Psychiatry & Psychotherapy Podcast

Timothy Lee, Loma Linda's Residency Program Director, delves into understanding delirium and its psychiatric implications. He distinguishes between hyperactive and hypoactive delirium, highlighting how symptoms like agitation and confusion can mislead families into thinking of schizophrenia. The discussion extends to the impact of simple infections, especially in the elderly, and the challenges in diagnosing related cognitive issues. Lee emphasizes the importance of careful medication management and tailored recovery strategies for affected patients.

On this week’s episode of the podcast, I interview Dr. Cummings, a reputable psychopharmacologist, about ketamine. We talk about psychedelics, the research behind it, both the positives and the negatives. We will look at how it is or is not helpful in psychiatric treatments.   (Disclaimer: There are no conflicts of interest to report. Neither Dr. Puder or Cummings is affiliated with any companies in favor of ketamine and other drug companies.) Ketamine Although ketamine has recently become a medication of great interest in psychiatry, it actually is a fairly old medication. It was first synthesized in 1962 and began human trials for anesthesia in 1964. It was finally approved by the FDA as a dissociative anesthetic in 1970. What has piqued interest in psychiatry is that infusion of a smaller dose of ketamine produces a rapid response in terms of reversal of depressed mood, suicidality, and some treatment-resistant depressed patients. The literature is rich (in one sense) as the most recent consensus statement (Sanacora, 2017) looked at seven randomized controlled trials, all of which support a robust antidepressant response and anti-suicide response. The difficulty with those trials is the majority of them lasted only one week. A few of the later trials lasted two to three weeks with two to three infusions per week. So, what’s lacking at this point is adequate data regarding long term treatment response and data about transitions to more traditional antidepressant treatments. 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

The podcast explores psychodynamic theory in therapy, discussing concepts like transference and unconscious processes. It highlights the impact of additional training on therapists' practice and the importance of empathy in therapeutic relationships. Emotional breakthroughs and transformative journeys of self-discovery are also explored.

Timothy Lee has talked to thousands of medical students about how to applying for residency programs, and here, he gives us a few tips on how to make it through the gauntlet, and how to have your best chance at landing the program you want.   Here is what Timothy Lee says: Stay calm Many students have been fine tuning their personal statements, and trying to get their resume just right, or hurrying to press the faculty to write letters of recommendation. It can be very stressful.   It’s okay to turn in information a little bit later, in order to have all of the paperwork you need. It’s even okay to review your statement after you’ve already turned it in. No one will lower their opinion based on that. You will need to have applied for the majority of the programs you are interested in by early or mid-October, otherwise the program director might wonder if you’re applying to them later as a backup plan. What matters in a personal statement? Every program director will have different opinions on what you write, and every program director will be looking for different things from your personal statement. For some people, it’s a chance to get to know the applicant a little bit. For others, it doesn’t really matter that much.   As long as your grammar and syntax are competent, you should be fine. Some people don’t worry about the format, and others are more particular. To be on the safe side, if you have access to a good mentor, run it by them. Also, don’t be too wordy—stick to a page and a half. Do step scores matter? Step scores are a very convenient screening tool for what matters, but there are studies that show that step scores are not directly correlated to success in residency performance. They are helpful, but are not the end-all-be-all. It’s only one part of the picture of an applicant. However, if you are going for a highly-competitive residency, you might need to worry about step scores a bit more. Apply to the right number of programs The number of programs is not the only way to increase your chance of success of getting in. Pay attention to the types of programs you are applying to as well. If you are applying for a good number of programs, make sure at least half of them are are ones you are a solid and potentially attractive candidate for. Keep a good perspective Ultimately, you are more than your CV, step score, or personal statement. If patients like you, that’s going to go a long ways. Your patients won’t know your scores, or where you graduated from medical school. They will know if you were competent, caring and connected. That is ultimately what matters. Join and discuss this episode with David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder  

Explore the essence of the therapeutic alliance as a partnership between clinician and patient. Discover how empathy and active listening foster trust and enhance treatment experiences. The podcast delves into patient fears and emphasizes the need for a supportive environment to address shame and anxiety. Learn why some therapists achieve better outcomes than others, and uncover the power of emotional transactions in therapy. Join the discussion on how simple gestures can dramatically influence patient dialogues and healing.

What is trauma? Emotional trauma comes from stress that is overwhelms a person’s neurological system. Some stress can be good and formative, or it can be bad and get stuck in the brain, causing someone deep emotional pain. Think of climbing Mount Everest. Some people choose to do that, and it’s easily one of the most stressful situations you can put yourself in on purpose. That’s good stress if you have trained for years and are ready for it. If someone forced you to climb Mount Everest, it would register in the brain as a trauma. Trauma is too big for the mind, brain, and nervous system to assimilate. It’s a memory, or experience, that gets stuck because the person believed it would result in their death, or at least serious injury. The brain has several mechanisms to keep something stuck so that the person will remember it, and try to avoid getting hurt in the same way in the future. It is a survival instinct. People commonly demonstrate symptoms of trauma when they’ve: Experienced a sexual violation Seen violence Experienced violence or abuse Been neglected—experienced the absence of something that they should have had. Been in near death experiences like car accidents or war People who have PTSD, or post traumatic stress disorder, have experienced a soul-level of brokenness, and even talking about the event, or having a memory of it, can bring it back with the same force that occured in the actual accident. They often have recurring nightmares, or repetitive symptoms that continue long after the event. Typical PTSD symptoms alternate between chronic shut down and fight and flight Fight and flight symptoms are: Sweating, nightmares, flashbacks, anger, rage, panic, hypervigilance, tense muscles, painful knotted gut Shut down symptoms are: Dissociation, freezing, emotional detachment, voice trembling, difficulty getting words out, numbness, apathy, fear, helplessness, dizzy, empty, nausea Moments in connection mode look like: curiosity, exploration, relaxed and full breathing, feeling grounded, true smiles By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join and discuss this episode with David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Explore the concept of healthy emotional boundaries in relationships, using property lines as a metaphor. Learn how self-awareness and body awareness can help in setting limits and recognizing discomfort. Delve into the psychological costs of saying yes out of guilt and the importance of maintaining personal power. Discover the role of clear communication in dating while navigating the challenges of parenting and personal interactions. Personal anecdotes highlight how boundaries can enhance fulfillment and emotional well-being.

In this episode we discuss: The history of bipolar illness, mood stabilizers, common treatments, psychopharmacology, psychotherapy goals, and more. For paraphrased transcription and blog: go here For more detailed notes by Dr. Cummings, go to my resource page.   By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Dr. Michael Cummings, a psychopharmacology expert, dives into the fascinating history and evolution of antidepressants, revealing unexpected breakthroughs along the way. He discusses the journey from early treatments for depression to the modern use of SSRIs and their impact on mood disorders. Highlighting the balance between efficacy and side effects, especially sexual dysfunction, Cummings also addresses innovative therapies on the horizon and the significance of therapy in recovery journeys. A must-listen for anyone interested in mental health!

Polyvagal theory by Stephen Porges explains three different parts of our nervous system, and their responses to stressful situations. Once we understand those three parts, we can understand our emotional reactions to trauma or high amounts of stress. Why is polyvagal theory important? For therapists, and pop-psychology enthusiast alike, understanding polyvagal theory can help with: Understanding trauma and PTSD Understanding the dance of attack and withdrawal in relationships Understanding how extreme stress leads to dissociation or shutting down Understanding how to read body language By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder