178 episodes

Official podcast feed of MDedge Psychiatry, part of the Medscape Professional Network. Episodes include interviews with leaders in psychiatry and psychology, masterclass lectures, and clinical perspective. Interviews are hosted by Dr. Lorenzo Norris, MD, Clinical Correlaction featuers Dr. Renee Kohanski, MD, and lecturers are chosen by MDedge Psychiatry. The information in this podcast is provided for informational and educational purposes only.

Psychcas‪t‬ Medscape Professional Network

    • Medicine
    • 4.4 • 51 Ratings

Official podcast feed of MDedge Psychiatry, part of the Medscape Professional Network. Episodes include interviews with leaders in psychiatry and psychology, masterclass lectures, and clinical perspective. Interviews are hosted by Dr. Lorenzo Norris, MD, Clinical Correlaction featuers Dr. Renee Kohanski, MD, and lecturers are chosen by MDedge Psychiatry. The information in this podcast is provided for informational and educational purposes only.

    Understanding Zoom fatigue and how to make videoconferencing less anxiety provoking with Dr. Géraldine Fauville

    Understanding Zoom fatigue and how to make videoconferencing less anxiety provoking with Dr. Géraldine Fauville

    Géraldine Fauville, PhD, joins Lorenzo Norris, MD, to discuss some of the causes of Zoom fatigue and strategies that can make videoconferences productive.
    Dr. Fauville is the lead researcher on the Zoom Exhaustion & Fatigue Scale project. She also is assistant professor in the department of education, communication, and learning at the University of Gothenburg (Sweden). Dr. Fauville has no disclosures.
    Dr. Norris is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures.
    Take-home points
    Dr. Fauville started her research on Zoom fatigue in the Virtual Human Interaction Lab at Stanford (Calif.) University, founded by Jeremy N. Bailenson, PhD. The lab has pioneered research on the common but poorly understood phenomenon of Zoom fatigue.  Videoconferencing, often through Zoom, has allowed people to connect throughout the pandemic, but there are features of this modality that can contribute to stress, and for many, social anxiety. Dr. Fauville and Dr. Norris discuss Zoom fatigue and which dynamics of videoconferencing contribute to a sense of anxiety, fatigue, and affect our general wellness in a society that has come to rely on videoconferencing as a primary form of communication and central to parts of our economy during the pandemic.  Dr. Fauville discusses how the size of faces on the screen and feeling observed activate anxiety and stress. Constant mirroring from seeing yourself reflected from the camera onto a screen can lead to self-judgment and negative emotions. Loss of traditional nonverbal communication and being forced to pay attention to verbal cues or exaggerate gestures can increase the cognitive load associated with conversations that occur via videoconference. Videoconferencing also restricts mobility, because people feel tethered to a small area within their camera’s view where they can be seen.  Summary
    During an in-person meeting, people will stare at you while you’re speaking, but on videoconferencing it can feel as if all eyes are on you the whole time, which contributes to stress and social anxiety.  Dr. Fauville discusses the “large face” dynamic; if these conferences were real-life interactions, it would be like having a very large face just a few inches from ours,  which can feel like an invasion of privacy. For the brain, having a face in close proximity to yours signals either a desire for intimacy or conflict.  Recommendation: Minimize the videoconferencing application as much as possible and keep the size of the faces smaller.  Zoom and other platforms lead to “constant mirroring.” Seeing our own image can result in persistent self-evaluation and judgment, which can contribute to anxiety and negative emotions.  Recommendation: Keep your camera on but hide self-view; doing so can combat this constant mirroring. Videoconferencing has severely limited mobility during meetings, which make people feel trapped in the view of the camera.  Recommendation: Using a standing desk allows for more freedom from the view of the camera. You can stretch your legs, walk around in the view of the camera, and create distance, especially if you have an external keyboard.  Nonverbal communication and behaviors are essential cues between humans. Videoconferencing that focuses on head and shoulders diminishes a large portion of body language. Videoconferences are more taxing for the brain than audio-only communication because people have to be even more in tune to the cues in speakers' verbal tones, and some nonverbal cues, such as nodding, become exaggerated.  Recommendation: Organizations should create guidelines aimed at mitigating Zoom fatigue. Suggestions include allowing people to turn off their cameras for portions of meetings or didactics, having a mix of audio/telephone and video meetings, and assessing whet

