, many private practices across the country, alongside partnerships with payers to really build tech-enabled navigation that tries to basically maximize triage support with electronic PROs. And to me, I really think these models can help scale access without overwhelming current care teams. So precision palliative care, Joe, in summary, I think should be flexible, scalable, and really needs to align based on what patients need. Dr. Joseph McCollom: No, I really appreciate, Ramy, you talking about that it really takes a village to get oncology care in both a competent and a compassionate way. And we need buy-in champions at all levels: the system level, the administrative level, the policy level, the tech level. And we need to change culture. I kind of want to just get your final impressions and also make sure that we make our listeners aware of our article. We should be able to have this in the show notes here as well to find additional tools and resources, all the studies that were discussed in today's episode. But, Ramy, what are some of your kind of final takeaways and conclusions? Dr. Ramy Sedhom: Before we wrap up, I just want to make sure we highlight a very exciting opportunity for residents considering a future in oncology and palliative medicine. Thanks to the leadership of Dr. Jamie Von Roen, who truly championed this cause, ASCO and the ABIM (American Board of Internal Medicine) have partnered to create the first truly integrated palliative care oncology fellowship. Trainees can now double board in just two years or triple board in three with palliative care, oncology, and hematology. And I think, Joe, as you and I both know, it's incredibly rewarding and meaningful to work at this intersection. To close our message, if there's one message I think listeners should carry with them, it's that palliative care is about helping people live as well as possible for as long as possible. And precision palliative care simply helps us do that better. We need to really develop systems that tailor support to individual need, value, and individual goals. Just like our colleagues in precision oncology mentioned, getting the right care to the right patient at the right time, and I would add in the right way. For those who want to learn more, I encourage you to read our full article in JCO, which is “Precision Palliative Care As a Pragmatic Solution for a Care Delivery Problem.” Joe, thank you so, so much for this thoughtful conversation and for your leadership in our field. And thank you to everyone for listening. Thank you all for being champions of this essential part of cancer care. If you haven't yet joined the ASCO Palliative Care Communities of Practice, membership is free, and we'd love to have you. Dr. Joseph McCollom: Thank you, Ramy, not only for sharing your insights today, but the pioneering work that you have done in our field. You are truly an inspiration to me in clinical practice, and it is an honor to call you both a colleague and friend.  And thank you for our listeners for joining us today. If you value the insights that you've heard on the ASCO Daily News Podcast, please subscribe, rate, and review wherever you get your podcasts. Thanks again. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:   Dr. Joseph McCollom @realbowtiedoc Dr. Ramy Sedhom @ramsedhom Follow ASCO on social media:   @ASCO on X (formerly Twitter) ASCO on Bluesky  ASCO on Facebook   ASCO on LinkedIn   Disclaimer: Dr. Joseph McCollom: No relationships to disclose Dr. Ramy Sedhom: No relationships to disclose

