PsychEd: educational psychiatry podcast PsychEd

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to forensic psychiatry with Dr. Amina Ali, a forensic psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. Dr. Ali joined the Forensic Division at CAMH in 2018. She is an Assistant Professor in the Department of Psychiatry at the University of Toronto. Prior to joining CAMH, Dr. Ali received her Doctor of Medicine at the American University of the Caribbean, completed her Psychiatry residency at the Icahn School of Medicine at Mount Sinai in New York, and fellowship in Forensic Psychiatry at the Albert Einstein College of Medicine.
Dr. Ali's leadership experience includes serving as Chief resident during her residency, for which she was bestowed a Residency Leadership Award from the Bronx Lebanon Hospital Center. She is a Competence By Design coach to residents and serves on the Psychiatry Competency Committee and as a CaRMS file reviewer for the University of Toronto General Psychiatry Residency Program. She is also a supervisor for forensic residents and sits on the subspecialty resident committees. Within the forensic division, Dr. Ali has contributed to the organization and implementation of the Summer Studentship in Forensic Psychiatry Program and is our Medical Education and Wellness Lead. Internationally, Dr. Ali was appointed to serve on the American Academy of Psychiatry and the Law Education Committee and most recently recruited to Chair their Civil Commitment and Consent to Treatment Working Group.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Describe the role of forensic psychiatry and its relation to the Ontario Review Board.
Outline the criteria for fitness to stand trial.
Describe the function and possible outcomes of a treatment order.
Outline the criteria for not criminally responsible on account of a mental disorder.
Distinguish between the disposition options available under the Ontario Review Board.
Demonstrate an enhanced ability to advocate for and support patients in navigating the forensic psychiatric system.
Guest: Dr. Amina Ali
Hosts: Alexander Simmons (PGY3), Kate Braithwaite (MD), and Rhys Linthorst (PGY5)
Audio editing by: Gaurav Sharma (PGY5)
Show notes by: Alexander Simmons (PGY3)
References:
Crocker, A. G., Nicholls, T. L., Seto, M. C., Charette, Y., Cote, G., Caulet, M. (2015). The National Trajectory Project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: the people behind the label. The Canadian Journal of Psychiatry, 60(3), 106-116.
Prpa, T., Moulden, H. M., Taylor, L., Chaimowitz, G. A. (2018). A review of patient-level factors related to the assessment of fitness to stand trial in Canada. International Journal of Risk and Recovery, 1(2), 16-22.
Carroll, A., McSherry, B., Wood, D., & Yannoulidis, LLB, S. (2008). Drug‐associated psychoses and criminal responsibility. Behavioral sciences & the law, 26(5), 633-653.
Watts, J. (2013). Updating toxic psychosis into 21st-century Canadian: Bouchard-Lebrun v. R. Journal of the American Academy of Psychiatry and the Law Online, 41(3), 374-381.
Crocker, AG, Nicholls, TL, Seto, MC, Cote, G, Charette, Y, Caulet, M. The national trajectory project of individuals found not criminally responsible on account of a mental disorder in Canada, Part 1: Context and methods. Canadian Journal of Psychiatry. 2015;60(3):98-105.
Schneider, RD. Mental health courts. Current Opinion in Psychiatry. 2008;21:510-513.
https://www.orb.on.ca/scripts/en/about.asp#dispositions
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Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode introduces the field of metabolic psychiatry, with a focus on patients with severe mental illness and metabolic syndrome. Our guest is Dr. Cindy Calkin, an Associate Professor in the Department of Psychiatry and Department of Neuroscience at Dalhousie University in Nova Scotia. Dr. Calkin has been a pioneer in the field of metabolic and neuroendocrine disorders in patients with bipolar disorder. Her research interests include examining the effects of obesity, insulin resistance and type II diabetes on the clinical course and outcomes in bipolar disorder.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to… 
Describe the burden of metabolic syndrome in the population with severe mental illnesses
Explain reasons for the comorbidity between metabolic syndrome and severe mental illness
Identify biopsychosocial strategies to prevent or treat metabolic conditions in this population
Guest: Dr. Cindy Calkin
Hosts: Angad Singh, Gaurav Sharma, and Sara Abrahamson
Audio editing by: Gaurav Sharma
Show notes by: Sara Abrahamson & Gaurav Sharma 
Conflicts of interest: Neither our guest nor hosts for this episode have declared any conflicts of interest related to this topic.
Interview content:
0:00 - Introduction
00:54 - Learning objectives
01:37 - Dr. Calkin’s career trajectory
9:45 - Describing the burden of metabolic syndrome in severe mental illness
14:16 - What is the relationship between metabolic syndrome and severe mental illness
25:23 - Why is metabolic syndrome underdiagnosed in severe mental illness
27:56 - How to measure and monitor insulin resistance in clinical practice
32:44 - How stigma impacts treatment of metabolic syndrome in the mentally ill
34:02 - Lifestyle interventions for metabolic syndrome in the mentally ill
37:06 - Medication interventions for metabolic syndrome in the mentally ill
39:44 - Directions for future research in the metabolic psychiatry
41:48 - Episode summary
References:
Bai, Y.-M., Li, C.-T., Tsai, S.-J., Tu, P.-C., Chen, M.-H., & Su, T.-P. (2016). Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder. BMC Psychiatry, 16(1), 448–448. https://doi.org/10.1186/s12888-016-1143-8
Calkin, C., Kamintsky, L., & Friedman, A. (2022). Reversal of insulin resistance is associated with repair of blood-brain barrier dysfunction and remission in a patient with treatment-resistant bipolar depression. Bipolar Disorders, 24(5), 553-555. https://doi.org/10.1111/bdi.13199
Calkin, C. V., Ruzickova, M., Uher, R., Hajek, T., Slaney, C. M., Garnham, J. S., ... & Alda, M. (2015). Insulin resistance and outcome in bipolar disorder. The British Journal of Psychiatry, 206(1), 52-57. https://doi.org/10.1192/bjp.bp.114.152850
Giménez-Palomo, A., Gomes-da-Costa, S., Dodd, S., Pachiarotti, I., Verdolini, N., Vieta, E., & Berk, M. (2022). Does metabolic syndrome or its component factors alter the course of bipolar disorder? A systematic review. Neuroscience and Biobehavioral Reviews, 132, 142–153. https://doi.org/10.1016/j.neubiorev.2021.11.026
Ho, C. S., Zhang, M. W., Mak, A., & Ho, R. C. (2014). Metabolic syndrome in psychiatry: advances in understanding and management. Advances in psychiatric treatment, 20(2), 101-112. https://doi.org/10.1192/apt.bp.113.011619
Leboyer, M., Godin, O., Llorca, P. M., Aubin, V., Bellivier, F., Belzeaux, R., Courtet, P., Costagliola, D., Dubertret, C., M’Bailara, K., Haffen, E., Henry, C., Laouamri, H., Passerieux, C., Pelletier, A., Polosan, M., Roux, P., Schwan, R., Samalin, L., … Etain, B. (2022). Key findings on bipolar disorders from the longitudinal FondaMental Advanced Center of Expertise-Bipolar Disorder (FACE-BD) cohort. Journal of Affective Disorders, 307, 149–156. https://doi.org/10.1016/j.jad.2022.03.053

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the field of critical psychiatry with Dr. Elia Abi-Jaoude and Lucy Costa. Dr. Abi-Jaoude is a staff psychiatrist at The Hospital for Sick Children and Assistant Professor and Clinician Investigator in the Department of Psychiatry at the University of Toronto in Toronto, Canada. Lucy Costa is Deputy Executive Director of the Empowerment Council, a voice for clients of mental health and addiction services primarily at the Centre for Addiction and Mental Health in Toronto.
 
While this topic could be very philosophical and expansive, we are going to focus our discussion by considering the practical implications of this field on psychiatric practice. What do you need to know about critical psychiatry as a trainee, and how might it impact your clinical practice?
 
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Define the term critical psychiatry and describe how the field has evolved over time
Review core principles of critical psychiatry and apply them to a clinical situation
Understand the potential benefits and harms of critical psychiatry and where the field is headed
 
Guests: Dr. Eila Abi-Jaoude and Lucy Costa
 
Hosts: Dr. Gaurav Sharma (PGY5), Dr. Nikhita Singhal (PGY5), Dr. Monisha Basu (PGY2), and Saja Jaberi (IMG)
 
Audio editing by: Gaurav Sharma
 
Show notes by: Gaurav Sharma and Nikhita Singhal
 
Conflicts of interest: Neither of our guests nor hosts have declared any conflicts of interest related to this topic.

Interview content:
Introduction - 00:13
Learning objectives - 02:35
Defining critical psychiatry - 03:33
How our experts got involved in critical psychiatry and incorporate it into their work - 04:50
What are some of the questions critical psychiatry tries to answer? - 15:07
Why care about critical psychiatry and “holding truths lightly”? - 23:55
Principles of critical psychiatry - 24:55
Applying critical psychiatry principles to a case - 32:40
Potential benefits and harms of a critical psychiatry approach - 41:49
Future directions for critical psychiatry - 58:29
Review of learning objectives and summary - 1:01:30
End credits - 1:03:17
 
Resources:
Critical Psychiatry Textbook
Restoring Study 329 
Psych Debate 14 | Critical Psychiatry and Diagnosis
 
References:
Barkil-Oteo A. Collaborative care for depression in primary care: how psychiatry could "troubleshoot" current treatments and practices. Yale J Biol Med. 2013 Jun 13;86(2):139-46.
Craddock N, Mynors-Wallis L. Psychiatric diagnosis: impersonal, imperfect and important. The British Journal of Psychiatry. 2014;204(2):93-95. doi:10.1192/bjp.bp.113.133090
Kirsch I. The emperor's new drugs: medication and placebo in the treatment of depression. Handb Exp Pharmacol. 2014;225:291-303. doi:10.1007/978-3-662-44519-8_16
Middleton H, Moncrieff J. Critical psychiatry: a brief overview. BJPsych Advances. 2019;25(1):47-54. doi:10.1192/bja.2018.38
O'Donoghue T, Crossley J. A critical narrative analysis of psychiatrists' engagement with psychosis as a contentious area. Int J Soc Psychiatry. 2020 Nov;66(7):724-730. doi: 10.1177/0020764020934516
Samara MT, Dold M, Gianatsi M, et al. Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia: A Network Meta-analysis. JAMA Psychiatry. 2016;73(3):199–210. doi:10.1001/jamapsychiatry.2015.2955
 
Important figures in the history of anti-psychiatry and critical psychiatry (discussion edited from episode for length):


Anti-Psychiatrists:
R. D. Laing (UK)
Thomas Szasz (USA)
Michel Foucault (France)
 
Critical Psychiatrists:
Joanna Moncrieff (UK)
Suman Fernando (UK)
Sami Tamini (UK)
Pat Bracken (UK)
Derek Summerfield (UK)
Sandra Steinguard (USA)
Critical Psychia

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