Podcasts about related conditions

Episode 175: Alcohol Use Disorder Basics   Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD.    Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments 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.What is Alcohol Use Disorder?AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: Alcohol is frequently used in higher quantities or for longer periods than planned.There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.A strong need or desire to consume alcohol—a craving.A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.Frequent consumption of alcohol under risky physical circumstances.Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcoholTolerance: requiring significantly higher alcohol intake to produce the same intended effect. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.How can we determine the severity of AUD? Mild: 2–3 symptomsModerate: 4–5 symptomsSevere: >/= 6 symptomsWho is at risk for AUD?Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. The risk factors for AUD are: Male genderAges 18-29Native American and White ethnicitiesHaving Significant disabilityHaving other substance use disorderMood disorder (MDD, Bipolar)Personality disorder (borderline, antisocial personality)What is heavy drinking?According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: Males who drink > 4 drinks daily or > 14 drinks per week Females who drink > 3 drinks on any given day or > 7 drinks per weekPathophysiology of AUD.The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase, which breaks down acetaldehyde. Who should be screened?A person with AUD may not be easy to diagnose in a simple office visit, but some clues may point you in that direction. First of all, patients with AUD may present to you during their sober state, that´s why ALL adults (including pregnant patients) must be screened for AUD in primary care )Grade B recommendation). The frequency has not been determined but as a general rule, at least in Clinica Sierra Vista, we screen once a year. The USPSTF has concluded that there is insufficient evidence to recommend screening adolescents between 12-17 years old. What are the clinical manifestations of AUD?Some symptoms may be subtle, including sleep disturbance, GERD, HTN, but some may be obvious, such as signs of advanced liver disease (ascites, jaundice, bleeding disorders, etc.)If you draw routine labs, you may find abnormal LFTs (AST:ALT ratio >2:1), macrocytic anemia (MCV >100 fL), and elevated Gamma-glutamyl transferase (GGT). All these findings are highly suggestive of AUD. Patients with AUD may present in either an intoxication or withdrawal state. Signs and symptoms of acute intoxication may include “slurred speech, nystagmus, disinhibited behavior, incoordination, unsteady gait, hypotension, tachycardia, memory impairment, stupor, or coma.” Signs and symptoms of withdrawal range from tremulousness to hallucinations, seizures, and death. They are seen between 4 and 72 hours after the last drink, peaking at 48 hours, and can last up to 5 days. Alcohol withdrawal is one of the few fatal withdrawal syndromes that we know in medicine, and the symptoms can be assessed using a CIWA assessment. Treatment of AUD.There are factors to consider before starting treatment: Evaluating the severity of AUD Establishing clear treatment goals is associated with better treatment outcomesAssessing readiness to change: It can be done by motivational interviewing and using the stages of change model, which are, Pre-contemplation, contemplation, preparation, action, maintenance, and relapse.Discussing treatment of withdrawal.Treatment may be done as outpatient or it may require hospitalization. Dr. Beare sent an email with this information: “The approach to treating patients with AUD can be broken into two parts - the first is withdrawal management and the second is the long-term maintenance part. You MUST have a good plan for withdrawal treatment as it can be fatal if it's not addressed properly.” “Patients with any history of seizures due to withdrawal or a history of delirium tremens need inpatient management. If their withdrawal symptoms are typically mild (agitation, tremors, sleeplessness, anxiety) then outpatient management may be appropriate, typically with a long-acting benzodiazepine such as Librium or Ativan.”According to Dr. Beare, “the human aspect isa key element in treating alcohol use disorder. These patients arrive with tremendous amounts of suffering, shame, guilt, and fear. The relationship between the patient and provider needs to be built with compassion and understanding that this disease is horrible from the patient's perspective and using an algorithmic and calculated approach can cause significant harm to the rapport-building process, leading to lower success rates.”Treatment requires a lot of motivation and willpower. Hopefully, we can use some tools to assist our patients to be successful.-For mild disorder, Psychosocial interventions like motivational interviewing and mutual help groups like AA meetings may be enough to help our patient quit drinking.-For moderate or severe disorder: 1st line treatment is Meditation and structured, evidence-based psychosocial interventions (CBT, 12-step facilitation); which leads to better outcomesFor patients who lack motivation, motivational interviewing can be a useful initial interventionFor motivated patients: medical management, combined behavioral intervention, or a combination of both can be utilizedFor patients with limited cognitive abilities, 12-step facilitation, or contingency management can be helpful For patients who have an involved partner: Behavioral couples therapy can be utilizedMedications for AUD.The first-line pharmacological treatment is Naltrexone. It is given as a daily single dose and can be started while the patient is still actively drinking. There is a monthly dose of long-acting injectable naltrexone as well. Naltrexone is contraindicated in individuals taking opioids, and patients with acute hepatitis or hepatic failure. Alternative 1st line treatment is Acamprosate which can be used in people with contraindications to Naltrexone.AUD is a chronic problem and requires a close follow-up to evaluate response to treatment and complications. Medications need to be used along with psychotherapy and support, and medications may need to be changed or adjusted depending on the patient. It is an individualized therapy that requires full engagement of the doctor, the patient, and their families or social support. In conclusion, I would just like to add that, be compassionate because AUD is not a choice. AUD is a chronic problem like diabetes and HTN and may require a long road to recovery. Treatment includes psychotherapy, medications, and regular follow-up.Thank you for listening!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:Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment, https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-clinical-features-adverse-consequences-screening-and-assessment, accessed on August 18, 2024.Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, Accessed on August 18, 2024.Alcohol use disorder: Treatment overview, https://www.uptodate.com/contents/alcohol-use-disorder-treatment-overview, assessed on August 18, 2024. Royalty-free music used for this episode, Grande Hip-Hop by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net

Ruhr University Bochum PhD student Laurin Plank has been exploring the idea of using social media posts as a diagnostic aid for mental health conditions. He says people could benefit from early detection. “If people only ever get help once they’ve developed the disorder, then a lot of damage has already been done,” he said. […]

Send us a Text Message. In this episode, join us for a coaching session with Karly. She shares her struggles with weight loss, staying consistent with exercise, and dealing with health issues like rheumatoid arthritis and gut problems. Through an honest discussion and practical advice, you'll learn how Karly plans to improve her lifestyle by making gradual, sustainable changes. This episode offers valuable insights and motivation for anyone facing similar challenges and looking for practical strategies to lead a healthier life.  If you're facing challenges on your fitness journey and need some guidance, I'm here to help. I'm currently opening slots for a few individuals to join my FREE 1:1 Coaching. Apply now for personalised support from me.WAS THIS HELPFUL?I'd be so grateful if you could take a moment to follow, leave a 5-star rating, and download a few more episodes. DISCOVER YOUR INNER SELF AND IMPROVE YOUR MINDSET! Start your weight loss journey now with my Mind Over Muscle ProgramExplore how to Work with meFollow me on Instagram: @renae.wellnesscoaching Check me on Facebook: Renae Elliott Wellness CoachingExplore my other services as a Certified Fitness Trainer

Dr. Carol and Kim Pittis discuss various patient treatment scenarios using Frequency Specific Microcurrent (FSM).  They highlight the importance of thorough patient history, imaging, and physical exams in diagnosing and treating conditions such as bone marrow edema, knee injuries, sleep apnea, and empty sella syndrome.  Listen to detailed case studies, including the treatment of a teenage hockey player with a thigh injury, and explore how to adapt treatment strategies when initial hypotheses do not yield the expected results.  Additionally, the conversation touches on the psychological aspect of treating adolescent athletes and the complexities of endocrine disorders. 00:24 Mindset and Mental Wellbeing Course Insights 01:27 Patient Case Study: Cervical Trauma and Pain Management 05:41 Understanding Spinal Cord and Leg Tightness 06:20 Personal Medical History and Treatment Insights 10:19 FSM Treatment Techniques and Case Studies 23:17 Exploring Hip Flexor and Related Conditions 30:12 Adapting Treatment Approaches and Flexibility of Mind 31:33 Case Introduction: Dislocated Patella 33:25 MRI Results and Analysis 34:49 Understanding Bone Marrow Edema 37:32 Psychological Impact on Teen Athletes 45:16 Sleep Apnea and Neurological Factors 49:03 Case Report: Hockey Player Injury 52:34 Endocrinology and Pituitary Issues 55:30 Q&A and Closing Remarks

At Feisty Media, we are all about reclaiming language and turning it on its head. That's why we're proud to present our limited series, HORMONAL - Periods, Pills, and Pregnancy: How Women's Hormones Impact Sports Performance. This series is hosted by double-board certified Obstetrician and Reproductive Endocrinologist Dr. Carla DiGirolamo, who has been featured in Boston Magazine as one of "Boston's Best Doctors" every year since 2019. Carla is joined by Feisty's own Selene Yeager, who has been hosting the Hit Play Not Pause podcast since 2020, and has conducted over 160 interviews with leading experts and top athletes in the perimenopause and menopause space. Combined with her background as a health and science journalist, Selene is great at reading the research and translating it into actionable steps for active women. During these four episodes, you will learn what you need to know to work with your body's fluctuating hormones and perform your best. Episode three discusses questions and confusion around hormone related conditions like PCOS, endometriosis, Hashimotos, and more. Plus, Sarah and Dr. DiGirolamo address fertility and egg freezing.What do we mean by balanced or imbalanced hormones?What might cause hormonal imbalances?When people take HRT to get their hormones "back in balance," what does this actually mean?Common hormonal conditions and concerns?PCOS definition and its effects on reproductive health?The difference between hypo and hyper-thyroidism?Why thyroid imbalances impair our overall performance, mood, and energy availabilityEndometriosis definition, management, and treatmentEgg freezing best practices for fertility preservation and recommendations from a fertility specialistFor everyone who is sick of the narrative that women's hormones are a curse, we are here for you. Together, we will learn how amazing it actually is to be hormonal.Have a hormonal question for Dr. DiGirolamo and Selene? Leave a voicemail at https://www.speakpipe.com/Hormonal or DM us at https://www.instagram.com/feisty_womens_performance/Listen to Episode 1 of HormonalListen to Episode 2 of HormonalSign up to Receive The Feisty 40+ Newsletter:https://www.feistymenopause.com/blog/Feisty-40-plus Sign up to Receive The Feist Newsletter:https://www.womensperformance.com/the-feist Follow us on Instagram:@feisty_womens_performance Feisty Media Website:https://livefeisty.com/ https://www.womensperformance.com/ Support our Partners:Hettas: Use code FEISTY20 for 20% off at https://hettas.com/ MOTTIV: Get two months of full premium access with the code FEISTY at mymottiv.com Lagoon Sleep: Go to LagoonSleep.com/performance and take the 2 minute sleep quiz to find your match, and then use the code PERFORMANCE for 15% off your first purchase

