PsychEd: educational psychiatry podcast PsychEd

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the “big picture” relationship between violence and severe mental illnesses such as schizophrenia and bipolar spectrum disorders. Our guest experts in this episode are Dr. Robert McMaster, Assistant Professor of Forensic Psychiatry at the University of Toronto and Dr. Ragy R. Girgis, Associate Professor of Clinical Psychiatry at Columbia University in New York.
This episode is a good companion to Episode 15: Managing Aggression and Agitation with Dr. Jodi Lofchy, which covers how to identify and manage acute risk of violence in a clinical setting.


The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
Describe the epidemiology of violence in severe mental illness (rates of perpetration vs. victimization, risk factors, quality of evidence) 
Understand and critique how society currently addresses violence in those with severe mental illness 
Discuss this topic with patients, caregivers and the public, and address common myths 
Guests: 
Dr. Robert McMaster - Assistant Professor of Forensic Psychiatry at the University of Toronto
Dr. Ragy R. Girgis - Associate Professor of Clinical Psychiatry at Columbia University in New York
Hosts: Dr. Alex Raben (Staff Psychiatrist), Dr. Gaurav Sharma (PGY4), Sena Gok(IMG), Josh Benchaya (CC4)
Audio editing by: Gaurav Sharma
Show notes by: Josh Benchaya, Gaurav Sharma, Sena Gok
 
Interview Content:
 
Learning Objectives: 02:29
Perceptions of Violence and Mental Illness: 03:53
Mental illness & Violence Link Evidence: 06:48
Violence Perpetration & Victimisation: 10:10
Risk of Violence Assessment (HCR 20 Model): 17:00
Mass Shootings & Mental Illness & Predictions: 20:30
Violence Risk Prediction: 25:25
Severe Mental Illness & Violence Risk Treatments: 29:40
Society’s approach to Severe Mental Illness & Violence Misperceptions: 38:30
Mental Illness and Violence Stigma: 45:03
Case Vignette & Approach: 46:44
Summary of the episode: 58:00
 
References:
 
de Mooij, L.D., Kikkert, M., Lommerse, N.M., Peen, J., Meijwaard, S.C., Theunissen, J., Duurkoop, P.W., Goudriaan, A.E., Van, H.L., Beekman, A.T. and Dekker, J.J., 2015. Victimization in adults with severe mental illness: prevalence and risk factors. The British Journal of Psychiatry, 207(6), pp.515-522.
Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community violence perpetration and victimization among adults with mental illnesses. American journal of public health, 104(12), 2342-2349.
Metzl, J.M., Piemonte, J. and McKay, T., 2021. Mental illness, mass shootings, and the future of psychiatric research into American gun violence. Harvard review of psychiatry, 29(1), p.81.
 
Buchanan, A., Sint, K., Swanson, J. and Rosenheck, R., 2019. Correlates of future violence in people being treated for schizophrenia. American Journal of Psychiatry, 176(9), pp.694-701.
 
Rund, B.R., 2018. A review of factors associated with severe violence in schizophrenia. Nordic journal of psychiatry, 72(8), pp.561-571.
 
Markowitz FE. Mental illness, crime, and violence: Risk, context, and social control. Aggress Violent Behav. 2011 Jan 1;16(1):36–44.
 
Pescosolido BA, Manago B, Monahan J. Evolving Public Views On The Likelihood Of Violence From People With Mental Illness: Stigma And Its Consequences. Health Aff Proj Hope. 2019 Oct;38(10):1735–43.
 
Ross AM, Morgan AJ, Jorm AF, Reavley NJ. A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact. Soc Psychiatry Psychiatr Epidemiol. 2019 Jan 1;54(1):11–31.
 
Srivastava K, Chaudhury S, Bhat PS, Mujawar S. Media and mental health. Ind Psychiatry J. 2018;27(1):1–5.
 
