PsychEd: educational psychiatry podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of schizophrenia with Dr. Jason Joannou and Dr. Andrew Lustig, two inpatient staff psychiatrists at the Centre for Addiction and Mental Health (CAMH) and assistant professors at the University of Toronto.

The learning objectives for this episode are as follows:

By the end of this episode, the listener will be able to...

• Articulate the basic psychopharmacology of antipsychotics
• Create a basic treatment presenting with a first episode of schizophrenia, based on the 2017 Guidelines for the Pharmacotherapy of Schizophrenia in Adults
• Summarize principles of longitudinal treatment, which includes treatment-resistant schizophrenia and psychosocial approaches to the illness.

References:

• Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616.
• Norman, R., Lecomte, T., Addington, D., & Anderson, E. (2017). Canadian treatment guidelines on psychosocial treatment of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 617-623.
• Tiihonen, J., Haukka, J., Taylor, M., Haddad, P. M., Patel, M. X., & Korhonen, P. (2011). A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. American Journal of Psychiatry, 168(6), 603-609.

Your input will help us improve this podcast and provide more insight into why and how podcasts are used in medical education. And remember you’ll also be given a chance to win a $230 gift card of your choice/pre-paid visa in addition to the good you’ll be doing. We look forward to listening to all of you for a change!

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 [email protected]. For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a broad overview of antisocial personality disorder and psychopathy with our guest expert - Dr. Donald Lynam. Dr. Lynam is a clinical psychologist by training, and professor at Purdue university, where he heads the Purdue's Developmental Psychopathology, Psychopathy and Personality Lab. While there may be some disagreement in the field, Dr. Lynam and I discuss how ASPD and psychopathy are two diagnostic constructs that are attempting to outline the same psychopathology, with the main difference being the degree of severity - for this reason, we use the terms antisocial and psychopathic interchangeably.

While not necessary, it may be of benefit for listeners to familiarize themselves with the DSM-V criteria for antisocial personality disorder, the psychopathy checklist (PCL), as well as the 5-factor model of personality. References for each are listed below in the references section, however, for a brief overview, one could do a quick google image search for each term (Wikipedia also has a succinct overview of the psychopathy checklist).

The learning objectives for this episode are as follows:

1. Develop a basic understanding of what is meant by antisocial personality and psychopathy
2. Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors
3. Describe the theoretical basis for the development of antisocial personalities

Guest Expert: Dr. Donald Lynam - Clinical psychologist, Investigator at Purdue University, Indiana

Produced and hosted by: Dr. Chase Thompson (PGY5 in Psychiatry)

Episode guidance and feedback: Dr. Gaurav Sharma (PGY4 in Psychiatry)

Interview Content:

0:50 - Learning objectives

1:40 - Dr. Lynam discusses his path to his current research interests

3:40 - Defining the terms antisocial personality disorder, sociopathy, psychopathy

8:30 - Discussing the possibility of antisocial behaviors without an antisocial personality

12:07 - Laying out the core features of antisocial individuals

18:20 - Antisocial personality from the perspective of the Big 5 personality model

22:00 - Discussion of the high-functioning psychopathy

25:06 - Prevalence of psychopathy

30:10 - Factors relevant to the development of psychopathy

39:30 - Prognosis and clinical trajectory

44:30 - Comorbid psychopathology

46:30 - Functions of antagonism or antisocial behaviours

49:30 - Treatment

References

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.
• Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R, Lynam DR. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Developmental psychology. 2003 Mar;39(2):222.
• Babiak P, Hare RD, McLaren T. Snakes in suits: When psychopaths go to work. New York: Harper; 2007 May 8.
• Hare RD. The psychopathy checklist–Revised. Toronto, ON. 2003;412.
• Hare RD, Harpur TJ, Hakstian AR, Forth AE, Hart SD, Newman JP. The revised psychopathy checklist: reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Sep;2(3):338.
• Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of abnormal psychology. 1991 Aug;100(3):391.
• Jones SE, Miller JD, Lynam DR. Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice. 2011 Jul 1;39(4):329-37.
• Lynam DR. Early identification of chronic offenders: Who is the fledgling psychopath?. Psychological bulletin. 1996 Sep;120(2):209.
• Miller JD, Lynam DR. Psychopathy and the five-factor model of personality: A replication and extension. Journal of personality assessment. 2003 Oct 1;81(2):168-78.

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 [email protected]. For more information, visit our website at psychedpodcast.org.

Welcome to PsychEd - the psychiatry podcast for medical learners, by medical learners. This episode covers the relationship between cannabis and psychotic disorders, as well as the potential impact of cannabis legalization in Canada, with our special guest Dr. Nitin Chopra. This episode was originated by Dr. Luke Fraccaro for his Grand Rounds.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to...

