Dr. O'Leary explores the history of clozapine, highlighting its initial revolutionary impact as the first atypical antipsychotic, followed by a ban on its use, followed by its re-emergences as a strictly monitored medication, and then culminating in new recommendations that greatly encourage its use. The discussion details the severe side effects that led to its initial discontinuation, and then emphasizes other critical but often overlooked adverse effects, such as metabolic syndrome, ...
This episode includes a fascinating interview with a researcher in ultrasound, Dr. Michael Canney who is an acoustics researcher the chief scientific officer at a French company named Carthera (https://carthera.eu/) and they make ultrasound devices that can disrupt the blood-brain barrier in order to let medicines into the brain that otherwise could only get through in very small amounts. We talk more broadly about the explosion of various applications of ultrasound beyond imaging, including...
This PsyDactic podcast episode, hosted by Dr. O'Leary, delves into the complex and often controversial topic of diagnosing Pediatric Bipolar Disorder and its differentiation from other conditions, particularly Disruptive Mood Dysregulation Disorder (DMDD). Dr. O'Leary, a Child and Adolescent Psychiatry Fellow, explores the DSM-5-TR diagnostic framework, the history of Pediatric Bipolar diagnosis, the debate surrounding irritability as a diagnostic criterion, and the challenges of distinguishi...
Gambling disorder may be the most under-diagnosed disorder in the DSM. This is an exhaustive treatment of the neurobiological, psychological, and societal aspects of gambling addiction, featuring discussions on the brain's reward system, cognitive distortions, and the impact of advertising and the design of gambling products. 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...
Functional Neurological Disorder was previously called Conversion Disorder or psychogenic neurological symptoms and is a condition in which a patient develops any number of neurological symptoms (such as loss of ability to move or seizure like episodes or inability to feel parts of their body or phantom pain) that cannot be explained by a clear lesion in the nervous system. It was called conversion disorder because it was previously thought that repressed emotions or desires had been co...
Dr. O'Leary introduces PsyDactic - Child and Adolescent Board Study edition by sharing the first of two episodes on behaviorism, that field of psychology that took the radical stance of completely ignoring the fact that we have a mind. 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 po...
-- Dr. O'Leary explores how an artificial intelligence tool summarizes recent data on the use of nicotinic receptor modulators for the treatment of anxiety and PTSD. Please send any comments to feedback@psydactic.com. 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 ...
"People are 14 times more likely to die during a hospital stay than outside of hospital for inpatient psychiatry." In the last episode, I shared an episode of Psychiatry Boot Camp, which is a podcast created by Dr. Mark Mullen to help medical students and junior residents hone their psychiatric skills. Mark interviews some of the most competent and amazing psychiatrists our country has to offer. I am excited that Mark let me share his interview with Dr. Tyler Black, who talk...
In the last episode, Dr. O'Leary interviewed the creator and host of the Psychiatry Bootcamp Podcast, Dr. Mark Mullen, who is currently a psychiatry clerkship director at St. Louis University School of Medicine. He created this podcast after discovering a dearth of resources available for medical students and junior psychiatry residents to prepare them for their transition to practice. He graciously allowed PsyDactic to include a couple of his episodes in this feed as a way to spr...
Dr. O'Leary is excited to introduce you to Psychiatry Boot Camp (PBC), a podcast created by Dr. Mark Mullen during his psychiatry residency to help prepare medical students for psychiatry residency. It covers fundamental topics in psychiatry and inspires young psychiatrists to think critically about their approach to the field. The curriculum is based on published literature on psychiatry crash courses and boot camps, and features interviews with experts in the field. Some specif...
--In today's episode, Dr. O'Leary explores agonists, inverse agonists, partial agonists, and antagonists. These terms describe how molecules bind to receptors and either increase, decrease, or prevent changes in receptor signaling. Agonists increase receptor activity, with full agonists like dopamine and serotonin raising activity to its maximum. Partial agonists can increase activity in the absence of full agonists but decrease it in their presence. Inverse agonists reduce the baseline activ...
--Dr. O'Leary discusses the term Transference, and if you listen until the end, he relates it to some computational neuroscience. Transference is a historically loaded term. Transference is supposed to be an unconscious process, so it can not really be observed, only inferred, so this means that both the definition of transference and any instance of it in psychotherapy is dependent upon the therapist’s model and their particular way of interpreting that model. But what exa...
-- More recently I have faced the diagnostic conundrum of catatonia in autism, and that is what I want to explore in more excruciating detail today. There is surprisingly little literature on the subject, and that is concerning because being able to identify and treat catatonia can be life-saving, not to mention life-altering for patients and their caretakers. Misidentifying catatonia as mere aggression or highly limited interests in autism can result in exactly the wrong m...
-- Dr. O’Leary interviews forensic psychiatrist and author Dr. Michael Schirripa about his career as a forensic psychiatrist, the release of his first thriller, Mindhunt, and his podcast Mindhunting. Dr. Shirripa explores how his love of literature influenced his decision to pursue forensic psychiatry and ultimately resulted in his creation of an international thriller with an ambitious forensic psychiatrist as the main character. We explore topics like medical ethics...
- - In the world of psychotropic medication, the question is not just whether it works or not, but whether it works better than a placebo and whether the effect size is clinically significant and the benefits outweigh the risks. In the case of MDMA (aka molly or ecstasy), the effect size for improving post-traumatic stress disorder symptoms reported by researchers has been very large. Often it is found to be two to three times higher than is often found for serotonin reuptake inhi...
The Narrative Fallacy describes our tendency to find meaning, connections, and causal relationships where they do not necessarily exist. In this episode, Dr. O'Leary had the pleasure of interviewing Dr. Alexey Tolchinsky. He recently published a paper called “Narrative fallacy and other limitations of psychodynamic case formulation.” Dr. Tolchenski did not invent the idea of the Narrative Fallacy, but he is working to apply this idea to his own clinical practice. We could all be...
Dr. O'Leary discusses a variety of concerns that all clinicians should have in mind when using psychometrics. In the end, he hopes you come away with some level of agreement with the statement: “Our primary concern should not be with the quantity of data, but with the quality of the data.” Statistics are conceptual machines that will produce results no matter what you feed them. These results can be truly helpful and informative. But statistics are also poop in p...
In this episode, Dr. O'Leary discusses a word that he has struggled to understand since medical school. The word is aphasia. The root “phasia” comes from the Greek phanai which means “to speak.” When aphasia is used medically, it refers to an inability to speak, although not always. More generally it is often used to mean a failure to understand or produce language, but it gets complicated. Dr. O'Leary reviews the brain regions responsible for various kinds of ap...
I did not until recently even consider the cerebellum when thinking about psychiatric conditions, but the more I read, the more I wonder why the cerebellum is not considered a potential important player in nearly every psychiatric disorder. Although it can be said that all brain regions primarily function to make predictions, the cerebellum is especially active at refining impromptu predictions through short periods of time as sensory data changes to help us better navigate the world, n...
The thalami are bilaterally symmetrical structures in the subcortical part of the brain that are cradled by the basal ganglia. They are major hubs of pretty much everything your brain does and all of the sensory information coming into the brain with the exception of smell. More primitive models of the brain visualized it as a bunch of relatively isolated modules, each specialized to perform a single task when queried and able to send that information to wherever it should go. M...