    • 41 min
    Patients can read our notes now? | Clinical Correlation

    Patients can read our notes now? | Clinical Correlation

    In this week's installment of Clinical Correlation, Renee Kohanski, MD, unpacks the new Open Notes mandate.
    Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

    • 11 min
    Precision medicine and mental health: Implementing pharmacogenomics into your private or institutional practice with Dr. Vicki L. Ellingrod

    Precision medicine and mental health: Implementing pharmacogenomics into your private or institutional practice with Dr. Vicki L. Ellingrod

    Guest host Vicki L. Ellingrod, PharmD, talks with Kristen M. Ward, PharmD, and Amy Pasternak, PharmD, about integrating pharmacogenomic testing into psychiatric practice.
    Dr. Ellingrod is senior associate dean at the University of Michigan College of Pharmacy, Ann Arbor, and professor of psychiatry in the medical school. She is also section editor of the savvy psychopharmacology department in Current Psychiatry. Dr. Ellingrod has no relevant financial relationships to disclose.
    Dr. Ward and Dr. Pasternak are clinical assistant professors of pharmacy at the University of Michigan.  Dr. Ward and Dr. Pasternak report no relevant disclosures. Dr. Ward and Dr. Pasternak are team leads in the University of Michigan’s Precision Health Implementation Workgroup.
    Take-home points
    Pharmacogenomics is defined as the study of the relationship between genetic variations and how our body responds to medications. Two common reasons for ordering pharmacogenomic testing are that a patient or clinician wants testing completed before starting the trial of a psychotropic medication and that there are concerns about nonresponse or loss of response to medications. Common insurance criteria used to justify such testing include at least one failed medical trial; future use of a medication likely to be affected by genetic variants, such as metabolism through CYP2D6 or CYP2C19; or identification of human leukocyte antigen (HLA) variants before starting carbamazepine or oxcarbazepine. Quality improvement and usability campaigns around pharmacogenomic testing include ensuring that testing results are readily available in the medical record. Results should be searchable. Alerts can be created for prescribers when they order a medication for which a patient has a relevant genetic variant. After ordering testing, clinicians should document the patient’s medication response genotype and phenotype in the medical record so the information can be used for medications other than psychotropics. Summary
    Pharmacogenomic testing may be ordered for several reasons, including cases in which a patient or clinician wants information before switching to another medication or there are questions about failed medication trials. For approximately 50% of individuals who undergo pharmacogenomic testing, there may not be a change in treatment plans, or the results might not be conclusive enough to affect treatment. However, pharmacogenomic testing is useful in reassuring and improving adherence in patients who experience somatic adverse effects to psychotropic medications and want to know whether those effects are related to their metabolism. Getting insurance companies to cover pharmacogenetic testing can be tricky, and clinicians should be familiar with the criteria requested by insurers before ordering the tests. Many of the genetic-testing companies include a patient-assistance program to cover payment when insurance companies do not. In the medical record, it’s important to document the patient's genotype and phenotype. The patient’s genotype affects their metabolism of medications beyond psychotropics. Pharmacogenomic testing results can prevent serious adverse drug reactions. If testing comments on a patient’s carrier status for specific HLA subtypes implicated in drug metabolism, carbamazepine or other related medications should be added to the patient’s drug allergy list. States requirements about informed consent for genetic testing vary, so any clinicians who order such tests should be informed about their local laws. References
    Ellingrod VL. Current Psychiatry. 2019 Apr;18(4):29-33.
    Deardorff OG et al. Current Psychiatry. 2018 Jul;17(7):41-5.
    Ellingrod VL and Ward KM. Current Psychiatry. 2018 Jan;17(1):43-6.
    Bishop JR. Current Psychiatry. 2010 Sep;9(9):32-5.
    Maruf AA et al. Can J Psychiatry. 2020 Aug;65(8):521-30.
    National Institutes

