This podcast is written and produced by psychiatry residents at the University of Toronto and is aimed at medical students and residents. Listeners will learn about fundamental and more advanced topics in psychiatry as our resident team explore these topics with world-class psychiatrists at U of T and abroad.
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PsychEd Episode 64: Introduction to Consultation-Liaison Psychiatry with Dr. Raed Hawa and Dr. Alan Wai
Friday, August 30, 2024 • Duration 01:15:24
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers an introduction to consultation-liaison psychiatry with Dr. Raed Hawa and Dr. Alan Wai, both from the University of Toronto.
Dr. Raed Hawa is an esteemed CL psychiatrist and educator. Dr Hawa's interests are in the areas of undergraduate, postgraduate, and continuing medical education. He also practices general sleep medicine with particular clinical interest in the areas of insomnia, co-morbid psychiatric and medical illnesses, and sleep-related movement disorders. He currently serves as the President of the Canadian Academy of Consultation-Liaison Psychiatry (CACLP) and holds the position of Professor at the Faculty of Medicine, University of Toronto. Additionally, Dr. Hawa is the Deputy Psychiatrist-in-Chief at the Centre for Mental Health, University Health Network. Dr. Hawa has earned American Board Certification in Psychiatry, with subspecialty certifications in Sleep Medicine and Psychosomatic Medicine (Consultation-Liaison Psychiatry). His expertise and contributions to the field have been recognized through his designation as a Distinguished Fellow of both the American Psychiatric Association (APA) and the Canadian Psychiatric Association (CPA).
Dr. Alan Wai is a psychiatrist at the University Health Network in Toronto and an Assistant Professor in the Department of Psychiatry at the University of Toronto. He provides inpatient CL psychiatry care and mental health and psychiatric care embedded in the Immunodeficiency Clinic at Toronto General Hospital, where he sees both persons living with and at risk of HIV. He received his medical degree from the University of British Columbia and completed his psychiatric residency training at the University of Toronto.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Outline the history and evolution of CL psychiatry
Define the role and scope of CL psychiatrists in diverse medical settings
Identify and assess common psychiatric disorders in CL settings
Provide differential diagnoses and a general approach to a CL patient through a sample case
Guests: Dr. Raed Hawa and Dr. Alan Wai
Hosts: Annie Yu (PGY3), Sena Gok (MD), and Matthew Cho (CC3)
Audio editing by: Sena Gok
Show notes by: Sena Gok
Interview content:
Introduction - 00:13
Learning objectives - 01:09
First guest introduction - 01:36
History of CL psychiatry - 03:18
Subspecialties within CL psychiatry - 10:33
Collaborative care of CL psychiatry - 14:00
Preparation for CL Rotation - 20:03
Bariatric clinic and CL psychiatry - 22:32
Future of CL psychiatry, AFC Certification - 27:45
Beran, C., & Sowa, N. A. (2021). Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision. Journal of the Academy of Consultation-Liaison Psychiatry, 62(2), 186–192. https://pubmed.ncbi.nlm.nih.gov/33288272
Lipowski, Z. J. (1974). Consultation-Liaison Psychiatry: An Overview. American Journal of Psychiatry, 131(6), 623–630. https://doi.org/10.1176/ajp.131.6.623
Swenson, J. R., Abbey, S., & Stewart, D. E. (1993). Consultation-liaison psychiatry as a subspecialty. A Canadian survey. General Hospital Psychiatry, 15(6), 386–391. https://doi.org/10.1016/0163-8343(93)90007-b
Taylor, G., & Doody, K. (1979). Psychiatric Consultations in a Canadian General Hospital. The Canadian Journal of Psychiatry, 24(8), 717–723. https://doi.org/10.1177/070674377902400803
PsychEd Episode 63: Balancing Perspectives on Safety and Involuntary Hospitalization with Jesse Mangan and Dr. Jim McQuaid
Wednesday, July 31, 2024 • Duration 01:44:35
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we discuss the practice of involuntary hospitalization (also referred to as involuntary commitment or certification) with two special guests and fellow podcast creators — Jesse Mangan and Dr. Jim McQuaid. Their podcast, Committable, focuses on the topic of involuntary commitment and features stories from people with lived experience as a window into complex conversations with attorneys, physicians, psychologists, and more. Jesse Mangan is the producer of Committable and someone who has experienced involuntary hospitalization. Dr. Jim McQuaid is an Associate Professor of Sociology at Framingham University.