Genflow Biosciences CEO Dr Eric Leire joins Proactive's Stephen Gunnion with details of two significant research grants in Belgium. The grants, aimed at fostering collaborations in advanced therapy medicinal products (ATMPs), notably support partnerships with EXO Biologics for exosome manufacturing and Revatis SA focusing on sarcopenia research. Sarcopenia, an age-related muscle loss condition, is a key area of Genflow's research. Dr Leire emphasized the importance of maintaining muscle mass for longevity and overall health. The Belgian government's non-dilutive funding covers 80% of the project costs, providing substantial financial support for Genflow. This funding setup is particularly beneficial as it offers more cash flow, shareholder value protection, and serves as a stamp of approval for the scientific rigour of Genflow's research. These collaborations are part of a three-year plan to build a robust biotech ecosystem in Belgium, involving academic centers and various biotech actors. This initiative is expected to significantly enhance Genflow's research capabilities and increase its company valuation through the achievement of meaningful milestones. Beyond these partnerships, Genflow is actively seeking further collaborations to expand its pipeline, focusing on gene therapy and age-related diseases. This strategy aims to reduce both financial and scientific risks in the current challenging biotech market, ensuring a diversified and robust research portfolio for the company. #GenflowBiosciences #DrEricLeire #BiotechInnovation #ResearchGrants #BelgiumBiotech #AdvancedTherapies #ExosomeManufacturing #SarcopeniaResearch #ATMP #BiotechCollaboration #GeneTherapy #AgeRelatedDiseases #BiotechIndustry #ScientificResearch #HealthTech #Longevity #BiotechFunding #MedicalScience #ProactiveLondon #BiotechNews #ProactiveInvestors #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

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

Coach Ted talks about the impact of breathing on the various conditions that we attribute to age.  

Welcome to Season 2! It's great to be back. The theme of this season is to ask the question 'why does supporting neurodivergent birth matter'? We kick things off by exploring this with Hayley Morgan who is an autistic mother, researcher and author. Hayley began writing about the autistic birth experience in 2015. Pregnant with her second child, her formal diagnosis of autism meant she learned about herself and her child on what would be a beautiful journey. Inspired to learn more about her neurotype, Hayley joined MSc Autism and Related Conditions at Swansea University Medical School. While completing this degree, she wrote for online magazines, blogs and more before submitting her MSc dissertation survey on the autistic birth experience.At the start of 2021 Hayley secured a book deal to co-author a book on the topic with JKP publishers and started her PhD on the autistic birth experience. This work is currently focused on specific issues raised from her MSc data i.e. autonomy, consent, capacity and specific barriers.Hayley is part of the team at the 'Maternity Autism Research Group'. You can find out more about the work they do, and links to a wide range of resources on this topic, at maternityautismresearchgroup.co.uk.Thank you for listening!Join the conversation on Instagram @neurodivergentbirth and at ndbirth.com.

Host: Sanj Kakar, M.D. @sanjkakar  Guest: Neha P. Raukar, M.D., M.S We've all been experiencing the intense heat and humidity, and did you know that this past July was one of the hottest months on record. Exposure to heat poses a major threat to high-risk populations by substantially contributing to increased morbidity and mortality. Our podcast today is tackling the most common heat-related conditions with Neha P. Raukar, M.D., M.S., Associate Professor of Emergency Medicine. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

U.S. President Joe Biden signed the Pregnant Workers Fairness Act (PWFA) and the Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP Act) into law on December 29, 2022. This combined legislation aims to bridge the gap in federal legal protections for employees who are affected by pregnancy or related conditions or who are breastfeeding. Listen to learn more about the requirements for employers under the PWFA and PUMP Act.

In this episode, we spoke with Dr. Nicole Bereolos about different diabetes-related skin conditions, such as acanthosis nigricans. Dr. Bereolos tells us how to recognize signs, manage symptoms, and if these skin conditions are something that people should be worried  Dr Bereolos is a clinical health psychologist and a certified diabetes care & education specialist in private practice in North Texas. She specializes in working with individuals living with chronic illness who want to optimize their quality of life. She also does speaking engagements to healthcare professionals and people living with chronic conditions and their families. “…We don't want diabetes to be in the driver's seat. We want to be in the driver's seat, the person living with it.”   In this episode you will learn:  Skin-related conditions in individuals with diabetes Acanthosis nigricans: causes, signs, and treatment Understanding the differences in skin conditions between type 1 and type 2 diabetes Preventing diabetes-related skin problems: recommendations for individuals with diabetes Connect with Yumlish: Website Instagram Twitter  Facebook LinkedIn Connect with Dr. Nicole Bereolos: Website Twitter LinkedIn --- Send in a voice message: https://podcasters.spotify.com/pod/show/yumlish/message

Sitting at FAACT's Roundtable Podcast is the newly installed president of the American Academy of Allergy, Asthma, and Immunology (AAAAI) and board-certified allergist, Dr. Jonathan Bernstein, who explores medical prior authorization barriers for people with food allergies and related conditions. Learn about the challenges and how you can address barriers and help support impact. To keep you in the know, below are helpful links for adults with food allergies:American Academy of Allergy, Asthma, and ImmunologyBernstein Allergy GroupNeedy Meds WebsiteGood RX WebsiteFixpriorauth.org (American Medical Association sponsored prior authorization advocacy website)You can find the FAACT Roundtable Podcast on Pandora, Apple Podcast, Spotify, Google Podcast, Stitcher, iHeart Radio, Podcast Chaser, Deezer, and Listen Notes.Visit us at www.FoodAllergyAwareness.org and follow us on Facebook, Twitter, Instagram, LinkedIn, Pinterest, TikTok, and YouTube. Contact us directly via Email.Sponsored by: Genentech*Please note that today's guest was not sponsored by Genentech or compensated in any way by the sponsor to participate in this specific podcast.Thanks for listening! FAACT invites you to discover more exciting food allergy resources at FoodAllergyAwareness.org!

We're repeating a conversation from our first season so you can get to know Bobby Knepper, our sound designer. Bobby was a listener whom we invited to chat with Rafael and Robert, and he then volunteered to make us sound better than we do in real life. In this conversation, we talk about knowing that you're different and not knowing why, emotional labor, growing up without peers, the power of hyperfocus, melting down, and a couple of life hacks. To listen to Bobby's songs, go to https://open.spotify.com/playlist/59VlLUag1hbDtkQLf3oNCg?si=12744afd1f714c7b5:00 the wonders of the internet6:38 Bobby's diagnosis disclosure8:50 seeing ASD as normal, just a difference 9:50 stimming jokes9:55 what makes disclosing difficult: emotional labor12:14 free diagnosis with Vanderbilt University, particularly interested in self-diagnosed adults.Vanderbilt Autism Resource Line - TRIAD Autism Services in Tennessee12:55 nuanced difference between self-diagnosis and official diagnosis13:38 WebMDWebMD13:47 General Anxiety DisorderGeneralized anxiety disorder - Symptoms and causes - Mayo Clinic14:31 Autistic OverloadSensory Overload: Symptoms, Causes, Related Conditions, and More15:30 Introductions16:40 Self-diagnosis & the difficulties of finding someone to do the diagnosis19:28 Autistic experience21:48 what led to Bobby's self-diagnosis at 1627:00 Bobby's system of tracking NT behaviors29:00 Being different and not knowing why29:26 autistic children grow up without peers30:45 When did autism speak its name to you?31:35 The room one kids/RainMan35:45: Bobby “I'm just young for my brain.”36:00 Jimmi comes into the scene/healthy Jimmi break37:25 Pandemic effects on us/love of being alone39:32 hit a wall/meltdown42:42 Big Warm Hug43:02 clip/quote Bobby 43:20 journaling and songwriting about the pain of autism44:05 the pain of not liking who you are is awful47:30 hyperfocus is a powerful tool49:00 what's beautiful about autism49:33 life hack: reading lips52:23 life hack: make music & harmonize with vocal melodies of others; jazz conversation53:22 synesthesia Synesthesia: Definition, Examples, Causes, Symptoms, and Treatment55:50 metaphors57:55 thinking in systems1:01:32 what was it like to let go of resistance to identifying as autistic1:05:05 autism and OCD behaviorsIs There a Link Between OCD and Autism?1:08:03 Robert: It's painful to be working in a bad system.1:10:40 The Green KnightThe Green Knight (2021) - IMDb1:12:50 autistics love to think and learn1:13:55 Documentary about intuition: InnSaei - The power of intuitionWatch InnSaei: The Power in Intuition | Prime Video1:21:32 Curiosity1:24:14 intuition and problem-solving skills1:25:04 having to explain how&

In today's episode, I'm joined by functional nutritionist Risa Groux, who talks about the connection between thyroid issues (and other auto-immune related conditions) and nutrition. She talks about how she helps her clients feel their best by tailoring their eating plans to their specific needs based on extensive lab work, the detoxification process, different types of diet plans and how they can help, and more. ************************* Risa Groux, CN is a Functional Nutritionist and Certified Autoimmune Coach in private practice in Newport Beach, California. She is passionate about cooking and creating healthy, nutritious food. She works with a wide array of clients from professional athletes, adults, and kids to the Biggest Loser from season four. Risa works with issues like diabetes, autoimmune disease, cancer, digestion, thyroid, and hormone imbalances, to name a few. Risa firmly believes that the body can heal itself with whole foods we obtain from the earth and sees living proof of that in her office each day. She looks at root causes using functional nutrition guidelines, blood and stool tests, and knows that weight loss is a side effect of wellness. Click to follow Risa on: Facebook and Twitter Check out Risa's website here! Click here to see Risa's course on acheiving optimal thyroid health! (And use code EndoBabe for 10% off!) ************************ Support the podcast & shop The Crystal Aesthetic here! Follow the Endo Babe Podcast on IG here! Join the Moon Magic Community here- for my wild&witchy spoonies! Click here to join the Endo Babe email list Check out other freebies + the Endo Babe blog here! Join my FREE Endo Babe Support Group on FB --- Support this podcast: https://anchor.fm/endobabepodcast/support

World-renowned celiac disease expert Dr. Stefano Guandalini, MD, sat down with us to answer your questions about celiac disease and the gluten-free diet. In this episode, the audience-submitted questions focused on conditions that are commonly seen alongside celiac disease. Dr. Guandalini is also the medical advisor for the sponsor of this Town Hall, imaware™.

There are many conditions and diseases that can be associated with your heart failure diagnosis. While diabetes and high blood pressure are common, infiltrative cardiomyopathy and severe lung disease are also possible. Tune in to this podcast episode to learn how to recognize your risk for related conditions and know what conversations you should be having with your doctor.

There are many conditions and diseases that can be associated with your heart failure diagnosis. While diabetes and high blood pressure are common, infiltrative cardiomyopathy and severe lung disease are also possible. Tune in to this podcast episode to learn how to recognize your risk for related conditions and know what conversations you should be having with your doctor.

Habits & Health episode 85 with Dr. Gil Kajiki, the author of Sick, Tired, Untreated and Abandoned: How the Medical Community Fails Hashimoto's Patients and How You Can Get Your Life Back. He is a Certified Functional Medicine Practitioner, Chiropractor, and patient educator with clients on 4 continents. His clientele include celebrities, corporate leaders, women stressed by family life and work, computer programmers, athletes, homemakers, radio show hosts, admin assistants, health practitioners and doctors. At the Valley Thyroid Institute, he and his staff are revolutionising the way that hypothyroidism and Hashimoto's Autoimmune Thyroid are diagnosed and corrected using drug-free solutions. His wife became ill with what at first appeared to be Epstein Barr. As he watched his wife's health deteriorate under the care of several doctors, Dr. Kajiki began a relentless search for answers to why his healthy wife could become so ill and yet no one seemed to know how to care for her. After more than two years of tests, medication, B12 shots, and finally hospitalisation, it was her husband and not her medical provider who came to her rescue. After countless hours of study, consultation with colleagues, and testing, Dr. Kajiki diagnosed his wife with Hashimoto's Thyroiditis, an autoimmune condition that attacks the thyroid. He spent the next several months treating her autoimmune condition through natural supplements, lifestyle modifications, and dietary changes. She is now symptom free and doesn't take any thyroid medication.   Full shownotes including a transcription available at: https://tonywinyard.com/dr-gil-kajiki/  Habits & Health links: Website - tonywinyard.com Facebook Page - facebook.com/TonyWinyard.HabitsAndHealth Facebook Group - facebook.com/groups/habitshealth Twitter - @TonyWinyard Instagram - @tony.winyard LinkedIn - uk.linkedin.com/in/tonywinyard YouTube How to leave a podcast review - tonywinyard.com/how-to-leave-a-podcast-review/ Details of online workshops to create habits for health - tonywinyard.com/training/ Are you in control of your habits or are they in control of you? Take my quiz to find out - tonywinyard.com/quiz

On this episode, Dr. Jeffrey Boris, a board-certified pediatric cardiologist and general pediatrician talks about his experience caring for patients with POTS since 2002. He has worked with patients who have multiple other diagnoses alongside their POTS, including joint hypermobility with or without Ehlers-Danlos syndrome, concussions, mast cell activation syndrome, Sjögren syndrome, eosinophilic esophagitis, median arcuate ligament syndrome, and other conditions. Dr. Boris advocates a creative, multi-pronged approach to helping children get back to school, sports, and their lives. He has published research in acclaimed medical journals to help doctors better understand POTS so more physicians will be available to treat it and join research efforts to better understand this disorder. In 2016, Dr. Boris was named “Physician of the Year” by Dysautonomia International, a leading organization seeking to improve the lives of people with autonomic nervous system disorders. He was recognized for his warmth, compassion and tireless commitment to his pediatric and young adult patients. Links: https://www.jeffreyborismd.com/ https://www.dysautonomiainternational.org/pdf/CHOP_Modified_Dallas_POTS_Exercise_Program.pdf

In this week's View, Dr. Eagle discusses cardiovascular outcomes in aortopathy in the GenTAC Registry of Genetically Triggered Aortic Aneurysms and Related Conditions, then looks at a systematic review and updated meta-analysis of the associations of dietary cholesterol, serum cholesterol, and egg consumption with overall and cause-specific mortality. Finally, Dr. Eagle explores the risk for acute myocardial infarction after ophthalmologic procedures.

Commentary by Dr. Valentin Fuster

In Part 2 of epidemiological studies published in January 2022, we'll focus on the association between cardiovascular health, diabetes and Alzheimer's disease. Naila will guide you through the latest research on how things like blood pressure, body mass index and insulin resistance are related to dementia and to AD pathology.  Sections in this episode:  Cardiovascular Factors (2:35)  BMI (12:25)  Diabetes and Related Conditions (14:49) -------------------------------------------------------------- To find the numbered bibliography with all the papers covered in this episode, click here, or use the link below:https://drive.google.com/file/d/1pESlNP2t6nTOdKkGvFUqm49L91Te-XHr/view?usp=sharingTo access the folder with ALL our bibliographies, follow this link (it will be updated as we publish episodes and process bibliographies), or use the link below:https://drive.google.com/drive/folders/1bzSzkY9ZHzzY8Xhzt0HZfZhRG1Gq_Si-?usp=sharingYou can also find all of our bibliographies on our website: www.amindr.com. --------------------------------------------------------------Follow-up on social media for more updates!Twitter: @AMiNDR_podcastInstagram: @AMiNDR.podcastFacebook:  AMiNDR  Youtube: AMiNDR PodcastLinkedIn: AMiNDR PodcastEmail: amindrpodcast@gmail.com  -------------------------------------------------------------- Please help us spread the word about AMiNDR to your friends, colleagues, and networks! And if you could leave us a rating and/or review on your streaming app of choice (Apple Podcasts, Spotify, or wherever you listen to the podcast), that would be greatly appreciated! It helps us a lot and we thank you in advance for leaving a review! Don't forget to subscribe to hear about new episodes as they come out too. Thank you to our sponsor, the Canadian Consortium of Neurodegeneration in Aging, or CCNA, for their financial support of this podcast. This helps us to stay on the air and bring you high quality episodes. You can find out more about the CCNA on their website: https://ccna-ccnv.ca/. Our team of volunteers works tirelessly each month to bring you every episode of AMiNDR. This episode was scripted and hosted by Naila Kuhlmann, edited by Chihiro Abe, and reviewed by Elyn Rowe and Anusha Kamesh. The bibliography was made by Anjana Rajendran and the wordcloud was created by Lara Onbasi (www.wordart.com). Big thanks to the sorting team for taking on the enormous task of sorting all of the Alzheimer's Disease papers into episodes each month. For January 2022, the sorters were Jacques Ferreira, Christy Yu, Kate Van Pelt, Kira Tosefsky, Dana Clausen, Eden Dubchak, Ben Cornish, Elyn Rowe and Ellen Koch. Also, props to our management team, which includes Sarah Louadi, Ellen Koch, Naila Kuhlmann, Elyn Rowe, Anusha Kamesh, and Jacques Ferreira for keeping everything running smoothly.Our music is from "Journey of a Neurotransmitter" by musician and fellow neuroscientist Anusha Kamesh; you can find the original piece and her other music on soundcloud under Anusha Kamesh or on her YouTube channel, AKMusic.   https://www.youtube.com/channel/UCMH7chrAdtCUZuGia16FR4w   -------------------------------------------------------------- If you are interested in joining the team, send us your CV by email. We are specifically looking for help with sorting abstracts by topic, abstract summaries and hosting, audio editing, creating bibliographies, and outreach/marketing. However, if you are interested in helping in other ways, don't hesitate to apply anyways.  --------------------------------------------------------------*About AMiNDR: *  Learn more about this project and the team behind it by listening to our first episode: "Welcome to AMiNDR!" 

In this episode, we learn about eosinophilic esophagitis (EoE) and eosinophilic gastrointestinal disease (EGID) with FAACT's Medical Advisory Board Member, board-certified allergist, immunologist, and pediatrician, Dr. Peter Capucilli. These conditions also require avoiding certain foods but are pretty unique. Listen in to discover how you can support people with EoE and EGIDs.To keep you in the know, here are a few helpful websitesCincinnati Center for Eosinophilic Disorders (CCED) ResearchAmerican Partnership for Eosinophilic Disorders (APFED)Campaign Urging Research for Eosinophilic Disease (CURED)International FPIES Association You can find the FAACT Roundtable Podcast on Pandora, Apple Podcast, Spotify, Google Podcast, Stitcher,  iHeart Radio, Podcast Chaser, Deezer, and Listen Notes.Visit us at www.FoodAllergyAwareness.org and follow us on Facebook, Twitter, Instagram, LinkedIn, Pinterest, and YouTube. Contact us directly via Email.Sponsored by:  The National Peanut Board* Please note that today's guest was not sponsored by the National Peanut Board or compensated in any way by the sponsor to participate in this specific podcast.

In part 2 of a 2 part series, John B. Williamson, Ph.D., discusses his article, "Posttraumatic Stress Disorder and Anxiety-Related Conditions" from the December Behavioral Neurology and Psychiatry Continuum issue. This article and the accompanying Continuum Audio interview are available to subscribers at continpub.com/posttraum.

In part 1 of a 2 part series, John B. Williamson, Ph.D., discusses his article, "Posttraumatic Stress Disorder and Anxiety-Related Conditions" from the December Behavioral Neurology and Psychiatry Continuum issue. This article and the accompanying Continuum Audio interview are available to subscribers at continpub.com/ptsd.

More information about this and other health topics can be found in my books "Low Dose Medicine" and "Cure Without Side effects" by following these links: ►►►https://amzn.to/3Bbx8fd ►►►https://amzn.to/36iaqDU To check the Low dose Medicine health kit follow this link: ►►►https://kit.co/cureswithoutsideffect/low-dose-medicine DISCLAIMER: Nothing contained in this video is intended nor can be taken to diagnose, treat, or cure any disease. It is for informational purposes only. This episode is also available as a blog post: https://cureswithoutsideffects.wordpress.com/2021/07/23/improve-your-health-series-stress-related-conditions/ --- Send in a voice message: https://anchor.fm/cureswithoutsideeffects/message

I am delighted to have Dr. Gil Blander, an internationally recognized anti-aging researcher, joining me on the show today! Gil has a background in the basic biology of aging and translating his discoveries into new ways of detecting and preventing age-related conditions. He received a Ph.D. in biology from the Weizmann Institute of Science and completed his postdoctoral fellowship at MIT. He has been featured In CNN Money, The New York Times, Forbes, The Financial Times, and The Boston Globe. There are many connections between Gil's childhood in Israel and his quest for longevity. One of his relatives passed away when he was twelve years old. When that happened, Gil realized that he would not live forever. It worried him, and that concern stimulated his interest in longevity and aging and prompted him to study biology, do a Ph.D. at the Weizmann Institute of Science, spend five years at MIT in the best lab to study aging, and found InsideTracker. Listen in today to find out all you need to know about the lifestyle choices that will promote anti-aging and longevity. IN THIS EPISODE YOU WILL LEARN Gil shares his background. What prompted Gil to leave the lab at MIT to go into the private sector. How and why caloric restriction extends our lifespan. How Gil transitioned from academia into the private sector. Gil explains what happens in the body when calories are restricted. How Gil managed to find the best blood biomarkers for longevity,   performance, and wellness. How Gil found the interventions to optimize anti-aging blood biomarkers. How nutrition and lifestyle changes can aid longevity. How the InsideTracker process works, and why it utilizes blood rather than saliva or urine for the testing. Gill talks about bio-individuality and clarifies some of the confusion often associated with epigenetic testing. Foods that promote or prevent longevity. The lifestyle choices that are essential for anti-aging and longevity. Gil talks about supplements. Connect with Cynthia Thurlow Follow on Twitter, Instagram & LinkedIn Check out Cynthia's website  Connect with Gil Blander (InsideTracker) On the website On Facebook, Instagram, LinkedIn,   and Twitter Book mentioned: Lifespan: Why We Age―and Why We Don't Have To  by Dr. David Sinclair

Look up: NESARC - National Epidemiological Survey of Alcohol and Related Conditions, George Valliant's study on AA attendance showed that most people who stay in AA remain abstinent over long periods of time; however, even his studies show that the people who stay in AA long - term constitute 5 percent of all attendees. In this episode I will discuss: the heat in the North American west, heat domes, ionospheric heaters, atheism, there is objective evidence of the existence of a higher power than humans, spirituality is not religion, AA and NA are neither cults nor cures, 12 Step treatment is not the only way to recover, a person must do the shadow work, there are AA and NA meetings available to attend almost constantly in America, it is good for people suffering from substance abuse problems to have a place to go, abstinence is the center core of 12 Step ideology, it is good to be abstinent from toxic substances and bad behaviors, people can recover with or without abstinence, ups and downs of sponsorship, singleness of purpose, AA and NA should stick with comradery and spirituality, George Valliant, the AA idea of powerlessness is absolutely false, alcoholic and addict identity, one drink or drug and total destruction, altering the serenity prayer and meaning of sobriety, Oxford Group and AA, Frank Buchman, Bill Wilson and Doctor Bob Smith, AA collectivism, most people recover on their own.

Arthritis rarely comes alone. Learn about related conditions and diseases that commonly occur with various types of arthritis, how they are related, and what you can do to prevent them or reduce their effects. Visit the Live Yes! With Arthritis Podcast site to read the blog and get show notes and a full transcript: https://arthritis.org/liveyes/podcast We want to hear from you. Tell us what you think about the Live Yes! With Arthritis Podcast. Get started here: https://arthritisfoundation.az1.qualtrics.com/jfe/form/SV_ebqublsylCl7BIh Special Guest: Amanda Nelson, MD MSCR RhMSUS.

This episode is also available as a blog post: http://lovewithsex.me/2021/07/02/how-to-deal-with-generalized-anxiety-disorder-and-its-related-conditions/ How to Deal with Generalized Anxiety Disorder and Its Related Conditions? #AnxietyManagementTips https://lovewithsex.me/?p=12109 How to Deal with Generalized Anxiety Disorder and Its Related Conditions? How to stop worrying about everything and enjoy an anxiety-free day. Recognizing the causes of anxiety disorder attacks

Fruit flies with low expression of a gene linked to neurodevelopment have disrupted sleep, poor memory and altered social behavior. The post Poor sleep could be core feature of autism, related conditions appeared first on Spectrum | Autism Research News.

Fruit flies with low expression of a gene linked to neurodevelopment have disrupted sleep, poor memory and altered social behavior.

ADHD doesn’t necessarily end at childhood. Research finds that about 50% of those cases persists into adulthood with problems with work and relationships.

Dr. Jennifer Mercier is the creator of Mercier Therapy, deep pelvic visceral manipulation that will help to bring about better organ mobility and restore overall blood flow so that optimal pelvic organ function can return. This therapy is paramount in helping women with pelvic pain, fertility problems, and pretty much any pelvic-related condition you can imagine.   In this episode, we talk about Jennifer's journey with endometriosis, how she went from treating herself to developing Mercier therapy which has helped countless women around the world, what visceral manipulation means and what you can expect from a session of Mercier Therapy, the physical aspect of fertility, and so much more!       To learn more about Dr. Jennifer Mercier, visit the show notes.

As we continue to make our way through the cluster A personality disorders, today we will be discussing Schizoid Personality Disorder. The DSM-V characterizes Schizoid Personality Disorder, or ScPD, as a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. linktr.ee/blackbirdadvocacy   REFERENCES: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed., American Psychiatric Association. Koch, J., et al., (2011). Sociodemographic and Diagnostic Characteristics of Homicidal and Nonhomicidal Sexual Offenders. Novovic, Z., et al., (2012). The role of schizoid personality, peritraumatic dissociation and behavioral activation system in a case of parricide. Apostolopoulos, A., et al., (2018). Association of Schizoid and Schizotypal Personality disorder with violent crimes and homicides in Greek prisons. Triebwasser, J., et al., (2012). Schizoid Personality Disorder. Pulay, A.J., et al., (2008). Violent Behavior and DSM-IV Psychiatric Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Clarke, G. (2012). Failures of the ‘moral defence' In the films Shutter Island, Inception and Memento: Narcissism or schizoid personality disorder? Blum, K., et al. (1997). Association of polymorphisms of dopamine D2 receptor (DRD2), and dopamine transporter (DAT1) genes with schizoid/avoidant behaviors (SAB).

In this episode, Heather interviews cardiologist, Manmeet Singh, MD and nurse practitioner in cardiovascular disease, Jodi Burany from the Karen Yontz Center for Cardio-Oncology at Aurora St. Luke's Medical Center and Advocate Aurora Health. They discuss how cancer treatment can affect the heart, signs and symptoms you might see, where to go if you need help, and how the cardiologist, oncologist, and nurses work together and come up with a customized treatment plan to minimize damage to the heart.If you are experiencing any symptoms discussed in this episode, please call the Karen Yontz Center for Cardio-Oncology at (414) 646-2662 or click on the link below.https://www.aurorahealthcare.org/services/heart-vascular/services-treatments/cardio-oncology-program#Related-Conditions

Dr. Thomas Joiner joins me to discuss why people commit suicide and how to prevent it. Thomas Joiner is an American academic psychologist and leading expert on suicide. He is the Robert O. Lawton Professor of Psychology at Florida State University, where he operates his Laboratory for the Study of the Psychology and Neurobiology of Mood Disorders, Suicide, and Related Conditions. He is author of Why People Die by Suicide (Harvard University Press 2005) and Myths about Suicide (Harvard University Press 2010), and the current editor-in-chief of Suicide and Life Threatening Behavior.In Why People Die by Suicide, Joiner posits the interpersonal theory of suicide, a three-part explanation of suicide which focuses on ability and desire. The desire to die by suicide comes from a sense of disconnection from others and lack of belonging, combined with a belief that one is a burden on others. The ability to die by suicide comes from a gradual desensitization to violence and a decreased fear of pain, combined with technical competence in one or more suicide methods. Under this model, a combination of desire and ability will precede most serious suicide attemptsIf you want go from feeling hopeless to hopeful, lonely to connected and like a burden to a blessing, then go to 1-on-1 coaching, go to www.thrivewithleo.com. Let’s get to tomorrow, together. National Suicide Prevention Lifeline800-273-TALK [800-273-8255]1-800-SUICIDE [800-784-2433]Teen Line (Los Angeles)800-852-8336The Trevor Project (LGBTQ Youth Hotline)866-488-7386National Domestic Violence Hotline800-799-SAFE [800-799-7233]Crisis Text LineText "Connect" to 741741 in the USALifeline Chathttps://suicidepreventionlifeline.org/chat/International Suicide Resources: https://www.iasp.info/resources/Crisis_Centres/

One of the greatest challenges that has been affecting so many people all over the world is stress. With so much going on every day, in and out of our lives, it has become difficult to avoid falling into the stress trap. But just because we all face it, one way or another, doesn't mean we can't overcome it. In this episode, Jen Du Plessis interviews Dr. Elizabeth Hughes, a Stanford-trained physician with more than 25 years of clinical experience treating thousands of patients with stress-related illnesses and having her own life nearly ruined by stress and chronic anxiety. Dr. Hughes shares with us her unconventional medical approach to treating stress-related conditions, moving into non-Western systems around health and healing. She takes us deep into her own unique process to turn off the body's harmful stress response—from eating to movement and everything in between. Listen in on this insightful discussion that could help you reverse stress-related illness symptoms and overcome the root that keeps you from living a long and healthy life.Love the show? Subscribe, rate, review, and share!Here's How »Join the Success to Significance Community today:jenduplessis.comFacebookTwitterLinkedInPinterestInstagramYouTube

Thanks for tuning in to the Armor Men's Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.In this segment Dr. Mistry and Donna Lee answer a listener's question on the diagnosis and treatment of urologic cancers and whether they might cause symptoms of Erectile Dysfunction. If you have a urology and health-related question that you would like to hear answered on the air, please email your questions to armormenshealth@gmail.com. Questions are answered anonymously, unless otherwise specified, and the answers will likely benefit many people with the same concerns.If you enjoyed today's episode, don't forget to like, subscribe, and share us with a friend! As always, be well!Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.We enjoy hearing from you! Email us at armormenshealth@gmail.com and we'll answer your question in an upcoming episode!Phone: (512) 238-0762Email: Armormenshealth@gmail.comWebsite: Armormenshealth.comOur Locations:Round Rock Office970 Hester's Crossing Road Suite 101 Round Rock, TX 78681South Austin Office6501 South Congress Suite 1-103 Austin, TX 78745Lakeline Office12505 Hymeadow Drive Suite 2C Austin, TX 78750Dripping Springs Office170 Benney Lane Suite 202 Dripping Springs, TX 78620

Narcissism and Narcissistic Personality Disorder are terms that have real meaning in psychology but are used very loosely in general vernacular. In this episode, Brett and I discuss what Narcissism actually is and how it is treated.  Narcissism A short Mayo Clinic article explaining narcissism and general symptoms:  https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662 A Psychology Today article on changing narcissistic behavior: https://www.psychologytoday.com/us/blog/romance-redux/201309/can-narcissists-chang%C3%A9 • Establishing connection without judgment and resisting the urge to get pulled into reacting to the arrogant and dismissive behavior is key. More dense clinical information The disorders in Cluster B are Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder and Narcissistic Personality Disorder.  https://pdfs.semanticscholar.org/4dc0/c34ab0bcd1c9d2f519770c6c01e94d5fad0f.pdf Narcissism and Borderline States: Kernberg, Kohut, and PsychotherapyNarcissism: a general term for feeling the person has for themselves. Borderline: a general term for severe disturbances of emotional life that are not neurotic but not severe enough to be called psychotic. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860525/pdf/PE_4_10_40.pdf Psychotherapy with a Narcissistic Patient Using Kohut’s Self Psychology ModelAccording to Kohut’s self-psychology model, narcissistic psychopathology is a result of parental lack of empathy during development. Consequently, the individual does not develop full capacity to regulate self-esteem. http://www.sakkyndig.com/psykologi/artvit/russell1985.pdf   Narcissism and the narcissistic personality disorder: A comparison of the theories of Kernberg and KohutThe transference signs of narcissism: • Kernberg (1970, p. 63) looks for the denial of the analyst as an independent person • Kohut (1972, p. 371) diagnoses patients as narcissistic only when their transference relationship is ‘idealizing’ (i.e. the analyst serves as an idealized self-object) or ‘self-aggrandizing’ (i.e. the analyst serves as a mirror for the narcissistic patient’s grandiose self) • Full comparison of theories starts on page 141 https://www.ncbi.nlm.nih.gov/pubmed/18557663 Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. (2008) METHOD: Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States. RESULTS: Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders among men. Dysthymic disorder was significantly and negatively associated with NPD. https://psychcentral.com/quizzes/narcissistic-personality-quiz/ For personal use only. Based upon Raskin, R. & Terry, H. (1988). A Principal-Components Analysis of the Narcissistic Personality Inventory and Further Evidence of Its Construct Validity. Journal of Personality and Social Psychology, 54(5). Instructions: Here you’ll find a list of 40 statements, one in Column A and the opposite in Column B. For each statement, choose the item from Column A or B that best matches you (even if it’s not a perfect fit). Complete the quiz on your own and in one sitting, which takes most people between 5 and 10 minutes to finish. In most browsers, you can click anywhere on the item to choose it (you do not have to click in the radiobox itself). Answer all questions for the most accurate result. • Was a pilot study to test for the internal validity of the test and construct validity of domains of the test.  • Internal validity was not supported thought construct validity was. • There is no “test” for narcissistic personality disorder accredited for clinical use

“As many as 1 in every 5 teens experience depression at some point during adolescence, but they often go undiagnosed and untreated.” My own son was diagnosed with depression at the age of 11, but he had been suffering for probably a year before that diagnosis. As a parent, I had an inkling but wasn't sure and really didn't know at what point to seek help and certainly didn't know what to expect when finally making that appointment. Today I am speaking with pediatrician Dr. Hector De Leon about depression in children and adolescents. We are chatting about what depression is, its symptoms, how it's diagnosed and what treatment looks like. From stigma to how to talk to your kids about it, Dr. De Leon covers everything you need to know to identify depression and get your child the help he needs.Topics• Understanding depression (4:50)• How depression is different in children (8:66)• Symptoms of depression (10:46)• Depression in older children vs. younger children (12:35)• How depression progresses (13:45)• Boys and depression (17:50)• How and When to seek a diagnosis (21:50)• How depression is diagnosed (24:06)• Related Conditions (25:38)• How to talk to your kids (27:00)• Treatment options (29:20)• Reoccurrence (34:44)• Resources (38:09)Show Notes and Links• Head over to https://findyourwords.org (https://findyourwords.org) to check out Kaiser Permanente's site on depression including a self-assessment tool• The CDC has several pages dedicated to depression check out the childhood depression page at https://www.cdc.gov/childrensmentalhealth/depression.html (https://www.cdc.gov/childrensmentalhealth/depression.html)• The American Academy of pediatrics also has several pages on depression that can be accessed at https://www.aap.org/ (https://www.aap.org/) including this article by Nerrisa S. Bauer that I pulled the above quote from available at https://www.aap.org/en-us/aap-voices/Pages/Adolescent-Depression.aspx (https://www.aap.org/en-us/aap-voices/Pages/Adolescent-Depression.aspx) • Want more Boys Built Better? Like us on Facebook at https://www.facebook.com/boysbuiltbetter/ (https://www.facebook.com/boysbuiltbetter/) or follow us on Instagram at https://www.instagram.com/boysbuiltbetter/ (https://www.instagram.com/boysbuiltbetter/)• Get full episode notes at https://boysbuiltbetter.com/ (https://boysbuiltbetter.com/) Support this podcast

Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. Jeff: As a quick survey of our audience before we begin, how many of you routinely encounter co-morbid psychiatric conditions in your ED patients, especially depression? Nachi: That would certainly be all of our listeners! Jeff: And how many of you struggle to admit or transfer patients for a formal psychiatric eval? Show More v Nachi: Again, just about all of our listeners I’m sure! Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Nachi: That would certainly be helpful. So now that we are all in agreement with just how necessary this episode is, let’s dive in. Jeff: This month’s issue was authored by Dr. Bernard Chang, Katherine Tezanos, Ilana Gratch and Dr. Christine Cha, who are all at Columbia University. Nachi: In addition, it was peer reviewed by Dr. Nicholas Schwartz of Mount Sinai School of Medicine in New York and Dr. Scott Zeller of the university of California-Riverside. Jeff: Quite the team, from a variety of backgrounds. Nachi: And just to put this topic into perspective - annually, there are more than 12 million ED visits for substance abuse and mental health crises. This represents nearly 12.5% of all ED visits. Of note, among these visits, nearly 650,000 individuals are evaluated for suicide attempt. Jeff: Looking more in depth, of the mental health complaints we see daily, mood disorders are the most common, representing 43%, followed by anxiety disorders, 26%, and then alcohol related conditions at 23% Nachi: And as is often the case, these numbers are likely underestimates, as many psychiatric complaints, especially depression, often go unnoticed by the patients and providers alike. In one study of patients who presented with unexplained chest and somatic complaints, 23% met the criteria for a major depressive episode. Jeff: Sad, but terrifying, though I suppose it all makes this issue so much more valuable. Nachi: Before we get to the evidence and an evidence-based approach, let’s start with some definitions. Jeff: Certainly a good place to start, but let me preface this with an important point - arriving at a specific psychiatric diagnosis in the ED is likely neither feasible nor realistic due to the obvious limitations, most namely, time - instead, you should focus on assessing and collecting information on the presenting symptoms and taking a comprehensive psychiatric and medical history. Nachi: According to DSM-5, to diagnose a major depressive disorder you must have 5 or more of the following: depressed mood, decreased interest or pleasure in most activities, body weight change, insomnia or hypersomnia, restlessness or slowing, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate or indecisiveness, or finally recurrent thoughts of death and or suicide. In addition, at least 1 of the symptoms must be either a depressed mood or loss of interest. Jeff: These symptoms must last most of the day, nearly every day, for 2 weeks. Nachi: And these symptoms must cause clinically significant distress or impairment across multiple areas of functioning. Jeff: So those were criterion A and B. Criterion C, D, and E state that a MDD does not include factors from substance use or medical conditions, psychotic disorders, or manic episodes. Nachi: Once you’ve had the symptoms for 2 years with little interruption, you likely qualify for a persistent depressive disorder rather than a MDD. Jeff: And if your symptoms repeatedly co-occur around menses, this is more likely premenstrual dysphoric disorder. Nachi: Moving on to suicide and suicide related concepts. Suicidal ideation is the consideration or desire to kill oneself. Jeff: These can be active or passive thoughts, for example, “I don’t want to be alive” vs “I want to kill myself.” Nachi: Other important terms include, the suicide plan, suicide attempt, suicide gesture and nonsuicidal self-injury. The plan typically includes the how, where, and when a person will carry out their attempt. Jeff: A suicide gesture is an action or statement that makes others believe that a person wants to kill him or herself, regardless of the actual plan. Nachi: I think that’s good for definitions, let’s discuss some more epidemiology. Based on 2005 data, the prevalence of 1 month MDD was 5% with a lifetime prevalence of major depression of 13%. Jeff: If those figures seem a bit high, another CDC study found that in a general population survey of a quarter million people between 2006-2008, 9% met the criteria for major depression. Pretty big numbers... Nachi: Sadly, though outpatient visits for depression and suicide related complaints have decreased over the years, while ED visits remain stable, implying that the ED is a critical entry point for depressed and suicidal patients. Jeff: It’s important to also recognize at risk populations. In several studies, the prevalence of MDD is reported as being nearly twice as high in women as it is in men. Nachi: MDD is also much more common in younger adults, with a prevalence of about 20% in those under 65 and a prevalence of just 10% in those 65 and older. Jeff: Additionally, being never-married / widowed / or divorced, being black or hispanic, having poor social support, major life events, and have a history of substance abuse are all serious risk factors for depression. Nachi: In terms of suicidality, nearly half of depressed adults in one study felt that they wanted to die, with ⅓ having thought about suicide. Taking it one step further, somewhere between 14-31% of depressed adults have attempted suicide, and roughly 1 in 10 depressed adults ultimately die by suicide. Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4 billion per year in the US. Nachi: That’s an incredible amount and much more than I would have guessed. Jeff: In terms specific risk factors for suicide and suicide related complaints - white men over 80 have the highest rate of suicide death in the US, with 51.6 deaths per year per 100,000 individuals. Nachi: You snuck in an important word there - suicide DEATH. While old people die the most from suicide, younger adults attempt suicide more often. Jeff: Along similar lines, while women attempt suicide nearly 4 times more frequently than men, men are 3 times more likely to die by suicide, likely related to their respective choice of suicide methods. Nachi: Lesbian, gay, and bisexual men or women are another at risk population, with rates of suicidal ideations being nearly twice that of their heterosexual counterparts Jeff: Despite the litany of risk factors we just ran through, the strongest single predictor for suicide related outcomes is a prior history of suicidal ideation or attempt, with individuals who have made a previous attempt being nearly 6 times more likely to make another. Nachi: And lastly, those who have had symptoms severe enough to warrant psychiatric admission have an increased lifetime risk of suicide also at 8.6% vs 0.5% for the general population, in one study. Jeff: Alright, so that wraps up the background, let’s move on to the actual evaluation. Nachi: When forming your differential, a crucial aspect is identifying potential secondary causes of depressive symptoms, as many depressive symptoms are driven by etiologies that require different management strategies and treatment. Be on the lookout for toxic-metabolic, infectious, neurologic disturbances, medication side effects, and recent medical events as the etiology for depressive episodes and suicidality. Jeff: Excellent point, which we’ll reiterate a few times throughout the episode - always be on the lookout for medical causes of new psychiatric symptoms. Next, we have my favorite, prehospital care - when doing your scene assessment, look out for possible signs of overdose such as empty pill bottles lying around. It’s also important to assess for the presence of firearms. Of course, this should not be done at the expense of acute medical stabilization. Nachi: And don’t forget to consider transport directly to institutions with full psychiatric services, especially for those with active suicidal ideations. Jeff: Once in the ED - start by maximizing the patient's privacy. Always use a nonjudgmental approach and use open-ended questions. Nachi: If feasible, map the chronology of depressive symptoms and their impact on the patient’s functional status. It’s also important to elicit any psychiatric history, including prior hospitalizations. Jeff: Screening for suicidality is critical in all patients with depressive symptoms given the elevated risk in this population. Though not broadly adopted in many EDs, there are a number of screening tools to assist you in this process, including the PHQ-9, ED SAFE PSS-3, and C-SSRS, which all asses for severity of suicide risk. These have been developed primarily for the outpatient and primary care settings. Nachi: And not surprisingly, MDCalc has online tools to help you use these risk assessments, so you can easily pull up a scoring tool on your phone should the appropriate clinical scenario arise. Jeff: The PHQ-9 was validated in various outpatient settings, including the ED. This is a self-administered depression questionnaire that has been found to be reliable across genders and different cultures. Interestingly, the PHQ-9 questionnaire contains one question about suicidality - how often is the patient bothered by thoughts that you would be better off dead or hurting yourself. Responding “nearly every day” increases your odds from 1 in 250 to 1 in 25 of attempting suicide. Nachi: The next tool to discuss is the ED-Safe PSS-3. The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. Jeff: In one study, using this tool doubled the number of suicide-risk cases detected. Nachi: Once someone has screened positive for recent suicidal ideations, further screening must be done via a secondary screener. Jeff: In one study, following this approach decreased the total number of suicide attempts by 30% following an ED visit. Nachi: And what would you advise to clinicians that are concerned that questioning a patient about suicidal ideation may actually encourage or introduce the idea of suicide in those who hadn’t already considered it? Jeff: Great question - It has been found that there has been no associated introduction of negative effect when a patient is asked about suicidal ideations. Concerns about iatrogenic effects should not prevent such evaluations. Nachi: Definitely reassuring that this has been looked into. Let’s move on to the physical. Jeff: The physical exam should include a cognitive assessment that focuses on identifying medical conditions, as well as a behavioral mental health status exam that focuses on identifying the presence and degree of depression. Nachi: And as you said, we would mention it a few times -- In the ED, you always want to make sure you aren’t missing an underlying medical condition that manifests as depression. Jeff: So important. Alright, let’s move on to diagnostic studies. And thanks to a systematic review of 60 studies on this topic, there is actually reasonably good data here. Nachi: According to this review, in patients with a known psychiatric disease presenting with exacerbating psychiatric complaints, routine serum and urine tox screening is not recommended. Additional screening tests should be considered in those with new psychiatric symptoms who are 65 years or older, those who are immunosuppressed, and those with concomitant medical disease. Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. They too call for a focused history and physical to guide testing. Nachi: It’s also worth highlighting one other incredibly important point from that ACEP policy - urine tox screens for drugs of abuse should not delay patient evaluation for transfer to a psychiatric facility. Jeff: Definitely a great policy to check out if you find yourself in all too frequent disagreements with your local psychiatric receiving facility. Nachi: You should also consider serum testing in those taking psychotropic medications with known toxic effects, such as lithium, as toxicity would change management. Jeff: Ok, last point about the work up, imaging studies of the brain should not be routinely ordered unless you have a high degree of suspicion. Nachi: That wraps up testing. Let’s move on to treatment. Jeff: First and foremost, you must maintain a safe environment. Effective precautions include alerts to staff about the potential safety risk in addition to searches of the patient and his / her belongings if applicable. Nachi: With the staff notified and the patient searched, the patient should be placed in a room without potentially dangerous items, like tubing or needles. Those who are at a very high risk may warrant continuous observation. Jeff: Speaking of safety, you will definitely want to engage in safety planning with the patient. Safety planning can be completed by any emergency clinician and should take about 20-45 minutes. Nachi: And while this is typically done by a psychologist or psychiatrist, this is something any emergency clinician can also easily do. Jeff: Safety planning beings with a brief interview. Next you establish a list of personalized and prioritized steps to help the patient through his or her next crisis. In a full plan, you should identify: warning signs, internal coping strategies, people and social settings that provide distraction, people whom the patient can ask for help, professionals or agencies whom the patient can contact during a crisis, and lastly how to make the environment safe (for example, lethal means counseling). Nachi: Of course, while the plan is meant to be a step by