    • 23 min
    Providing mental health services and fostering resilience in the wake of mass traumas such as the Jan. 6 Capitol siege

    Providing mental health services and fostering resilience in the wake of mass traumas such as the Jan. 6 Capitol siege

    Lorenzo Norris, MD, speaks with Tonya Cross Hansel, PhD, about processing incidents such as the Jan. 6, 2021, siege on the Capitol, and determining how to foster recovery.
    Dr. Hansel is an associate professor with the Tulane University School of Social Work in New Orleans. She has no conflicts of interest.
    Dr. Norris is associate dean of student affairs and administration at George Washington University, Washington. He has no disclosures.
    Take-home points
    Dr. Hansel’s research focuses on measuring traumatic experiences and implementing systematic recovery initiatives that address negative symptoms by emphasizing individual and community strengths. The tendency to come together in times of vulnerability is a human instinct. The Jan. 6 Capitol siege was a traumatic and polarizing event; in a Pew survey 1 week later, 37% of respondents expressed a strong negative emotion in response to the riot. The unpreparedness of the U.S. Capitol Police and other law enforcement agencies led to fear and shock as much of the nation watched the breach unfold in real time on television. A variety of groups attended the protest. Some groups were involved in domestic terrorism, and others were part of political groups who came protest their grievances against the government. Those who attended the event with the intent of engaging in violence and instilling fear are considered domestic terrorists. Dr. Hansel said an event such as the insurrection wears on society by causing chronic stress, and one-time events such as the insurrection can lead to a prolonged state of anxiety. Terrorism and violence are sometimes triggered by disenfranchisement when violence seems like the only way to make one’s voice heard. Disasters with an economic fallout, such as natural disasters or the ongoing COVID-19 pandemic, can result in greater disenfranchisement. Prevention of future attacks and domestic terrorism must balance people’s ability to speak out and protest with an effort to avoid disenfranchisement. The way forward must also include addressing chronic fear. Dr. Hansel suggests that building community over shared values is a powerful way to foster resilience after disaster. In the pandemic, we have all experienced sacrifice and hardship. When society moves beyond survival mode, efforts must be made to connect over our shared sense of loss. References
    Hartig H. In their own words: How Americans reacted to the rioting at the U.S. Capitol. Pew Research Center. 2021 Jan 15.
    Pape RA and Ruby K. The Capitol rioters aren’t like other extremists. The Atlantic. 2021 Feb 2.
    Ellis BH et al. Studies in Conflict & Terrorism. 2019 May 31. doi: 10.1080/1057610X.2019.1616929.
    Hansel T et al. Traumatology. 2020;26(3):278-84.
    Saltzman LY et al. Curr Psychiatry Rep. 2017 Jun 19. doi: 10.1007/s/1920-017-0786-6.
    Hall BJ et al. PLoS One. 2015 Apr 24. doi 10.1371/journal.pone.0124782.
    *  *  *
    Show notes by Jacqueline Posada, MD, associate producer of the Psychcast; assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington; and staff physician at George Washington Medical Faculty Associates, also in Washington. Dr. Posada has no conflicts of interest.
    For more MDedge Podcasts, go to mdedge.com/podcasts
    Email the show: podcasts@mdedge.com

    • 42 min
    Spectrum vs. narcissism: An unlikely differential | Clinical Correlation

    Spectrum vs. narcissism: An unlikely differential | Clinical Correlation

    One wouldn't think autism spectrum disorder belonged in the same universe as narcissistic personality disorder. Yet sometimes emotional disconnection and seeming lack of empathy leads to miscommunication. There is one key difference, however.
    Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

    • 11 min
    Psychedelics, violence, and psychiatric treatment: Assessing the early and emerging research with Dr. Brian Holoyda

    Psychedelics, violence, and psychiatric treatment: Assessing the early and emerging research with Dr. Brian Holoyda

