PsyDactic

Today I talk about guns.  More specifically, I talk about talking about guns. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com .  All opinions expressed in this podcast are exclusively those of the person speaking and shoul...

Today I am continuing an intermittent series called, “In a Word,” and the word that I chose for today is akathisia.  Akathisia is broadly defined as an inability to remain still.  If you ask someone with Akathisia to stop moving, they will likely become very uncomfortable, but while they are moving, they experience at least some relief. Please leave feedback at https://www.psydactic.com or send an...

There is a narrative wave in popular psychology and neuroscience that has taken a small amount of very basic science and twisted it into a fantastic narrative of feast and famine.  Its central character is dopamine.  The Dopamine Detox also known as dopamine fasting is a pseudoscientific treatment that at best illustrates how magnificently strange and evidence-less some claims about dopamine can b...

I have recently added some artificial intelligence produced answers to psychiatry questions in my past episodes in an effort to try to understand what it is that AI text generators can do and what value they might add to my future as a psychiatrist versus what problems it might introduce into my practice. I realized that since I have opened this pandora's box, I need to provide some more cont...

What is a placebo?  You may already be thinking something like: A placebo is an imitation, fake, sham, decoy, or trick treatment that we give to people in studies to see if the treatment under investigation is any better or worse.  Placebos are supposed to be both benign and inert, meaning they should neither harm nor help a patient beyond the patient feeling or reporting that they are better or w...

This episode is the second in an intermittent series I am calling In A Word. Psychiatry is full of terms that are either poorly defined or used in such broad ways that they are not very helpful by themselves.  Trying to come to terms with terms we throw around can help us to understand the conditions we treat better, and hopefully will help us to communicate more precisely and effectively in the f...

Bayesian reasoning is likely operating in your mind whether you realize it or not, whether you can do the math or not.  In this episode, Dr. O'Leary explores how to explicitly use Bayesian reasoning to put actual numbers to our inherent biases.  Attention Deficit Hyperactivity Disorder (ADHD) seems like a good place to start. Please leave feedback at https://www.psydactic.com or send any comm...

S ociety is in upheaval in the way that it discusses mental health.  There are many loud voices out there. Some of these advocate for more openness and less stigma with regard to how we treat people with behavioral and psychological disorders, and by "treat," I don’t mean with drugs or therapy, but with our words, actions, policies, laws, and inaction.  One example of these voices is Dr....

Dr. O'Leary reviews one of the most frustrating diseases that a patient and their family might approach a psychiatrist with: Huntington’s Disease.  Huntington’s Disease is a neurodegenerative disorder, which means that over the course of the disease neurons die or cease to function correctly and this worsens over time.   The death of neurons in the caudate nucleus and putamen results in chore...

It is unlikely that any model of major depressive disorder is likely to find universal signals among those diagnosed because the symptoms are so diverse.  However, it does seem likely that models, such as brain-network models, will be able to identify common dysfunctions among those with similar symptom burdens (for example, those with primarily anhedonic symptoms, dysphoria, or with excessive rum...

Bipolar disorder is a complex, often debilitating and potentially life threatening illness in which the patient goes from episodes of depression to episodes of mania or hypomania, most often with periods of relative euthymia in between these episodes.  The most common way to conceptualize the treatment of bipolar disorder is by phase. The ideal goal would be preventing the distinct manic and depre...

In previous episodes I have tried to draw pictures in your mind (using those fat crayons that babies like to chew on) of some of the brain networks that are important in many mental illnesses.  We have talked specifically about the Default Mode Network (that is concerned with imaginal thoughts and self-referential thoughts and memories), the Dorsal and Ventral Attention Networks (that help us to i...

What is salience?  Fundamentally it is a value judgment that determines where your brain will place its limited resources.  There are a lot of things that could draw our attention.  The world is full of sights, sounds, smells, pressures, temperatures, stretches.  Our mind is full of thoughts.  Without a salience network, we wouldn’t know what matters and what doesn’t.  We would just randomly scan...

Today, I am going to explore the Attention Networks, which are the parts of our brain that get really excited when, for example, we see something that we have never seen before, something that appears to be moving on its own volition (and might harm us), something that appears out of place (like an eyeball on the floor), or something that reminds us of something we really want (I’ll let you pick t...

B ehaviors are complex.  We have networks of neurons functioning in systems, some of which ramp other systems up, and some of which dampen others down.  This ballet of correlation (when increased activity in one network predicts increased activity in another) and anticorrelation (when increased activity in one network predicts decreased activity in another) can help us to understand what is going...

One of the most influential models in psychiatry’s history for understanding brain dysfunction is the monoamine hypothesis.  In short, it proposes that deficiencies or excess of certain neuromodulating agents, in particular the monoamines serotonin, dopamine, and norepinephrine (AKA noradrenaline) drive many psychiatric disorders.  The paper I will primarily reference is a publication by the same...

This is an episode to report updates in the DSM 5-TR that can be practice changing.  I will also divulge a little about myself and how my philosophy and values have changed. In particular, I am reminded of how I have struggled to understand transgendered and other gendered individuals. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and...

I originally promised a review of the Bush Francis Catatonia Rating Scale, but while reviewing it, I came across some questions that I think are even more interesting.  I will discuss Bush Francis, but I want to do it in a larger context of the challenges that Psychiatrists face with diagnosis in general. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic...

Dr. O discusses the remaining hyperactive or “excited” signs of catatonia including echolalia, echopraxia, and agitation.  In previous episodes, Dr. O discussed other hyperactive or “excited” signs, including mannerisms and stereotypy.  All of these signs share the common feature that the patient is doing something odd, repetitive, or unexpected.  Dr. O also gets on his soap box about the arbitrar...

In this episode, I discuss Catalepsy, Postering, Grimacing and Waxy Flexibility. I grouped the diagnostic signs that I am going to cover today because they are all similar.  Your patient acts like a wax statue. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript,...

Stupor, Mutism, and Negativism on the surface appear to have some overlapping features.  Of all the features of catatonia that non-experts might be able to describe, stupor and mutism are like the ones.  They are also the most common signs.  A patient is not entirely unconscious, but they don’t move, they stare forward, they don’t talk, and they don’t follow commands. Please leave feedback at http...

In the last episode, I promised [or threatened] to get into more of the nitty-gritty of the symptoms of catatonia.  Well, like it or not, that is what I am going to do in this episode.  Today I will focus on Mannerisms and Stereotypy, two of the potential signs of catatonia. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (...

In this episode, I introduce a diagnosis that is not a diagnosis.  By that, I mean that it is a condition that we may find our patients in, but it is not considered to be a diagnosis by itself, like major depressive disorder or schizophrenia are considered to be diagnoses.  I am talking about catatonia, a condition characterized by either a lack of interaction with the world or as purposeless inte...

This episode is a quick take in a new intermittent series I am calling “In a Word,” and in this series I hope to dig down into some neuropsychiatric terms that we use every day, but maybe don’t really understand very well.  The first word I am taking on is PERSEVERATION.  The reason I chose PERSEVERATION is because I see it written in psych notes by med studs and residents frequently, but for you...

My last three episodes focussed on classical cases of Obsessive Compulsive Disorder, but the DSM 5 has included a few other related diagnoses in the same chapter including body dysmorphic disorder (BDD), hoarding disorder, trichotillomania, and excoriation disorder.  Each of these have distinct obsessional components and compulsions, age of onset, degree of insight, and chronic course.  Hence, the...