Episode 199: Essential Screenings for Young AdultsDr. Lopez presents the most important screening tests for young adults. Dr. Arreaza adds some input on screening for depression and anxiety. Written by Alejandra Lopez, MD. Edits by Hector Arreaza, MD. Rio Bravo Family Medicine Residency Program. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Lopez: Screening is testing done to help identify disease in a person or population that typically appears healthy. Our goal as clinicians is to see which children are at increased risk of disease and will merit additional testing. For clinicians, testing should be both easy to perform and interpret. Now let's talk about prevention in young adults.Dr. Arreaza: I can see it is important to talk about young adults because that population may be very hesitant to go to the doctor, in general. Tell us more about it.Dr. Lopez: We all know that early detection and prevention are key, but many young adults skip routine check-ups. Why is that? Sometimes it's lack of awareness, fear, or just not knowing where to start. That's why today, we'll focus on four key screenings that every adolescent and young adult should know about.The Annual Physical ExamDr. Arreaza: I'm excited to talk about it. Many young adults only see a doctor when they're sick, but screenings help catch issues early, sometimes before symptoms even appear. Tell us about the annual wellness exams and why they matter.Dr. Lopez: Let's start with the basics—annual wellness exams. Many young people don't feel the need to see a doctor if they're feeling fine. So, these check-ups are important because many serious health conditions start silently, meaning no symptoms at first. Dr. Arreaza: What do we look for in an annual exam?Dr. Lopez: An annual check-up:· It is important to track growth and development (especially important for adolescents)It also helps monitor blood pressure, weight, and BMI to help find out who is at risk for elevated or low BP, underweight or overweight/obesity, by analyzing both weight and body mass index.· Discuss lifestyle habits like diet, exercise, and sleep· Evaluate whether you are up to date on vaccinations or due for age-appropriate vaccines.· Address any mental health concernsIt's also a great opportunity for young people to establish a relationship with a provider they trust. This makes it easier to discuss sensitive topics like sexual health or mental health.Dr. Arreaza: So, you say that the annual physical exam helps identify all these issues early, and at the same time, you establish a relationship of trust with a doctor who you may need at any time. STI ScreeningDr. Arreaza: That brings us to our second key screening: testing for sexually transmitted infections (STIs). There are many STIs. Let's focus on gonorrhea, chlamydia, syphilis, and HIV. Dr. Lopez, can you breakit  down for us? Who needs STI screening, and why is it so important?Dr. Lopez: Absolutely. The CDC recommends that ALL sexually active women under age 25 get screened for chlamydia and gonorrhea annually. HIV testing should also be done at least once for all young adults and annually for those at higher risk. Why is this the case? Because Many STIs have no symptoms, but untreated infections can lead to serious complications like infertility or pelvic inflammatory disease (PID) in women. The good news is that these infections are easily treatable if caught early. If caught later in life, then women and men alike are at risk for worse conditions. Dr. Arreaza: Let's talk about how do we do it?Dr. Lopez: STI screening is simple:· For chlamydia and gonorrhea, it's usually a urine test or a vaginal/cervical/oral swab.· For HIV, it's a quick blood test or even an oral swab.Many young adults avoid testing because of fear, stigma, or concerns about privacy, but most clinics offer confidential or even anonymous testing. Doctors do not share any information regarding the minor or young adult or any patient for that matter. AND if we are requested to share any information with others- then it is our obligation as doctors to ALWAYS ASK THE PATIENT before sharing ANY health information with third parties/other entitiesDr. Arreaza: And that includes parents of minors. Doctors are not allowed to discuss STI test results with parents of minors unless they are authorized by the patient or if the patient is in danger, for example, if this is a result of sexual abuse.Mental Health ScreeningsDr. Arreaza: Now, let's talk about something that's just as important as physical health—mental health. Depression and anxiety are very common in young people, but many don't seek help. How do doctors screen for depression?Dr. Lopez: Screening for depression is now a standard part of primary care. The most commonly used tool is the PHQ-9 questionnaire, which asks about:· Mood changes (sadness, hopelessness)· Loss of interest in activities· Sleep disturbances· Changes in appetite· Difficulty concentratingA score on this test can help determine whether someone is at risk of depression and needs further evaluation or support.Dr. Arreaza: And why should we screen for depression?Dr. Lopez: Because early treatment makes a huge difference. Depression can affect school, work, relationships, and even physical health. But with therapy, lifestyle changes, and sometimes medication, people can and do recover.I always tell young adults: Mental health is just as important as physical health. Seeking help is a sign of strength, not weakness.Dr. Arreaza: This is a USPSTF recommendation GRADE B. We are encouraged to screen adults, including pregnant and postpartum women, as well as older adults.HPV Screening & VaccinationDr. Lopez: Dr. Arreaza, finally, let's talk about HPV—one of the most preventable causes of cancer. The human papillomavirus (HPV) is the most common STI worldwide, and it's responsible for almost all cases of cervical cancer, as well as throat, anal, and penile cancers. The good news? The HPV vaccine is over 90% effective at preventing these cancers. Dr. Arreaza: In fact, from 2015 to 2018, U.S. women ages 14 to 19 experienced an 88% decrease in HPV-related disease. That's a direct result of the vaccine's effectiveness.Dr. Lopez: It's recommended for:· All boys and girls, starting at the age of 9. ACIP gave new recommendations for use of a 2-dose schedule for girls and boys who initiate the vaccination series at ages 9-14 years. Three doses remain recommended for persons who start HPV vaccination at ages 15-26 years and for immunocompromised persons.· Catch-up vaccination is recommended for people up to age 26 (and in some cases, up to 45 with provider recommendation)Dr. Arreaza: And what about screening for HPV? How do we screen?Dr. Lopez: Great question, Dr. Arreaza. Pap smears start at age 21, for all women regardless of sexual activity, and are repeated every 3-5 years depending on HPV testing. Many people think Pap smears check for STIs, but they actually look for abnormal cervical cells that could lead to cancer. HPV vaccination plus routine screening means cervical cancer is one of the most preventable cancers today!Closing Thoughts & Call to ActionDr. Arreaza: That wraps up today's discussion on essential health screenings for young adults! Dr. Lopez, any final take-home messages?Guest: My biggest message is don't wait until something is wrong to see a doctor. Preventative care is simple, quick, and can save lives.If you're between the ages of 13-26, here's what you should do:-Get an annual wellness exam-Get tested for STIs if sexually active-Check in on your mental health and talk to someone if you need support-Get the HPV vaccine if you haven't already and follow up on screeningTaking these small steps today leads to better health for years to come!Host: That's fantastic! Dr. Lopez. I hope all our primary care providers can take these easy steps to keep our young community healthy. If you found this episode helpful, share it with a friend, and don't forget to subscribe to our podcast for more practical health discussions.Dr. Lopez: Until next time—thanks for chiming in, medical community. Take care and take charge of your health!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources. U.S. Centers for Disease Control and Prevention, CDC.gov, https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm, accessed on June 26, 2025.Recommendation: Anxiety Disorders in Adults: Screening, United States Preventive Services Taskforce, June 20, 2023, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening, accessed on June 26, 2025.Recommendation: Depression and Suicide Risk in Adults: Screening, United States Preventive Services Taskforce, June 20, 2023, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-adults, accessed on June 26, 2025.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Skip the Queue is brought to you by Rubber Cheese, a digital agency that builds remarkable systems and websites for attractions that helps them increase their visitor numbers. Your host is Paul Marden.If you like what you hear, you can subscribe on iTunes, Spotify, and all the usual channels by searching Skip the Queue or visit our website SkiptheQueue.fm.If you've enjoyed this podcast, please leave us a five star review, it really helps others find us. And remember to follow us on Twitter  or Bluesky for your chance to win the books that have been mentioned in this podcast.Competition ends on 9th July 2025. The winner will be contacted via Bluesky. Show references: Matthew Tanner, Vice President of AIM and Independent Consultant https://aim-museums.co.uk/Richard Morsley, CEO of Chatham Historic Dockyardhttps://thedockyard.co.uk/Hannah Prowse, CEO, Portsmouth Historic Quarterhttps://portsmouthhq.org/Dominic Jones, CEO Mary Rose Trusthttps://maryrose.org/Andrew Baines, Executive Director, Museum Operations, National Museum of the Royal Navyhttps://www.nmrn.org.uk/ Transcriptions: Paul Marden: Welcome to Skip the Queue. The podcast of people working in and working with visitor attractions, and today you join me in Portsmouth Historic Dockyard. I am actually in the shadow of HMS Victory at the moment, right next door to the Mary Rose. And I'm at the Association of Independent Museum's annual conference, and it is Wednesday night, and we're just about to enjoy the conference dinner. We've been told by Dominic Jones, CEO of Mary Rose, to expect lots of surprises and unexpected events throughout the meal, which I understand is a walking meal where we'll partake of our food and drink as we're wandering around the museum itself, moving course to course around different parts of the museum. So that sounds very exciting. Paul Marden:  Today's episode, I'm going to be joined by a I don't know what the collective noun is, for a group of Maritime Museum senior leaders, but that's what they are, and we're going to be talking about collaboration within and between museums, especially museums within the maritime sector. Is this a subject that we've talked about a lot previously? I know we've had Dominic Jones before as our number one most listened episode talking about collaboration in the sector, but it's a subject I think is really worthwhile talking about. Paul Marden: Understanding how museums work together, how they can stretch their resources, increase their reach by working together and achieving greater things than they can do individually. I do need to apologise to you, because it's been a few weeks since our last episode, and there's been lots going on in Rubber Cheese HQ, we have recently become part of a larger organisation, Crowd Convert, along with our new sister organisation, the ticketing company, Merac.Paul Marden:  So there's been lots of work for me and Andy Povey, my partner in crime, as we merge the two businesses together. Hence why there's been a little bit of a lapse between episodes. But the good news is we've got tonight's episode. We've got one more episode where I'll be heading down to Bristol, and I'll talk a little bit more about that later on, and then we're going to take our usual summer hiatus before we start the next season. So two more episodes to go, and I'm really excited. Paul Marden:  Without further ado, I think it's time for us to meet our guests tonight. Let me welcome our guests for this evening. Matthew Tanner, the Vice President of AIM and an Independent Consultant within the museum sector. You've also got a role within international museums as well. Matthew, remind me what that was.Matthew Tanner: That's right, I was president of the International Congress of Maritime Museums.Paul Marden: And that will be relevant later. I'm sure everyone will hear. Richard Morsley, CEO of Chatham Historic Dockyard Trust. I've got Hannah Prowse with me, the CEO of Portsmouth Historic Quarter, the inimitable chief cheerleader for Skip the Queue Dominic Jones, CEO of Mary Rose Trust.Dominic Jones: Great to be back.Paul Marden: I expect this to be the number one episode because, you know, it's got to knock your previous episode off the hit list.Dominic Jones: Listen with guests like this. It's going to be the number one. You've got the big hitters, and you've even got one more to go. This is gonna be incredible.Paul Marden:  Exactly. And I've got Andrew Baines, the Executive Director Museum Operations at the National Museum of the Royal Navy. That's quite a title.Dominic Jones: He loves a title that's a lot shorter than the last.Paul Marden: Okay, so we always have icebreakers. And actually, it must be said, listeners, you, unless you're watching the YouTube, we've got the the perfect icebreaker because we've started on Prosecco already. So I'm feeling pretty lubed up. Cheers. So icebreakers, and I'm going to be fair to you, I'm not going to pick on you individually this time, which is what I would normally do with my victims. I'm going to ask you, and you can chime in when you feel you've got the right answer. So first of all, I'd like to hear what the best concert or festival is that you've been to previously.Hannah Prowse: That's really easy for me, as the proud owner of two teenage daughters, I went Tay Tay was Slay. Slay. It was amazing. Three hours of just sheer performative genius and oh my god, that girl stamina. It was just insane. So yeah, it's got to be Tay Tay.Paul Marden: Excellent. That's Taylor Swift. For those of you that aren't aware and down with the kids, if you could live in another country for a year, what would Dominic Jones: We not all answer the gig. I've been thinking of a gig. Well, I was waiting. Do we not all answer one, Rich has got a gig. I mean, you can't just give it to Hannah. Richard, come in with your gig.Richard Morsley: Thank you. So I can't say it's the best ever, but. It was pretty damn awesome. I went to see pulp at the O2 on Saturday night. They were amazing. Are they still bringing it? They were amazing. Incredible. Transport me back.Matthew Tanner:  Members mentioned the Mary Rose song. We had this.Dominic Jones: Oh, come on, Matthew, come on. That was brilliant. That was special. I mean, for me, I'm not allowed to talk about it. It's probably end ups. But you know, we're not allowed to talk you know, we're not allowed to talk about other than here. But I'm taking my kids, spoiler alert, if you're listening to see Shawn Mendes in the summer. So that will be my new favourite gig, because it's the first gig for my kids. So I'm very excited about that. That's amazing. Amazing. Andrew, any gigs?Andrew Baines: It has to be Blondie, the amazing. Glen Beck writing 2019, amazing.Dominic Jones:  Can you get any cooler? This is going to be the number one episode, I can tell.Paul Marden:  Okay, let's go with number two. If you could live in another country for a year, which one would you choose? Hannah Prowse: Morocco. Paul Marden: Really? Oh, so you're completely comfortable with the heat. As I'm wilting next.Hannah Prowse: Completely comfortable. I grew up in the Middle East, my as an expat brat, so I'm really happy out in the heat. I just love the culture, the art, the landscape, the food, the prices, yeah, Morocco. For me, I thinkMatthew Tanner: I've been doing quite a lot of work recently in Hong Kong. Oh, wow. It's this amazing mix of East and West together. There's China, but where everybody speaks English, which is fantastic.Dominic Jones:  I lived in Hong Kong for a few years, and absolutely loved it. So I do that. But I think if I could choose somewhere to live, it's a it's a bit of cheating answer, because the country's America, but the place is Hawaii, because I think I'm meant for Hawaii. I think I've got that sort of style with how I dress, not today, because you are but you can get away with it. We're hosting, so. Paul Marden:  Last one hands up, if you haven't dived before, D with Dom.Dominic Jones: But all of your listeners can come Dive the 4d at the Mary Rose in Portsmouth Historic Dockyard, as well as the other amazing things you can do here with our friends and National Museum of Portsmouth Historic Quarter, he will cut this bit out.Paul Marden:  Yeah, there will be a little bit of strict editing going on. And that's fair. So we want to talk a little bit today about collaboration within the Maritime Museum collective as we've got. I was saying on the intro, I don't actually know what the collective noun is for a group of Maritime Museum leaders, a wave?Hannah Prowse: A desperation?Paul Marden: Let's start with we've talked previously. I know on your episode with Kelly, you talked about collaboration here in the dockyard, but I think it's really important to talk a little bit about how Mary Rose, Portsmouth Historic Dockyard and the National Museum of the Royal Navy all work together. So talk a little bit for listeners that don't know about the collaboration that you've all got going. Dominic Jones:  We've got a wonderful thing going on, and obviously Hannah and Andrew will jump in. But we've got this great site, which is Portsmouth Historic Dockyard. We've got Portsmouth Historic Quarter that sort of curates, runs, owns the site, and I'll let Hannah come into that. We've got the Mary Rose, which is my favourite, amazing museum, and then we've got all of the museums and ships to the National Museum of the Royal Navy. But do you want to go first, Hannah, and talk about sort of what is Portsmouth Historic Quarter and the dockyard to you? Hannah Prowse:  Yeah, so at Portsmouth Historic Quarter, we are the landlords of the site, and ultimately have custody of this and pretty hard over on the other side of the water. And it's our job to curate the space, make sure it's accessible to all and make it the most spectacular destination that it can be. Where this point of debate interest and opportunity is around the destination versus attraction debate. So obviously, my partners here run amazing attractions, and it's my job to cite those attractions in the best destination that it can possibly be.Matthew Tanner: To turn it into a magnet that drawsDominic Jones: And the infrastructure. I don't know whether Hannah's mentioned it. She normally mentions it every five seconds. Have you been to the new toilets? Matthew, have you been to these new toilets?Paul Marden: Let's be honest, the highlight of a museum. Richard Morsley: Yeah, get that wrong. We're in trouble.Hannah Prowse: It's very important. Richard Morsley: But all of the amazing ships and museums and you have incredible.Paul Marden: It's a real draw, isn't it? And you've got quite a big estate, so you you've got some on the other side of the dockyard behind you with boat trips that we take you over.Andrew Baines:  Absolutely. So we run Victor here and warrior and 33 on the other side of the hub with the Royal Navy submarine museum explosion working in partnership with BHQ. So a really close collaboration to make it as easy as possible for people to get onto this site and enjoy the heritage that we are joint custodians of. Paul Marden:  Yeah, absolutely. It's amazing. So we're talking a little bit about museums collaborating together, which really is the essence of what we're here for conference, isn't it? I remember when we had the keynote this morning, we were talking about how important it is for everybody to come together. There's no egos here. Everyone's sharing the good stuff. And it was brilliant as well. Given that you're all maritime museums, is it more important for you to differentiate yourselves from one another and compete, or is it more important for you to collaborate?Richard Morsley: Well, from my perspective, it's there is certainly not competitive. I think there's sufficient, I was sufficient distance, I think, between the the attractions for that to be the case, and I think the fact we're all standing here today with a glass of wine in hand, with smiles on our face kind of says, says a lot, actually, in terms of the collaboration within the sector. And as you say that the the AIM conference today that for me, is right, right at the heart of it, it's how we as an independent museum sector, all come together, and we share our knowledge, we share our best practice, and once a year, we have this kind of amazing celebration of these incredible organisations and incredible people coming together and having a wonderful couple of days. Matthew Tanner: But if I could step in there, it's not just the wine, is it rum, perhaps. The maritime sector in particular is one that is is so closely knit and collected by the sea, really. So in the international context, with the International Congress, is about 120 museums. around the world that come together every two years into the fantastic Congress meetings, the connections between these people have come from 1000s of miles away so strong, it's actually joy and reminds us of why we are so excited about the maritime.Paul Marden: I saw you on LinkedIn last year. I think it was you had Mystic Seaport here, didn't you?Dominic Jones: We did and we've had Australia. We've had so many. It all came from the ICM conference I went with and we had such a good time, didn't we saw Richard there. We saw Matthew, and it was just brilliant. And there's pinch yourself moments where you're with museums that are incredible, and then afterwards they ring you and ask you for advice. I'm thinking like there's a lady from France ringing me for advice. I mean, what's that about? I passed her to Andrew.Hannah Prowse: I think also from a leadership perspective, a lot of people say that, you know, being a CEO is the loneliest job in the world, but actually, if you can reach out and have that network of people who actually are going through the same stuff that you're going through, and understand the sector you're working in. It's really, really great. So if I'm having a rubbish day, Dom and I will frequently meet down in the gardens outside between our two offices with a beer or an ice cream and just go ah at each other. And that's really important to be able to do.Dominic Jones: And Hannah doesn't laugh when I have a crisis. I mean, she did it once. She did it and it hurt my feelings.Hannah Prowse: It was really funny.Dominic Jones:  Well, laughter, Dominic, Hannah Prowse: You needed. You needed to be made. You did. You did. But you know, and Richard and I have supported each other, and occasionally.Richard Morsley: You know, you're incredibly helpful when we're going through a recruitment process recently.Hannah Prowse: Came and sat in on his interview.Richard Morsley: We were rogue. Hannah Prowse: We were so bad, we should never be allowed to interview today. Paul Marden:  I bet you were just there taking a list of, yeah, they're quite good. I'm not going to agree to that one.Hannah Prowse: No, it was, it was great, and it's lovely to have other people who are going through the same stuff as you that you can lean on. Richard Morsley: Yeah, absolutely.Dominic Jones: Incredible. It's such an important sector, as Matthew said, and we are close, the water doesn't divide us. It makes us it makes us stronger.Matthew Tanner: Indeed. And recently, of course, there's increasing concern about the state of the marine environment, and maritime museums are having to take on that burden as well, to actually express to our puppets. It's not just about the ships and about the great stories. It's also about the sea. It's in excess, and we need to look after it. Paul Marden: Yeah, it's not just a view backwards to the past. It's around how you take that and use that as a model to go forward. Matthew Tanner: Last week, the new David Attenborough piece about the ocean 26 marathon museums around the world, simultaneously broadcasting to their local audiences. Dominic Jones: And it was phenomenal. It was such a good film. It was so popular, and the fact that we, as the Mary Rose, could host it thanks to being part of ICM, was just incredible. Have you seen it? Paul Marden:  I've not seen Dominic Jones: It's coming to Disney+, any day now, he's always first to know it's on. There you go. So watch it there. It's so good. Paul Marden: That's amazing. So you mentioned Disney, so that's a kind of an outside collaboration. Let's talk a little bit. And this is a this is a rubbish segue, by the way. Let's talk a little bit about collaborating outside of the sector itself, maybe perhaps with third party rights holders, because I know that you're quite pleased with your Lego exhibition at the moment.Richard Morsley: I was actually going to jump in there. Dominic, because you've got to be careful what you post on LinkedIn. There's no such thing as I don't know friends Exactly. Really.Dominic Jones: I was delighted if anyone was to steal it from us, I was delighted it was you. Richard Morsley: And it's been an amazing exhibition for us. It's bringing bringing Lego into the Historic Dockyard Chatham. I think one of the one of the things that we sometimes lack is that that thing that's kind of truly iconic, that the place is iconic, the site is incredible, but we don't have that household name. We don't have a Mary Rose. We don't have a victory. So actually working in partnership, we might get there later. We'll see how the conversation, but yeah, how we work with third parties, how we use third party IP and bring that in through exhibitions, through programming. It's really important to us. So working at a Lego brick Rex exhibition, an exhibition that really is a museum exhibition, but also tells the story of three Chatham ships through Lego, it's absolutely perfect for us, and it's performed wonderfully. It's done everything that we would have hoped it would be. Dominic Jones: I'm bringing the kids in the summer. I love Chatham genuinely. I know he stole the thing from LinkedIn, but I love Chatham. So I'll be there. I'll be there. I'll spend money in the shop as well.Richard Morsley: Buy a book. Yeah.Paul Marden: Can we buy Lego? Richard Morsley:  Of course you can buy Lego. Paul Marden: So this is a this is a magnet. It is sucking the kids into you, but I bet you're seeing something amazing as they interpret the world that they've seen around them at the museum in the Lego that they can play with.Richard Morsley: Of some of some of the models that are created off the back of the exhibition by these children is remind and adults actually, but mainly, mainly the families are amazing, but and you feel awful at the end of the day to painstakingly take them apart.Richard Morsley: Where is my model?Dominic Jones: So we went to see it in the Vasa, which is where he stole the idea from. And I decided to, sneakily, when they were doing that, take a Charles model that was really good and remodel it to look like the Mary Rose, and then post a picture and say, I've just built the Mary Rose. I didn't build the Mary Rose. Some Swedish person bought the Mary Rose. I just added the flags. You get what you say. Hannah Prowse: We've been lucky enough to be working with the Lloyds register foundation this year, and we've had this brilliant she sees exhibition in boathouse four, which is rewriting women into maritime history. So the concept came from Lloyd's Register, which was, you know, the untold stories of women in maritime working with brilliant photographers and textile designers to tell their stories. And they approached me and said, "Can we bring this into the dockyard?" And we said, "Yes, but we'd really love to make it more local." And they were an amazing partner. And actually, what we have in boathouse for is this phenomenal exhibition telling the stories of the women here in the dockyard.Richard Morsley: And then going back to that point about collaboration, not competition, that exhibition, then comes to Chatham from February next year, but telling, telling Chatham stories instead of. Hannah Prowse:  Yeah, Richard came to see it here and has gone, "Oh, I love what you've done with this. Okay, we can we can enhance, we can twist it." So, you know, I've hoped he's going to take our ideas and what we do with Lloyd's and make it a million times better.Richard Morsley: It's going to be an amazing space.Dominic Jones: Richard just looks at LinkedIn and gets everyone's ideas.Andrew Baines: I think one of the exciting things is those collaborations that people will be surprised by as well. So this summer, once you've obviously come to Portsmouth Historic Dockyard and experience the joys of that, and then you've called off on Chatham and another day to see what they've got there, you can go off to London Zoo, and we are working in partnership with London Zoo, and we have a colony of Death Watch beetle on display. Paul Marden:  Oh, wonderful. I mean, can you actually hear them? Dominic Jones: Not necessarily the most exciting.Andrew Baines: I'll grant you. But you know, we've got a Chelsea gold medal on in the National Museum of the Royal Navy for collaboration with the Woodlands Foundation, looking at Sudden Oak death. And we've got an exhibition with ZSL at London Zoo, which I don't think anybody comes to a National Maritime Museum or an NMRN National Museum The Royal Navy, or PHQ, PhD, and expects to bump into tiny little animals, no, butDominic Jones: I love that, and it's such an important story, the story of Victor. I mean, look, you're both of you, because Matthew's involved with Victor as well. Your victory preservation and what you're doing is incredible. And the fact you can tell that story, it's LSL, I love that.Andrew Baines: Yeah. And we're actually able to feed back into the sector. And one of the nice things is, we know we talk about working collaboratively, but if you look at the victory project, for example, our project conservator came down the road from Chatham, equally, which you one of.Richard Morsley: Our your collections manager.Paul Marden: So it's a small pool and you're recycling.Andrew Baines: Progression and being people in develop and feed them on.Matthew Tanner:  The open mindedness, yeah, taking and connecting from all over, all over the world, when I was working with for the SS Great Britain, which is the preserved, we know, great iron steam chip, preserved as as he saw her, preserved in a very, very dry environment. We'll take technology for that we found in the Netherlands in a certain seeds factory where they had to, they had to package up their seeds in very, very low humidity environments.Paul Marden:  Yes, otherwise you're gonna get some sprouting going on. Matthew Tanner:   Exactly. That's right. And that's the technology, which we then borrowed to preserve a great historic ship. Paul Marden: I love that. Dominic Jones:  And SS Great Britain is amazing, by the way you did such a good job there. It's one of my favourite places to visit. So I love that.Paul Marden:  I've got a confession to make. I'm a Somerset boy, and I've never been.Dominic Jones: Have you been to yoga list? Oh yeah, yeah. I was gonna say.Paul Marden: Yeah. I am meeting Sam Mullins at the SS Great Britain next next week for our final episode of the season. Matthew Tanner: There you go.Dominic Jones: And you could go to the where they made the sale. What's the old court canvas or Corker Canvas is out there as well. There's so many amazing places down that neck of the woods. It's so good.Paul Marden: Quick segue. Let's talk. Let's step away from collaboration, or only very lightly, highlights of today, what was your highlight talk or thing that you've seen?Richard Morsley: I think for me, it really was that focus on community and engagement in our places and the importance of our institutions in the places that we're working. So the highlight, absolutely, for me, opening this morning was the children's choir as a result of the community work that the Mary Rose trust have been leading, working.Dominic Jones:  Working. So good. Richard Morsley: Yeah, fabulous. Paul Marden:  Absolutely. Matthew Tanner: There's an important point here about about historic ships which sometimes get kind of positioned or landed by developers alongside in some ports, as if that would decorate a landscape. Ships actually have places. Yes, they are about they are connected to the land. They're not just ephemeral. So each of these ships that are here in Portsmouth and the others we've talked about actually have roots in their home ports and the people and the communities that they served. They may well have roots 1000s of miles across the ocean as well, makes them so exciting, but it's a sense of place for a ship. Hannah Prowse: So I think that all of the speakers were obviously phenomenal.Dominic Jones: And including yourself, you were very good.Hannah Prowse: Thank you. But for me, this is a slightly random one, but I always love seeing a group of people coming in and watching how they move in the space. I love seeing how people interact with the buildings, with the liminal spaces, and where they have where they run headlong into something, where they have threshold anxiety. So when you have a condensed group of people, it's something like the AIM Conference, and then they have points that they have to move around to for the breakout sessions. But then watching where their eyes are drawn, watching where they choose to go, and watching how people interact with the heritage environment I find really fascinating. Paul Marden: Is it like flocks of birds? What are moving around in a space? Hannah Prowse: Exactly. Yeah.Paul Marden: I say, this morning, when I arrived, I immediately joined a queue. I had no idea what the queue was, and I stood there for two minutes.Dominic Jones: I love people in the joint queues, we normally try and sell you things.Paul Marden: The person in front of me, and I said, "What we actually queuing for?" Oh, it's the coffee table. Oh, I don't need coffee. See you later. Yes.Dominic Jones: So your favourite bit was the queue. Paul Marden: My favourite..Dominic Jones: That's because you're gonna plug Skip the Queue. I love it.Dominic Jones: My favourite moment was how you divided the conference on a generational boundary by talking about Kojak.Dominic Jones: Kojak? Yes, it was a gamble, because it was an old film, and I'll tell you where I saw it. I saw it on TV, and the Mary Rose have got it in their archives. So I said, Is there any way I could get this to introduce me? And they all thought I was crazy, but I think it worked. But my favorite bit, actually, was just after that, when we were standing up there and welcoming everyone to the conference. Because for four years, we've been talking about doing this for three years. We've been arranging it for two years. It was actually real, and then the last year has been really scary. So for us to actually pull it off with our partners, with the National Museum of the Royal Navy, with Portsmouth Historic quarter, with all of our friends here, was probably the proudest moment for me. So for me, I loved it. And I'm not going to lie, when the children were singing, I was a little bit emotional, because I was thinking, this is actually happened. This is happening. So I love that, and I love tonight. Tonight's going to be amazing. Skip the queue outside Dive, the Mary Rose 4d come and visit. He won't edit that out. He won't edit that out. He can't keep editing Dive, The Mary Rose.Dominic Jones: Andrew, what's his favourite? Andrew Baines: Oh yes. Well, I think it was the kids this morning, just for that reminder when you're in the midst of budgets and visitor figures and ticket income and development agreements, and why is my ship falling apart quicker than I thought it was going to fall apart and all those kind of things actually just taking that brief moment to see such joy and enthusiasm for the next generation. Yeah, here directly connected to our collections and that we are both, PHQ, NRN supported, MRT, thank you both really just a lovely, lovely moment.Paul Marden: 30 kids singing a song that they had composed, and then backflip.Dominic Jones: It was a last minute thing I had to ask Jason. Said, Jason, can you stand to make sure I don't get hit? That's why I didn't want to get hit, because I've got a precious face. Hannah Prowse: I didn't think the ship fell apart was one of the official parts of the marketing campaign.Paul Marden: So I've got one more question before we do need to wrap up, who of your teams have filled in the Rubber Cheese Website Survey. Dominic Jones: We, as Mary Rose and Ellen, do it jointly as Portsmouth historic document. We've done it for years. We were an early adopter. Of course, we sponsored it. We even launched it one year. And we love it. And actually, we've used it in our marketing data to improve loads of things. So since that came out, we've made loads of changes. We've reduced the number of clicks we've done a load of optimum website optimisation. It's the best survey for visitor attractions. I feel like I shouldn't be shouting out all your stuff, because that's all I do, but it is the best survey.Paul Marden: I set you up and then you just ran so we've got hundreds of people arriving for this evening's event. We do need to wrap this up. I want one last thing, which is, always, we have a recommendation, a book recommendation from Nepal, and the first person to retweet the message on Bluesky will be offered, of course, a copy of the book. Does anyone have a book that they would like to plug of their own or, of course, a work or fiction that they'd like to recommend for the audience.Paul Marden: And we're all looking at you, Matthew.Dominic Jones: Yeah. Matthew is the book, man you're gonna recommend. You'reAndrew Baines: The maritime.Paul Marden: We could be absolutely that would be wonderful.Matthew Tanner: Two of them jump into my mind, one bit more difficult to read than the other, but the more difficult to read. One is Richard Henry. Dana D, a n, a, an American who served before the mast in the 19th century as an ordinary seaman on a trading ship around the world and wrote a detailed diary. It's called 10 years before the mast. And it's so authentic in terms of what it was really like to be a sailor going around Cape corn in those days. But the one that's that might be an easier gift is Eric Newby, the last great grain race, which was just before the Second World War, a journalist who served on board one of the last great Windjammers, carrying grain from Australia back to Europe and documenting his experience higher loft in Gales get 17 knots in his these giant ships, absolute white knuckle rides. Paul Marden: Perfect, perfect. Well, listeners, if you'd like a copy of Matthew's book recommendation, get over to blue sky. Retweet the post that Wenalyn will put out for us. I think the last thing that we really need to do is say cheers and get on with the rest of the year. Richard Morsley: Thank you very much. Andrew Baines: Thank you.Paul Marden: Thanks for listening to Skip the Queue. If you've enjoyed this podcast, please leave us a five star review. It really helps others to find us. Skip The Queue is brought to you by Rubber Cheese, a digital agency that builds remarkable systems and websites for attractions that helps them to increase their visitor numbers. You can find show notes and transcripts from this episode and more over on our website, skipthequeue fm.  The 2025 Visitor Attraction Website Survey is now LIVE! Dive into groundbreaking benchmarks for the industryGain a better understanding of how to achieve the highest conversion ratesExplore the "why" behind visitor attraction site performanceLearn the impact of website optimisation and visitor engagement on conversion ratesUncover key steps to enhance user experience for greater conversionsTake the Rubber Cheese Visitor Attraction Website Survey Report

