PsychEd: Educational Psychiatry Podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of perinatal psychiatry Describe the key issues that should be addressed in pre-conception psychiatric counseling Discuss the management approach for prescribing medications during pregnancy Recognize the prevalence of mood disorders during the perinatal period Recall the diagnostic criteria for postpartum depression Consider the risk factors and explanatory models for postpartum depression Discuss the use of screening tools for postpartum depression Outline the treatment for postpartum depression Describe the clinical presentation of postpartum psychosis and recognize the urgency of this condition List important risk factors for postpartum psychosis Discuss the management for postpartum psychosis   Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Produced by: Nima Nahiddi (PGY4), Audrey Le (PGY1), Rebecca Marsh (PGY2) and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00 Learning objectives - 00:43 Defining the field of perinatal psychiatry - 01:55 Key issues to address in preconception counseling - 02:50 Management approach for prescribing medications during pregnancy - 07:00 Prevalence of mood disorders during the perinatal period - 12:11 Diagnostic criteria for postpartum depression - 14:05 Differentiating postpartum psychosis from postpartum depression - 16:52 Risk factors and explanatory models for postpartum depression - 18:58 Screening tools for postpartum depression - 20:15 Treatment for postpartum depression - 22:13 Pharmacotherapy - 22:20 Psychotherapy - 27:34 Clinical presentation of postpartum psychosis - 29:07 Risk factors for postpartum psychosis - 30:43 Postpartum psychosis prognosis and impacts on attachment- 32:57 Management of postpartum psychosis -35:30 Closing comments - 38:00   Resources: Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ open, 7(1), e013372. https://doi.org/10.1136/bmjopen-2016-013372 Boukhris, T., Sheehy, O., Mottron, L., & Bérard, A. (2016). Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children. Jama Pediatrics, 170(2), 117-24. doi: 10.1001/jamapediatrics.2015.3356. Brown, A. S., Gyllenberg, D., Malm, H., McKeague, I. W., Hinkka-Yli-Salomäki, S., Artama, M., Gissler, M., Cheslack-Postava, K., Weissman, M. M., Gingrich, J. A., & Sourander, A. (2016). Association of Selective Serotonin Reuptake Inhibitor Exposure During Pregnancy With Speech, Scholastic, and Motor Disorders in Offspring. JAMA psychiatry, 73(11), 1163–1170. https://doi.org/10.1001/jamapsychiatry.2016.2594 Cohen, J. , Hernández-Díaz, S. , Bateman, B. , Park, Y. , Desai, R. , Gray, K. , Patorno, E. , Mogun, H. & Huybrechts, K. (2017). Placental Complications Associated With Psychostimulant Use in Pregnancy. Obstetrics & Gynecology, 130(6), 1192-1201. doi: 10.1097/AOG.0000000000002362. Huybrechts, K. F., Hernández-Díaz, S., Patorno, E., Desai, R. J., Mogun, H., Dejene, S. Z., Cohen, J. M., Panchaud, A., Cohen, L., & Bateman, B. T. (2016). Antipsychotic Use in Pregnancy and the Risk for Congenital Malformations. JAMA psychiatry, 73(9), 938–946. https://doi.org/10.1001/jamapsychiatry.2016.1520 Huybrechts, K. F., Palmsten, K., Avorn, J., Cohen, L. S., Holmes, L. B., Franklin, J. M., Mogun, H., Levin, R., Kowal, M., Setoguchi, S., & Hernández-Díaz, S. (2014). Antidepressant use in pregnancy and the risk of cardiac defects. The New England Journal of Medicine, 370(25), 2397–2407. https://doi.org/10.1056/NEJMoa1312828 Imaz, M. L., Oriolo, G., Torra, M., Soy, D., García-Esteve, L., & Martin-Santos, R. (2018). Clozapine Use During Pregnancy and Lactation: A Case-Series Report. Frontiers in Pharmacology, 9, 264. https://doi.org/10.3389/fphar.2018.00264 Nörby, U., Forsberg, L., Wide, K., Sjörs, G., Winbladh, B., & Källén, K. (2016). Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy. Pediatrics, 138(5), e20160181. https://doi.org/10.1542/peds.2016-0181 Nörby, U., Winbladh, B., & Källén, K. (2017). Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics, 140(6), e20170747. https://doi.org/10.1542/peds.2017-0747 Reis, M., & Källén, B. (2013). Combined use of selective serotonin reuptake inhibitors and sedatives/hypnotics during pregnancy: risk of relatively severe congenital malformations or cardiac defects. A registered study. BMJ Open, 3, e002166. doi:10.1136/bmjopen-2012-002166 Sundram S. (2006). Cannabis and neurodevelopment: implications for psychiatric disorders. Human psychopharmacology, 21(4), 245–254. https://doi.org/10.1002/hup.762   References: Boland, R., Verduin, M., & Ruiz, P. (2021). Psychopharmacology. In Kaplan & Sadock's synopsis of psychiatry (Twelfth edition.). Philadelphia: Wolters Kluwer. Jones, I., Chandra, P.S., Dazzan, P., & Howard, L.K. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet, 384(9956), 1789-1799. doi: 10.1016/S0140-6736(14)61278-2. Nieldson, D., Videbech, P., Hedegaard, M., Dalby, J., & Secher, N.J. (2005). Postpartum depression: identification of women at risk. An International Journal of Obstetrics and Gynaecology, 107(10), 1210-1217. https://doi-org.myaccess.library.utoronto.ca/10.1111/j.1471-0528.2000.tb11609.x Schiller, C.E., Meltzer-Brody, S., & Rubinow, D.R. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48-59. doi: 10.1017/S1092852914000480 Viguera, A. (2021). Mild to moderate postpartum unipolar major depression: Treatment. UpToDate. Accessed 2021-01-18. Wisner, K.L., Sit, D.K.Y., & McShea, M.C. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498. doi:10.1001/jamapsychiatry.2013.87   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers perinatal psychiatry with Dr. Tuong Vi Nguyen, Assistant Professor, Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University and Scientist, RI-MUHC, Brain Repair and Integrative Neuroscience (BRaIN) Program, Centre for Outcomes Research and Evaluation.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Define the field of reproductive psychiatry Discuss the possible neurobiological pathways impacting mood and cognition during the reproductive cycle of women.  Discuss the influence of sociocultural gender roles on psychopathology.    List the DSM-V diagnostic criteria of premenstrual dysphoric disorder. Recall the epidemiology of premenstrual dysphoric disorder. Describe the steps in the diagnostic evaluation for premenstrual dysphoric disorder. List lifestyle and psychopharmacologic interventions for premenstrual dysphoric disorder. Discuss common mental health concerns during the perimenopausal period. Guest: Dr. Tuong Vi Nguyen   Hosts: Nima Nahiddi (PGY4), Audrey Le (PGY1), and Arielle Geist (PGY2)    Audio editing by: Audrey Le   Show notes by: Arielle Geist    Interview content: Introduction - 00:00 Learning objectives - 01:00 Defining the field of perinatal psychiatry - 01:50 Discussing neurobiological pathways impacting mood and cognition during the reproductive cycle - 02:47 The influence of sociocultural gender roles on psychopathology -05:28 DSM-V criteria of premenstrual dysphoric disorder - 11:18 Epidemiology of premenstrual dysphoric disorder - 13:40 Diagnostic evaluation of premenstrual dysphoric disorder - 14:38 Management of premenstrual dysphoric disorder  Pharmacologic - 17:45 Lifestyle - 24:15 Perimenopausal period - 24:45 Closing comments - 31:39   Resources: Brzezinski, A., Brzezinski-Sinai, N.A., & Seeman, M.V. (2017). Treating schizophrenia during menopause. Menopause, 24(5), 582-588. doi: 10.1097/GME.0000000000000772. Epperson, C.N., Steiner, M., Hartlage, A., Eriksson, E., Schmidt, P.J., Jones, I., & Yonkers, K.A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. The American Journal of Psychiatry, 169(5), 465-475. DOI: 10.1176/appi.ajp.2012.11081302 Marsh, W.K., Gershenson, B., & Rothschild, A.J. (2015). Symptom severity of bipolar disorder during the menopausal transition. International Journal of Bipolar Disorders, 3(1), 35. DOI: 10.1186/s40345-015-0035-z Soares, C.N., Almeida, O.P.,  Joffe, H., & Cohen, L.S. (2001). Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women a double-blind, randomized, placebo-controlled trial. Archives of General Psychiatry, 58(6), 529-534. doi:10.1001/archpsyc.58.6.529 Weber, M.T., Maki, P.M., & McDermott, M.P. (2013). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001   References: Kornstein S.G., & Clayton, A.H. (2004). Sex differenes in neuroendocrine and neurotransmitter systems. In Women’s mental health: A comprehensive textbook (pp.3-30). Guilford Press.  Chrisler, J. C., & Johnston-Robledo, I. (2002). Raging hormones?: Feminist perspectives on premenstrual syndrome and postpartum depression. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 174–197). Guilford Press. American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers psychedelic-assisted psychotherapy with Dr Emma Hapke and Dr Daniel Rosenbaum, both of whom are psychiatrists at the University Health Network in Toronto and co-founders of UHN’s Nikean Psychedelic Psychotherapy Research Centre (in addition to being lecturers in the Department of Psychiatry at the University of Toronto).   The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Briefly describe the history of psychedelics in psychiatry List the four classes of psychedelic drugs and their mechanism of action Summarize the evidence regarding psychedelic-assisted psychotherapy for various psychiatric disorders Discuss patient selection considerations for psychedelic-assisted psychotherapy Describe the safety, tolerability and possible side effects of psychedelic-assisted psychotherapy Understand how a psychedelic-assisted psychotherapy session is practically carried out   Guests: Dr Emma Hapke and Dr Daniel Rosenbaum   Hosts: Dr Chase Thompson (PGY4), Dr Nikhita Singhal (PGY3), Jake Johnston (CC4), and Annie Yu (CC4)   Audio editing by: Nikhita Singhal   Show notes by: Nikhita Singhal   Interview Content: Introduction - 0:00 Learning objectives - 02:47 Definitions/categories of psychedelics - 03:24 Classic psychedelics - 04:15 Empathogens (e.g. MDMA) - 07:15 Etymology of the term “psychedelic” - 09:30 Ketamine - 12:24 Iboga - 13:28 Brief history of psychedelic medicine - 17:51 Current evidence and ongoing trials - 27:38 MDMA and PTSD - 29:26 Psilocybin and treatment-resistant depression - 32:24 A word of caution - 34:29 End-of-life care - 38:47 Practical aspects of psychedelic-assisted psychotherapy sessions - 45:45 Safety considerations - 01:04:04 Future directions - 01:10:33 Closing comments - 01:19:07   Resources: Books: How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (Michael Pollan) The Doors of Perception (Aldous Huxley) The Human Encounter With Death (Stanislav Grof and Joan Halifax) Brainwashed podcast series (CBC): https://www.cbc.ca/listen/cbc-podcasts/440-brainwashed Zendo Project (psychedelic peer support): https://zendoproject.org Nikean Psychedelic Psychotherapy Research Centre: https://www.uhn.ca/MentalHealth/Research/Nikean-Psychedelic-Psychotherapy-Research-Centre California Institute of Integral Studies (CIIS): https://www.ciis.edu Multidisciplinary Association for Psychedelic Studies (MAPS): https://maps.org PsychEd Episode 27 - Serotonin Pharmacology: From SSRIs to Psychedelics with Dr Robin Carhart-Harris) PsychEd Episode 34 - Ketamine for Treatment-Resistant Depression with Dr Sandhya Prashad   References: Carhart-Harris R, Giribaldi B, Watts R, et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021;384(15):1402-1411. https://doi.org/10.1056/nejmoa2032994 Carhart-Harris R, Nutt D. Serotonin and brain function: a tale of two receptors. Journal of Psychopharmacology. 2017;31(9):1091-1120. https://doi.org/10.1177/0269881117725915 Davis AK, Barrett FS, May DG, et al. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(5):481–489. https://doi.org/10.1001/jamapsychiatry.2020.3285 Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. dhttps://dx.doi.org/10.1177%2F0269881116675513 Griffiths RR, Johnson MW, Richards WA, et al. Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors. J Psychopharmacol. 2018;32(1):49-69. https://doi.org/10.1177/0269881117731279 Johnson MW, Hendricks PS, Barrett FS, Griffiths RR. Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. Pharmacol Ther. 2019;197:83-102. https://doi.org/10.1016/j.pharmthera.2018.11.010 Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. 2021;27(6):1025-1033. https://doi.org/10.1038/s41591-021-01336-3 Mithoefer MC, Mithoefer AT, Feduccia AA, et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry. 2018;5(6):486-497. https://doi.org/10.1016/s2215-0366(18)30135-4 Nicholas CR, Henriquez KM, Gassman MC, et al. High dose psilocybin is associated with positive subjective effects in healthy volunteers. J Psychopharmacol. 2018;32(7):770-778. https://doi.org/10.1177/0269881118780713 Reiff CM, Richman EE, Nemeroff CB, et al. Psychedelics and Psychedelic-Assisted Psychotherapy. Am J Psychiatry. 2020;177(5):391-410. https://doi.org/10.1176/appi.ajp.2019.19010035 Rosenbaum D, Boyle AB, Rosenblum AM, Ziai S, Chasen MR, Med MP. Psychedelics for psychological and existential distress in palliative and cancer care. Curr Oncol. 2019;26(4):225-226. https://dx.doi.org/10.3747%2Fco.26.5009 Swift TC, Belser AB, Agin-Liebes G, et al. Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress. Journal of Humanistic Psychology. 2017;57(5):488-519. https://doi.org/10.1177/0022167817715966   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers interpersonal psychotherapy (IPT) with Dr. Paula Ravitz, an Associate Professor of Psychiatry at the University of Toronto and Senior Clinician-Scientist at the Lunenfeld-Tanenbaum Research Institute of Mt Sinai Hospital. Dr. Ravitz held the Morgan Firestone Psychotherapy Chair at the Mount Sinai Hospital from 2011 to 2021 and is a past president of the International Society of Interpersonal Psychotherapy. The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Define interpersonal psychotherapy Describe the core principles and phases of IPT Become familiarized with some psychological theories underpinning IPT List some patient selection considerations for IPT Describe the efficacy and evidence base for IPT  Understand how IPT is practically carried  out  Briefly compare and contrast IPT to other common psychotherapies Guest: Dr. Paula Ravitz (paula.ravitz@sinaihealthsystem.ca) Hosts: Jake Johnston and Sena Gok Audio editing by: Jake Johnston Show notes by: Jake Johnston Interview Content: Introduction - 00:00 Learning objectives - 02:10 Definition/overview of IPT - 02:53 Core principles and phases - 07:20 Psychological theories - 19:30 Patient selection considerations - 24:42 Contraindications - 35:57 Evidence base and history - 38:10 Practical components of IPT - 43:57 Maintenance IPT - 59:52 IPT vs other psychotherapies - 62:56  Closing comments - 71:17 Online IPT course - 74:30 Resources: Summary of IPT written in layman's terms: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/interpersonal-psychotherapy The International Society of Interpersonal Psychotherapy (ISIPT) has a helpful overview of IPT and helpful resources for finding more information and IPT training opportunities: https://interpersonalpsychotherapy.org/ ‘Psychotherapy Essentials to Go’ book series mentioned during episode:  https://www.penguinrandomhouse.ca/series/CNL/psychotherapy-essentials-to-go The online IPT curriculum is now available as a University of Toronto, Faculty of Medicine-sponsored open-access online course through Coursera, that is free for learners to audit - https://www.coursera.org/learn/learn-ipt References: Bernecker, S. L., Coyne, A. E., Constantino, M. J., & Ravitz, P. (2017). For whom does interpersonal psychotherapy work? A systematic review. Clinical psychology review, 56, 82–93. https://doi.org/10.1016/j.cpr.2017.07.001 Chaimowitz, G., Weerasekera, P., & Ravitz, P. (2021). Psychotherapy in Psychiatry. The Canadian Journal of Psychiatry, 66(11), 999–1004. https://doi.org/10.1177/07067437211040958 Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis. The American journal of psychiatry, 173(7), 680–687. https://doi.org/10.1176/appi.ajp.2015.15091141  Dennis, C. L., Grigoriadis, S., Zupancic, J., Kiss, A., & Ravitz, P. (2020). Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial. The British journal of psychiatry : the journal of mental science, 216(4), 189–196. https://doi.org/10.1192/bjp.2019.275  Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., & Docherty, J. P. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of general psychiatry, 46(11), 971–983. https://doi.org/10.1001/archpsyc.1989.01810110013002 Klerman, G. L., Dimascio, A., Weissman, M., Prusoff, B., & Paykel, E. S. (1974). Treatment of depression by drugs and psychotherapy. The American journal of psychiatry, 131(2), 186–191. https://doi.org/10.1176/ajp.131.2.186  MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 588–603. https://doi.org/10.1177/0706743716659276 Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., Velyvis, V., Kennedy, S. H., Lam, R. W., MacQueen, G. M., Milev, R. V., Ravindran, A. V., Uher, R., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 61(9), 524–539. https://doi.org/10.1177/0706743716659418 Ravitz, P., & Watson, P. (2014). Interpersonal Psychotherapy: Healing with a Relational Focus. FOCUS, 12(3), 275-284. https://doi.org/10.1176/appi.focus.12.3.275 Ravitz, P., Watson, P., Lawson, A., Constantino, M. J., Bernecker, S., Park, J., & Swartz, H. A. (2019). Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974-2017). Harvard review of psychiatry, 27(3), 165–180. https://doi.org/10.1097/HRP.0000000000000219 Swartz, H. (2021). Interpersonal Psychotherapy (IPT) for depressed adults: Indications, theoretical foundation, general concepts, and efficacy. UpToDate. Accessed 2021-10-12. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness with our guest expert Dr. Sonu Gaind. This episode was originated by Dr. Urvashi Prasad for her Grand Rounds.    