Psychiatry & Psychotherapy Podcast
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Understanding Placebo
29 november 2018 · 1 uur 1 min
What is placebo? Lees meer
The original meaning of the word placebo is, "I will please." That statement comes from a time when doctors didn't have our modern code of ethics, and they would prescribe whatever would make the person feel better. They probably had the best intentions, but they also would have known that whatever they were prescribing might not have been a real medication for the symptoms the patient was experiencing.
Doctors, even then, knew that suggestion was powerful, sometimes more powerful than the medicine they were prescribing.
Laypeople who hear the word "placebo" automatically think of sugar pills. They may think only that it's something a doctor gives to placate and make people feel better when they aren't getting the active medication. Placebos have long been used as a comparison arm for clinical trials. Usually it is in the form of an inert sugar pill or sham-procedure. Researchers can observe a psychobiological response known as the placebo effect.
But when thinking about the word "placebo," we must think of the entire effect of it, and it is perhaps better termed "the meaning effect." As I discussed in last week's episode of the podcast, the meaning we give something creates belief, and belief is a potent change mechanism, even when it comes to our physical health. It is especially potent when it comes to mental health.
The placebo effect encompasses the therapeutic alliance, expectations, natural healing of the body and mind, and the environment of therapy. It involves the power of suggestion, mood, and the beliefs behind even one positive or negative interaction with a doctor. It also, as we will see, involves studies involving heavy-hitting medication.
When there is an increased ritual, there is an increased placebo effect. During a hospital stay, the surgery preparation, meetings with doctors, nurses and therapists can have an incredibly therapeutic effect on a patient. It is possible to see biological mechanisms triggered by psychosocial…
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Perinatal Mood and Anxiety Disorders
15 november 2018 · 58 min
For many, motherhood is a beautiful, unique, and meaningful experience. The mother-child bond is a relationship that has the potential to be a deeply loving and positive experience for both the mother and child. However, motherhood can be distressing, which is why it is imperative that we, as providers, understand the unique psychiatric issues that are associated with this time period in a woman's life. Lees meer
Perinatal mood and anxiety disorders, or PMAD for short, is the term used to describe mood and anxiety disorders that affect women during the perinatal period, which is the timeframe from pregnancy to 12 months postpartum. PMAD encompasses a variety of disorders, such as anxiety, depression, obsessive-compulsive disorder, bipolar mood disorder, psychosis, and PTSD.
Details on connecting with Kelly Rivinius through social media or about her free support group:here
By listening to this episode, you can earn 1 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
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Therapeutic Alliance Part 2: Meaning and Viktor Frankl's Logotherapy
30 oktober 2018 · 45 min
Episode CME activity objectives: Lees meer
In the context of a therapeutic alliance, apply the information given in this episode to help draw out meaning in others.
Identify who Viktor Frankl was and how his work and legacy have shaped how we understand and utilize meaning in psychiatry.
Define psychic determinism.
Recognize that meaning is idiosyncratic and unique to each individual.
Recognize the multitude of ways people can find meaning in their lives and the various ways they can express and convey this.
Summarize the various studies listed in this episode that have shown how meaning and the creation of meaning can have a positive impact.
David Puder, M.D. has no conflicts of interest to report.
In the celebrated book Man's Search for Meaning, author Viktor Frankl wrote about his intimate and horrific Holocaust experience. He found that meaning often came from the prisoners' small choices—to maintain belief in human dignity in the midst of being tortured and starved and bravely face these hardships together.
"The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal." - Viktor Frankl
"We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances, to choose one's own way." - Viktor Frankl
Frankl argued that the ultimate human drive is the "will to meaning," which could be described as the meaning to be found in the present and in the future. For example, I ha…
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Psychiatric Approach to Delirium
8 oktober 2018 · 50 min
Delirium is an acute change in a person's sensorium (the perception of one's environment or understanding of one's situation). It can include confusion about their orientation, cognition or mental thinking. Lees meer
With hyperactive delirium, a patient can become aggressive, violent and agitated with those around them. A patient experiencing delirium can have hallucinations and hear things, they can become paranoid, and they are overall confused. A family or non-psychiatric medical staff might be concerned that the patient is experiencing something like schizophrenia.