    Brian Holoyda, MD, MPH, MBA, conducts a Masterclass on the history of psychedelic research and how the renaissance of this drug class could affect psychiatric patients.
    Dr. Holoyda, a forensic psychiatrist, practices in the San Francisco Bay Area. He also provides psychiatric consultations across the country. Dr. Holoyda has no disclosures.
    Take-home points
    The effects of psychedelics are dose dependent and difficult to predict. The impact of psychedelic treatment on violent behaviors was studied since the 1960s with varying results. More recent studies suggest that psychedelic use (excluding phencyclidine, or PCP) is associated with less violent crime. Dr. Holoyda recommends that, before psychiatrists treat patients with psychedelic-assisted psychotherapy, patients should be screened for history of violence or aggression while using psychedelics (and in general) and a history of serious mental illness. Patients require informed consent about the risk of violence and interventions used to control aggressive behaviors. Summary
    In 1960, the Harvard Psilocybin Project included a study in the Concord (Mass.) Prison in which researchers hypothesized that using psychedelic-assisted psychotherapy in prisoners would reduce risk of violent recidivism. The original authors, including Timothy Leary, PhD, published varying results of the study – including that psychedelic use reduced recidivism. However, some argue the overly positive results from the first analysis were attributable to a halo effect. A recent reanalysis showed that the base rate for recidivism in the intervention group was 34%, and not significantly different from that of the control group. Psychiatrists have continued to use psychedelic-assisted therapy for patients with psychopathology and treatment-resistant sexual offenders to investigate whether the transcendent experiences can change their personalities, including the development of insight and empathy. Dr. Holoyda published a review of all published cases in medical literature discussing psychedelic use and violent behavior. Most of the cases were published in the 1960s-1970s, when psychedelics were viewed negatively as a product of the counterculture era. More recent observational studies identified that psychedelics use is associated with a greater likelihood of carrying a firearm as well as intimate partner violence, but these newer studies are fraught, because PCP is sometimes classified as a psychedelic. Other epidemiological studies have identified reductions in violent behaviors associated with psychedelics use, compared with other illicit substances. Those reductions in violent behaviors include a lower probability of supervision failure, and a lower risk of intimate partner violence and drug distribution. Peter S. Hendricks, PhD, and associates analyzed data from 225 million individuals who took the National Survey on Drug Use and Health from 2002 to 2014 with a focus on psychedelics use, excluding PCP. They found that a lifetime history of psychedelic use decreased the odds of theft, assault, and arrest for property and violent crime. Studies such as this suggest that individuals who favor psychedelics may be less prone to violent crime rather than a direct effect of psychedelics on decreasing violent crime. As psychedelics enter the clinical sphere, clinicians must keep in mind that experiences on these agents are unpredictable. In a study of unmonitored psychedelic use, individuals report putting themselves or others at risk. Others reported behaving aggressively or violently, and others sought help at a hospital. Before using psychedelics in a therapeutic environment, clinicians should assess patients’ past use and experience on psychedelics. They also should screen for history of “bad trips,” leading to aggression, agitation, paranoia, and risky behaviors. In clinical trials with ps

    • 21 min

Customer Reviews

4.4 out of 5
51 Ratings

51 Ratings

Jenna Cheng, DO ,

Enjoyable and Endlessly Inspiring

Dr. Norris brings up so many insightful points, and does a phenomenal job highlighting key aspects of the guest speaker’s message. He also makes the discussion fun and relatable. I find myself thinking about materials discussed in the podcast for days, whether it’s about neuropolarizatkon, development of personality disorders, or suicide prevention. I am a third year psychiatry resident and I frequently reference information I learned from here in my didactics, and it makes for a great discussion among the residents.

Humhoney ,

A note on Cannabis Medicine

There is a difference between using Cannabis medicinally, & abusing it. It is not a panacea, same as psychiatric medications that carry far larger negative effects. I have worked with this plant medicinally for over 20 years within the clinical scope. Individualized medicine is important. As with most things poison vs cute is in the dose.
Last “marijuana,” is a derogatory slang word for the cannabis plant.
The information is well documented by now. Stop the stigma.

Sunfun315 ,

Relatable Topics

I really enjoy listening to the Psychcast podcast. They cover topics that are relatable yet educational. I would be interested in hearing more podcasts about mental health, gut health and mental health and perhaps mental disorders and women who seek help but may be dismissed by physicians who think that they are over exaggerating their symptoms. Love this!

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