Stuart H. Media portrayal of mental illness an

Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode covers the mental status examination and makes use of practical and fictional examples to delve deeper into the skills and concepts
 
Learning Objectives:
 
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Explain the utility and purpose of the mental status examination in psychiatry
Describe the major components of the mental status examination and be familiar with some of the common vocabulary used
Incorporate the mental status in a way that respects patients in presentation, documentation and formulation in clinical practice 
 
Topics:
2:37 - Learning objectives
3:10 - Definition of the MSE
6:48 - History of the MSE
9:00 - Limitations of the MSE
15:37 - Strengths of the MSE
21:30 - ASEPTIC Mnemonic
23:04 - Appearance and Behaviour
37:42 - Speech
51:51 - Emotion (mood and affect)
1:03:51 - Perception
1:08:38 - Thought Form and Content
1:17:30 - Insight and Judgement
1:27:40 - Cognition
 
Hosts: Andreea Chiorean (CC4), Saja Jaberi (IMG), Dr. Weam Seiffien (PGY2), Angad Singh (CC2), Dr. Annie Yu (PGY1), and Dr. Alex Raben, staff psychiatrist.
 
Guest Experts: Us!
 
Video clips:
Speech: 
Mojo Jojo: https://youtu.be/y4qNWPPlYE4?t=48
Family guy video: no longer available
 
Emotion
Eeyore: https://youtu.be/7xPnUe6Xcbw?t=12
 
Squidward: https://youtu.be/FjrOWnywPok?t=195
 
Bubbles: https://youtu.be/rAC4W563Ayk?t=339
 
Perception
A Beautiful Mind: https://youtu.be/vNa37tOB4rE
 
Insight and Judgement
Simpsons: no longer available
Mr. Magoo: https://youtu.be/eWEnzLFd4P4?t=201
 
Cognition
Still Alice: https://youtu.be/mhiXAJO8kBc?t=67



Resources:
MSE template: https://www.therapistaid.com/therapy-worksheet/mental-status-exam
Emotion wheel: https://feelingswheel.com/
MSE vocabulary: http://www.columbia.edu/itc/hs/medical/psychmed/1_2004/mental_status_exam.pdf



References:
Bell, R. (1977). The Mental Status Examination. 16(5).Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198.
Donnelly, J., Rosenberg, M., & Fleeson, W. P. (1970). The evolution of the mental status—past and future. American Journal of Psychiatry, 126(7), 997-1002.
Norris, D. R., Clark, M. S., & Shipley, S. (2016). The Mental Status Examination. 94(8).
Norton, J. W., & Corbett, J. J. (2000, February). Visual perceptual abnormalities: hallucinations and illusions. In Seminars in neurology (Vol. 20, No. 01, pp. 0111-0122). Copyright© 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Notes, T. (2020). Comprehensive Medical Reference and Review for the Medical Council of Canada Qualifying Exam (MCCQE) Part I and the United States Medical Licensing Exam (USMLE) Step II 36th ed: Toronto Notes for Medical Students.
Recupero, P. R. (2010). The Mental Status Examination in the Age of the Internet. The Journal of the American Academy of Psychiatry and the Law, 38(1).
Robinson D. J. (2002). Mental status exam explained (2nd ed.). Rapid Psychler Press.
Robinson D. J. (1998). Brain Calipers: a guide to a successful mental status exam. Rapid Psychler Press.
Ross, C. A., & Leichner, P. (1988). Residents Performance on the Mental Status Examination. The Canadian Journal of Psychiatry, 33(2), 108–111. https://doi.org/10.1177/070674378803300207
Sadock, B. J., & Sadock, V. A. (2007). Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Lippincott Williams & Wilkins Publishers.
Segal, D. L. (Ed.). (2019). Diagnostic interviewing. Springer.
Snyderman, D., & Rovner, B. (2009).

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we’ll explore a topic that we’re sure many listeners are eager to learn about: The Assessment of Major Neurocognitive Disorder, also known as dementia with Dr. Lesley Wiesenfeld who is a Geriatric Psychiatrist and Psychiatrist-in-Chief at Mount Sinai Hospital in Toronto, where she leads the Geriatric Consult Liaison Psychiatry Service. She is also an Associate Professor in the Department of Psychiatry at the University of Toronto.
 