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Appreciate the individual and societal functions of involuntary hospitalization
Understand the potential benefits and risks associated with involuntary hospitalization from the perspective of health care professionals as well as service users and the community at large
Describe actions you can take as a practitioner (who has the power to certify) that may better serve your community and those you care for
Identify meaningful ways to continue the conversation about these issues in medical education or training and beyond
*This episode was recorded in 2021. Through a saga involving lost and recovered audio files, we’re thrilled to finally be able to release it, and believe that the topic is just as timely and relevant as ever!
Guests: Jesse Mangan and Dr. Jim McQuaid
Hosts: Anita Corsini, Nikhita Singhal, Gray Meckling, and Alex Raben
Audio editing by: Nikhita Singhal
Nikhita Singhal
PsychEd Episode 54: Cannabis and Psychosis with Dr. Nitin Chopra
Monday, May 29, 2023 • Duration 01:08:36
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)
PsychEd Episode 53: Insomnia with Dr. Michael Mak
Monday, April 24, 2023 • Duration 01:12:41
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
PsychEd episode 52: How to Use Lithium
Thursday, March 30, 2023 • Duration 35:21
Welcome to PsychEd — the psychiatry podcast for medical learners, by medical learners. This episode is an introduction to the use and monitoring of lithium in bipolar disorder. Join Tingting Yan (CC4) and Dr. Alex Raben (staff psychiatrist at CAMH and lecturer at the University of Toronto) for a lively case-based discussion.
Learning Objectives
The learning objectives for this episode are as follows:
By the end of this episode, the listener will be able to…
Describe the indications and process for starting lithium
Monitor and interpret serum lithium levels
List short and long-term adverse effects of lithium
Produced by: Tingting Yan CC4, Dr. Alex Raben (staff psychiatrist)
Hosts: Tingting Yan, Alex Raben
Audio editing by: Alex Raben
Show notes by: Alex Raben
Contents:
Learning objectives: 00:44
Lithium background and brief history: 2:48
Women’s health and lithium: 5:28
Underutilization of lithium: 8:02
Baseline blood work for lithium: 11:32
Choosing a lithium starting dose: 14:32
Lithium serum levels: 16:17
Lithium titration: 20:46
Lithium toxicity: 23:48
References
PsychEd Episode 51: Mental Illness and Violence with Dr. Robert McMaster and Dr. Ragy Girgis
Monday, February 27, 2023 • Duration 01:02:47
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.
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:
PsychEd Episode 50: The Mental Status Examination
Friday, January 27, 2023 • Duration 01:49:14
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.
PsychEd Episode 49: Dementia Assessment with Dr. Lesley Wiesenfeld
Friday, November 25, 2022 • Duration 01:22:19
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]
Hosts: Dr. Luke Fraccaro (PGY-3), Dr. Mark Fraccaro (PGY-4), Sena Gok (international medical graduate)
Audio editing by: Sena Gok
PsychEd Episode 48: History of Psychiatry with Dr. David Castle
Friday, October 28, 2022 • Duration 01:04:29
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
PsychEd Episode 47: Understanding the DSM-V-TR with Dr. Michael First
Monday, September 12, 2022 • Duration 52:19
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
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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.
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:
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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
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Tondo L, Alda M, Bauer M, Bergink V, Grof P, Hajek T, Lewitka U, Licht RW, Manchia M, Müller-Oerlinghausen B, Nielsen RE. Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders. 2019 Dec;7(1):1-0.
Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders. 2018 Mar;20(2):97-170.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
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.
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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.
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References cited by our experts:
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CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.
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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
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.
Castle, D., Bassett, D., King, J., & Gleason, A. (2013). A primer of clinical psychiatry. Elsevier Health Sciences.
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