Psychiatry & Psychotherapy Podcast

In this week’s episode, we continue our series on Adverse Childhood Experiences by delving deeper into the lasting effect of ACEs on the brain and body. We explore the intricate impact of ACEs on the HPA axis, inflammation, and neurobiology, shedding light on their role in various psychiatric disorders. We highlight how these changes may indicate a shared phenotype resulting from early adversity but that they likely do not explain the entire effect ACEs have on an individual.

Listening to The Shrink Next Door elicited a range of emotions in me, including angst, sadness, intrigue, and heartache. For those unfamiliar with the story, it revolves around a psychiatrist named Ike who isolates his patient, Marty, from his family, takes over his business, lives in his house, charges him over a million dollars, and makes him undertake various projects for him. We will discuss the podcast's characters as if they are fictional. The podcast, akin to House of Cards for the psychotherapy world, reveals the manipulation and betrayal that can occur behind the scenes. Just as House of Cards exposed viewers to the Machiavellian tactics in politics, The Shrink Next Door disrupts the sacred space of the therapy office. This week, I am joined by Dr. Eric Bender, a psychiatrist and psychotherapist, to discuss, The Shrink Next Door. Dr. Bender practices in San Francisco, has been featured multiple times on GQ’s online show The Breakdown, Wired magazine’s Tech Help, and on YouTube.

The purpose of this episode is to provide a clear and simple guide for clinicians on the diagnosis of complex PTSD (C-PTSD) and how it differs from post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). It is intended to complement and add to recent episodes on attachment and trauma: 213: Reflective Functioning, 203 and 204 on adverse childhood experiences. In today’s episode of the podcast, we are joined by Dr. Adam Borecky. Dr. Borecky is a psychiatrist and therapist who helped author the Connection Index and is part of Dr. Puder’s core team. His practice utilizes a holistic approach towards therapy and medication management.

In this episode, we welcome back Dr. Michael Cummings to answer questions sent in by podcast listeners. Topics include Valproic Acid, Lithium, Treating Veterans, Restless Leg Syndrome, and much more.

In this episode, we discuss “reflective function,” which is a precursor to the concept of mentalization. Reflective function is best understood not as synonymous with mentalization, but as a scale from -1 to 9, based off certain adult attachment interview questions that measure the person’s ability to describe their own and others’ internal states, motivations, and articulate a nuanced and unique understanding of life from 0 to 12 years old. This scale was developed by attachment researchers at the University of London, including Dr. Howard Steele and Dr. Peter Fonagy.

In today’s episode, we talk with Dr. Bruce Perry who co-authored, The Boy Who Was Raised As A Dog, Born For Love: Why Empathy is Essential and Endangered, and What Happened to You? Conversations on Trauma, Resilience, and Healing (2021). We are also joined by Megan White Zappitelli, M.D., a child and adolescent psychiatrist, and Maddison Hussey, M.D., a child and adolescent fellow.

In this episode, we are joined by a panel of experts to discuss treatment of psychosis. Experiences of psychosis are common. When these experiences lead to interference in achieving life goals and/or distress, individuals can benefit from seeking evidenced-based care. The earlier individuals experiencing psychosis come to treatment, the better the outcomes. We are all allies in connecting these young people to care and services. Recovery is possible—people living with psychosis experiences can lead full, meaningful, and fulfilling lives.

In this episode, we welcome back fan favorite Dr. Michael Cummings and ask questions sent in by listeners. Topics include Schizophrenia, Social Media Trends, and the SSRI controversy. We are thrilled to dedicate an episode that allows individuals to ask pointed questions and glean from Dr. Cummings' expertise.

Learning how to approach patients with PTSD and severe trauma is necessary to help long term. Dr. Patricia Resick has plenty of experience in dealing with PTSD and is on the podcast today, sharing her wisdom so that we may better serve patients suffering from trauma.

Therapies of depth, insight, and relationship have been missing from, if not pushed out of, the public conversation on mental health treatment. After decades of attack from multiple fronts, these therapies are misunderstood, undervalued, and overlooked by the general public. In order to address this challenge and change this trajectory, we must start by listening to the public and understand their needs, values, and preferences about therapy. Dr. Linda Michaels and colleagues conducted an extensive research project, leveraging qualitative and quantitative tools and techniques widely used in the corporate world, focused on “listening” to the public and understanding what people want and need from therapy. Linda Michaels, PsyD, MBA, is a clinical psychologist in private practice in Chicago. She is also chair and co-founder of the Psychotherapy Action Network (PsiAN), a non-profit that advocates for quality therapy. Link to blog here.

In this Episode, Dr. David Puder, Dr. Adam Borecky, and Joanie Burns discuss the 5-factor approach to holistic, patient-centered psychiatric care. This approach takes into account that each individual who seeks care is unique in their physiological and psychological make-up and that multiple factors influence both physical and mental health (for better or worse). The 5-factor approach to treatment is based on the importance of sensorium and its pivotal role in regulating thoughts, feelings, and overall mental health. Sensorium is a lens to understand how we focus on various things. Sensorium is total brain function, which fluctuates throughout the day and depends on a number of factors, including sleep, stress levels, and more.

In this episode, we are joined by Dr. Anthony W. Bateman and Dr. Peter Fonagy to discuss their expertise on Mentalization. Mentalization refers to the capacity to reflect upon and understand one's own state of mind and the states of mind of others. This involves recognizing and making sense of one's own and others’ emotions, beliefs, needs and desires. People use this tool consciously and unconsciously to make sense of others and themselves. Often done automatically, a person may form beliefs about the people they interact with, making assumptions about their mental states. These beliefs tend to have a strong influence on the mental state of the person, whether or not they are correct.

Dr. Jonathan Shedler is well known for his work on the efficacy of psychodynamic therapy. He has highlighted the importance of the initial phase of therapy in establishing a foundation for successful treatment. Dr. Shedler strongly believes the consultation phase is crucial to developing a working alliance between client and therapist and building a treatment frame and structure. Without this foundation, there is no mutual understanding about the goal or the purpose of treatment, and psychotherapy should not move forward. Join us in this episode as Dr. Shelder discusses how to create a firm starting foundation in clinical practice.

In this week’s episode of the podcast, we will continue our discussion regarding adverse childhood experiences (ACEs) and their influence on the development of future mental health disorders. The greatest predictive factor of the relationship between ACEs and future mental health disorders has to do with the severity, duration, and number of traumatic events. We’ll explore the Childhood Trauma Questionnaire and the data of how ACEs increase the risk of certain personality disorders and psychiatric conditions. Link to blog: https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-204-adverse-childhood-experiences-part-2-measurement-impact-on-future-mental-health-dissociation-and-timing-of-trauma

In today's episode post, we embark on an in-depth exploration of adverse childhood experiences (ACEs) and their profound impact on adult mental and physical health. The CDC defines ACEs as, “potentially traumatic events that occur in childhood.” ACEs include (but are not limited to) physical, emotional, sexual abuse, neglect, household dysfunction, such as domestic violence or parental substance abuse. We'll investigate how these early negative events are critical predictors of adult psychiatric diagnoses, including substance use disorders (SUDs), depression, anxiety, PTSD, psychosis, and personality disorders. Our analysis extends to the intricate ways ACEs affect an individual's physiology and psychology. This episode will be the first of a mini-series of several episodes surrounding the impact of ACEs and how we can treat patients who experienced trauma. Link to Blog here

In today’s episode of the podcast, we interview Dr. Judith Beck, a prominent figure in the field of psychology and author of the highly regarded textbook, Cognitive Behavior Therapy: Basics and Beyond, which is a staple in the academic journey of many students in psychiatry, psychology, counseling, social work, and psychiatric nursing. This book, translated into 20 languages, is a key resource in the U.S. as well as globally. Dr. Beck serves as the president of the Beck Institute for Cognitive Behavior Therapy, which she co-founded with her late father, Dr. Aaron Beck, who is considered the father of CBT. The Beck Institute is a non-profit organization based in Philadelphia. In addition to her leadership role, she is a Clinical Professor of Psychology in Psychiatry at the University of Pennsylvania, where she educates residents.

The underreporting of psychotic symptoms by patients in depression is a significant concern, frequently driven by the fear of consequences like hospitalization or the stigma of embarrassment. We'll discuss the history, the differential to consider when thinking of psychotic depression, mechanisms, and treatment. Notably, individuals with psychotic depression face a suicide rate double that of their non-psychotic counterparts. A recent cohort study by Paljärvi in 2023 revealed a stark contrast: deaths due to suicide were 2.6% in the psychotic depression cohort, compared to 1% in the non-psychotic group. Alarmingly, most suicides occurred within the first two years following diagnosis. People who suffer from psychotic depression often do not report their psychotic symptoms, leading to inadequate response to normal depression treatments. With 6-25% of individuals with major depressive disorder (MDD) exhibiting psychotic features, it is imperative to understand and address these unique challenges. Join us as we unravel the complexities of this underrecognized aspect of mental health.

Join us today on the 200th episode of the podcast, as Dr. Puder sits down with Dr. Mark Mullen to discuss the podcast, answer some questions about his personal journey in psychiatry, and reflect on some of his favorite episodes. Dr. Mark Mullen is a 4th year psychiatry resident at Creighton University in Omaha, Nebraska, and the host of his own podcast, Psychiatry Bootcamp.

Motivational interviewing serves as a versatile enhancement to various professional practices, whether it’s behavioral therapy, medication counseling, classroom teaching, or sports coaching. In the words of Dr. William Miller, “It’s a way of being with people to help people make changes.” This method emphasizes a collaborative and empathetic interaction style, focusing on empowering individuals to drive their own change, making it a valuable asset in any change or growth-oriented setting.

What causes burnout among residents? There are many factors associated with burnout supported in the literature. We can break them down into environmental factors, personal factors, and non-modifiable factors. In this episode, we dive into the major factors of resident burnout and how the connection index can improve resident morale.