1. Briefly summarize the effects of cannabis on mental health and cognition, with a focus on psychosis.
2. Appreciate the evidence for cannabis use as a potential cause of persistent psychotic disorders.
3. Discuss the possible impact that recent cannabis legislation may have had on cannabis use and psychosis in Canada.

Guest Expert Dr. Nitin Chopra is an addictions psychiatrist at the Centre for Addiction and Mental Health (CAMH) and is an Assistant Professor in the Department of Psychiatry at the University of Toronto. He has an interest in concurrent disorders and is a staff psychiatrist on the Concurrent Addictions Inpatient Treatment Service and Concurrent Outpatient Medical and Psychosocial Addiction Support Service. Through his work on the Psychiatry Addictions Capacity Building and Consultation Service (PACCS) at CAMH and the Addiction Medicine and Psychosocial Addictions ECHO program, he is evolving into a leader in capacity building and education for addictions treatment. Furthermore, Dr. Chopra also works on the Early Psychosis Unit at CAMH and has extensive clinical experience working with patients experiencing psychosis, often with comorbid cannabis and other substance use.

Grand Rounds Presenter: Dr. Luke Fraccaro (PGY3)

Produced by: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)

Hosts: Dr. Luke Fraccaro (PGY3), Dr. Alex Raben (staff psychiatrist), and Josh Benchaya (MS4)

Audio Editing by: Dr. Luke Fraccaro (PGY3)

Show notes by: Dr. Luke Fraccaro (PGY3)

Conflicts of Interest: There are no known conflict of interests to report

Topics:

• 0:00 - Introduction
• 2:50 - Objectives
• 3:55 - Case example
• 7:25 - Overview of cannabis effects of mental health
• 10:45 - Differentiating clinically between cannabis-induced psychosis and a primary psychotic disorder
• 13:11 - Cannabis causing acute psychotic symptoms
• 14:15 - Back to the case
• 16:05 - Overlapping risk factors for cannabis use and psychotic disorders
• 18:14 - Cannabis use as a potential cause of persistent psychotic disorders (Reviewing the evidence)
• 30:14 - Summary of the relationship between cannabis and psychosis and how to apply it clinically
• 35:20 - Cannabis legalization in Canada
• 39:45 - Canadian studies on potential impact of cannabis legalization on psychosis
• 44:33 - Brief review of American studies on potential impact of cannabis legalization on psychosis.
• 46:35 - Summary of potential impact of legalization
• 47:42 - Questions and discussion
• 1:06:15 - Summary and Outro

Resources:

• Canada’s Lower-Risk Cannabis Use Guideline: https://www.camh.ca/-/media/files/lrcug_professional-pdf.pdf
• Cannabis legalization and regulation in Canada: https://www.canada.ca/en/health-canada/programs/engaging-cannabis-legalization-regulation-canada-taking-stock-progress/document.html

References:

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Arlington, VA: American Psychiatric Association, 2022.
2. Tourjman SV, Buck G, Jutras-Aswad D, Khullar A, McInerney S, Saraf G, Pinto JV, Potvin S, Poulin MJ, Frey BN, Kennedy SH, Lam RW, MacQueen G, Milev R, Parikh SV, Ravindran A, McIntyre RS, Schaffer A, Taylor VH, van Ameringen M, Yatham LN, Beaulieu S. Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force Report: A Systematic Review and Recommendations of Cannabis use in Bipolar Disorder and Major Depressive Disorder. Can J Psychiatry. 2022 Jun 16:7067437221099769. doi: 10.1177/07067437221099769. Epub ahead of print. PMID: 35711159.
3. Xue S, Husain MI, Zhao H, Ravindran AV. Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies. Can J Psychiatry. 2021 Feb;66(2):126-138. doi: 10.1177/0706743720952251. Epub 2020 Sep 10. PMID: 32909828; PMCID: PMC7918873.
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Welcome to PsychED, the educational psychiatry podcast for medical learners, by medical learners.

This episode covers the approach to treating Major Depressive Disorder, as described by the CANMAT (Canadian Network for Mood and Anxiety Treatments) Guidelines. We discuss with Dr. Sid Kennedy, the founding chair of CANMAT, the past president of International Society for Affective Disorders, as well as a staff psychiatrist and scientist at Toronto Western and St. Michael’s Hospitals in Toronto.