Hyperactive delirium symptoms in patients:
Waxing and waning —it comes and goes
Issues with concentration
Pulling out medical lines
Yelling profanities
Throwing things
Agitated
Responding to things in the room that aren't there
Not acting like themselves
Hypoactive delirium is much more common than hyperactive delirium (based on research studies), but it is often missed because the presentation is much less dramatic. People with hypoactive delirium are confused and disoriented, but they are not expressing their confusion verbally or physically.
Hypoactive delirium symptoms:
Slower movement
Softer speech
Slower responses
Withdrawn
Not eating as much
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
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Ketamine and Psychedelics with Dr. Michael Cummings
25 september 2018 · 38 min
On this week's episode of the podcast, I interview Dr. Cummings, a reputable psychopharmacologist, about ketamine. We talk about psychedelics, the research behind it, both the positives and the negatives. We will look at how it is or is not helpful in psychiatric treatments. Lees meer
(Disclaimer: There are no conflicts of interest to report. Neither Dr. Puder or Cummings is affiliated with any companies in favor of ketamine and other drug companies.)
Ketamine
Although ketamine has recently become a medication of great interest in psychiatry, it actually is a fairly old medication. It was first synthesized in 1962 and began human trials for anesthesia in 1964. It was finally approved by the FDA as a dissociative anesthetic in 1970.
What has piqued interest in psychiatry is that infusion of a smaller dose of ketamine produces a rapid response in terms of reversal of depressed mood, suicidality, and some treatment-resistant depressed patients.
The literature is rich (in one sense) as the most recent consensus statement (Sanacora, 2017) looked at seven randomized controlled trials, all of which support a robust antidepressant response and anti-suicide response. The difficulty with those trials is the majority of them lasted only one week. A few of the later trials lasted two to three weeks with two to three infusions per week. So, what's lacking at this point is adequate data regarding long term treatment response and data about transitions to more traditional antidepressant treatments.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
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Instagram: dr.davidpuder
Twitter: @DavidPuder
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What is psychodynamic theory?
20 september 2018 · 50 min
On this week's episode of the podcast, I interviewed Allison Maxwell, a social worker and PhD student of clinical social work. I refer patients to her regularly for psychoanalysis, and she has had a wonderful impact on their mental health journey. Lees meer
What is psychodynamic theory?
Psychodynamic therapy is a form of talk therapy where the practitioner work focuses on the patient's emotion, fantasies, dreams, unconscious drives and wishes, early and current life relationships, and the relationship that is forming between the patient and therapist.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join and discuss this episode with David on Instagram: dr.davidpuder
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Advice for medical students applying to psychiatric residency
16 september 2018 · 11 min
Timothy Lee has talked to thousands of medical students about how to applying for residency programs, and here, he gives us a few tips on how to make it through the gauntlet, and how to have your best chance at landing the program you want. Lees meer
Here is what Timothy Lee says:
Stay calm
Many students have been fine tuning their personal statements, and trying to get their resume just right, or hurrying to press the faculty to write letters of recommendation. It can be very stressful.
It's okay to turn in information a little bit later, in order to have all of the paperwork you need. It's even okay to review your statement after you've already turned it in. No one will lower their opinion based on that. You will need to have applied for the majority of the programs you are interested in by early or mid-October, otherwise the program director might wonder if you're applying to them later as a backup plan.
What matters in a personal statement?
Every program director will have different opinions on what you write, and every program director will be looking for different things from your personal statement. For some people, it's a chance to get to know the applicant a little bit. For others, it doesn't really matter that much.
