Psychiatry & Psychotherapy Podcast

What is an eating disorder? One of the most important things about anorexia and bulimia is understanding that they are caused by a complex interplay of genetics, epigenetics, early development, and current stressors. They can lead to dangerous outcomes because of how the eating disorder changes both the body and the brain. Many therapists and nutritionists, as you’ll hear in my conversation with Sarah Bradley, don’t treat from multiple angles, and often lack empathy into this condition. There are three main types of eating disorders we will cover here: Anorexia is the practice of cutting calories to an extreme deficit or refusing to eat. Bulimia involves purging, or vomiting, the food that has been eaten. Orthorexia is a fixation and obsession on eating healthy food (like only eating green vegetables with lemon juice). Statistics: Anorexia traditionally lasts for an average of eight years. Bulimia traditionally lasts for an average of five years. Approximately 46% of anorexia patients fully recover, 33% improve, and 20% remain chronically ill. Approximately 45% of those with bulimia make a full recovery, 27% improve, and 23% continue to suffer. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram:dr.davidpuder Twitter:@DavidPuder Facebook: DrDavidPuder Youtube channel

Maris Loeffler, an MFT specializing in grief, shares profound insights into navigating loss and helping others heal. She discusses the complexities of grief, including emotional and physiological symptoms, emphasizing the need for empathy in therapeutic settings. Maris explores how attachment styles impact grief responses and the importance of creating a safe space for clients to express their emotions. Additionally, she highlights the significance of integrating body-based techniques in therapy, aiming for a holistic approach to emotional healing.

Michael Cummings, a seasoned psychiatrist with expertise in schizophrenia and psychopharmacology, discusses the unique journey of clozapine, the gold standard for treatment-resistant schizophrenia. He reveals its accidental discovery and how initial concerns about side effects delayed its use in the U.S. The conversation covers clozapine's remarkable efficacy, its complex side effects, and the critical need for careful monitoring. Cummings emphasizes individualized treatment strategies and outlines the importance of addressing lifestyle factors to enhance patient outcomes.

Shelly Jane, a psychiatrist and PTSD specialist affiliated with Stanford University, shares her insights on trauma and healing. She addresses the alarming connections between PTSD and suicide rates, especially among veterans. The discussion dives into moral injury, intergenerational trauma, and the therapeutic alliance's importance in recovery. Shelly also highlights the complexities of managing long-term benzodiazepine use and the ongoing conversations around marijuana as a treatment option. The episode wraps up with an emphasis on networking and collaboration in the mental health community.

Schizophrenia is a diagnosis of exclusion. Doctors and therapists need to be able to rule everything else out before they can land on schizophrenia as an official diagnosis. There are specific symptoms are known as “first-rank symptoms,” which we will cover later in the article, that will help with diagnosing patients (Schneider, 1959). Eighty-five percent of people with schizophrenia endorse these symptoms, but be wary of jumping to conclusions because they are not specific to schizophrenia and, in some studies, are also endorsed by bipolar manic patients (Andreasen, 1991). DSM5 (Diagnostic and Statistical Manual of Mental Disorders 5th ed.) Schizophrenia is a clinical diagnosis made through observation of the patient and the patient’s history. There must be 2 or more of the characteristic symptoms below (Criterion A) with at least one symptom being items 1, 2 or 3. These symptoms must be present for a significant portion of time during a 1 month period (or less, if successfully treated). The patient must have continuous, persistent signs of disturbance for at least 6 months, which includes the 1 month period of symptoms (or less, if successfully treated) and may include prodromal or residual periods. For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset. If the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational achievement. Criterion A: A. Positive symptoms (presence of abnormal behavior) 1. Delusions 2. Hallucinations 3. Disorganized speech (eg, frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior B. Negative symptoms (absence or disruption of normal behavior) 5. Negative symptoms include affective flattening, alogia, avolition, anhedonia, asociality. By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram:dr.davidpuder Twitter:@DavidPuder Facebook: DrDavidPuder Youtube channel