In this episode, Dr. Kennedy discusses the origins of the CANMAT and how the guidelines are structured and constructed. We talk briefly about consideration of specifiers and symptoms in tailoring treatment. We then approach psychotherapy, pharmacotherapy, electrostimulation, and complementary and alternative therapies as treatment options, using the case from the previous episode on the diagnosis of depression.

Evidence-based psychotherapies for depression include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). We explain briefly the theoretical underpinnings of each. Patient suitability and availability of quality therapy are considered. Some evidence demonstrate a superiority of combining psychotherapy with pharmacotherapy (Cuijpers 2009).

The first-line pharmacotherapy includes antidepressant classes SSRI (selective serotonin reuptake inhibitor), SNRI (serotonin and norepinephrine reuptake inhibitor), NDRI (norepinephrine and dopamine reuptake inhibitor), and NaSSA (norepinephrine and specific serotonergic antidepressant). We discuss side effects with a focus on SSRIs, and understanding them from serotonin receptor profiles. We talk about the delayed onset of antidepressants, using validated tools to measure improvement, and strategies to optimize dosage, or using adjuncts with partial responses. We explore results from STAR*D (Trivedi et al, 2006) regarding response rates to medications.We touch briefly on antidepressant selection and the limited evidence of superiority of one medication/class over another (Cipriani et al 2009).

Brain stimulation includes electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and Deep Brain Stimulation (DBS). Dr. Kennedy discusses the cultural origins of misconceptions around ECT and explores the current practice of ECT today, which includes general anesthesia for the comfort of patients. We explain briefly the practice of rTMS and DBS.

Complementary and alternative therapies are briefly explored, including light therapy which has increasing evidence not only for seasonal patterns of depression. Dr. Kennedy discusses the limited evidence available to support any complementary therapies including nutraceuticals and exercise.

The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:

1. Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features
2. Apply the CANMAT Guidelines in discussing treatment options for MDD
3. Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD
4. Psychotherapy
   • Identify CBT, IPT, and MBCT as evidence-based psychotherapies for depression
   • Explain factors for choosing psychotherapy versus pharmacotherapy as first-line treatment
   • Describe the efficacy of psychotherapy in relation to pharmacotherapy
5. Pharmacotherapy
   • Identify SSRI, SNRI, NDRI, and NaSSA as classes of antidepressants that are first-line for depression
   • Explain the time of onset and side effect profile of SSRIs
   • Apply the guideline to either optimize, switch, or add adjunctive therapies with limited or partial responses to medication
   • Identify some factors to consider in choice of antidepressants
6. Brain Stimulation
   • Identify ECT, rTMS, and DBS as brain stimulation treatments for depression
   • Criticize the cultural origins of stigma around ECT
   • Describe the current practice of ECT, rTMS, and DBS
7. Complementary and Alternative Therapies
   • Describe Light Therapy as the only evidence-based complementary treatment strategy
   • Recognize the limited data in support of other therapies including nutraceuticals and exercise

Guest Staff Psychiatrist: Dr. Sid Kennedy (Toronto Western Hospital and St. Michael’s Hospital, Toronto)

For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at [email protected] For more information visit our website: psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto.

Dr. Courtney earned his MD in 2004 at Queen’s University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth.

Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to...

1. Outline the prevalence and risk factors for depression in children and adolescents
2. Explain how children and adolescents with depression present in clinical practice
3. Discuss the use of screening tools for depression in this population
4. Describe an approach to the management of depression in children and adolescents
5. Outline the management of an adolescent with suicidal thoughts or behaviours

Guest: Dr. Darren Courtney

Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5)

Audio editing by: Nikhita Singhal

Show notes by: Kate Braithwaite and Nikhita Singhal

Interview Content:

• Introduction - 0:00
• Learning objectives - 02:11
• Prevalence of depression in youth - 03:11
• Risk factors for depression in youth - 06:25
• Diagnosing depression in youth - 08:30
• Screening tools - 14:24
• Approach to taking a history from youth - 19:45
• Management of depression in youth - 30:12
• Psychotherapies - 33:20
• Medications - 37:37
• Assessing and managing suicidality in youth - 44:00
• Measurement based care - 51:00
• Final thoughts - 55:10

Resources:

• Previous PsychEd episodes:
• PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn
• PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy
• PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer
• ICHOM Set of Patient-Centered Outcome Measures for Children & Young People with Depression & Anxiety
• Screening tools/rating scales:
• Revised Children's Anxiety and Depression Scale (RCADS)
• Mood and Feelings Questionnaire (MFQ)
• NICE guideline: Depression in children and young people: identification and management
• NICE guideline: Self-harm: assessment, management and preventing recurrence
• The CARIBOU Pathway by CAMH: A youth-cente...