Psychiatry Boot Camp

Dr. Nicholas Kontos, Director of the Consultation-Liaison Psychiatry Fellowship at Massachusetts General Hospital and Harvard Medical School assistant professor, dives deep into the complexities of factitious disorders and malingering. He explores patient motivations for deception, emphasizing the importance of compassion in psychiatry. The conversation includes practical interviewing techniques, the nuances of the therapeutic discharge, and the ethical responsibilities of clinicians. Kontos highlights the balance of professionalism and dignity when navigating deceptive behaviors in healthcare.

Dr. Caitlin Adams, a psychiatrist at Massachusetts General Hospital, specializes in functional neurological disorders (FND). She breaks down the complexities of FND and debunks misconceptions about voluntary control over symptoms like functional weakness. Dr. Adams emphasizes the importance of effective communication and reducing stigma in treatment. The discussion includes key diagnostic signs, the biopsychosocial model, and therapeutic strategies such as cognitive behavioral therapy and specialized physical therapy, all aimed at enhancing patient engagement and recovery.

Dr. Christina Wichman, a Professor of Psychiatry and Obstetrics & Gynecology, shares her expertise in reproductive psychiatry. She discusses the unique challenges of treating mental health during pregnancy and postpartum, emphasizing the need for compassion and validated screening tools. The conversation explores various perinatal mood disorders, medication management, and the innovative Periscope Project aimed at improving access to care. Dr. Wichman also highlights the importance of preconception planning and navigating the balance between maternal and child health.

In this insightful discussion, Dr. Anne O'Melia, Chief Clinical Officer at ERC Pathlight, and Dr. Patricia Westmoreland, forensic psychiatry expert, explore the complexities of eating disorders. They address how to identify when disordered eating requires clinical attention, detailing anorexia, bulimia, and ARFID. The conversation covers prevalence rates, high-risk populations, and emphasizes the urgent need for compassionate care and empathy in treatment. Listeners gain valuable insights into navigating levels of care and the critical role of building therapeutic alliances.

Dr. Mira Zein, Associate Professor of Psychiatry and Behavioral Science at Stanford University, walks us through decisional capacity determinations.This is a great episode for learners rotating through a consultation-liaison psychiatry service, and will really help you shine on rounds when you quote the Appelbaum-Grisso criteria (seriously, do it)! We also invite psychiatry residents and CL psychiatrists to share this episode with their favorite primary team to help non-psychiatrists make capacity determinations on their own... They are often best suited to do so!Dr. Zein walks us through the Appelbaum-Grisso criteria and discusses each criterion (communication, appreciation, understanding, rationality) in detail. This discussion goes beyond a textbook understanding of the topic, delving into several difficult cases of determining decisional capacity. We discuss common reasons for psychiatric consultation regarding capacity, and how to navigate difficult conversations when fielding consults. You will also learn about common illnesses that can cause diminished capacity, and how to proceed if a patient is found to lack decisional capacity (for a certain decision, at a certain time 😉).Key resources:1) APA Resource Document on Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist (2019)2) Seminal Article on Appelbaum-Grisso Criteria (Appelbaum 1988)3) Evaluating Capacity: Appelbaum’s Framework Interpreted Diagrammatically (Bari 2023)SUPPORT OUR PARTNERS:⁠SimplePractice.com/bootcamp⁠ (Now with AI documentation! Exclusive 7 day free trial and 70% off four months)⁠Oasis Psychiatry Conferences ⁠(enter code BOOTCAMP at checkout for additional 10% savings)⁠Beat the Boards⁠ (enter code BOOTCAMP at checkout for addition 10% savings)⁠CME to Go⁠ (enter code BOOTCAMP at checkout for addition 10% savings) Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Paula Zimbrean, Professor of Psychiatry and Yale School of Medicine and Director of Transplant Psychiatry Services at Yale New Haven Hospital, introduces us to the field of transplant psychiatry. We discuss the role of psychiatrists in solid organ transplantation, including pre-transplant evaluations. We then discuss the various phases through which transplant patients require support, starting with a diagnosis of advanced organ disease. We cover the pre-transplant phase, peri-operative recovery, early post-transplant stressors, and finally psychiatric considerations that last months to years after transplant. Dr. Zimbrean discusses ethical challenges faced by psychiatrists working in a transplant setting, and shares considerations for the future of transplant psychiatry.Selected references: Transplant Psychiatry: A Case-Based Approach to Clinical Challenges Transplant Psychiatry: An Introduction SUPPORT OUR PARTNERS:SimplePractice.com/bootcamp (Now with AI documentation! Exclusive 7 day free trial and 70% off four months)Oasis Psychiatry Conferences (enter code BOOTCAMP at checkout for additional 10% savings)Beat the Boards (enter code BOOTCAMP at checkout for addition 10% savings)CME to Go (enter code BOOTCAMP at checkout for addition 10% savings) Learn more about your ad choices. Visit megaphone.fm/adchoices

Tyler Black, a child and adolescent psychiatrist at the University of British Columbia, dives into the critical topic of suicide risk assessment. He debunks common myths and emphasizes the necessity of empathetic communication during evaluations. The discussion highlights the emotional burden felt by both patients and healthcare providers. Black categorizes suicidal motivations using a sociological framework and stresses the importance of tailored interventions. He also navigates the complexities of patient autonomy versus safety in mental health care.

Dr. George Grossberg, Henry and Amelia Nasrallah Endowed Professor of Psychiatry & Behavioral Neuroscience at Saint Louis University School of Medicine, past president of the American Association for Geriatric Psychiatry, and past president of the International Psychogeriatric Association, orients us to behavioral disturbances in patients with neurocognitive disorders. We walk through common behavioral disturbances in patients with dementia, including apathy, depression, psychosis, and agitation. We discuss management strategies including nonpharmacological and pharmacological interventions. Dr. Grossberg shares his expertise on difficult clinical management decisions when working with this population, and centers us around the importance of knowing the patient as well as the disease.Selected References: ⁠Progress in Pharmacologic Management of Neuropsychiatric Syndromes in Neurodegenerative Disorders: A Review (Cummings 2024) Neuropsychiatric Symptoms of Dementia and their nonpharmacological and pharmacological management (Tampi 2022)⁠ Management of BPSD Algorithm (Chen with Osser 2021)⁠ Atypical Antipsychotics for Aggression and Psychosis in Alzheimer's disease (Ballard 2006) Efficacy and Adverse Effects of Atypical Antipsychotics for Dementia (Schneider 2006) Sequential Drug Treatment Algorithm for Agitation and Aggression in Alzheimer's and Mixed Dementia (Davies 2018) SUPPORT OUR PARTNERS:⁠SimplePractice.com/bootcamp⁠ (Now with AI documentation! Exclusive 7 day free trial and 70% off four months)⁠Oasis Psychiatry Conferences ⁠(enter code BOOTCAMP at checkout for additional 10% savings)⁠Beat the Boards⁠ (enter code BOOTCAMP at checkout for addition 10% savings)⁠CME to Go⁠ (enter code BOOTCAMP at checkout for addition 10% savings) Learn more about your ad choices. Visit megaphone.fm/adchoices

Catatonia isn’t just mysterious, it’s one of the most treatable yet misunderstood syndromes in psychiatry. In this episode, I continue my conversation with Dr. Mark Oldham, diving deep into what to actually do when you suspect catatonia. We talk through the Lorazepam challenge, what a “positive” response really means, and why sometimes a single dose can look like a miracle. We also dig into the gray zones—how to approach patients who don’t respond, when to move to ECT, and what to do when catatonia overlaps with delirium or psychosis. Dr. Oldham shares his framework for identifying special cases, from benzodiazepine withdrawal to clozapine discontinuation, and explains why history-taking, not algorithms, is psychiatry’s most powerful diagnostic tool. Takeaways: Start simple, but think deeply. Lorazepam remains first-line for catatonia, but the absence of RCTs means clinical reasoning still leads the way. ECT is definitive and underused. For refractory or malignant catatonia, ECT is often curative, but access and consent barriers remain a major challenge. Not all catatonia is the same. Withdrawal states, chronic schizophrenia, and periodic catatonia each demand tailored interventions. Delirium and catatonia can coexist. Treat both cautiously, start low, go slow, and always look for autoimmune or neurological causes. History is your best guide. Behind every catatonic presentation is a story, missing it can mean missing the cure. Selected references: ⁠British Association for Psychopharmacology Guidelines⁠ ⁠⁠Rochester Catatonia Assessment Resources⁠⁠ ⁠NEJM Review on Catatonia⁠ ⁠Nature Review on Catatonia⁠ ⁠Schizophrenia Research Volume on Catatonia⁠ ⁠Describing the Features of Catatonia (Oldham)⁠ SUPPORT OUR PARTNERS: ⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠Beat the Boards⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠Sales@Human-Content.Com⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

When a patient stops moving, stops speaking, or stares through you like you’re not there, it’s easy to miss what’s really happening. In this episode, I’m joined again by Dr. Mark Oldham, one of the leading voices on catatonia, to break down what this strange, often misunderstood syndrome actually looks like in the real world. We walk through the diagnostic features step-by-step, how to assess, what to ask, and what’s too often overlooked. From the history of the disorder to modern DSM confusion, from the meaning of “waxy flexibility” to the haunting truth about patients who are fully aware but trapped inside their bodies, this conversation will completely change the way you think about motor symptoms and psychiatric emergencies. Takeaways: Catatonia is common, but underrecognized. It’s not just “psychiatric immobility.” It spans a spectrum from stupor to hyperactivity. Diagnosis starts with curiosity. Learn to test for features like mutism, posturing, and negativism systematically. Many patients are aware. Always treat them with dignity and assume comprehension, even when they can’t respond. It’s treatable and rapidly reversible. A single dose of lorazepam can sometimes unlock a frozen mind and body. Malignant catatonia kills. When autonomic instability appears, it’s a medical emergency that demands immediate escalation and often ECT. Selected references: British Association for Psychopharmacology Guidelines ⁠Rochester Catatonia Assessment Resources⁠ NEJM Review on Catatonia Nature Review on Catatonia Schizophrenia Research Volume on Catatonia Describing the Features of Catatonia (Oldham) SUPPORT OUR PARTNERS: ⁠⁠SimplePractice.com/bootcamp⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠Beat the Boards⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠Sales@Human-Content.Com⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices