PsychEd: educational psychiatry podcast PsychEd

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…
Outline the prevalence and risk factors for depression in children and adolescents
Explain how children and adolescents with depression present in clinical practice
Discuss the use of screening tools for depression in this population
Describe an approach to the management of depression in children and adolescents
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-centered program for the treatment of depression
Includes links to download free clinician-specific and youth-specific resources co-developed with youth and mental health clinicians
Clinical Innovations and Tools | Cundill Centre for Child

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers HIV/AIDS psychiatry with special guests from two international settings to provide complementary perspectives on HIV psychiatry. Dr. Adriana Carvalhal, HIV Psychiatrist and Staff Psychiatrist at Scarborough Health Network in Canada and Dr. Leigh Van Den Heuvel, Psychiatrist and Associate Professor in the Department of Psychiatry, at Stellenbosch University in South Africa.
The learning objectives for this episode are as follows:
 By the end of this episode, you should be able to…
Understand the unique mental health needs of people living with HIV and the bidirectional relationship between HIV and mental health
Identify HIV-specific mental health disorders and how to screen for these conditions
Outline the overall approach to treatment for HIV patients with mental health disorders
Guests: Dr. Adriana Carvalhal and Dr Leigh Van Den Heuvel
Produced by: Saja Jaberi (MD), Kate Braithwaite (MD) and Gaurav Sharma (PGY5)
Hosts: Kate Braithwaite (MD) and Gaurav Sharma (PGY5)
Audio editing by: Gaurav Sharma (PGY5)
Show notes by: Saja Jaberi (MD) and Gaurav Sharma (PGY5)
Conflicts of Interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic. Generic names are used for all medications referenced.
Contents:
Introduction - 0:19
Learning objectives - 3:52
The bidirectional relationship between HIV and psychiatric illness - 4:24
Prevalence of psychiatric illness in HIV - 9:56
Screening for psychiatric illness in HIV populations - 12:11
HIV Associated Neurocognitive Disorder (HAND) - 19:27
Diagnostic Criteria - 20:19
Clinical Presentation & Etiology - 23:03
Risk Factors - 26:56
Screening Tools - 32:06
Treatment - 36:59
HIV Psychiatry case example - 39:48
Navigating the differential diagnosis - 41:44
Initial management & addressing comorbidities - 44:30
Drug-drug interactions between antiretroviral and psychiatric medications - 48:04
Review of learning objectives & final thoughts - 52:04
Outro - 55:55
 
Resources:
Clinical Care Guidelines for Adults and Adolescents Living with HIV in Ontario, Canada (occguidelines.com)
Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2020 - Canada.ca  
HIV and Clinical Depression 
https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Anxiety-2012.pdf 
https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-CognitiveDisorder-2012.pdf 
International HIV Dementia Scale (IHDS) - Mental Health Screening - National HIV Curriculum (uw.edu)/
Liverpool HIV Interactions (hiv-druginteractions.org)
References:
Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.
Angelovich TA, Churchill MJ, Wright EJ, Brew BJ. New Potential Axes of HIV Neuropathogenesis with Relevance to Biomarkers and Treatment. Curr Top Behav Neurosci. 2021;50:3-39. doi: 10.1007/7854_2019_126. PMID: 32040843.
Awori V, Mativo P, Yonga G, Shah R. The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus. South Afr J HIV Med. 2018 Apr 12;19(1):674. doi: 10.4102/sajhivmed.v19i1.674. PMID: 29707383; PMCID: PMC5913780.
Bloch M, Kamminga J, Jayewardene A, Bailey M, Carberry A, Vincent T, Quan D, Maruff P, Brew B, Cysique LA. A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review. Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19. PMID: 27325690;

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers trauma and addictions with Dr. Gabor Maté, a retired physician who, after 20 years of family practice and palliative care experience, worked for over a decade in Vancouver’s Downtown East Side with patients challenged by drug addiction and mental illness. The bestselling author of five books published in thirty languages, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Maté is an internationally renowned speaker highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. For his groundbreaking medical work and writing he has been awarded the Order of Canada, his country’s highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver. His fifth book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture was released on September 13, 2022.
 
The learning objectives for this episode are as follows:
 
By the end of this episode, you should be able to…
Understand the connection between trauma and the development of addictions and other mental illnesses
Critically reflect on current diagnostic and treatment paradigms
Apply principles of trauma-informed care to psychiatric assessment and the provision of mental health services
 
Guest: Dr Gabor Maté
 
Hosts: Sena Gok, Rhys Linthorst, Angad Singh, Nikhita Singhal, and Alex Raben
 
Audio editing by: Sena Gok
 
Show notes by: Nikhita Singhal
 
Interview Content:
Introduction - 0:00
Learning objectives - 01:43
Defining trauma - 02:14
Current dominant views of addiction - 07:27
Defining addiction - 11:05
Relationship between trauma and addiction - 16:15
Neurobiology of addiction - 17:20
Brain development - 25:48
Genetic susceptibility - 36:10
Trauma-informed approach to treatment - 39:45
Importance of therapeutic relationships - 44:10
Societal barriers - 48:15
Harm reduction - 54:32
Closing comments - 01:00:14
 
Resources:
Books:
In the Realm of Hungry Ghosts (Gabor Maté)
The Myth of Normal (Gabor Maté)
The Body Keeps The Score (Bessel van der Kolk)
The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions (Jaak Pansepp, Lucy Biven)
Dr Gabor Maté’s website: https://www.drgabormate.com
Adverse Childhood Experiences (ACEs) study: https://doi.org/10.1016/s0749-3797(98)00017-8
More information on ACEs from Harvard University’s Center on the Developing Child: What Are ACEs? And How Do They Relate to Toxic Stress?
Compassionate Inquiry (psychotherapeutic approach developed by Dr Gabor Maté)
 
References:
Brown, T., Berman, S., McDaniel, K., Radford, C., Mehta, P., Potter, J., & Hirsh, D. A. (2021). Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Academic medicine: journal of the Association of American Medical Colleges, 96(5), 661–667. https://doi.org/10.1097/ACM.0000000000003587
Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/
Colon-Rivera Hector, A., Aoun, E. & Vaezazizi, L. M. (2023). Addiction Psychiatric Medicine: A Comprehensive Board Review. Elsevier.
Dugosh, K.L. & Cacciola J. (2022). Clinical assessment of substance use disorders. In J. A. Melin (Ed.), UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfun

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Medical Assistance in Dying (MAiD) and mental illness as a sequel to our previous episode on MAiD with our guest experts, Dr. Sonu Gaind and Dr. Jeffrey Kirby. 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, the listener will be able to…
Gain an understanding of the current state of Medical Assistance in Dying for primarily mental illness in Canada
Evaluate the arguments in support of and against implementation of Medical Assistance in Dying for primarily Mental Illness 
Understand next steps and future directions of Medical Assistance in Dying for primarily mental illness in Canada
Discuss the possible impact that Medical Assistance in Dying might have on the profession of psychiatry 
 
Guest Experts:
Dr. Sonu Gaind who is a Professor in the Faculty of Medicine at the University of Toronto (U of T) and Chief of Psychiatry at Sunnybrook Health Sciences Centre, and clinically works as a psycho-oncology consultant. As Medical Assistance in Dying (MAiD) policies have been evolving in Canada, Dr. Gaind has testified in front of numerous expert, parliamentary and senate committees 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, was retained by the former Attorney General of Canada as an expert in the Truchon and Lamb cases, and chaired his former hospitals MAiD team.  He has spoken across the country and internationally on the subject. 
 
Dr. Jeffrey Kirby is a (retired) Professor in the Department of Bioethics, Faculty of Medicine, Dalhousie University. He has an educational background and professional experience in medicine, philosophy and health care ethics. Dr. Kirby has published a set of academic papers in high-impact, international, bioethics journals on a variety of MAID-related topics including: assisted dying for suffering arising from mental health conditions, morally-relevant distinctions between paradigm and non-paradigm MAID circumstances, meso- and macro-level (MAID-related) health policy development, and organ donation after MAID and institutional conscientious objection to MAID. He made several, virtual and written, Bill C-7 related submissions to the Senate Committee on Legal and Constitutional Affairs regarding matters/issues of relevance to the potential consideration of mental health disorders as sole-qualifying conditions for MAID in Canada. He is a former member of the Expert Panel on MAiD and Mental Illness. 
 
Grand Rounds Presenter: Dr. Urvashi Prasad (PGY4)
Produced by: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben  (staff psychiatrist)
Hosts: Dr. Urvashi Prasad (PGY4) and Dr. Alex Raben (Staff Psychiatrist)
Peer Reviewer: David Eapen-John (MS4)
Audio editing by: Dr. Urvashi Prasad  (PGY4) 
Show notes by: Dr. Urvashi Prasad (PGY4)
 
Resources: 
 Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html.



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. 
 Canada, Health. “Government of Canada.” Canada.ca, / Gouvernement Du Canada, 27 Mar. 2023, https://www.cana

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…
Briefly summarize the effects of cannabis on mental health and cognition, with a focus on psychosis.
Appreciate the evidence for cannabis use as a potential cause of persistent psychotic disorders.
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: 
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. 
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 Reco

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the Journey Through Stages of Sleep with Dr. Michael Mak, Assistant Professor in the Department of Psychiatry at the University of Toronto, and an Adjunct Research Professor at Western University.
 
The learning objectives for this episode are as follows:
 
Understand the basics of sleep physiology, including the stages of sleep
Recognize the clinical features of insomnia disorder using the ICSD-3 and DSM-5-TR criteria 
Develop an approach to the assessment of insomnia 
Identify the pharmacological and non-pharmacological treatments for insomnia disorder 
 
Guest: Dr. Michael Mak (Staff Psychiatrist)
 
Hosts: Dr. Vanessa Aversa (PGY4), Andreea Chiorean (CC4), Sena Gok (IMG)
 
Audio editing by: Sena Gok
 
Show notes by: Sena Gok
 
Contents:
Introduction:  0:16
Learning Objectives:  01:49
Definition and  Clinical features of insomnia (ICSD-3 and DSM-5-TR criteria):  02:39
Insomnia prevalence, cost effects:  05:25
Sleep physiology:  10:05
Stages of Sleep:  11:37
Changes in Sleep stages during Insomnia:  14:35
Melatonin/Orexin systems:  15:45
Assessment and diagnosis of Insomnia:  21:00
Risk Factors of Insomnia:  30:12
CBT for Insomnia (CBT-I):  31:35
Relaxation-based techniques:  40:25
Contraindication for Insomnia:  42:15
Pharmacological treatments of insomnia:  45:15
Summary:  1:11:10

Resources:
1. Wainberg M, Jones SE, Beaupre LM, Hill SL, Felsky D, Rivas MA, et al. Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank. PLOS Med. 2021 Oct 12;18(10):e1003782. 
2. Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial. JAMA. 2009 May 20;301(19):2005–15. :
3. Crescenzo FD, D’Alò GL, Ostinelli EG, Ciabattini M, Franco VD, Watanabe N, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. The Lancet. 2022 Jul 16;400(10347):170–84. 
4. Watanabe Y, Kuroki T, Ichikawa D, Ozone M, Uchimura N, Ueno T. Effect of smartphone-based cognitive behavioral therapy app on insomnia: a randomized, double-blind study. Sleep. 2023 Mar 1;46(3):zsac270. 
5. Erland LAE, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 13(02):275–81. 
6. Sweetman A, McEvoy RD, Smith S, Catcheside PG, Antic NA, Chai-Coetzer CL, et al. The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial. Sleep. 2020 Jul 13;43(7):zsaa002. 
7.  Origins of Sleep Medicine: Dr. Nathaniel Kleitman,, Dr. Mark Mahowald, Dr. Carlos Schenck
https://aasm.org/mark-mahowald-md-and-carlos-schenck-md-to-receive-william-c-dement-award/
8.  CBT-Insomnia lab at the Toronto Metropolitan University:
https://drcolleencarney.com/lab/
9.  CBT-Insomnia Applications:
 https://www.sleepio.com/
 https://www.ptsd.va.gov/appvid/mobile/cbticoach_app_public.asp
 https://www.blackdoginstitute.org.au/research-projects/sleep-ninja/
 https://www.somryst.com/

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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