As long as your grammar and syntax are competent, you should be fine. Some people don't worry about the format, and others are more particular. To be on the safe side, if you have access to a good mentor, run it by them. Also, don't be too wordy—stick to a page and a half.
Do step scores matter?
Step scores are a very convenient screening tool for what matters, but there are studies that show that step scores are not directly correlated to success in residency performance. They are helpful, but are not the end-all-be-all. It's only one part of the picture of an applicant. However, if you are going for a highly-competitive residency, you might need to worry about step scores a bit more.
Apply to the right number of programs
The number of progr…
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Therapeutic Alliance Part 1
6 september 2018 · 46 min
What is a therapeutic alliance? Lees meer
The therapeutic alliance is a collaborative relationship between the physician and the patient. Together, you jointly establish goals, desires, and expectations of your working partnership.
Every interview with a patient, whether it's for diagnostic, intake, evaluative, or psychopharmacology purposes, has therapeutic potential. The treatment starts from your first greeting—how you listen, empathize, and even how you say goodbye.
It's built from a partnership and dialogue, like any other relationship. It's not built from medical interrogation. It's not about pulling medical information to be able to make a diagnosis. We have to make it a positive experience for patient, so they can begin to talk about what's negative in their lives.
The therapeutic alliance is full of meaning, and it uses every emotional transaction therapeutically. If they get angry, sad, or have fear you will abandon them, as a therapist, it's our job to figure out how to help them through that feeling within the relationship. The doctor can express desire for the patient to share, in real time, how the patient is feeling, even about his or her relationship with the doctor.
Why do we care?
We all know that some talk therapists have better outcomes than other talk therapists. What's interesting though, is that some some psychiatrists' placebos worked better than other psychiatrists' active drugs. One study of NIMH data of 112 depressed patients treated by 9 psychiatrists with placebo or imipramine, found that variance in BDI score (a score that measures depression) due to medication, was 3.4% and variance due to psychiatrist was 9.1%. One-third of psychiatrists had better outcomes with the placebo than one-third had with imipramine.
Another book argues that the therapist is more important to outcome than theory or technique. Many other studies have shown that therapeutic alliance directly correlates to success rates.
By listening to this episode, you can earn…
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How to Treat Emotional Trauma
23 augustus 2018 · 1 uur 10 min
What is trauma? Lees meer
Emotional trauma comes from stress that is overwhelms a person's neurological system. Some stress can be good and formative, or it can be bad and get stuck in the brain, causing someone deep emotional pain.
Think of climbing Mount Everest. Some people choose to do that, and it's easily one of the most stressful situations you can put yourself in on purpose. That's good stress if you have trained for years and are ready for it. If someone forced you to climb Mount Everest, it would register in the brain as a trauma.
Trauma is too big for the mind, brain, and nervous system to assimilate. It's a memory, or experience, that gets stuck because the person believed it would result in their death, or at least serious injury.
The brain has several mechanisms to keep something stuck so that the person will remember it, and try to avoid getting hurt in the same way in the future. It is a survival instinct.
People commonly demonstrate symptoms of trauma when they've:
Experienced a sexual violation
Seen violence
Experienced violence or abuse
Been neglected—experienced the absence of something that they should have had.
Been in near death experiences like car accidents or war
People who have PTSD, or post traumatic stress disorder, have experienced a soul-level of brokenness, and even talking about the event, or having a memory of it, can bring it back with the same force that occured in the actual accident. They often have recurring nightmares, or repetitive symptoms that continue long after the event.
Typical PTSD symptoms alternate between chronic shut down and fight and flight
Fight and flight symptoms are:
Sweating, nightmares, flashbacks, anger, rage, panic, hypervigilance, tense muscles, painful knotted gut
Shut down symptoms are:
Dissociation, freezing, emotional detachment, voice trembling, difficulty getting words out, numbness, apathy, fear, helplessness, dizzy, empty, nausea
Moments in connection mode look like:
curiosity, explorati…
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Setting Boundaries in Relationships
11 augustus 2018 · 52 min
What are boundaries? Lees meer
When we refer to boundaries, we are talking about emotional walls that are healthy. Boundaries are meant to keep us in relationship with the people that we love.
Think of them as your property lines around your house. You know where your lines are, where your property ends and your neighbors begins. Therefore you know what you are supposed to take care of and what your neighbor is supposed to take care of.
A boundary defines our self. Within ourselves, our "property" consists of our physical body, our desires, our intellect, and our ability to make decisions. It gives us a sense of defining what is "me" and what is "not me."
We are not supposed to take on too much of other people's emotional experiences. When I was a newly practicing psychiatrist, I didn't know that, and I felt depressed after meeting with a depressed patient. It is possible to have an understanding of what is happening in someone's emotional world, but not take it on yourself.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Connect With and Join Lindsay Puder's Instagram: LindsayPuder
Join David on Instagram: dr.davidpuder
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The History and Nuances of Bipolar Illness
2 augustus 2018 · 52 min
In this episode we discuss: Lees meer
The history of bipolar illness, mood stabilizers, common treatments, psychopharmacology, psychotherapy goals, and more.
For paraphrased transcription and blog: go here
For more detailed notes by Dr. Cummings, go to my resource page.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
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Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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The History, Mechanism and Use of Antidepressants
24 juli 2018 · 59 min
In this week's episode of the podcast, Dr. Michael Cummings and I talk about the history of antidepressants, and their use in overcoming depression and anxiety disorders. Lees meer
By listening to this episode, you can earn 1 Psychiatry CME Credits.
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Join David on Instagram: dr.davidpuder
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Emotional Shutdown—Understanding Polyvagal Theory
10 juli 2018 · 1 uur 38 min
Polyvagal theory by Stephen Porges explains three different parts of our nervous system, and their responses to stressful situations. Once we understand those three parts, we can understand our emotional reactions to trauma or high amounts of stress. Lees meer
Why is polyvagal theory important?
For therapists, and pop-psychology enthusiast alike, understanding polyvagal theory can help with:
Understanding trauma and PTSD
Understanding the dance of attack and withdrawal in relationships
Understanding how extreme stress leads to dissociation or shutting down
Understanding how to read body language
By listening to this episode, you can earn 1.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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The Psychology of Procrastination
3 juli 2018 · 47 min
What is procrastination? Lees meer
Procrastination is the act of avoiding something through delay or postponement.
You might be procrastinating when:
There is a gap between your intention and action
You feel like avoiding something
You find yourself easily distracted
You feel overwhelmed by tasks at the last minute
You always feel rushed to complete a project
You're hesitant to truthfully update someone on your progress
It usually brings about feelings of:
Shame
Guilty
Anxiety
Regret
Anger
Inauthenticity
Why do we procrastinate?
We procrastinate because our brains receive a reward for avoidance. Avoidance brings immediate relief from the distress associated with the task. Although we may experience discomfort in the final moments before a task is due, we rarely think about the past or future when procrastinating.
This creates a problematic cycle, one that erodes at our self-confidence. It also causes us to keep up a steady stream of "I should be…" in our subconscious minds.
The ingredients for procrastination
Personal & System Based Factors of ProcrastinationThere are fixed factors related to procrastination, things that are innate to each of our different psychological experiences. For example, someone with ADHD is more likely to procrastinate.
The fixed personal factors are:
Higher Impulsivity
Lower conscientiousness—lower drive to be organized and accomplish.
Limited attention-span
Boredom / Low Interest
The variable personal factors are:
Willpower
Distress tolerance
Willingness to ask for help
Task-focused vs value-focused
Self-consciousness & anxiety
The variable task or system-based factors are:
Unclear goals & expectations
Unrealistic goals & expectations
Distractions
Lack of accountability or mentors
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
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Join David on Instagram: dr.davidpuder
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How to Fix Emotional Detachment
30 juni 2018 · 1 uur 2 min
Do you ever feel out of touch with your emotions? Or have you ever felt like you had to hide your real emotions? When people do that—emotionally detach—they develop what therapists call "incongruence." Lees meer
Most therapy is actually centered around getting patients back in touch with their emotions. On this week's podcast, Ginger Simonton and I talk about the different methods we use to help our patients develop and maintain healthy emotional congruence.