May is Mental Health Awareness Month!Mental Health Mississippi was developed to make that process easier and to serve as a hub of information for all mental health resources available in our state.Hinds Behavioral Health Services (Region 9)specializes in outpatient community mental health services for adults, children and youth, families, elderly, and those with chemical dependencies and substance use disorders. Our mission is to provide quality, effective mental health services to the citizens of Hinds County.In a mental health crisis you need help fast. Call us and we will come to you. 601-321-2400 24/7Mobile Crisis Response Team 601-955-6381. Mobile Crisis Teams provide guidance and support to adults and children who are experiencing a mental health crisis. The teams work closely with law enforcement to reduce the likelihood that a person experiencing a mental health crisis is unnecessarily placed in a more restrictive environment, like jail, a holding facility, hospital, or inpatient treatment.Region 8 Mental Health Services provides services in five central Mississippi counties, but if you need immediate crisis assistance, contact your Mobile Crisis Response Team.PHQ-9 (Patient Health Questionnaire-9)Psychology Today: Find a Therapist, Psychologist, Counselor. Hosted on Acast. See acast.com/privacy for more information.

Are you struggling to support young patients—and maybe even yourself—with the emotional aftermath of our “new normal”? In this compelling episode of Pediatric Meltdown, Dr. Colleen Cullinan returns to unpack the reality of pediatric depression in a world rocked by uncertainty. Discover why traditional approaches, like focusing solely on symptoms, may actually miss the bigger picture when kids are faced with unprecedented stress. Learn how changing the narrative, adopting techniques such as Acceptance and Commitment Therapy (ACT), and making small, values-driven changes can help children—and parents—find hope, function, and connection again. This episode isn't just about treating depression; it's about transforming how we relate to struggle and building resilience against the tide of ongoing adversity. Tune in for real stories, actionable tools, and a refreshing reminder: even the heaviest feelings can be given a name, a shape, and ultimately, a little less power.[00:00 - 08:40] The Impact: Symptom Overload, and Functional ImpairmentThe pandemic has significantly amplified youth mental health issues, leading to increased rates and severity of pediatric depression and anxiety.Symptom checklists like the PHQ-9 now reveal almost universal distress—so much so that a "normal" score is rare.Chronic uncertainty and prolonged stress (for both kids and adults) exacerbate feelings of hopelessness, helplessness, and irritability.The primary care challenge: shifting from symptom identification to understanding the real-life impact on activities, relationships, and overall well-being.[08:41 - 28:29] Rethinking Depression in Pediatrics: Connection, and Therapy ApproachesConnection—not just checking PHQ-9 scores—is a critical protective factor for youth mental health and should be the heart of clinical encounters.Traditional Cognitive Behavioral Therapy (CBT) and newer Acceptance and Commitment Therapy (ACT) are compared — with ACT focusing on accepting thoughts and changing relationships with them, not just “fixing” or disputing them.Dr. Cullinan explains how ACT techniques, including physicalizing and naming despair, help kids distance from and better manage their feelings.The “beach ball” metaphor illustrates how fighting negative thoughts can cause you to miss life's joys—and how letting them coexist with living can restore function and hope.[28:30 -58:59] Strategies: Playful Experiments, Values-Based Goals, Motivational ToolsPractical examples include using humor, metaphor, and even quick physical challenges (like the “lemon” exercise) to help kids gain distance from distressing thoughts.Naming depressive feelings or thoughts (e.g., “pathetic,” “Bob”) can help externalize and reduce their influence, making them easier to talk about and manage.Motivational Interviewing is highlighted as a powerful tool—but only if it genuinely centers each child's unique values and interests, not the provider's agenda.Avoidance, not just the presence of sadness or fear, is flagged as the true engine of suffering; the focus shifts to acceptance and gentle behavioral activation.[59:00-1:06:47] Building Resilience: Safety, Nurture, New Frames, and Practical PearlsChildren's beliefs and “frames” about themselves and the world are shaped by repeated messages—caregivers can help reframe these with new, nurturing narratives.Safe, stable, nurturing relationships offer the strongest protection and resilience against depression and trauma, as explored through frameworks like toxic stress and child transformation health.Providers can make meaningful impact in just minutes with new language, metaphors, and reframing exercises—even in a busy primary care setting.[1:06:48 -...

