PsyDactic - Residency T. Ryan O'Leary

What is a placebo?  You may already be thinking something like: A placebo is an imitation, fake, sham, decoy, or trick treatment that we give to people in studies to see if the treatment under investigation is any better or worse.  Placebos are supposed to be both benign and inert, meaning they should neither harm nor help a patient beyond the patient feeling or reporting that they are better or worse after they received some kind of treatment.  It seems strange that there is something that can take innumerable forms and still seems to work at least a little bit on so many different things. Placebos are like an all-powerful potion or magic spell.  For some treatments, even active treatments, placebo effects account for the vast majority of the effect size and it is not just an illusion.


Please leave feedback at https://www.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 exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

This episode is the second in an intermittent series I am calling In A Word. Psychiatry is full of terms that are either poorly defined or used in such broad ways that they are not very helpful by themselves.  Trying to come to terms with terms we throw around can help us to understand the conditions we treat better, and hopefully will help us to communicate more precisely and effectively in the future.  Dissociation is a word that has frustrated me.  I have heard it used to describe everything from daydreaming to a feeling of complete detachment of someone from their own body to having lost a previous identity and adopted a new one.  The term is used to describe various aspects of many psychiatric disorders.  It is prominently featured in disorders like borderline personality disorder and post-traumatic stress disorder. There is even a controversial diagnosis called Dissociative Identity Disorder.

At the end, I give ChatGPT another go.
Please leave feedback at https://www.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 exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Bayesian reasoning is likely operating in your mind whether you realize it or not, whether you can do the math or not.  In this episode, Dr. O'Leary explores how to explicitly use Bayesian reasoning to put actual numbers to our inherent biases.  Attention Deficit Hyperactivity Disorder (ADHD) seems like a good place to start.
Please leave feedback at https://www.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 exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

You may have heard that Dr. Google now has some serious competition.  It comes from artificial intelligence. Chat GPT is a text generating program that was trained to respond to prompts from users like you and me.  What will it say to our psychiatry patients?  I gave it some prompts to find out.
Please leave feedback at https://www.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 exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Society is in upheaval in the way that it discusses mental health.  There are many loud voices out there. Some of these advocate for more openness and less stigma with regard to how we treat people with behavioral and psychological disorders, and by "treat," I don’t mean with drugs or therapy, but with our words, actions, policies, laws, and inaction.  One example of these voices is Dr. Jake Goodman who posed with a pill on his tongue in a TIC TOC post to demonstrate that even as a physician, he may also need medication assistance for his mental health.  The outpouring of support, vitriol and shenanigans that resulted demonstrates how divided our society is on this issue, and in many ways how unrealistic our view of doctors and of mental illness is.
Please leave feedback at https://www.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 exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary reviews one of the most frustrating diseases that a patient and their family might approach a psychiatrist with: Huntington’s Disease.  Huntington’s Disease is a neurodegenerative disorder, which means that over the course of the disease neurons die or cease to function correctly and this worsens over time.   The death of neurons in the caudate nucleus and putamen results in choreiform or dance-like movements of the extremities which earned it the moniker “Huntington’s Chorea." Huntington's Disease can result in many psychiatric symptoms and these may start to occur during the prodromal stage before the choreiform movements develop.  Sleep disturbances, apathy, executive dysfunction, memory impairment, personality change, irritability and aggression, disinhibition and impulsivity (including hyper-sexuality), depression, mania, delusions, paranoia and other psychotic symptoms, obsessions and compulsions, and most prominently a high risk of suicide.


Please leave feedback at https://www.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 exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.