The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Briefly summarize the history of Medical Assistance in Dying in Canada Define the present policy on Medical Assistance in Dying and Mental Health in Canada Evaluate the arguments in support of and against the implementation of Medical Assistance in Dying in Mental Health Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry   Guest expert: Dr. Sonu Gaind  is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Humber River Hospital. Dr. Gaind has testified in front of the Federal External Panel on Options for a Legislative Response to Carter v. Canada, the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the Special Joint Commons/Senate Committee on Physician-Assisted Dying, and the Senate Committee on Legal and Constitutional Affairs on issues relevant to mental health and mental illness that need to be considered in the MAiD framework. Dr. Gaind chaired the time-limited Canadian Psychiatric Association Task Force on Assisted Dying, was selected to sit on the Council of Canadian Academies Expert Panel on Mental Disorders and Assisted Dying, and has spoken across the country and internationally on the subject.   Grand Rounds Presenter: Dr. Urvashi Prasad (PGY3)   Produced by: Dr. Urvashi Prasad (PGY3) and Dr. Alex Raben  (staff psychiatrist)   Hosts: David Eapen-John (MS2), Dr. Alex Raben (Staff Psychiatrist)   Audio editing by: Dr. Alex Raben (Staff Psychiatrist)   Show notes by: Dr. Urvashi Prasad (PGY3)     Resources: Assisted Suicide in Canada https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada (Website) Council of Canadian Academies, 2018. The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition. Ottawa (ON):  The Expert Panel Working Group on MAID Where a Mental Disorder Is the Sole Underlying Medical Condition  https://cca-reports.ca/wp-content/uploads/2018/12/The-State-of-Knowledge-on-Medical-Assistance-in-Dying-Where-a-Mental-Disorder-is-the-Sole-Underlying-Medical-Condition.pdf References: Government of Ontario, Ministry of Health and Long-Term Care. “Medical Assistance in Dying.” Health Care Professionals - MOH, Government of Ontario, Ministry of Health and Long-Term Care, 13 May 2021, https://www.health.gov.on.ca/en/pro/programs/maid/. Tabitha Marshall. “Assisted Suicide in Canada.” The Canadian Encyclopedia, 3 Dec. 2021, https://www.thecanadianencyclopedia.ca/en/article/assisted-suicide-in-canada. “Get the Facts: Canada's Medical Assistance in Dying Law.” Dying With Dignity Canada, https://www.dyingwithdignity.ca/get_the_facts_assisted_dying_law_in_canada#mental_illness. Jones, Roland M, and Alexander I F Simpson. “ Medical Assistance in Dying: Challenges for Psychiatry.” Frontiers in psychiatry vol. 9 678. 10 Dec. 2018, doi:10.3389/fpsyt.2018.00678 Thienpont, Lieve et al. “Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study.” BMJ open vol. 5,7 e007454. 27 Jul. 2015, doi:10.1136/bmjopen-2014-007454 Gaind, KS. (2020). What does “irremediability” in mental illness mean? Canadian Journal of Psychiatry. Online first May 22, 2020. pp 1‐3. doi: 10.1177/0706743720928656 “Maid Volunteer Advocacy Council.” Mental Illness and MAID, https://sencanada.ca/content/sen/committee/432/LCJC/Briefs/MentalIllnessandMAID_e.pdf. Canada, Health. “Second Annual Report on Medical Assistance in Dying in Canada 2020.” Canada.ca, / Government of Canada Gouvernement Du Canada, 30 June 2021, https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html#highlights.  Komrad, Mark S. “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients.” Psychiatric Times, 1 June 2021, https://www.psychiatrictimes.com/view/canada-law-provide-not-prevent-suicide.      CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer, a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement.    The learning objectives for this episode are as follows:   By the end of this episode, you should be able to… Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populations Incorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches  Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours    Guest expert: Dr. Juveria Zaheer    Hosts: Dr. Chase Thompson (PGY4)   Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson    Audio editing: Dr. Chase Thompson   Show notes: Dr. Chase Thompson   00:00 – Introduction 01:14 – Learning objectives 04:00 – Overview of suicide rates across populations 07:20 - Sex and gender differences in suicide 08:50 - Suicide following discharge from hospital 14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors 20:50 - Meeting patients and families where they are at 23:30 - Suicide safety plans  28:30 - Evidence-based approaches to suicide prevention  32:30 - Commentary on strength of evidence for interventions in suicide prevention 38:40 - Addressing suicidality in borderline personality disorder 47:00 - Ethics of involuntary hospitalization for suicidality 50:00 - Future of suicide prevention  References: Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83. Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346. Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open, 9(3), e023883. Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA psychiatry, 74(7), 694-702. Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies. Social psychiatry and psychiatric epidemiology, 54(12), 1459-1470. Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168-179. Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074. Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study. JAMA psychiatry, 74(6), 563-570. Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140. Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900. Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophrenia research, 202, 347-353. Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527-543. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

In this enlightening discussion, Dr. Wei-Yi Song, a leading psychiatrist and ECT services director, demystifies electroconvulsive therapy. He shares the history of ECT, debunks widespread myths, and explores its efficacy for severe mental illnesses like depression and bipolar disorder. Dr. Song also dives into the neurobiological mechanisms at play and the safety of the procedure. With a focus on personalized patient management, he emphasizes the importance of education to reshape perceptions of this misunderstood treatment.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Clinical High Risk for Psychosis with Dr. Thomas Raedler, Psychiatrist and associate professor at the University of Calgary and one of the authors of the Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis.   The learning objectives for this episode are as follows: By the end of this episode, you should be able to…   Recognize a patient who may be clinically high-risk for psychosis and provide a differential diagnosis  Understand the importance, utility and prognosis of these risk categories  Have an approach to initial management and the array of treatment options for a patient with    Hosts: Dr. Luke Fraccaro (PGY-2), Dr. Rebecca Marsh (PGY-1), Dr. Alex Raben Episode lead: Dr. Luke Fraccaro Audio-engineered by: Dr. Rebecca Marsh Guest experts: Dr. Thomas Raedler Show Notes by: Dr. Luke Fraccaro   Resources:   Addington, J., Francey, S., Morrison, A.  (2006). Working with People at High Risk of Developing Psychosis: A Treatment Handbook  McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: handbook for diagnosis and follow-up. Oxford University Press.   References : Addington, J., Addington, D., Abidi, S., Raedler, T., & Remington, G. (2017). Canadian treatment guidelines for individuals at clinical high risk of psychosis. The Canadian Journal of Psychiatry, 62(9), 656-661. Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., ... & Heinssen, R. (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry, 168(8), 800-805. Addington, J., & Heinssen, R. (2012). Prediction and prevention of psychosis in youth at clinical high risk. Annual review of clinical psychology, 8, 269–289.  Carrión, R. E., McLaughlin, D., Goldberg, T. E., Auther, A. M., Olsen, R. H., Olvet, D. M., Correll, C. U., & Cornblatt, B. A. (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA psychiatry, 70(11), 1133–1142. https://doi.org/10.1001/jamapsychiatry.2013.1909 Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., Barale, F., Caverzasi, E., & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220–229.  Fusar-Poli P, Salazar de Pablo G, Correll CU, et al. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. 2020;77(7):755–765. doi:10.1001/jamapsychiatry.2019.4779 Fusar-Poli, P., Schultze-Lutter, F., Cappucciati, M., Rutigliano, G., Bonoldi, I., Stahl, D., Borgwardt, S., Riecher-Rössler, A., Addington, J., Perkins, D. O., Woods, S. W., McGlashan, T., Lee, J., Klosterkötter, J., Yung, A. R., & McGuire, P. (2016). The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophrenia bulletin, 42(3), 732–743.  Kuharic, D. B., Kekin, I., Hew, J., Kuzman, M. R., & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews, (11). Nelson, B., Amminger, G. P., Bechdolf, A., French, P., Malla, A., Morrison, A. P., ... & Wood, S. J. (2020). Evidence for preventive treatments in young patients at clinical high risk of psychosis: the need for context. The lancet. Psychiatry, 7(5), 378. Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., ... & Morrison, A. (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European psychiatry, 30(3), 388-404. Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., ... & Buckby, J. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11-12), 964-971.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com.  For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the second of two episodes covering the topic of eating disorders. In this episode, we explore the treatment of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital.    The learning objectives for the episode are as follows:   By the end of this episode, you should be able to… Outline the management of eating disorders using a biopsychosocial framework. Identify the indications for various levels of care (inpatient, residential, day hospital, outpatient, etc). Understand the ethical and medicolegal dilemmas (i.e. involuntary treatment) that may arise in treatment of eating disorders. Consider the treatment of special populations (i.e. children and adolescents, older adults, men, LGBTQ+ individuals).   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY3), Dr. Vanessa Aversa (PGY4)   Audio editing by: Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa, Dr. Nikhita Singhal   Interview Content: Introduction - 0:00  Learning objectives - 00:39 Biological approaches to treatment: Nutritional rehabilitation - 03:47 Medications - 06:00 Psychological approaches to treatment -16:35 Treatment of comorbidities - 23:45 Levels of care - 26:00 Ethical dilemmas - 32:40 Special populations: Children and adolescents - 35:35 Older adults - 36:45 Men - 37:55 LGBTQ+ - 40:23 Novel interventions - 42:48 Closing - 51:47   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca. The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca. Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10 Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019. Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. 2006. Geller J, Isserlin L, Seale E, et al. The short treatment allocation tool for eating disorders: current practices in assigning patients to level of care. J Eat Disord. 2018;6(45). https://doi.org/10.1186/s40337-018-0230-2 McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008 Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7 Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the first of two episodes covering the topic of eating disorders. In this episode, we explore the diagnosis, etiology, and symptomatology of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. Dr. Staab joins us again for Part 2, which will focus on eating disorder treatment.   By the end of this episode, you should be able to… Recognize the clinical features of the following eating disorders using DSM-5 diagnostic criteria:  Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Avoidant/Restrictive Food Intake Disorder (ARFID) Other Specified Feeding or Eating Disorder (OSFED) Identify predisposing factors for eating disorders using a biopsychosocial framework. List common comorbid psychiatric conditions associated with eating disorders. Identify and describe the medical complications of eating disorders.   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY2), Dr. Vanessa Aversa (PGY3)   Audio editing by: Dr. Nikhita Singhal, Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa   Interview Content: Introduction - 0:00  Learning objectives - 2:08 DSM-5 definition, clinical features, and associated comorbidities of: Anorexia Nervosa (AN) - 4:27 Bulimia Nervosa (BN) - 12:36 Binge Eating Disorder (BED) - 18:08 Avoidant/Restrictive Food Intake Disorder (ARFID) - 21:43 Other Specified Feeding or Eating Disorder (OSFED) - 26:21 Approach to the initial assessment of a patient with an eating disorder - 29:45 Predisposing factors and explanatory models for the development of eating disorders: Biological factors - 38:10 Psychological factors - 44:00 Sociocultural factors - 48:02 Onset of eating disorders - 49:34 Possible precipitating factors - 51:50 Medical complications of eating disorders: Cardiovascular - 56:13 Endocrine - 58:09 Musculoskeletal - 1:03:20 Gastrointestinal - 1:05:17 Neurological - 1:08:13 Renal - 1:08:59 Dermatological - 1:09:26 Relevant laboratory investigations - 1:11:27 Overview of refeeding syndrome - 1:12:30 Closing - 1:14:27   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca. The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca. Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10 Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019. Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017. McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008 Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7 Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.