step approach for the patient, you should encourage the patient to seek professional help at any time if it is necessary. Jeff: Great point. And while safety planning typically is most effective when combined with other interventions, research suggests that it does enhance outpatient treatment engagement after an ED visit and in one study, reduce subsequent suicide attempts by 30% vs usual care. That’s a huge win for something that’s not that hard to do. Nachi: Similar to safety planning, let’s discuss no-suicide contracts. No-suicide contracts or no-harm contracts are verbal or written agreements between the patient and the clinician to articulate that he or she will not attempt to hurt him or herself. Though there isn’t a ton of evidence, at least one RCT showed that safety planning was superior to contracts. Jeff: Lethal-means counseling on the other hand is a potentially helpful prevention strategy. In lethal means counseling, you merely have to address the patient’s access to lethal means. By slowing their access to their lethal means, it is thought that the relatively short-lived suicidal crises may pass before they could access said means. Nachi: For example, you could provide options for restricting access to lethal means, such as disposal, locking up and giving the key to someone else, or temporarily giving the means to a friend. Jeff: And this may be a good time to involve friends and or family, especially when dealing with suicidal youths. Nachi: This is such an important and simple intervention that has actually been shown to reduce suicide attempts and deaths. Unfortunately, few ED clinicians address lethal means. Jeff: Pro tip: since most ED clinicians chart with templates, add something to your standard suicidality / psychiatric template about lethal means. This will serve as an important reminder to address it in real time. Nachi: That is a really great idea to ensure you don’t skip over this underutilized counseling. Jeff: The next aspect of treatment to discuss is follow up. Follow up is critical for both depressed and suicidal patients. Follow up can come in many forms and at a minimum should include the national suicide prevention lifeline. Nachi: The authors even simplify this for us a bit, providing 5 easy steps to help make sure patients follow through with ED discharge recommendations. Jeff: First, provide a standard handout that includes a list of outpatient providers. Next provide the patient the 24 hours crisis line number. After that, ask the patient to identify the most viable resources and address any barriers the patient may have in getting there. Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. Nachi: And if this seems too burdensome for a single provider, think about identifying a staff member who may help the patient with follow up - perhaps a social worker or case manager. Follow up is so important, it’s critical that the ball not be dropped after you’ve put in so much hard work to make the plan. Jeff: As always, the team approach is preferred. Alright so the last treatment to discuss is actual pharmacotherapy. Since commonly prescribed antidepressants take up to 6-8 weeks to have a clinical effect, the administration of psychotropic medications is not routinely initiated in the ED. Interestingly, there may be a role for ketamine, yes, ketamine, in conjunction with oral meds. More on that in a few minutes though... Nachi: Let’s talk first about special populations - the only one we will discuss this month is military veterans. Jeff: Recent evidence has demonstrated an association between exposure to blast and concussive injuries and subsequent depressive and anxiety symptoms. Nachi: In part, because of this, among veterans presenting for emergency psychiatric services, approximately 52% reported suicidal ideations in the prior week and 70% reported current depressive symptoms. Clearly this is a major problem in this population. Jeff: But to bring it back to ED care, in one study, among depressed veterans with death by suicide, 10% had visited a VA ED in the 30 days prior to their death. Nachi: And this is in no way meant to be a knock-on VA ED docs - they are dealing with a very at risk population. But it is worth highlighting the importance of the ED visit as an excellent opportunity to begin to engage the patient in long term care. Jeff: Exactly, every ED visit is an opportunity that shouldn’t be missed. Nachi: Let’s talk controversies and cutting-edge topics from this issue. Jeff: First, let’s start by returning to ketamine and the treatment-resistant depression and suicidality. Nachi: Recent trials, including RCTs have found that low doses of ketamine administered via a variety of routes, may have a significant therapeutic effect towards reducing suicidality in patients in the acute setting. Jeff: To this end, Esketamine, an intranasal version of ketamine has already been FDA approved for treatment resistant depression. Nachi: This has huge implications for some of the psychiatrically sickest patients, so be on the lookout for more in the future. Jeff: Next we have the zero-suicide model. This is a program of the national action alliance for suicide prevention that involves a multi pronged approach to reducing suicide based on the premise that suicide is preventable. This model involves educating clinicians on best practices, identifying screening and assessment tools for engagement, treatment, and disposition. Nachi: Though not yet implemented in the ED setting, this may offer a novel approach to ED patients with psychiatric emergencies in the ED. Jeff: The next controversy is a big one - alcohol intoxication and suicide risk. There is a bidirectional relationship between depression and alcohol abuse and dependency. Not only is alcohol abuse a lifetime risk factor for completed suicide, those who make suicide attempts or present with suicidal ideations are more likely to be intoxicated. Nachi: In addition, formerly intoxicated patients may deny their previous thoughts and intentions when sober. Interestingly, though such patients have an increased lifetime risk of death by suicide. Jeff: Given this paradox and the evidence that exists, the authors recommend observing the patient until they have reached a reasonable level of sobriety. This effective level of sobriety should be based on clinical assessment and not blood alcohol levels. If the patient unfortunately has reached a place where they are at risk of withdrawal, this should be treated while in the ED. Nachi: It’s worth noting that ACEP guidelines and guidelines from the american association for emergency psychiatry have both supported a personalized approach that emphasize evaluating the patient’s cognitive abilities rather than a specific blood alcohol level to determine when to pursue a formal psychiatric assessment. Jeff: Very important point - in this high-risk population, you are targeting a clinical endpoint, not a laboratory end point and this is backed by several national guidelines. Nachi: Moving on to the next topic - let’s discuss post discharge patient contact. Jeff: Though not something many ED clinicians routinely do, this may be something to consider implementing in your department. And this doesn’t even have to be something as time consuming as a phone call. In one study, sending a brief postcard 9 times a year with a quick “hope things are well” type message to patients discharged after deliberate self-harm reduced self-poisonings by 50%. Nachi: Though other studies including other methods of follow up have not shown as drastic results, generally the results have shown a positive impact. Jeff: Next we have to discuss the various screening tools. Though we previously mentioned screening tools in a positive light, using such decision-making tools is still of limited utility due to the fact that they rely on self-reporting and suicidal thoughts and behaviors are complex and may require the consideration of hundreds of risk factors. Nachi: And while implicit association tests are being developed to predict suicidal thoughts and behaviors, and computer models and machine learning are being used to enhance our screening tools, there is still a long way to go before such tools perform more independently with acceptable performance. Jeff: The last cutting-edge topic to discuss is telepsychiatry. Nachi: Just as telestroke has changed stroke care forever, as technology advances, telepsychiatry may provide a solution to easily expand access to outpatient services and consultation in a cost effective manner - offering quick psychiatric care to those that never had access. Jeff: Let’s move on to the final section of the article. Disposition, which can be a bit complicated. Nachi: The decision for discharge, observation, or admission depends on clinical judgment and local protocols. Appropriate disposition is often fraught with legal, ethical, and psychological considerations. Jeff: It’s also worth noting that patients with suicidal ideations tend to have overall longer lengths of stay when compared to other patients on involuntary mental health hold. Nachi: There are however some suicide risk assessment tools that can help in the disposition decision planning such as C-SSRS, SAFE-T, and ICARE2. C-SSRS is a series of questions that assess the quality of suicidal ideation. SAFE-T is 5 step evaluation and triage tool that assesses various qualities and makes treatment recommendations. ICARE2 is provided by the American College of Emergency Physicians as a result of an iterative literature review and expert consensus panel. It also integrates many risk factors and treatment approaches. Jeff: It goes without saying that none of these tools are perfect. They should be used to assist in your clinical decision making. Nachi: For depressed but not actively suicidal patients, ensure close follow up with a mental health clinician. These patients typically do not require inpatient hospitalization. Jeff: Let’s also touch upon involuntary confinement here. Patients who are at imminent risk of self harm who refuse to stay for evaluation may need to be held involuntarily until a complete psychiatric and safety evaluation is performed. Nachi: Before holding a patient involuntarily, it is important to fully familiarize yourself with the state and county laws as there is wide variation. The period of involuntary confinement should be as short as possible. Jeff: With that, let’s close out this month’s episode with some high yield points and clinical pearls. Risk factors for major depression include female gender, young or old age, being divorced or widowed, black or Hispanic ethnicity, poor social support, and substance abuse. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt. When evaluating a patient with depressive symptoms, try to identify potential secondary causes, as this may influence your management strategy. When assessing for depression, perform a complete history and consider underlying medical causes that may be contributing to their presentation. Consider serum testing for the patient’s psychiatric medications if the medications have known toxic effects. 1. Routine serum testing and urine toxicology testing are not recommended for psychiatric patients presenting to the emergency department. Imaging of the brain should not be ordered routinely in depressed or suicidal patients. Depression places patients at a significantly increased risk for alcohol abuse and dependence. In addition to providing appropriate follow up resources to your depressed patients, emergency clinicians should consider making a brief follow up telephone call to the patient. Telepsychiatry may improve access to mental health providers and allow remote assessment and care from the ED. Suicide risk assessment tools such as C-SSRS, SAFE-T, and ICARE2 can help when deciding on disposition from the ER. It may be necessary to hold a patient against their will if they are at immediate risk of self-harm. Though not routinely administered in the ED for this purpose, psychotropic medications, such as ketamine, have proven helpful in acute depressive episodes. Patients who are actively suicidal should be admitted to a psychiatric observation unit or inpatient psychiatric unit. Nachi: So that wraps up Episode 28! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And don’t forget to check out the lineup for the upcoming Clinical Decision Making in Emergency Medicine conference hosted by EB Medicine, which will take place June 27th-30th. Great speakers, great location, what more could you ask. Jeff: And the address for this month’s cme credit is ebmedicine.net/E0519, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 1. Owens PL, Mutter R, Stocks C. Mental health and substance abuse-related emergency department visits among adults, 2007: statistical brief #92. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. (US government report) 12. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington DC: American Psychiatric Association; 2013. (Reference book) 15. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807-816. (Survey data; 49,093 patients) 16. Centers for Disease Control and Prevention. Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. 2010;59(38):1229-1235. (Government survey data analysis; 235,067 subjects) 97. Murrough J, Soleimani L, DeWilde K, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45(16):3571-3580. (Randomized controlled trial; 24 participants) 100. Griffiths JJ, Zarate CA, Rasimas J. Existing and novel biological therapeutics in suicide prevention. Am J Prev Med. 2014;47(3):S195-S203. (Review article)

Mayor Soglin and Assistant Streets Superintendent Steve Schultz discuss the impending weekend weather and City preparation.

Episode 3 - Aren't Psych Patients Dangerous? An exploration of risk of violence in mental health patients and review of relevant large studies. Funding graciously provided by the Alberta Medical Association. References Elbogen EB, Johnson SC. The Intricate Link Between Violence and Mental DisorderResults From the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. JD009;66(JD):15JD–161. doi:10.1001/archgenpsychiatry.JD008.537 U.S Department of Health and Human Services / National Institutes of Health / National Institute on Alcohol Abuse and Alcoholism. (JD006).National Epidemiologic Survey on Alcohol and Related Conditions. Retrieved from https://pubs.niaaa.nih.gov/publications/arhJD9-JD/74-78.htm Steadman HJ, Mulvey EP, Monahan J, et al. Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods. Arch Gen Psychiatry. 1998;55(5):393–401. doi:10.1001/archpsyc.55.5.393 Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there arelationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012 Mar;47(3):487-503. doi: 10.1007/s001JD7-011-0356-x. Epub 2011 Feb 26. PubMed PMID: 21359532. Walsh E, Moran P, Scott C, McKenzie K, Burns T, Creed F, Tyrer P, Murray RM, Fahy T; UK700 Group. Prevalence of violent victimisation in severe mental illness. Br J Psychiatry. JD003 Sep;183:JD33-8. PubMed PMID: 1JD948997. Hiroeh U, Appleby L, Mortensen PB, Dunn G. Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. Lancet. JD001 Dec JDJD-JD9;358(9JD99):JD110-JD. PubMed PMID: 117846JD4. Hiday VA, Swartz MS, Swanson JW, Borum R, Wagner HR. Criminal victimization of persons with severe mental illness. Psychiatr Serv. 1999 Jan;50(1):6JD-8. PubMed PMID: 9890581.

Some physical conditions are specifically caused by the actions of traveling.  Others are caused by what you run into in foreign countries.  In this episode Dr. Nedd goes over the most common travel related conditions and illnesses, what causes them and how to either prevent them or quickly treat them with natural methods.   Today, Dr....

Several laws offer protection for people living with celiac disease, like the Affordable Care Act, the Food Allergen Labeling and Consumer Protection Act and the Gluten-Free Food Labeling Law. To help our listeners better understand these protections, we've brought Janelle Smith from the Celiac Disease Foundation into our studio to discuss the laws and how they can help (or potentially hurt) individuals with celiac disease. 

If there was a magical pill to allow people with celiac disease to eat gluten, would you take it? To help families better understand current drug therapies under development for celiac disease, Dr. Jocelyn Silvester from the Celiac Disease Research Program at Harvard Medical School and Boston Children's Hospital joins our podcast to discuss the research into treatments for celiac disease and gluten-related conditions. She''ll dive into how the therapies would work and the timeframe for release on the market. Dr. Silvester also touches on research to develop tools to better measure adherence to the gluten-free diet. 

Digestive Problems and Related Conditions

Authors Dr Sidney Gospe (Division of Pediatric Neurology and Professor of Neurology and Pediatrics, University of Washington, Seattle Children's Hospital, Seattle) and Professor Bernard Schmitt (Division of Clinical Neurophysiology/Epilepsy, University Children's Hospital, Zurich) discuss the issues of Pyridoxine-dependent epilepsy and related conditions and how to treat them with Editor In Chief of Developmental Medicine and Child Neurology, Dr Peter Baxter. Related journal articles: Seizures and paroxysmal events: symptoms pointing to the diagnosis of pyridoxine-dependent epilepsy and pyridoxine phosphate oxidase deficiency http://www3.interscience.wiley.com/cgi-bin/fulltext/123334976/PDFSTART Pyridoxine-dependent epilepsy and pyridoxine phosphate oxidase deficiency: unique clinical symptoms and non-specific EEG characteristics http://www3.interscience.wiley.com/cgi-bin/fulltext/123349115/PDFSTART

Host: Mark Nolan Hill, MD Guest: Randi Hagerman, MD It's responsible for more than five percent of all cases of autism, and it's the most common cause of inherited mental retardation. But are we as familiar as we need to be with Fragile X syndrome, and a series of genetic conditions related to Fragile X? Host Dr. Mark Nolan Hill welcomes Dr. Randi Hagerman, professor and endowed chair of Fragile X research, and medical director of the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute at the University of California, Davis School of Medicine, for a stimulating conversation about our rapidly expanding knowledge of these genetic conditions. How do the signs and symptoms manifest in children, and how does Fragile X impact our elder generations?

Host: Mark Nolan Hill, MD Guest: Randi Hagerman, MD It's responsible for more than five percent of all cases of autism, and it's the most common cause of inherited mental retardation. But are we as familiar as we need to be with Fragile X syndrome, and a series of genetic conditions related to Fragile X? Host Dr. Mark Nolan Hill welcomes Dr. Randi Hagerman, professor and endowed chair of Fragile X research, and medical director of the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute at the University of California, Davis School of Medicine, for a stimulating conversation about our rapidly expanding knowledge of these genetic conditions. How do the signs and symptoms manifest in children, and how does Fragile X impact our elder generations?

We have Kenneth Anderson, from HAMS (Harm Reduction Abstinence and Moderation Support) and the Harm Reduction Network with us today. He will be talking about harm reduction, what that means, how that differs from traditional forms of treatment (like twelve-step abstinence models), and the way that the harm reduction model can help people who are not yet ready for, or not willing to practice total abstinence, but would still like to change their drinking habits. Kenneth is the founder and CEO of the HAMS Harm Reduction Network, a free-of-charge support group for people who want to make any kind of positive change to their drinking habits, from safer drinking to reduced drinking, to quitting altogether. There are seventeen elements to the HAMS program, which are all optional and can be done in any order. Although HAMS is an alcohol-focused group, they don't stop anyone from talking about any other addictions or problems that they may have. Episode link>>>> www.theaddictedmind.com/89 ( http://www.theaddictedmind.com/89 ) HAMS has a handbook, called How To Change Your Drinking, which was written by Kenneth. The book was published ten years ago and about 22 000 copies have been sold on Amazon. Kenneth used to drink a lot and he was getting into trouble as a result. He tried turning to several different groups, Alcoholics Annonymous included, for help but they did not work for him. He tried Moderation Management for a while, and while he was there, he developed the Harm Reduction approach. He was fascinated by the concept of harm reduction and began volunteering at the Needle Exchange Program in Minneapolis. There, he learned a lot and it completely changed his perspective. He realized the importance of encouraging every positive change. The problem with abstinence models is that they are perfectionistic. So any improvement that anyone makes, apart from abstaining entirely, is not deemed to have any value whatsoever. The Harm Reduction Model is about every positive change and it is a very pragmatic model in the United States. It was started in Holland, when drug users decided to do something to help themselves, and decided to start handing out clean needles to prevent their friends from dying. This model used to be illegal in the United States and it is still illegal in many places. Harm Reduction encourages people to pick a goal that fits them. A goal that is do-able and right for them. Many people who come to Harm Reduction eventually choose to abstain completely. In the broad definition of Harm Reduction, it also encompasses abstinence. It is about creating a better quality of life in the present moment. There is research data available from the Rowntree Foundation, about people reducing their heroin usage from addictive to occasional use, although heroin is very difficult to moderate. The National Epidemiological Study of Alcohol and Related Conditions, was done by the American government's National Institute of Alcohol and Alcohol Abuse. It surveyed more than 40 000 people and it was found that about half of the people with alcohol dependence recovered by controlling their drinking and half recovered by abstaining. Generally, about 85% of all the alcoholics who recover do it on their own. It sometimes takes a long time, but recovery from alcoholism through controlled behavior does happen. Early on, there were a great number of approaches to addiction treatment. Kenneth is currently writing a history of addiction treatments in America. Aversion Therapy was big in the US until the 1980s. There was a chain of about 25 Aversion Therapy hospitals, using conditioned taste aversion, or electric shocks, and there were no alternative treatments available at the time. What sets the Harm Reduction Network apart from all other recovery programs is that they are willing to welcome and support anyone who wants to make any kind of positive change to their drinking habits. They have online groups and a forum on their website so that you can do all the work yourself, for free. They also have a very popular Facebook group. Better Is Better is one of HAMS's most popular models. *Links and resources:* The HAMS website - www.hams.cc ( http://www.hams.cc/ ) The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: Review and summary of findings - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618096/