By listening to this episode, you can earn 1 Psychiatry CME Credits.
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Join David on Instagram: dr.davidpuder
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The History and Use of Antipsychotics
19 juni 2018 · 46 min
In the latest podcast, Dr. Cummings and I talked about antipsychotics, the particular branch of psychopharmacology that deals with medicines that treat psychotic experiences and other mental disorders, such as: Lees meer
Schizophrenia
Severe depression
Severe anxiety
Bipolar disorder
Psychosis exhibiting hallucinations and delusions
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
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Join David on Instagram: dr.davidpuder
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How Psychiatric Medications Work with Dr. Cummings
12 juni 2018 · 51 min
In the latest episode of the Psychiatry and Psychotherapy Podcast, Dr. Puder interviews Dr. Cummings, a psychopharmacologist. They discuss the way medicine works in our bodies, and if medicine or therapy is more effective for treating different disorders. They also talk about the different factors that affect absorption rates, such as gastrointestinal surgeries, liver health and actual dosage. Lees meer
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
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Prescribing Strength Training for Depression
29 mei 2018 · 52 min
Can strength training help alleviate depression? In this episode, Dr. David Puder is joined by Trent Jones, a Starting Strength athlete, to discuss how systematic strength training can significantly impact mental health. From boosting confidence and assertiveness to reducing symptoms of depression, we explore the science and personal stories behind this powerful intervention. Lees meer
Key topics include:
The transformative mental health benefits of resistance training.
Insights from research studies showing the link between strength training and reduced depressive symptoms.
How strength training fosters assertiveness, confidence, and resilience.
Practical tips to start your own strength training journey, even if you're a beginner.
Whether you're a clinician looking for holistic treatments for depression or someone seeking new tools for personal growth, this episode offers actionable insights and inspiration.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
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Using Microexpressions in Psychotherapy
24 mei 2018 · 42 min
In the third and final installment on microexpressions, Ariana Cunningham and Dr. David Puder talk about how learning microexpressions can help you build empathy and connect with other people. Lees meer
As Paul Eckman demonstrated in his research, they can be potent glimpses into someone's emotional experience.
In this episode we talk about:
How emotions come into play in our dreams and other unconscious ways.
How to use what we learn from them carefully and with curiosity, rather than with a know-it-all attitude.
How we create psychological defense to cope with reality
How we might experience problematic relationship patterns through a theory called object relations.
How our emotions happen out of our awareness.
Preventing emotional overload and empathic exhaustion.
Emotional transference and how to stop it.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
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Join Ariana on Instagram: @joyspotting
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Microexpressions: Fear, Surprise, Disgust, Empathy, and Creating Connection Part 2
15 mei 2018 · 46 min
Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face. Lees meer
In this episode, we describe the science of the microexpressions of fear, disgust, and surprise and how to use it to connect with others.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources
Join Ariana on Instagram: @joyspotting
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Microexpressions to Make Microconnections Part 1
8 mei 2018 · 1 uur 22 min
Microexpressions are brief, involuntary facial expressions that are cues to the true emotions that someone is feeling. We see microexpressions in tiny twitches of the brows, the lips and nose. They can last for as little as 1/15th of a second on the face. Lees meer
In this episode we describe the science of microexpressions, emotion and how to use it to connect with others.
For full PDF of the episode with links to videos of each emotion go to: https://psychiatrypodcast.com/resources
By listening to this episode, you can earn 1.25 Psychiatry CME Credits.
Link to blog.
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Join Ariana on Instagram: @joyspotting
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Hormonal Contraceptives & Mental Health
3 mei 2018 · 37 min
New research on hormonal contraceptives, "the pill", and how it influences mental health. Dr. David Puder and Dr. Mona Mojtahedzadeh explore: Lees meer
Claims about the mental health consequences of hormonal contraception
Unique Influences of progesterone and estrogen on the brain
How ovulation changes attraction and desire
Discuss the controversy around recent studies that show that hormonal contraception increases the risk of depression
Critique of those studies and counters to those critiques
Kelly Brogan and other contrasting views and their influence on this field
By listening to this episode, you can earn 0.5 Psychiatry CME Credits.
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Postpartum Depression with Dr. Pereau
24 april 2018 · 50 min
Overcoming Postpartum Depression Lees meer
Link to show on: iTunes, Google Play, Stitcher, Overcast, PlayerFM, PodBean, TuneIn, Podtail, Blubrry, Podfanatic
This week on the podcast, I joined with Dr. Pereau to talk about postpartum depression, both from a personal level and as those who treat it in our patients.
Dr. Pereau is incredibly honest and vulnerable in this emotional episode as she shares her story. Throughout it, she talks about the symptoms of her postpartum depression, including:
Intrusive thoughts
Emotional disconnection from her baby
Sleep deprivation
Hopelessness
Problems with concentration
Disconnection from passion and joy
Panic attacks and anxiety
Poor self care
It had never occurred to Dr. Pereau that she would struggle with postpartum depression, though she had treated many people with it, and could easily recognize symptoms in others. Often, when we are experiencing these kinds of things, it's hard to identify the symptoms within ourselves. We understand the need for someone with a recognizable disorder, such as bipolar or schizophrenia, to get help. But depression can be a slippery, indefinable problem when it comes to labeling ourselves.
If you are dealing with postpartum depression, know that it can be treated, and there absolutely hope to work through it. Here are some things that can help:
Breastfeeding to stimulate connection and positive hormone production
SSRI treatment (medications prescribed by a doctor)
Talk therapy
A good support system
If you've been experiencing the symptoms we discuss in this podcast, there are plenty of resources, plenty of people who can help you during this time.
The Edinburgh Postnatal Depression Scale is a simple questionnaire that can tell you if you are experiencing postpartum depression.
For a list of local support groups in the region, www.postpartumprogress.com is a wonderful resource.
Postpartum Support International is another great resource for online support groups and educational materi…
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Performance Enhancement with Dr. MaryEllen Eller
17 april 2018 · 52 min
Our bodies are "wired" to perform. Learning how to consciously modulate your internal sympathetic state is the key to unlocking optimal performance. The autonomic nervous system (ANS) facilitates survival by generating the fight-or-flight response and promotes recovery following activation (the ability to relax). The ANS achieves this by balancing two complementary systems: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). For example, your ANS is currently adjusting your pupillary diameter, respiratory rate, blood pressure, heart rate, skin conductance, sweat production, sphincter tone and postural muscles (just to name a few) to allow you to focus your eyes to read this information without passing out, falling over, overheating or urinating on yourself. Lees meer
For PDF with full notes on our discussion and breathing: https://psychiatrypodcast.com/resources
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
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Join Dr. Eller on:
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Sensorium: Medications, Drugs (THC, Alcohol), Medical Issues, Sleep, and Free Will
5 april 2018 · 47 min
Learn: Lees meer
Why to optimize medical issues like hypertension and diabetes
Change psychiatric and non-psychiatric medications to optimize brain function
Optimize sleep to obtain rest and increase brain function
How drugs influence the brain short and long term to change sensorium
How viewing yourself without "free will" influences brain function
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
For PDF with citations and full notes go to: https://psychiatrypodcast.com/resources
Join David on Instagram: dr.davidpuder
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Exercise as a Prescription for Depression, Anxiety, Chronic Stress (like Diabetes) and Sensorium
23 maart 2018 · 37 min
Western society faces is the most unhealthy we've ever been. It's reached epidemic proportions: depression, anxiety, poor focus and sensorium issues, chronic stress, and diseases of chronic stress (like diabetes). The solution is simple—exercise and healthy eating. Lees meer
In this episode, I will be going through 17 studies on how exercise influences and improves these factors. I will cover how it works, and how to develop an exercise program from the perspective of a doctor, not just for body sculpting.