Clinical manifestations Many people worry that they have schizophrenia. I receive messages or inquires often of people asking about symptoms and manifestations. If you have those types of questions, or if you’re a mental health professional who needs to brush up on symptoms and medications, this article should help you. There are many clinical observations of how schizophrenia presents itself. Cognitive impairments usually precede the onset of the main symptoms[1], while social and occupational impairments follow those main symptoms.   Here are the main symptoms of schizophrenia: Hallucinations: a perception of a sensory process in the absence of an external source. They can be auditory, visual, somatic, olfactory, or gustatory reactions. Most common for men “you are gay” Most common for women “you are a slut or whore” Delusions: having a fixed, false belief. They can be bizarre or non-bizarre and their content can often be categorized as grandiose, paranoid, nihilistic, or erotomanic Erotomania = an uncommon paranoid delusion that is typified by someone having the delusion that another person is infatuated with them. This is a common symptom, approximately 80% of people with schizophrenia experience delusions. Often we only see this from their changed behavior, they don’t tell us this directly. Disorganization: present in both behavior and speech. Speech disorganization can be described in the following ways: Tangential speech – The person gets increasingly further off the topic without appropriately answering a question. Circumstantial speech – The person will eventually answer a question, but in a markedly roundabout manner. Derailment – The person suddenly switches topic without any logic or segue. Neologisms – The creation of new, idiosyncratic words. Word salad – Words are thrown together without any sensible meaning. Verbigeration – Seemingly meaningless repetition of words, sentences, or associations To note, the most commonly observed forms of abnormal speech are tangentiality and circumstantiality, while derailment, neologisms, and word salad are considered more severe. Cognitive impairment: Different processing speeds Verbal learning and memory issues Visual learning and memory issues Reasoning/executive functioning (including attention and working memory) issues Verbal comprehension problems By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder Youtube channel  

What is schizophrenia? It is a psychotic disorder that typically results in hallucinations and delusions, leaving a person with impeded daily functioning. The word schizophrenia translates roughly as the "splitting of the mind," and comes from the Greek roots schizein ( "to split") and phren- ( "mind").   The onset of the disease typically occurs in young adulthood; for males, around 21 years of age, for females, around 25 years of age.   We don’t know exactly what causes schizophrenia. There are certain predictors for it, and as I discussed the basics and pharmacology a previous podcast, frequent marijuana use can increase the risk of a psychotic or schizophrenic illness to about 4 times what it would be without THC use. History of schizophrenia Sometimes, in ancient literature, it can be difficult to distinguish between the different psychotic disorders, but as far as we know, the oldest available description of an illness resembling schizophrenia is thought to have existed in in the Ebers papyrus from Egypt, around 1550 BC. Throughout history, in groups with religious beliefs, the misunderstanding of the psychopathologies caused people to paint those with mental health disorders as receiving divine punishments. This theme of divine punishment continues today in some parts of the world. It wasn’t until Emil Kraeplin, a german psychiatrist (1856-1926) that schizophrenia was suggested to be more biological and genetic in origin. In around 1887, Kraeplin differentiated what we call schizophrenia today from other forms of psychosis. At that time he described schizophrenia as dementia of early life. In 1911, Eugen Bleuler introduced schizophrenia as a word in a lecture at a psychiatric conference in Berlin (Kuhn, 2004). Bleuler also identified the positive and negative symptoms of schizophrenia which we use today. Kurt Schneider, a german psychiatrist, coined the difference between endogenous depression and reactive depression. He also improved the diagnosis of schizophrenia by creating a list of psychotic symptoms typical in schizophrenia that were termed “first rank symptoms.”   His list was: Auditory hallucinations Thought insertion Thought broadcasting Thought withdrawal Passivity experiences Primary delusions Delusional perception (the belief that a normative perception has a certain significance) Sigmund Freud furthered the research, believing that psychiatric illnesses may result from unconscious conflicts originating in childhood. His work eventually affected how the psychiatric world and society generally viewed the disease. The history and lack of understanding of the disease is a dark history, and it is still deeply stigmatized, but psychiatry has made massive leaps in understanding schizophrenia and changing how it is viewed in modern society. Nazi germany, the United States, and other Scandinavian countries (Allen, 1997) used to sterilize individuals with schizophrenia. In the Action T4 program in Nazi Germany, there was involuntary euthanasia of the mentally unwell, including people with schizophrenia. The euthanasia started in 1939, and officially discontinued in 1941 but didn’t actual stop until military defeat of Nazi Germany in 1945 (Lifton, 1988). Dr. Karl Brandt and the chancellery chief Philipp Bouhler expanded the authority for doctors so they could grant anyone considered incurable a mercy killing. In reading about this event, it seems that This caused approximately 200,000 deaths. In the 1970’s, psychiatrists Robins and Guze introduced new criteria for deciding on the validity of a diagnostic category (Kendell, 2003). By the 1980’s, so much was understood about the disease that the DSM (Diagnostic and Statistical Manual of Mental Disorders) was revised. Now, schizophrenia is ranked by World Health Organization as one of the top 10 illnesses contributing to global burden of disease (Murray, 1996). Unfortunately, it is still largely stigmatized, leading to an increased schizophrenia in the homeless population, some estimates showing up to 20% vs the less than 1% incidence in the US average population. In conclusion On the podcast episode, we discuss the media’s portrayal of schizophrenia. Although media paints mentally ill as often violent, on average people with mental illness only cause 5% of violent episodes. This is just one example of how the stigma is furthered. The more we understand about this disorder—what causes it, how we can help, how we can provide therapy and medicate and treat patients—the better. Getting rid of the stigma by learning the history and also moving beyond preconceived ideas to the newest science will also help de-isolate people with schizophrenia and help support them in communities, giving them a chance at a normal, healthy life. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder    