Send us a message with this link, we would love to hear from you. Standard message rates may apply.Depression requires a comprehensive treatment approach addressing biological, psychological, and social dimensions for true healing. We explore the three essential components of effective depression management: medication, therapy, and behavioral activation.• Depression categorized as mild, moderate, or severe, with treatment options varying accordingly• PHQ-9 questionnaire serves as both diagnostic tool and progress tracker• SSRIs (like Lexapro, Prozac, and Zoloft) serve as first-line medications with fewer side effects• Antidepressants typically require six weeks at therapeutic dose to determine effectiveness• Psychotherapy, especially cognitive behavioral therapy, proven equally effective as medication• Combined medication and therapy approach provides superior outcomes to either alone• Psychology Today website offers accessible therapist-finding tool• Exercise (30-60 minutes, 3x weekly) prescribed as essential treatment component• Behavioral activation through resuming enjoyable activities crucial for recovery• Recovery is possible with comprehensive treatment even when motivation is lowVisit psychologytoday.com to find therapists in your area based on specialty, insurance coverage, session format, and more.Support the showProduction and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

Do you suspect that you have depression or related mental disorders? Take Mission Connection's (866-833-1822) PHQ-9 test, which you can complete in just two minutes, to determine whether you should seek professional help. Take the test at https://missionconnectionhealthcare.com/blog/quiz/depression-test/ Mission Connection City: San Juan Capistrano Address: 30310 Rancho Viejo Rd. Website: https://missionconnectionhealthcare.com/

Enjoy the episode? Send us a text!Can a marriage survive the weight of depression? Join us in this eye-opening episode of Relationship Radio as we tackle this pressing question and guide you through the labyrinth of depression within a marriage in crisis. We break down major depressive disorder, its symptoms, and the PHQ-9 screening tool to help you understand the profound impact depression can have on both individuals and their relationships. We explore how biochemical imbalances and external stressors like infidelity can exacerbate the situation, reinforcing the importance of seeking professional help.Moreover, we offer a lifeline of hope and practical solutions to reclaim your mental health and strengthen your marriage. We discuss a range of treatment options including medication, cognitive behavioral therapy, and even innovative methods like magnetic therapy. We share promising insights on the effectiveness of these treatments, especially magnetic therapy, urging listeners to take proactive measures. This episode is packed with essential information and heartfelt advice, designed to support both individual well-being and the health of your relationship. Don't miss this opportunity to learn how to navigate and overcome depression in your marriage.

In this conversation, Liz Rohr and Shelby Pope discuss the importance of taking a comprehensive history of substance use, and how to assess and treat stimulant use disorder. They cover the challenges healthcare providers face in asking the right questions, and emphasize the need for open conversations and non-judgmental approaches.They cover screening for addiction, how to elicit a substance use history, including types and routes of substance use. Shelby covers the mechanism of action of cocaine and methamphetamine in the brain, the withdrawal symptoms associated with stimulant use disorder, and the next steps for primary care providers in managing patients with stimulant use disorder. They also explore the use of psychosocial interventions and off-label pharmacologic treatments for stimulant use disorder.TakeawaysOpen and non-judgmental conversations are essential when discussing substance use with patients.Screening practices, such as using screeners like PHQ-2, SBIRT, and DAST, can help identify substance misuse or struggles.Taking a comprehensive history of substance use, including the type, amount, frequency, and motivation, is crucial for providing appropriate care.Healthcare providers should be aware of the different routes of administration and the potential risks associated with each.Stimulant use disorder, particularly cocaine and methamphetamine use, can have significant adverse effects and poor outcomes. Cocaine and methamphetamine are both monoamine neurotransmitter reuptake inhibitors, increasing serotonin, norepinephrine, and dopamine levels in the brain.There is a withdrawal syndrome associated with stimulant use disorder, characterized by depression, fatigue, and sleep disturbances.In managing patients with stimulant use disorder, primary care providers should consider triage based on severity and acuity, and refer patients to appropriate resources such as rehab or the ER.Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the mainstay of treatment for stimulant use disorder.Off-label pharmacologic treatments for stimulant use disorder include mirtazapine, bupropion, injectable naltrexone, topiramate, and psychostimulants.It is important for healthcare providers to be aware of state regulations and their own comfort level in prescribing off-label medications for stimulant use disorder.For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/treating-substance-use-disorder ______________________________© 2024 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Vida Plena's 2023 Impact Report: Measuring Progress and Looking Ahead, published by Vida Plena on July 23, 2024 on The Effective Altruism Forum. We from Vida Plena are proud to present our first Annual Impact Report. 2023 was our first full year. It was a year of learning. We had just finished a successful pilot and started the year with the mission of building a solid foundation and proving that our therapy model works at scale. This first annual impact report is our attempt to capture through charts and graphs bits of crucial evidence about who we've helped in 2023 and where we can continue to improve. Background Context Vida Plena (meaning 'a flourishing life' in Spanish) is a nonprofit organization based in Quito, Ecuador which launched in 2022 (see our launch post here). Our mission is to build strong mental health in low-income and refugee communities, who otherwise would have no access to care. We provide evidence-based depression treatment using group interpersonal therapy, which is highly cost-effective and scalable. Main Findings Our main findings during the process of creating this report were: In 2023, we screened 882 people for depression. 434 (49%) of these became participants, taking at least 1 group session. Program participants had an average reduction of 6.6 in the PHQ-9 questionnaire. 68% of participants with moderate to severe depression clinically improved (5 points drop in PHQ-9). Five points are considered to be a clinically significant improvement. We also saw reductions in secondary indicators of self-harm thoughts and suicidal ideation, anxiety, psychosocial functioning, and employment. Participants who fill out our end-line survey also report high satisfaction with the program and increased feelings of hope and purpose. 90% of participants came from vulnerable groups, the most common of which were people experiencing food insecurity (56%), female heads of households (34%), and migrants and refugees (22%). Participant recovery seems to be related mostly to the baseline level of depression and not so much to the number of sessions taken or other variables like the modality of the sessions (virtual or in person). Challenges While we are excited with these results, there are many challenges and areas we still feel we need to improve. In particular: Even though 5 points is considered to be a clinically significant change on the PHQ-9 scale, the 6.6-point drop is still below our more ambitious target. In 2024, we aim to improve this margin to nine points across participants entering with moderate to severe depression. Relatedly, we aim to improve our participant retention rate. Our initial findings suggest that participants may drop out when they start feeling better. We believe there is room for them to continue improving and learning important skills to enhance their resilience and strengthen their support network if they attend more therapy sessions. Limitations We are also aware that this first report has limitations. First, we rely basically on pre-post participant comparisons, with no randomized control group. We try to partially compensate for this fact by considering spontaneous remission data from the scientific literature. However, our priority in the coming years is to implement control groups where people who are not involved in Vida Plena g-IPT sessions take PHQ-9 assessments over eight weeks to determine our population's spontaneous remission rates. Secondly, some of the data we collect is likely subject to multiple biases. For example, the program satisfaction data we have, as well as many secondary indicators, come from people who take the end-line survey by the end of their 8th group session. People who get so far into the program without dropping out are likely the ones who saw the most value in it, and this can skew our conclus...

Summary. Who We Are: Kaya Guides runs a self-help course on WhatsApp to reduce depression at scale in low and middle-income countries. We help young adults with moderate to severe depression. Kaya currently operates in India. We are the world's first nonprofit implementer of Step-by-Step, the World Health Organization's digital guided self-help program, which was proven effective in two RCTs. Pilot: We ran a pilot with 103 participants in India to assess the feasibility of implementing our program on WhatsApp with our target demographic and to generate early indicators of its effectiveness. Results: 72% of program completers experienced depression reduction of 50% or greater. 36% were depression-free. 92% moved down at least a classification in severity (i.e. they shifted from severe to moderately severe, moderately severe to moderate, etc). The average reduction in score was 10 points on the 27-point PHQ-9 depression questionnaire. Context: To offer a few [...] ---Outline:(04:44) Part 1. About the Kaya Guides Program(04:49) What is Kaya Guides and what do we do?(05:13) How the program works(05:35) Evidence base(06:11) Why guided self-help is effective(06:50) Why this work matters(07:52) Program design(08:46) Target participant profile(09:14) Impact measurement(10:00) Part 2. Pilot Impact and Cost-Effectiveness(10:18) Impacts on depression(11:01) Comparison(12:10) Effect Size Estimate(14:35) Takeaway(15:02) Cost-Effectiveness(15:29) Pilot Cost-Effectiveness(17:15) 2025 Projected Cost-Effectiveness(19:15) Program Impacts According to Participants(22:50) Part 3. Recruitment(22:55) Quick Stats(24:20) Participant Profile(25:38) Part 4. Retention(27:45) Part 5. Participant Feedback(31:19) What's Next(32:05) Support Us--- First published: June 16th, 2024 Source: https://forum.effectivealtruism.org/posts/6NaRJpSn2zfRSnGYN/kaya-guides-pilot-results --- Narrated by TYPE III AUDIO.

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Kaya Guides Pilot Results, published by RachelAbbott on June 16, 2024 on The Effective Altruism Forum. Summary Who We Are: Kaya Guides runs a self-help course on WhatsApp to reduce depression at scale in low and middle-income countries. We help young adults with moderate to severe depression. Kaya currently operates in India. We are the world's first nonprofit implementer of Step-by-Step, the World Health Organization's digital guided self-help program, which was proven effective in two RCTs. Pilot: We ran a pilot with 103 participants in India to assess the feasibility of implementing our program on WhatsApp with our target demographic and to generate early indicators of its effectiveness. Results: 72% of program completers experienced depression reduction of 50% or greater. 36% were depression-free. 92% moved down at least a classification in severity (i.e. they shifted from severe to moderately severe, moderately severe to moderate, etc). The average reduction in score was 10 points on the 27-point PHQ-9 depression questionnaire. Context: To offer a few points of comparison, two studies of therapy-driven programs found that 46% and 57.5% of participants experienced reductions of 50% or more, compared to our result of 72%. For the original version of Step-by-Step, it was 37.1%. There was an average PHQ-9 reduction of 6 points compared to our result of 10 points. Effect Size: Our effect size is estimated at 0.54, compared to an effect size of 0.48 for the original version of Step-by-Step. This is likely to be an upper bound. Cost-Effectiveness: We estimate that the pilot was 7x as cost-effective as direct cash transfers at increasing subjective well being. This accounts for the initial effect, not duration of effects. The cost per participant was $96.27. We project that next year we will be 20x as cost-effective as direct cash transfers. These numbers don't reflect our full impact, as we may be saving lives. Four participants said overtly that the program reduced their suicidal thinking. Impacts: Participants reported that the program had profound impacts on their lives, ranging from improved well-being to regaining control over their lives and advancing in their education and careers. Recruitment: We were highly successful at recruiting our target population. 97% of people who completed the baseline depression questionnaire scored as having depression. 82% scored moderate to severe. Many of our participants came from lower-income backgrounds even though we did not explicitly seek out this group. Participants held professions such as domestic worker, construction and factory worker and small shopkeeper. 17% overtly brought up financial issues during their guide calls. Retention: 27% of participants completed all the program content, compared to 32% in the WHO's most recent RCT. In the context of a digitally-delivered mental health intervention, which are notorious for having extremely low engagement, this is a strong result. Guide call retention was higher: 36% of participants attended at least four guide calls. Participant Feedback: 96% of program completers said they were likely or very likely to recommend the program. Participant feedback on guide calls was overwhelmingly positive and their commentary gave the sense that guide calls directly drive participant engagement. Negative feedback focused on wanting more interaction with guides. Feedback on the videos was mixed. For the chatbot, it was neutral. Feedback on the exercises was generally positive for the exercises, although there were signs of lack of engagement with some exercises. The stress reduction exercises were heavily favored. Support Kaya Guides: To support us, donate here or contact Rachel Abbott at rachel@kayaguides.com. Per our most recent assessment, it costs us $96 to provide mental healthcare t...

A 28-year-old woman presents with new onset worsening fatigue, present for approximately the last month. She is 28 weeks pregnant with her second child, has a 1.5-year-old healthy child at home, says she remembers being tired towards the end of her pregnancy with her first child, but states, “This is worse than with my last pregnancy”. She denies vaginal bleeding or discharge, abdominal pain, or other concerning issues, is sleeping about 7 hours per night, and has adequate access to nutritious food. She is not taking a prenatal vitamin, reporting, “I kept throwing up every time I took one.” During early pregnancy. PHQ-9 screening tool results are without concern.Labs results are as follows.Hemoglobin 9.2g per dl (NL=12-14)Hct=27% (NL=36-42%)Total RBC= 2.9 million (3.9 to 5.2 million cells per microliter (million/µL)MCV 75 FL (NL=80-98)MCH 22 PG (NL=27-33)RDW 18% (NL=11.5-15%)These results are most consistent with:A. Pregnancy related hemodilution.B. Folic acid deficiency anemiaC. Iron deficiency anemia.D. Beta thalassemia minor.Visit fhea.com to learn more!

Join Catherine on this episode of Social Workers, Rise! as she delves into the crucial topic of assessing and addressing depression in clients. With staggering statistics revealing the prevalence of depression worldwide, Catherine emphasizes the importance of initiating conversations and reducing stigma surrounding mental health. Tune in for an exclusive excerpt from her course, 'The Clinical Essentials for the Future Therapist,' designed to empower new practitioners and enhance therapeutic skills. Learn about practical assessment tools like the PHQ-9 and gain valuable insights to navigate the complexities of depression in clinical practice. ____________________________________ ⁠Tap Here to Subscribe⁠ to the Social Workers, Rise! Email Resource List ⁠Tap Here⁠ to shop career courses for Social Workers. ____________________________________ Thank you to our SPONSORS ⁠RISE Directory⁠ - A national directory of Clinical Supervisors who are looking to help the next generation of Clinical Social Workers GROW. ⁠Therapist Development Center (TDC) Homepage⁠ ⁠TDC Continuing Education Courses⁠ ⁠On The Edge of Life: An Introduction to Treating Suicidality ⁠ Use the code SWRISE10 at checkout to receive 10% off --- Send in a voice message: https://podcasters.spotify.com/pod/show/socialwork/message Support this podcast: https://podcasters.spotify.com/pod/show/socialwork/support

This week's replay is Dr. Fareeha Malik, DDS, mom of 2 with a history of severe postpartum depression. PPD ended up informing her relationships and and even her reproduction. Of course, we discuss how she she found healing. Bringing home a baby doesn't always mean mom's eternal happiness. Not all mothers feel “the way they should” after the baby is born, and may feel lost if they don't know where to turn for resources. This endangers not only mom but also a newborn.In a time when 14000 children have been unalived in a completely manmade g-cide, this episode still has its place as one of the struggles mothers face. And for those of our momsisters delivering via C-section without anesthesia, delivering prematurely due to stress, shock, and manmade famine, PPD is a real threat with deep seated claws. May Allah SWT first and foremost secure the survival of our momsisters and their newborns born in an ongoing g-cide, and protect them from every evil of the heart and mind, and destroy the enemies who threaten their physical states. Ameen. We were so into the conversation that we didn't get to review the valuable resources we have for our community. check out the shownotes on our website or DM us.Links:1. Edinburgh Postnatal Depression Scale: http://perinatology.com/calculators/Edinburgh%20Depression%20Scale.html2. PHQ-9 Screening Tool: https://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf3. American College of Obstetrics & Gynecology patient handout on PPD: https://www.acog.org/Patients/FAQs/Postpartum-Depression?IsMobileSet=false4. Nisa Helpline: https://nisahelpline.com/who-we-are/ 1-888-315-NISA (6472)  available 12 hours during the day, or email info@nisahelpline.com anytime5. National Suicide Prevention Hotline: 1-800-273-8255 available 24/7 for helpSupport the show1. Web: www.mommyingwhilemuslim.com2. Email: salam@mommyingwhilemuslim.com3. FB: Mommying While Muslim page and Mommyingwhilemuslim group4. IG: @mommyingwhilemuslimpodcast5. YouTube: https://www.youtube.com/channel/UCrrdKxpBdBO4ZLwB1kTmz1w

In this episode of Derms and Conditions, host James Q Del Rosso, DO, sits down with Jennifer Hsiao, MD, associate professor of clinical dermatology at Keck Medicine of University of Southern California, to discuss the multifaceted world of hidradenitis suppurativa (HS). From addressing diagnostic obstacles to understanding comorbidities, this episode guides clinicians through the many complexities of HS management. They begin by exploring the diagnostic hurdles associated with HS, with Dr Hsiao sharing insights to help clinicians navigate through potential misdiagnoses. She emphasizes the importance of recognizing subtle indicators of the disease and thinking outside the box when it comes to the location of lesions, as they may present in atypical areas. She also highlights the significance of recurrent history, which can serve as a diagnostic hallmark. Next, the pair discusses comorbidities associated with HS, with Dr Hsiao detailing the importance of inquiring about patients' primary care arrangements. She notes that while dermatologists may not directly manage these comorbidities, they can play a vital role in identifying and initiating the necessary steps toward management. The discussion then moves to the significant psychological impact of HS, emphasizing the necessity of open dialogue with patients about the psychological toll of HS and the benefits of seeking mental health support. Screening tools like the PHQ-2 can aid in identifying patients at risk and initiating necessary interventions. They next address the limitations of current clinical guidelines for HS and the need for a paradigm shift towards intervening earlier in the disease process to prevent irreversible tissue damage. The discussion concludes with the presentation of a clinical scenario describing a patient transitioning from oral antibiotics to a biologic, with Dr Hsiao outlining her suggested approach for such a patient.

Episode 161: Depression FundamentalsFuture doctors Madeline Tena and Jane Park define depression and explain different methods to diagnose it. Non-pharmacologic and pharmacologic treatment is mentioned briefly at the end.  Written by Madeline Tena, MSIII, and Jane Park, MSIII. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition. Per the language of Mental Health, depression can be defined as a mood, a symptom, a syndrome of associated disorders, or a specific mental disorder. As a state of mood, depression is associated with feelings of sadness, despair, emptiness, discouragement, and hopelessness. The sense of having no feelings or appearing tearful can also be a form of depressed mood. A depressed mood also can be a part of a collection of symptoms that explain a syndrome. Depression as a mental disorder can encompass depressive syndromes. Per the American Psychiatric Association DSM-5-TR, depressive disorders commonly include sad, empty, irritable mood, accompanied by changes in one's functional capacity. They can be classified by severity and recurrence, and associated with hypomania, mania, or psychosis. Depressive disorders include major depressive disorder (including major depressive episodes), persistent depressive disorder, premenstrual dysphoric disorder, substance-induced depressive disorder, depressive disorder due to medical condition, other specified depressive disorder, and unspecified depressive disorder.Today, we will cover unipolar depressive disorder, also known as major depressive disorder. MDD.Major depressive disorder is a mood disorder primarily characterized by at least one major depressive episode without manic or hypomanic episodes. Depressive episode is a period of at least 2 weeks of depressed mood or anhedonia in nearly all activities for most of the day nearly every day, with four or more associated symptoms in the same 2 weeks. We will discuss specific symptoms for diagnosis further on. Epidemiology of depression.Nationally or regionally representative surveys in 21 countries estimate that the 12-month prevalence of major depressive disorder across all countries is 5 percent. Furthermore, the prevalence of major depressive disorder plus persistent depressive disorder in developed countries (United States and Europe) is approximately 18 percent. Multiple studies consistently indicate that in the general population of the United States, the average age of onset for unipolar major depression and for persistent depressive disorder (dysthymia) is approximately 30 years old. During 2020, approximately ⅕ US adults have reported receiving a diagnosis by a healthcare provider, with the highest prevalence found among young adults age (18-24 year age… generation Z). Within the US there was considerable geographic variation in the prevalence of depression, with the highest state and county estimates of depression observed along the Appalachian and southern Mississippi Valley regions. Why do we care about depression?Because depression is associated with impaired life quality. It can impair a patient's social, physical, and psychological functioning. Also, depression is associated with mortality. A study done by UPenn Family Practice and Community Medicine in 2005 showed that among older, primary-care patients over a 2-year follow-up interval, depression contributed as much to mortality as did myocardial infarction or diabetes. A prospective study from 2005-2017 that followed 186 patients for up to 38 years further showed that patients with major depressive disorder had 27 times higher incidence rate of suicide than the general population. (1, 2). Also, patients dying by suicide visit primary care physicians more than twice as often as mental health clinicians. It is estimated that 45% of patients who died by suicide saw their primary care physician in the month before their death. Only 20% saw a mental health professional a month before their death. (3)Suicidality in depression.It seems that primary care physicians often do not ask about suicidal symptoms in depressive patients. A 2007 study by Mitchell Feldman at the University of California San Francisco showed that 152 family physicians and internists who participated in a standardized patient with antidepressants, suicide was explored in only 36% of the encounters. (4)Physicians, including primary care physicians, should ask patients with depression about suicidality with questions such as: Do you wish you were dead? In the past few weeks, have you been thinking about killing yourself? Do you have a plan to kill yourself? Have you ever tried to kill yourself? (5) Screening for depression.The USPSTF recommends screening for depression in all adults: 18 years old and over regardless of risk factors. Some factors increase the risk of positive screening, such as temperament (negative affectivity/neuroticism), general medical illness, and family history. First-degree family members of people with MDD have a 2-4 times higher risk of MDD than the general population. Furthermore, social history can increase risk as well: sexual abuse, racism, and other forms of discrimination.It is important to highlight the risk in women because they may also be at risk related to specific reproductive life stages (premenstrual period, postpartum, perimenopause). The USPSTF includes pregnant individuals and patients in the postpartum period to be screened for depression. Screening tools. The US Preventive Services Task Force recommends depression screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years (grade B). Similarly, the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) has also recommended annual screening for depression in children aged 12 and older. (6) Some tools used for screening in this age group are the Patient Health Questionnaire for Adolescents (PHQ-A) and the primary care version of the Beck Depression Inventory (BDI). For the general adult population, it is recommended that all patients not currently receiving treatment for depression be screened using the Patient Health Questionnaire-2 (PHQ-2) (7)PHQ 2 is a survey scored 0-6. The survey asks two questions: Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things.Feeling down, depressed, or hopeless.Answers should be given in a numerical rating. 0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day. A score ≥ 3 is considered positive, and a follow-up full clinical assessment is recommended. The PHQ-2 has a sensitivity of 91% and a specificity of 67% when compared to a semi-structured interview. Keep in mind that the PHQ-2 may be slightly less sensitive to older individuals. Individuals who screen positive with PHQ-2 should have additional screening with the PHQ-9, which is a nine-item, self or clinician-administered, brief questionnaire that is specific to depression. (8) Its content maps directly to the DSM-5 criteria for major depression. (9)The PHQ-9 is a set of 9 questions. The answers are scored similarly to PHQ-2, with a numerical scoring between 0 and 3. (0=Not at all; 1=Several days; 2=More than half the days; 3=Nearly every day). Dr. Arreaza, you will be my patient today, are you ready? It's important that you think about the last 2 weeks.Over the last 2 weeks, how often have you been bothered by any of the following problems?Little interest or pleasure in doing things. [Dr. Arreaza answers, “sometimes”. Jane asks, “is it several days or nearly every day?”. Dr. Arreaza answers, “nearly every day” 3]Feeling down, depressed or hopeless [Dr. Arreaza: every day 3]Trouble falling or staying asleep, or sleeping too much [Dr. Arreaza: not at all 0]Feeling tired or having little energy [Dr. Arreaza: not at all 0]Poor appetite or overeating [Dr. Arreaza: every day 3]Feeling bad about yourself- or that you are a failure or have let yourself or your family down [Dr. Arreaza: several days 1]Trouble concentrating on things, such as reading the newspaper or watching television [Dr. Arreaza: Several days 2]Moving or speaking so slowly that other people could have noticed. Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual. [Dr. Arreaza: Not at all 0]Thoughts that you would be better off dead, or of hurting yourself [Not at all 0]Jane: Your score is 12.Maddy: Regarding severity, a total score of 1-4 suggests minimal depression. 5-9 suggests mild, 10-14 moderate, 15-19 moderately severe, and 20-27 severe depression. PHQ-9 with patients' scores over 10 had a specificity of 88% and sensitivity of 88% for MDD. (10)But if there are at least 4 non-zero items, including question #1 or #2, consider a depressive disorder and add up the scores. If there are at least 5 non-zero items including questions #1 or #2, consider major depressive disorder specifically. The questionnaire is the starting point for a conversation about depression.A couple of things to note: 1. Physicians should make sure to verify patient responses given the questionnaire can be self-administered. Diagnosis also requires impairment in the patient's job, social, or other important areas of functioning. 2. Diagnosis requires a ruling-out of normal bereavement, histories of manic episodes, depressive episodes better explained by schizoaffective disorder, any superimposed schizophrenia, a physical disorder, medication, or other biological cause of depressive symptoms.Once a patient is newly diagnosed and/or started on treatment, a regular interval administration (e.g. 2 weeks or at every appointment) of PHQ-9 is recommended. The PHQ-9 has good reliability, validity, and high adaptability for MDD patients in psychiatric hospitals for screening and evaluation of depression severity. (12) Other than PHQ-9, there is also Geriatric Depression Scale-15 for older patients with mini mental status exam (MMSE) that scored over 10. (13)For postpartum depression, the preferred screening tool is the Edinburgh postnatal depression scale[Click here (stanford.edu)].Non-pharmacologic and pharmacologic treatment.Now that we have diagnosed the patient, we have to start management. Patients can consider non-pharmacologic treatment such as lifestyle modifications. This can include sleep hygiene, reduction in drug use, increased social support, regular aerobic exercise, finding time for relaxation, and improved nutrition. Furthermore, based on severity, patients can start psychotherapy alone or psychotherapy + pharmacotherapy. Admission is required for pts with complex/severe depression or suicidality. There should be an assessment of efficacy at 6 weeks.There is a warning about patients aged 18-24 who are at increased risk of suicide when taking SSRI within the first couple weeks of treatment. Mediations: SSRI, SNRI, tricyclic antidepressants, MAOIs, and Atypical antidepressants: including trazodone, mirtazapine (Remeron), bupropion (Wellbutrin SR). More research is being done on psychedelic drugs such as ketamine and psilocybin as possible treatments. There are therapies such as ECT available too.Potential Harm of Tx: Potential harms of pharmacotherapy: -SNRI:  initial increases in anxiety, insomnia, and restlessness, and possible sexual dysfunction and headaches as well. Compared with the SSRI class, the SNRI class tends to induce more nausea, insomnia, dry mouth, and in rare cases hypertension.-Tricyclic: Cause of numerous side effects, very infrequently prescribed unless the patient is not responding to other forms of treatment. Side effects that are included are: dry mouth. slight blurring of vision, constipation, problems passing urine, drowsiness, dizziness,  weight gain, excessive sweating (especially at night). Avoid TCAs in elderly patients.-MAOIS: MAO-IS can cause side effects too, including dizziness or lightheadedness, dry mouth, nausea, diarrhea or constipation, drowsiness, and insomnia. Furthermore, other less common side effects can include involuntary muscle jerks, hypotension, reduced sexual desire/ ability to orgasm, weight gain, difficulty starting urine flow, muscle cramps, and paresthesia.Remember to screen your patients. In case you establish a diagnosis, discuss treatments, including non-pharmacologic and pharmacologic options. Warn your patients about side effects and the timing to see the benefits of the medication, usually after 6 weeks. __________________Conclusion: Now we conclude episode number 161, “Depression Fundamentals.” Future doctors Park and Tena discussed depression and its risk factors, screening, and treatment. They went through the PHQ2 and PHQ9 as screening tools, as well as commonly used treatments and their side effects, such as SSRIs. Dr. Arreaza also highlighted the importance of asking about suicidality in your depressed patients, there is a lot of room for improvement in that aspect. This week we thank Hector Arreaza, Madeline Tena, and Jane Park. Audio editing by Adrianne Silva.Talk_OutroEven without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Angst F, Stassen HH, Clayton PJ, Angst J. Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002;68(2-3):167-181. doi:10.1016/s0165-0327(01)00377-9. https://pubmed.ncbi.nlm.nih.gov/12063145/Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054. https://pubmed.ncbi.nlm.nih.gov/31211337/ Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2000302/.Brief Suicide Safety Assessment,National Institute of Mental Health (NIMH), July 11, 2020. https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/adult-outpatient/bssa_outpatient_adult_asq_nimh_toolkit.pdfBeck A, LeBlanc JC, Morissette K, et al. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10(1):24. Published 2021 Jan 12. doi:10.1186/s13643-020-01568-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802305/Williams, John; Nieuwsma, Jason. Screening for depression in adults, UpToDate, updated on November 30, 2023. https://www.uptodate.com/contents/screening-for-depression-in-adults.Instrument: Patient Health Questionnaire-9 (PHQ-9), National Institute on Drug Abuse, https://cde.nida.nih.gov/instrument/f226b1a0-897c-de2a-e040-bb89ad4338b9.Lowe B, et al. Monitoring depression-treatment outcomes with the Patient Health Questionnaire-9 (PHQ-9). Med Care, 42, 1194-1201, 2004.Sun, Y., Fu, Z., Bo, Q. et al.The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC Psychiatry20, 474 (2020). https://doi.org/10.1186/s12888-020-02885-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging Ment Health. 2013;17(5):638-645. doi:10.1080/13607863.2012.758231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701937/.Royalty-free music used for this episode: Old Mexican Sunset by Videvo, downloaded on Nov 06, 2023 from https://www.videvo.net