The learning objectives for this episode are as follows:
 
Define Major Neurocognitive Disorder (aka Dementia) as per DSM-5 diagnostic criteria
Identify differential diagnoses for cognitive decline and list differentiating clinical features 
Outline an approach to the assessment of a patient presenting with cognitive decline, including the role of a comprehensive history, psychometric tools and other investigations [ Relevant PMH/risk factors, ADLs/IADLs to cover on history, psychometric tools such as MMSE, MoCA and tie this back into major cognitive domains when to consider imaging, bloodwork including specialized testing such as ApoE genetic tests] 
Classify the major subtypes of Neurocognitive Disorders, their epidemiology, and clinical presentations [ Vascular dementia, Alzheimer’s, Frontotemporal, Lewy Body, Parkinson’s,    Mixed dementia - Early onset dementia]
 
Guest: Dr. Lesley Wiesenfeld ( Lesley.Wiesenfeld@sinaihealthsystem.ca )
 
Hosts: Dr. Luke Fraccaro (PGY-3), Dr. Mark Fraccaro (PGY-4), Sena Gok (international medical graduate)
 
Audio editing by: Sena Gok
 
Show notes by: Sena Gok
 
Interview Content:
Introduction: 0:13
Learning Objectives: 02:35
Diagnostic criteria of Major Neurocognitive Disorder: 03:20
Difference between Major and Mild Neurocognitive Disorder: 05:20
Red Flags of Cognitive Declines: 06:50
Normal Aging vs Major Neurocognitive Disorder: 10:00
Clinical Vignette – introduction: 11:35
Patient Assessment: 16:50
Past medical/family / Psychosocial history: 21:55
Clinical Vignette - Assessment: 37:45
Physical examination: 43:50
Investigations: 45:53
Role of genetic testing: 53:24
Clinical Vignette – Diagnosis: 57:50
 
References:
 
American Psychiatric Association. (2022). Neurocognitive Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
 
Sadock, B. J., Sadock, V. A., Ruiz, P., & Kaplan, H. I. (2015). Neurocognitive Disorders. Kaplan and Sadock’s Synopsis of Psychiatry (11th ed.). Wolters Kluwer
 
DSM-5-TR Fact Sheets (https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets )
 
Gauthier S, Patterson C, Chertkow H, Gordon M, Herrmann N, Rockwood K, Rosa-Neto P, Soucy JP. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012 Dec;15(4):120-6. doi: 10.5770/cgj.15.49. Epub 2012 Dec 4. PMID: 23259025; PMCID: PMC3516356.
 
Gauthier S, Chertkow H, Theriault J, Chayer C, Ménard MC, Lacombe G, Rosa-Neto P, Ismail Z. CCCDTD5: research diagnostic criteria for Alzheimer's Disease. Alzheimers Dement (N Y). 2020 Aug 25;6(1):e12036. doi: 10.1002/trc2.12036. Erratum in: Alzheimers Dement (N Y). 2022 Feb 03;6(1):e12088. PMID: 32864413; PMCID: PMC7446944.



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 delves into the history of psychiatry with Dr David Castle, the inaugural Scientific Director of the Centre for Complex Interventions at the Centre for Addictions and Mental Health and a Professor in the Department of Psychiatry at the University of Toronto. Prior to migrating to Canada in 2021, he spent 15 years as a Professor of Psychiatry at St Vincent’s Hospital and the University of Melbourne in Australia.
 
The learning objectives for this episode are as follows:
 
By the end of this episode, you should be able to…
Gain an appreciation for the historical context of the field of psychiatry Understand how illness categories and treatments have been shaped by this history  Compare and contrast how various past societies viewed and conceptualized mental illness Apply lessons learned from historical practices to appraise current approaches  
Guest: Dr David Castle
 
Hosts: Dr Alex Raben (Staff Psychiatrist), Gaurav Sharma (PGY4), Nikhita Singhal (PGY4), Andreea Chiorean (CC4)
 
Audio editing by: Dr Alex Raben
 
Show notes by: Dr Nikhita Singhal
 
Interview Content:
 
1:45 - Learning Objectives
 
3:25 - Ancient Times
 
14:42 - Middles Ages 
 
23:56 - Renaissance to Enlightenment
 
34:55 - 19th-20th Centuries
 
47:55 - 20th-21st Centuries
 
1:00:48 - Final Thoughts
 
Resources:
Shrinks: The Untold Story of Psychiatry (Jeffrey A Lieberman)  
References:
The Emotional Foundations of Personality: A Neurobiological and Evolutionary Approach (Kenneth L Davis, Jaak Panksepp) Illustration of Bedlam (William Hogarth) Pinel, médecin en chef de la Salpêtrière en 1795 (Tony Robert-Fleury) Castle, D., Bassett, D., King, J., & Gleason, A. (2013). A primer of clinical psychiatry. Elsevier Health Sciences. de Leon J. DSM-5 and the research domain criteria: 100 years after Jaspers' General psychopathology. Am J Psychiatry. 2014 May;171(5):492-4. https://doi.org/10.1176/appi.ajp.2013.13091218 Eisenberg L. Mindlessness and brainlessness in psychiatry. Br J Psychiatry. 1986 May;148:497-508. https://doi.org/10.1192/bjp.148.5.497 Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977 Apr 8;196(4286):129-36. https://doi.org/10.1126/science.847460 Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003 Jan;160(1):4-12. https://doi.org/10.1176/appi.ajp.160.1.4 Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970 Jan;126(7):983-7. https://doi.org/10.1176/ajp.126.7.983 Rosenhan DL. On being sane in insane places. Science. 1973 Jan 19;179(4070):250-8. https://doi.org/10.1126/science.179.4070.250 Scheff TJ. The labelling theory of mental illness. Am Sociol Rev. 1974 Jun;39(3):444-52. https://doi.org/10.2307/2094300 Szasz T. The myth of mental illness: 50 years later. The Psychiatrist. Cambridge University Press; 2011;35(5):179–182. https://doi.org/10.1192/pb.bp.110.031310  
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. In this episode, we present a focused summary of the latest changes in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) with our guest expert — Dr. Michael First, a Professor of Clinical Psychiatry at Columbia University, NY. Dr. First is an internationally recognized expert on psychiatric diagnosis and assessment issues, he is the editor and co-chair of the DSM-5 text revision project (DSM-5-TR), the editorial and coding Consultant for the DSM-5, the chief technical and editorial consultant on the World Health Organization ICD-11 revision project and was an external consultant to the NIMH Research Domain Criteria project (RDOC).
 
The learning objectives for this episode are as follows:
Understand the rationale for undertaking a DSM-5-TR as well as the revision process itself
 To become familiar with disorder, text and symptom code additions and modifications to the DSM-5-TR
 To understand the purpose and function of the DSM in its current form and be able to contemplate future directions
 
Guest Expert: Dr. Michael First – staff psychiatrist and professor of clinical psychiatry at Columbia University, USA.
Produced and hosted by: Dr. Alex Raben (staff psychiatrist) and Saja Jaberi (international medical graduate)
Audio editing by: Dr. Alex Raben
Show notes by: Saja Jaberi
Interview Content:
2:53 - Learning objectives
3:34 - Brief description of the DSM and its history
4:54 – ICD vs. DSM 
7:43 - Rationale behind the new revision
11:11 - Characteristics of the DSM-5-TR revision process and the people behind it
16:54 - Case presentation and Differential Diagnosis
23:07 - Prolonged Greif disorder
27:04 - Most important changes to the terminology used in the manual
39:34 - Pros and cons of the DSM
44:30 - A brief Comparison to the RDOC Framework
49:04 – Future Directions of the DSM
 
References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Text Revision ed. 2022.
 DSM-5-TR Fact Sheets https://psychiatry.org/psychiatrists/practice/dsm/educational-resources/dsm-5-tr-fact-sheets
 
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. 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:
 
Develop a basic understanding of what is meant by antisocial personality and psychopathy
Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors 
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 assessmen