On today’s episode of of the podcast, I will discuss marijuana use and how it affects mental health with Daniel Binus, the chief psychiatrist at Beautiful Minds, near Sacramento, California. Also joining us is a third-year medical student, Victoria Agee. There are a few reasons we believe this is important to talk about. First, as medical professionals, we often see patients who want help with their anxiety, depression, ADD and suicidality. They say they use cannabis, and that they need cannabis, to help calm those symptoms. When we explain the research to them, it still takes them awhile to let go of their habits and embrace other forms of therapy and medication that is a better long-term option. Also, we head into a time when marijuana is being legalized, there are tons of THC companies that will benefit from suppressing this information and even suppress these studies we will reference here. Hiding this information could be detrimental to society’s mental health. While there are some potential benefits to one component of marijuana (CBD), something I will review in the future (evidence is fairly young in that field), the THC component can be highly damaging to mental health. Whether or not people are willing to admit it, cannabis is actually highly addictive. One of the symptoms of addiction is intellectualizing reasons for use. Not only does it change the way the brain functions, it changes the way we see and perceive the world. It also changes our visual and spatial abilities. If you’re an architect or use math in your job, it deeply affects those abilities as well. THC stays in your brain a long time—it can be weeks (or even a month) before people get the full function of their brain back and the fog has cleared. Link to blog. Link to YouTube video. Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder    

Join Ginger Simonton, a dedicated PhD student researching childhood sexual abuse and its lasting effects on health. She delves into the critical link between unresolved trauma and the well-being of survivors, shedding light on the importance of trauma-informed care. Ginger discusses the intergenerational impact of abuse and the role of community support in healing. She highlights innovative therapeutic approaches that empower patients and the necessity of compassionate care in navigating their recovery journey.

Explore the transformative power of forgiveness and its surprising effects on mental health. Understand the difference between forgiveness and reconciliation, and learn why letting go of anger can enhance your well-being. Delve into personal stories that illustrate the stages of forgiveness, revealing how they can lead to emotional liberation. Discover the spiritual dimensions of forgiveness as it's framed within various religious contexts. This insightful discussion provides valuable strategies for both personal growth and therapeutic practice.