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

The prevalence of mental health issues is greater in patients with cardiovascular disease than the general population--but do you know what to look for? Guest Valerie Hoover, PhD, discusses the connection of both positive and negative psychological factors on cardiac outcomes, the importance of symptom recognition, and how regular screening for depression using a validated tool can make a significant difference for patients.Assessment of Depression and Depressive Systems. Depression and Coronary Heart Disease (AHA 2008): https://www.ahajournals.org/doi/full/10.1161/circulationaha.108.190769 Screening and Management of Depression in Patients with CVD (ACC 2019): https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.01.041 Depression Screening and Treatment Guidlines in Cardiac Patients (2022). https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009338 PHQ-2: https://www.hiv.uw.edu/page/mental-health-screening/phq-2 Comparison of PHQ-2 and PHQ-9 to Predict Death or Rehospitalization in Heart Failure (Circulation, 2015): https://www.ahajournals.org/doi/full/10.1161/circheartfailure.114.001488 PHQ-2 and PHQ-9 (Heart Foundation): https://www.heartfoundation.org.au/getmedia/52e4d9ab-dbb1-47a6-bb41-94b986176910/Depression-screening-support-tool.PDF Cardiac Distress Inventory (Australian Centre for Heart Health): https://www.australianhearthealth.org.au/resources/p/cardiac-distress-inventoryPsychosocial Factors and CVD (JACC 2020): https://www.ahajournals.org/doi/10.1161/JAHA.120.017112 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Medicalisation is the how human experience becomes something that needs medical attention.There are pros and cons of this including the ‘need' for medicine vs something that is being sold to us something that is unnecessary.I look at some examples in this episode and why it is something that needs consideration.Links:Ivan Illich: https://www.theguardian.com/news/2002/dec/09/guardianobituaries.highereducationSadness vs depression?: https://www.sciencedirect.com/science/article/abs/pii/S0277953617302551#:~:text=Medicalization%20describes%20a%20process%20by,normal%20behavior%20into%20medical%20conditions.A discussion on medicalisation: https://news.harvard.edu/gazette/story/2009/04/scholars-discuss-medicalization-of-formerly-normal-characteristicsThe story behind PHQ-9 and assessing depression: https://www.medicalrepublic.com.au/strange-history-of-a-depression-screening-tool/86457Lay referral: https://bjgp.org/content/49/445/617THE HEALTH FIX (paperback version out Jan 24)!: https://www.amazon.co.uk/Health-Fix-Transform-Your-Weeks/dp/1914239296https://www.amazon.co.uk/Health-Fix-Transform-Your-Weeks/dp/1914239296 Hosted on Acast. See acast.com/privacy for more information.

Dr. Josef Witt-Doerring's journey, spanning from his time at the FDA to his transition into the pharmaceutical industry and eventual establishment of a private practice, is marked by its uniqueness. His commitment to vocalizing his concerns and upholding ethical standards challenges the traditional practices often associated with his field.Dr. Josef Witt-Doerring is a psychiatrist who specializes in tapering patients off psychiatric medications. Over the last four years he has helped hundreds of patients successfully stop their psychiatric medications. He is a trained expert in psychiatric medicine and in the identification and treatment of adverse drug reactions. Dr. Witt-Doerring has also had the privilege of helping several patients with litigation related to psychiatric drug injuries. 
Witt-Doerring PsychiatryDr. Josef: Social Media and Professional LinksNote: This podcast episode is designed solely for informational and educational purposes, without endorsing or promoting any specific medical treatments. We strongly advise consulting with a qualified healthcare professional before making any medical decisions or taking any actions.*If you are in crisis or believe you have an emergency, please contact your doctor or dial 911. If you are contemplating suicide, call 1-800-273-TALK to speak with a trained and skilled counselor.RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / X (Twitter)Substack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically Genuine—-----------FREE DOWNLOAD! DISTRESS TOLERANCE SKILLS—----------ADDITIONAL RESOURCES2:00 - Dr. Josef Witt-Doerring Open Letter to Psychiatric and Family Medicine Colleagues23:30 - Patient Health Questionnaire (PHQ-9 & PHQ-2)24:00 - Enduring pain: how a 1996 opioid policy change had long-lasting effects24:30 - Liability and Patient Suicide - PMC25:00 - Reframing the Key Questions Regarding Screening for Suicide Risk | Depressive Disorders | JAMA28:00 - The Treatment for Adolescents With Depression Study (TADS): Long-term Effectiveness and Safety Outcomes30:30 - Accutane: iPLEDGE41:00 - PDUFA VII: Fiscal Years 2023 – 2027 | FDA49:00 - Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy51:00 - Dr. Josef YouTube: Antidepressants Nearly Ruined my Marriage1:02:00 - David Healy: Post-SSRI Sexual Dysfunction | RxISK1:08:00 - Antidepressants and Mass Shootings/Murder Suicide: An interview with Dr. David Healy1:13:00 - Your Consent is Not Required - Rob Wipond1:46:00 - The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure: Lukianoff, Greg, Haidt, Jonathan

In the latest episode of the #BuzzPodcast, Mark Hyder is joined by QRM's Director of Reimbursement, Megan Ussery, and Sr. VP of Integrity and Quality Improvement, Stacey Hallissey, to discuss CMS's move from the PHQ-9 to the PHQ-2 to 9 assessment model.

Dr. Julia Rowland shares the newest evidence-based recommendations from SIO and ASCO on integrative therapies for managing anxiety and depression symptoms in adults with cancer. Listen in to hear recommended options, such as acupuncture, aromatherapy, hypnosis, mindfulness, music therapy, relaxation, reflexology, Tai Chi and/or Qigong, and yoga. Dr. Rowland also discusses therapies the panel investigated but found insufficient evidence to support a recommendation for use in treating anxiety and depression. We also review how this guideline complements the recent ASCO guideline on conventional therapies for managing anxiety and depression, and the impact for patients and clinicians. Read the full guideline, "Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults with Cancer: SIO-ASCO Guideline" at www.asco.org/survivorship-guidelines TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/survivorship-guidelines. Read the full text of the update and review authors' disclosures of potential conflicts of interest disclosures in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.00857    Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.  My name is Brittany Harvey and today I'm interviewing Dr. Julia Rowland from the Smith Center for Healing in the Arts, Co-chair on “Integrative Oncology Care of Anxiety and Depressive Symptoms in Adult Patients with Cancer: Society for Integrative Oncology – American Society of Clinical Oncology Guideline.”  Thank you for being here, Dr. Rowland.   Dr. Julia Rowland: Lovely to be here, Brittany. Thanks for this opportunity.  Brittany Harvey: We're glad to have you on.  Then before we discuss this guideline, I'd just like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including the guest on this episode, are available in line with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.  So then I'd like to jump into the content of this guideline. So Dr. Rowland, what is the purpose of this joint SIO and ASCO guideline?  Dr. Julia Rowland: The purpose of the joint guideline, Brittany, published in the Journal of Clinical Oncology is to provide evidence-based recommendations to healthcare providers on integrative approaches to managing anxiety and depression symptoms in their adult cancer patients. By integrative approaches, we mean such interventions as yoga, relaxation, hypnosis, mindfulness, acupuncture, music therapy in treating anxiety and depression. Many of these therapies are already being used by people with cancer both during and after their treatment, with rates increasing over time. While use of integrative interventions can serve to improve quality of life, reduce stress, and provide individuals with a sense of control over their health, and they're often reported by patients as doing just that, it's important to note that for the purpose of this guideline, we examine specifically the ability of these interventions to significantly reduce symptoms of anxiety and depression. Brittany Harvey: Great. And then, as you just mentioned, this guideline covers both anxiety and depression. So then I'd like to review the recommendations made by the expert panel and we'll go in order of those. So starting with those recommendations for anxiety, what integrative therapies are recommended for managing symptoms of anxiety experienced after diagnosis or during active treatment?  Dr. Julia Rowland: The strongest recommendations in the guideline are for the use of mindfulness-based interventions, which include mindfulness-based stress reduction, meditation, and mindful movement. These interventions were recommended across the board to treat both anxiety and depression symptoms in patients in active treatment, and those post-treatment due to the strong evidence to show their benefits to patients. Yoga was also recommended for patients with breast cancer to treat both anxiety and depression symptoms, although the strength of the evidence was moderate. Data was less compelling for its use during or after treatment in other cancers, likely due to the lack of small numbers of non-breast cancer survivors included in study samples. There was also evidence for the use of relaxation, music therapy, and reflexology for treating anxiety symptoms during active treatment, and that the use of hypnosis and aromatherapy using inhalation were of modest to some benefit during diagnostic or treatment procedures. Brittany Harvey: Understood. Thank you for reviewing those recommendations. And you already mentioned a few items that are helpful and recommended for adults with cancer experiencing anxiety post-treatment, but which additional integrative therapies are recommended for this patient population?  Dr. Julia Rowland: In addition to mindfulness-based interventions and yoga, acupuncture, Tai Chi, and/or Qigong, and reflexology are recommended for treating anxiety symptoms post-treatment.  Brittany Harvey: Excellent. Thank you for that summary of recommendations. So then, moving into the recommendations on depression, what does the expert panel recommend for adults with cancer experiencing symptoms of depression?  Dr. Julia Rowland: For depression symptoms during treatment, the panel recommended mindfulness-based interventions, yoga, music therapy, relaxation, and reflexology, while post-treatment mindfulness-based interventions, yoga, and Tai Chi or Qigong were recommended.  Brittany Harvey: Excellent. Thank you for reviewing all the recommendations that the panel put forward. So this guideline reviewed a large breadth of integrative therapies. Are there any therapies that the panel reviewed but couldn't make a recommendation for, for this particular guideline?  Dr. Julia Rowland: Thank you for asking that question because as people listen to this podcast, they may realize that there are some therapies that may be widely used by their population or in their center or clinic, including such things as natural products and supplements, melatonin, healing touch, massage, light therapy, to name a few. Where the panel found in its review of the literature of over 110 studies or systematic reviews, there was insufficient evidence for the vast majority of these to make any conclusive recommendation. It just means we have a lot more work to do in assessing the efficacy of these, especially in treating anxiety and depression.  One intervention stands out in particular that's widely used and that's expressive writing. While this may be very helpful for improving quality of life or making sense of the cancer experience and providing an outlet for self-expression, the data does not support its use for treating anxiety and depression. It may be because it's too brief an intervention for conditions that have more depth and permanence. It doesn't mean you can't use it for other purposes, but the panel did not recommend its use for treating anxiety and depression. Brittany Harvey: Understood. That makes sense that there are some integrative therapies that work across different parts of the treatment spectrum and that there are some areas in which we just don't have the evidence yet. So, thank you for reviewing all of those recommendations.  So then, how does this guideline complement the recently published ASCO Guideline on the Management of Anxiety and Depression in Adult Survivors of Cancer?  Dr. Julia Rowland: That's a terrific question. The recently published ASCO Guideline on Management of Anxiety and Depression in Adult Cancer Survivors represents an update of our original 2014 guideline. The ASCO guideline provided recommendations regarding the use of conventional therapies, psychological, behavioral, and psychopharmacologic interventions for managing anxiety and depression. The current SIO and ASCO guidelines sought to expand upon and essentially complement these recommendations by identifying those integrative therapies that might also be effective in the management of anxiety and depression in adults treated for cancer. Further, the SIO and ASCO guidelines attempted to determine when, in the course of care, during diagnosis and active treatment and/or post-treatment, these interventions worked best. Both sets of recommendations strongly endorse the benefits of mind-body interventions in addressing both anxiety and depression, specifically mindfulness-based interventions in this SIO and ASCO guideline and cognitive, behavioral, behavioral activation, and mindfulness-based stress management programs in the ASCO guideline. Brittany Harvey: It's great to have these complementary guidelines available at the same time for a complete approach to managing anxiety and depression during treatment and post-treatment. So then, in your view, Dr. Rowland, what is the importance of this guideline and how will it impact clinicians and patients with symptoms of anxiety and/or depression? Dr. Julia Rowland: Brittany, cancer takes a significant psychological toll on affected individuals. Research has shown that cancer survivors have a significantly elevated risk of developing mental health disorders compared with the general population. Despite this, their psychological symptoms are often under-recognized and undertreated. As the number of cancer survivors continues to grow, so does the challenge to healthcare providers of meeting their mental health needs. Anxiety and depression symptoms have long been associated with lower quality of life and higher mortality in people with cancer. Treating symptoms of anxiety and depression using evidence-based, integrative therapies has the potential to not only improve patients' quality of life and help them better manage their care but may also improve length of life.  With the publication of this guideline, we now know which therapies could have the biggest impact. An added benefit of incorporating, or at least considering, integrative therapies to manage anxiety and depression are that they have few, if any, side effects, can be readily modified to accommodate individuals with multiple comorbidities, are well received by the majority of patients, and can be received in a variety of settings, including at home and online. Brittany Harvey: Those are key points that you just made. These recommendations are key for improving quality of life for patients, and it's great to have options for patients, including, as you mentioned, at home.   So then finally, what are the outstanding questions for the use of integrative approaches in managing anxiety and depression in patients with cancer? Dr. Julia Rowland: As I look at these new guidelines, both the SIO and ASCO, as well as the renewed ASCO guidelines, perhaps the biggest question raised is how to increase the use of recommended care. And I think there are three parts to this challenge. One critical first part is raising awareness about these guidelines, which it's hoped this podcast will help us achieve. A second, equally critical step, however, is identifying available treatment resources. While most treatment clinics and centers have access to mental health resources in a number of settings, this may be quite limited. Further, it's not clear how many such programs include integrative programs and services.  In addition to the questions about availability, lack of familiarity with some of these therapeutic modalities may leave clinicians reluctant to refer their patients for such care and raise questions for them about how to assess the training and qualifications of integrative care providers and the rigor of the therapy they provide. An important recommendation made by both ASCO and the SIO and ASCO Anxiety and Depression Management Guideline panels is that oncology clinicians should conduct a landscape analysis of who is and what types of programs are available to provide the recommended therapies to their patients. Arguably, not knowing where to refer a patient suffering from anxiety and depression is the most significant area to that patient's receipt of optimal care. The landscape review should include in-house or affiliated mental health providers, integrative program leads if present, local professionals, and organizations offering this care, as well as access to community-wide and national groups providing integrative care remotely via online and telephone. Asking patients themselves who they have seen and found helpful in improving their emotional well-being can also broaden resource lists generated.   A third challenge is how best to identify and refer those patients most in need. Recommendations regarding screening and assessment of anxiety and depression were not within the scope of the SIO and ASCO guidelines. However, in the two published ASCO Guidelines on use of conventional interventions for managing anxiety and depression, both the 2014 original and the updated 2023 revised, the expert panels emphasize the critical need to routinely screen for both anxiety and depression using standardized measures such as the GAD-7 and the PHQ-9.  ASCO's QOPI or Quality Oncology Practice Initiative already includes screening for emotional distress early in the course of care as a key practice standard. Other appropriate times for screening include changes in disease or treatment status, transition to palliative and end-of-life care, and when clinically indicated. Screening is the critical and necessary first step to identification and referral for appropriate and timely care of cancer patients and survivors suffering from anxiety and depression. Figuring out how to do this well and systematically should be a priority for reducing the burden of cancer nationally. Brittany Harvey: Absolutely. As you mentioned, screening is critical for identifying patients experiencing anxiety and depression, and I appreciate you reviewing those implementation barriers and how clinicians and practices can work to reduce these barriers and increase the uptake of these recommendations. We'll have some of those resources linked in the guideline also on the ASCO website and in the show notes of this episode.  So I want to thank you so much for your insights on this guideline and for your time today, Dr. Rowland. Dr. Julia Rowland: My pleasure, Brittany. I hope the word gets out and we'll see more uptake of these affected therapies and in broader use. Thank you.  Brittany Harvey: Definitely. That's the goal of all of these guidelines.  I also want to thank all of our listeners for tuning into the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/survivorship-guidelines.  You can also find many of our guidelines and interactive resources in the newly redesigned ASCO Guidelines app available for free in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of medical conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

https://swiy.co/WhatAreYourThoughtsWelcome to the Pediatric Meltdown podcast, where we delve into the challenges and triumphs of pediatric healthcare. Today, host Lia Gaggino has the pleasure of introducing her guest, (and self-proclaimed “superfan” of Pediatric Meltdown), Dr. Alisa Minkin, a trailblazing pediatrician and host of the JOWMA Podcast, a show dedicated to health education for the Orthodox Jewish community. In today's episode, Dr. Minkin shares her inspiring journey as a pediatrician and her unwavering commitment to mental health awareness. Drawing from her experiences as a parent to a child with special needs, as well as her advocacy for mental health screenings, Dr. Minkin's story is one of passion, resilience, and making a difference in the lives of children and families. Despite the barriers of time and limited resources, she has embraced telehealth as a double-edged sword and implemented crucial mental health screenings in her practice. Her desire to hear more voices of lived experiences, particularly from autistic and neurodivergent individuals and family partners, reminds us of the importance of inclusion and diverse perspectives in approaching pediatric care. Her journey serves as an inspiration for healthcare professionals and parents alike. With her passion and determination, she is indeed a true mental health warrior. So, grab your headphones and tune in to this episode – you don't want to miss this thought-provoking episode.The Spoons Theory: The spoon theory is a metaphor describing the amount of physical and/or mental energy that a person has available for daily activities and tasks, and how it can become limited. It was coined by writer and blogger Christine Miserandino in 2003 as a way to express how it felt to have lupus; explaining the viewpoint in a diner, she gave her friend a handful of spoons and described them as units of energy to be spent performing everyday actions, representing how chronic illness forced her to plan out days and actions in advance so as to not run out of energy.The metaphor has since been used to describe a wide range of disabilities, mental health issues, forms of marginalization, and other factors that might place an extra and often unseen burden on people living with them. From Spoon theory - Wikipedia[03:10 - 09:01] Barriers to meeting mental health needsLimited time for pediatricians to address mental health concerns during appointments.Lack of resources, especially for those who accept insurance or Medicaid.Challenges in finding qualified therapists and mental health resources.Disparities between Medicaid and private insurance coverage for mental health services.[09:02 - 14:24] Training Programs and Resources Case reviews and phone calls as part of the Reach programUtilizing Project Teach, a child psychiatry access programListening to podcasts, including the Joma and Pediatric Meltdown podcastsLearning from personal experiences and emotionally resonant stories[14:25 - 22:34] Personal Reflections and AdvocacyHighlighting the importance of suicide prevention and her sister's experience with it.Discussing the journey of implementing suicide prevention screening in her practice and allied supergroup.Expressing gratitude for the support received from experts in the field.Describing the introduction of combined ASQ Gad and PHQ screening tools in her practice.[22:35 - 32:47] The Importance of Advocacy and Creativity in...

Low testosterone in men is becoming a bigger problem with each passing decade. But what is the most significant cause of hypogonadism (the technical term for low testosterone)? It isn't diet. It's not environmental toxins or concussions, though they can affect a guy's levels. It isn't even drinking Bud Light. As you might surmise from the article's title, the most significant cause of low testosterone is circadian syndrome, a condition related to a disrupted circadian rhythm and sleep debt. A new study shows how much of a problem this is for American men. In this article, I'll discuss some of the key findings and what we can do about them. What is the prevalence of low testosterone? The most current research shows that 20-50% of U.S. males have testosterone deficiency.Kwong JCC, Krakowsky Y, Grober E. Testosterone deficiency: a review and comparison of current guidelines. J Sex Med. (2019) 16:812–20. doi: 10.1016/j.jsxm.2019.03.262 The cutoff for clinically diagnosed testosterone deficiency is a blood level 300 ng/dl, which is where the data comes from, suggesting that up to half of American men have low testosterone. In comparison, optimal testosterone levels are between 800-1200 ng/dl.  The problem is likely worse than that, as American men are less likely to get a checkup with their doctor than women, and even if they do, their doctors rarely check testosterone levels. What happens to men with low testosterone? Low testosterone leads to physical, mental, and sexual problems, including: Physical Changes: increased body fat, decreased muscle mass and strength, fragile bones, hot flashes, fatigue, and increased cholesterol levels.Mulligan, T., Frick, M. F., Zuraw, Q. C., Stemhagen, A., & McWhirter, C. (2006). Prevalence of hypogonadism in males aged at least 45 years: the HIM study. International Journal of Clinical Practice, 60(7), 762-769. Mental and Emotional Changes: changes in mood and mental capacity, including feelings of depression, irritability, trouble concentrating, and impaired memory.Shores, M. M., Sloan, K. L., Matsumoto, A. M., Moceri, V. M., Felker, B., & Kivlahan, D. R. (2012). Increased incidence of diagnosed depressive illness in hypogonadal older men. Archives of General Psychiatry, 61(2), 162-167. Sexual Dysfunction: reduced sexual desire, fewer spontaneous erections, and infertility.Khera, M. (2016). Male hormones and men's quality of life. Current Opinion in Urology, 26(2), 152-157. In many cases, as men develop any of these health problems, the health problems themselves lead to a greater decline in testosterone, which worsens the problems, which further tanks testosterone. You must break the downward cycle, and sleep is likely the most important place to start. What is Circadian Syndrome (CircS)? According to the study authors, CircS is primarily diagnosed based on hypertension, dyslipidemia, central obesity, diabetes, short sleep duration, and depression. Each of those symptoms is mainly governed by circadian rhythms, which are major regulators in almost every aspect of human health and metabolism. Association between the prevalence rates of circadian syndrome and testosterone deficiency in US males: data from NHANES (2011–2016) The Circadian Syndrome is diagnosed when a person has at least 4 of the following: Central obesity: waist circumference ≥102 cm (40 inches); High triglycerides (TG): TG ≥150 mg/dl or using TG-lowering drugs Low high-density lipoprotein cholesterol: high-density lipoprotein cholesterol

About Dale Cook:Dale is an expert in digital mental health. As co-founder and CEO of Learn to Live, he's part of a member-focused mental healthcare company that provides online programs and 24/7 clinician coaching to empower people to improve their mental health. Learn to Live serves over 33 million people through health plans, employers, and universities across the country.Dale has been recognized for his innovative approaches to healthcare as a recipient of the (Real) Power 50 award and the Business Leader in Healthcare: Startup award. Dale has been featured in various local and national publications, including Forbes, The Observer, National Public Radio, O, The Oprah Magazine, and others. Dale provides a welcoming and inspiring voice around mental health and the importance of driving engagement with digital healthcare solutions for at-risk populations.He is an active member of multiple healthcare entrepreneur groups focused on improving healthcare at the state and federal levels and is a member of the Governor's Taskforce on Broadband in Minnesota, which seeks to ensure quality broadband access for all Minnesotans. Dale is also a Fellow of the fifth class of the Health Innovators Fellowship at the Aspen Institute and a member of the Aspen Global Leadership Network. Things You'll Learn:Cognitive Behavioral Therapy programs have been studied for over two decades, and research shows that, when done correctly, digital CBT can be as effective as face-to-face CBT.Some necessary psychometric assessments are the PHQ-9 for depression, the GAD-7 for general anxiety, and the SPIN for social anxiety.Almost half of the people in the United States will suffer from a mental health problem at any point in their lives, but only one in four will seek care.Currently, teen mental health is one of the most important and talked about issues in this space.More than half of the counties in the US don't have a mental healthcare practitioner.Resources:Connect with and follow Dale Cook on LinkedIn.Follow Learn to Live on LinkedIn.Visit the Learn to Live Website!

Today is a very special episode because I not only have the pleasure of hosting this podcast, but I am also the guest. Yes, that's right! Today, in honor of Maternal Mental Health Month, I'm opening up my heart and sharing my postpartum story with you once again; I last told my story way back in Episode 1 in June 2016. I want all of you who know me as Dr. Kat professionally to understand why I am so deeply passionate about the cause of maternal mental health. Join us now! Karen Kleiman is a well-known international maternal mental-health expert with over 35 years of experience. As an advocate and author of several groundbreaking books on postpartum depression and anxiety, her work has been featured on the internet and within the mental health community for decades. In 1988, Karen founded The Postpartum Stress Center, a treatment and training facility for prenatal and postpartum depression and anxiety. Katayune Kaeni, Psy.D. PMH-C, “Dr. Kat,” is a perinatal mental health-certified psychologist, author of The Pregnancy Workbook: Manage Anxiety and Worry with CBT and Mindfulness Techniques, and host of the Mom & Mind Podcast, covering personal stories and expert interviews related to perinatal mental health. She is also the board chair of Postpartum Support International, an organization whose mission is to promote awareness, prevention, and treatment of mental health issues related to childbearing in every country worldwide. Dr. Kat began specializing in perinatal mental health after her own experience with postpartum depression, anxiety, and OCD over 12 years ago. Dr. Kat continues to work virtually with clients across California.  Show Highlights: How Dr. Kat's first pregnancy, even though planned and easy, resulted in a long, difficult labor that jump-started postpartum depression, anxiety, and OCD Why new moms struggle to know what's normal, not normal, too much, or not enough How feeling inadequate and incompetent as a new mom was part of Dr. Kat's anxiety and her battle with perfectionism How she felt alone and disconnected even from her husband, and NO ONE knew what was happening on the inside How scary intrusive thoughts put her in emotional turmoil Why shame and stigma are greater for mental health professionals–and will silence them at times How Dr. Kat carried on her therapy work with clients as the depression grew, making her feel trapped, exhausted, embarrassed, and confused How finally taking the PHQ-9 depression screening test for herself finally opened her eyes to the truth of what she was going through How she shut down even with her therapist and turned to a naturopathic physician, acupuncture, and other healing alternatives Why therapists MUST address the suffering client in front of them with curiosity and questions Why Dr. Kat is so deeply driven to help other moms break through and find the help and support to know that THEY WILL BE OK Resources: Connect with Karen: Website, Twitter, Instagram, Facebook, Book: Good Moms Have Scary Thoughts and LinkedIn Check out Karen Kleiman's other books: Website and Amazon Visit www.postpartum.net for resources and support!  Visit www.postpartum.net/professionals/certificate-trainings/ for information on the grief course.   Visit my website, www.wellmindperinatal.com, for more information, resources, and courses you can take today! Learn more about your ad choices. Visit megaphone.fm/adchoices

https://302.buzz/PM-WhatAreYourThoughtsAggression in children is a complex issue that can leave parents feeling helpless and desperate for a solution. Many turn to medication as a quick fix, but according to Dr. Lia Gaggino's guest, Dr. Peter Jensen, multiple medications are not always the answer. It's important to assess the situation correctly and consider alternative approaches before turning to medication. In this episode, Doctors Gaggino and Jensen explore the various causes of aggression in children and provide tips on how to handle it effectively without resorting to excessive medication. Whether you're a parent, caregiver, or educator, the information provided in this episode can help you better understand aggression in children and how best to support them. Get your pad and pencils ready, you'll be taking notes on this one. [00:30 -27:46] Understanding the Different Types of Aggression in Children and How to Treat ThemThe Importance of Assessing and Diagnosing before Prescribing MedicationAggression in children can fall into different categories, such as chronically irritable and explosive or misinterpreting social cuesDiagnostic Skills Help in Identifying the Underlying Causes of Aggressive Behaviors in ChildrenBipolar disorder and schizophrenia are unlikely causes of aggressive behavior in children[27:47- 38:02] Understanding and Treating Aggressive Behaviors in Children Treatment for ADHD should be maximized before turning to other medicationsResperidone and Aripiprazole have been approved by the FDA to treat aggression in childrenPrimary care providers need to get comfortable with atypical medications Guidelines for treating maladaptive aggression in youth are available in the journal Pediatrics[38:03 -48:14] Evaluating Medication for Children with Mental Health DisordersTrauma should be considered when treating children with psychiatric medications.Avoid the "pharmacotherapy of desperation," which involves adding multiple medications without clear rationale. Deprescribing, or slowly decreasing medication use, can be helpful for children on multiple medications that may not be effective.A thorough evaluation of the underlying disorder, using rating scales and input from multiple sources, is essential for choosing the right medication.[48:15 - 57:06] Top Screening Tools for Child Mental HealthVanderbilt Rating Scale is essential for monitoring ADHD in kids on stimulantsPHQ-9 is a quick and free depression scale that is recommended by the US Preventive Services Task Force and Academy of PediatricsSCARED is an effective tool for tracking and screening anxiety in children and can be given to parents or youthPSC-17 is ideal for well-child visits as it has only 17 items and screens for inattention, ADHD, anxiety, and depressionSuicide specific tools like ASK Screening Questions and Columbia should be used alongside PHQ-9 for better screening of suicidal ideation and behavior; CRAFFT can be used to screen for substance use in teenagers. [57:07 - 1:04:54] Closing segment TakeawayYou can reach Dr. Peter JensenWebsite: https://thereachinstitute.org/LinkedIn:

Depresyon hakkında bazı bilgiler ve sizden gelen 6 farklı hikaye.(Hikayelerini gönderen, yorum yazan herkese ve tüm Patreon destekçilerine teşekkürler).Bölümler:(00:05) Eğlenceli konular: Depresyon ve anskiyete.(01:10) Mutluluk için tasarlanmadık.(03:05) Kordoba Emirinin 14 mutlu günü.(04:15) Depresyonun farkı.(04:55) PHQ-9 testi.(06:05) Alper'in hikayesi.(07:45) EM'in hikayesi.(09:55) A'nın hikayesi.(10:20) Kitap: Adult Children of Emotionally Immature Parents.(11:05) Kitap: This Is Your Brain on Food.(11:35) T'nin hikayesi.(13:35) Kitap: Hayatı Yeniden Keşfedin.(14:37) F'nin hikayesi.(18:05) M'nin hikayesi.(28:25) Patreon Teşekkürleri..Kaynaklar:Yazı: Humans aren't designed to be happy – so stop tryingDepresyon Testi: PHQ-9 (Türkçe)Makale: Can Dancing Relieve Depression Symptoms?Makale: How Journaling Helps Manage DepressionVideo: Why Depression is Different per GenerationYazı: Serotonin Nedir?Kitap: Adult Children of Emotionally Immature Parents.Kitap: This Is Your Brain on Food.Kitap: Hayatı Yeniden Keşfedin.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Ep33: Nurse Coaches Take Care of Each Other- John Huaylinos, BSN, RN, HN-BC, HWNC-BC Highlights“In today's world it is vital we take care of the person on your left, the person on your right, and the ones that matter the most. When you connect with what matters the most, life is... I've learned life is more rewarding.” ~John HuaylinosAh-Ha'sCOVID has amplified grief and bereavement loss which affects mental wellness on a personal and systemic degreeMental wellness requires advocacy. And includes everything in body, mind and soulEveryone has had scarring to their soul, and when we can recognize this, we can connect at a deeper level to humansNurses can bury themselves in their work, this can lead to suppressing real desires and needs for self-care and self-compassionWhen Nurses explore their desires and need, this leads to self-preservation at a deep levelResources and LinksGAD-7 (General Anxiety Disorder-7) Measures severity of anxiety.PHQ-9 (Patient Health Questionnaire-9) Objectifies degree of depression severity.Integrative Nurse Coach Certificate Program

Podcast 285: TEAM-CBT for Chronic Pain. Featuring Derek Reilly-- with the Exciting Findings from a New British Outcome Study Rhonda begins the podcast with two inspiring emails about our recent podcast on “The Unexpected Results of the Latest Beta Test id the Feeling Good App, Part 1 of 2, published on2-28-2022. One is from Vivek Kishore, who used to come to all of my Sunday hikes prior to the pandemic, and Rizwan Syed, from Pakistan, who is an enthusiastic member of my Tuesday training group at Stanford as well as Rhonda's Wednesday training group. Here's what Vivek wrote Dear David and Jeremy, This is so amazing and has the potential to change the world. I am sure millions across the globe will benefit from this app. Can't wait for its launch. Thank you! Vivek Here's what Rizwan wrote: Dear David: Reading your books changed my life completely. I am so much happy and optimistic about life compared to highly critical of myself and others and had been so much bitter. I am sure your team therapy app would be as mind boggling and revolutionary as had been your bibliotherapy. I am no God. Had I been one, I definitely would have chosen you as my prophet to spread my message. Rizwan Today, we interview Derek Reilly, a Cognitive Behavioral Psychotherapist, and Registered Mental Health Nurse with 20 years of clinical practice  specializing in the treatment in chronic pain. He is an Accredited CBT therapist with the British Association for Behavioral and Cognitive Psychotherapies in the United Kingdom, and a TEAM certified Level 3 TEAM-CBT therapist. Derek is also a founding member of the new TEAM-CBT UK group. He has published papers on panic, OCD, and pain. He lives in Darfield, a small village in South Yorkshire, which is a mining area in England. Derek, like a previous guest, Dr. Peter Spurrier, attended a two-day workshop I conducted on TEAM-CBT in the treatment of anxiety disorders in London in 2015. Although I felt quite discouraged during and after the workshop, thinking I'd done a poor job, and since the crowd size was modest at best, a number of those who attended apparently got the message and became excited about TEAM. Derek said that the emphasis on T = Testing and on A = Assessment of Resistance made the biggest impact on him. He explained it like this: David described the four forms of Outcome Resistance and the four forms of Process Resistance. I suddenly realized that resistance was huge in the population I was treating, and that my biggest error had been trying to “help,” which usually just triggered more resistance and yes-butting by my patients, who would complain that no one was helping them with their pain. Dropout rates were high, and I also felt frustrated with the lack of progress I was seeing in my patients. Both Derek and Peter then attended my four-day intensive at the South SF Conference Center in 2017 and got hooked. Derek said: I thought about testing, and where it could be improved, and developed my own Pain Problem Survey (PPS) of the most common kinds of negative thoughts I was seeing in my patients, as well as the negative feelings these thoughts were triggering, like frustration, anger, anxiety, and more. I asked them to rate three emotions on a scale of 0 to 10, as well as their cognitions and behaviors, and tried to figure out what the resistance was all about. I also discovered that the simple step of T = Testing helped greatly with the E = Empathy, because my patients began to feel understood. This was different from the way I'd been trained which was to push this or that technique to “help” with their pain. He said that the concept of “acceptance” is a popular and common buzzword these days among mental health professionals, but there's a huge difference between intellectual “acceptance” and acceptance at the gut level. He liked the fact that TEAM offered specific tools to bring resistance to conscious awareness and to quickly reduce the resistance as well, as the paradoxical techniques that David has developed. Some of the common Negative Thoughts he heard from his patients included: I should bed doing things quicker. I should be responding faster. The doctor should fix me. Why is this happening to me? This is unfair! Many had been feeling demoralized that there was no medical solution, and ashamed of the fact that the could no longer work and do things that had once been automatic, like housework, or picking up and hugging the grandchildren, or going to work and earning money. Their disabilities seem to contradict their personal values, and they felt like they were letting people down. He said: Many of my patients had 10 or even 20 years of suffering and failed treatments, including multiple surgeries in some cases for back pain, for example, and often complained that nobody had been listening to them. That's why the E of TEAM was so important, and I practiced using the Five Secrets of Effective Communication to respond to their complaints. I worked especially hard on Feeling Empathy. Previously, I'd been way to quick to try to “help,” that just turned my patients off. I was helped by the empathy technique David developed called “What's my grade?” I ask my patients, “would you give me an A, a B, or a C or lower so far?” This was crucial. Then, when I went on to the A = Assessment of Resistance, we began to uncover, or discover, what their negative thoughts and feelings showed about them that was positive and awesome. Because I was practicing in an economically deprived area, I, and many of my colleagues, thought this would be a waste of time, and that my patients might not “get it” because it would seem too brainy or intellectual. But it was the opposite, and by the third session, many were already beginning to see things through an entirely different set of eyes. For example, they could see the many positive in their feelings of shame, inadequacy, anxiety, hopelessness, and even anger. So they began to feel proud of their negative thoughts and feelings. It was also helpful to take the “shoulds” out of their negative thoughts and feelings using methods like the Semantic Method and the Double Standard Technique. These approaches proved much more effective in helping people come to terms with loss/change. Derek described his work with a man who'd been struggling with chronic back pain and depression and daily alcohol abuse, who'd had a suicide attempt and felt useless. Derek said: He was open to examining his own role in his problems, and agreed to cut down on his alcohol intake. He found the Positive Reframing to be helpful, and saw that his negative thoughts and feelings were actually an expression of his high standards, and that his frustration was the expression of his determination not to give up. His guilt and shame showed that he had a conscience, and a moral compass, and that he was honest with himself, and that his frustration and depression about being unable to work showed his core values. Then we did the Magic Dial to see how much he wanted to dial down each negative feeling, like guilt, and used a variety of M = Methods to challenge and crush his negative thoughts. Once he pinpointed and challenged his Hidden Should Statements, his feelings of self-acceptance increased dramatically. Then we ended up using the Externalization of Voices to wipe out his negative thoughts. Derek and I discussed the role of negative emotions in patients with chronic pain and other “medical” symptoms, like dizziness, and chronic fatigue. I summarized my experience as a medical student working in Stanford's outpatient medical clinic with Dr. Allen Barbour, and how that approach was similar to the approach that Derek was taking. I summarized my statistical modeling of three data bases that all showed identical results that the correlation between physical pain and emotional distress is not because physical pain causes emotional distress, but because emotional distress causes an amplification in the experience of pain. This is true of physical pain with a clear medical cause, such as arthritis, as well as so-called “psychogenic pain” where no physical cause can be detected. Derek summarized his recent study of 60 chronic pain patients he treated with TEAM, which was a retrospective “clinical audit,” or chart review study. The study indicated a 57% reduction in scores on the PHQ-9 & GAD7 (commonly used depression and anxiety tests). These reductions were significant at the p < .0001 level. The changes  in the scores on the PPS were also significant. This is the first piece of preliminary evidence in the UK to show effective TEAM-CBT can be in the treatment of chronic pain. He is writing up these finds with a colleague, Anne Garland, a Consultant Nurse Psychotherapist, and hopes to publish them soon. He also found that other negative feelings were also comparably reduced, including the “big three:” frustration, guilt, and anxiety. Derek and his colleagues have their own Tuesday training group in England, and I will soon be joining them with Rhonda for a 90 minute Q and A session. If you'd like to learn more about Derek's work, or if you're interested in training, you can contact him at dwr1971@yahoo.co.uk or www.feelinggood.uk.com. Rhonda and I greatly enjoyed the recording and share great enthusiasm for Derek's work spreading the word about TEAM-CBT in England. We hope you enjoyed the podcast as well, and thank you for your support of our efforts! Rhonda, Derek, and David