Some things I am covering:
Strength training decreases depression
Strength training increases cognitive function
Fitness decreases risk of dementia
Exercise increases BDNF
Strength training and exercise in treatment for diabetes
By listening to this episode, you can earn 0.5 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
For PDF with citations: https://psychiatrypodcast.com/my-resources
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Diet on Cognitive Function, Brain Optimization, Sensorium Part 2
15 maart 2018 · 24 min
What are the best diets for the brain and cognitive function? Lees meer
How much does diet influence our sensorium?
What particular foods are important?
How do we change our genes to optimize our brain?
By listening to this episode, you can earn 0.5 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
For PDF with citations and detailed notes go to: My Resource Page
Ask David questions on Instagram: dr.davidpuder
Twitter: @DavidPuder
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Schizophrenia with Dr. Cummings: Controversies, Brain Science, Crime, History, Exercise, Successful Treatment
6 maart 2018 · 57 min
In this episode, Dr. Puder addresses the fascinating realm of schizophrenia with Dr. Cummings, a previous guest in the show. Dr. Cummings is a psychiatrist with a wealth of experience from working at Patton State Hospital in California, one of the biggest forensic hospitals in the world. Lees meer
-Defining Schizophrenia
-Living with Schizophrenia and Perception of Reality
-Are Negative Symptoms in Schizophrenia Precipitated by Medications?
-Emil Kraepelin, and the Early Studies on Schizophrenia
-The Pathology, Biology, and Genetics of Schizophrenia
-Cannabis Use and Risk For Schizophrenia
-The Loss of Brain in Schizophrenia
-Counter-arguments Against Robert Whitaker's "Anatomy of an Epidemic"
-Schizophrenia Prevention in High Risk Population
-Australian Study on Children of Schizophrenic Parents
-Crime, Violence, Mass Shootings and Schizophrenia
-Medical Management of Schizophrenia
-1st Break Psychosis
-Long-acting Injectable Antipsychotics in Early Illness
-Medication Adherence
-Exercise, Lifestyle, Diet Optimization
By listening to this episode, you can earn 1 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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CV of Dr. Michael A. Cummings
Assistant Producer: Arvy Wuysang
Editor: Trent Jones
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Physicians Receiving Treatment, with Dr. Trenkle
28 februari 2018 · 47 min
This week I had a discussion with Dr. Darcy Trenkle on the difficulty of providers to get psychiatric treatment, using ourselves as the examples. In a recent article nearly 40% of physicians surveyed said they would be reluctant to seek formal medical care for treatment of a mental health problem because of concern that this may put their medical license in jeopardy. Physicians have three times the national average for suicide and have unique stressors and often a culture not conducive to seeking help. We discussed difficulties we had in contemplating getting care for different issues we faced. Hopefully, this will open a discussion regarding the conflicts providers have in engaging needed help. Dr. Trenkle is a psychiatrist in Southern California and is affiliated with Loma Linda University Health. She received her Medical Degree from Loma Linda University School of Medicine. She completed her residency training at Loma Linda University in 2015. She is the Medical Director for Electroconvulsive Therapy as well as Program Development for the Behavioral Medical Center at Loma Linda University. If you are a Medical Student, Resident or Attending listening to this and need help, please reach out to a local provider. We are open to receive emails if you are local, our names are searchable in the Loma Linda email system. Lees meer
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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Sensorium: Total Brain Function Optimization Part 1
19 februari 2018 · 42 min
Sensorium is the total brain capacity for focusing, processing, and interpreting. It is not a static state—it can fluctuate throughout the day. Lees meer
It can be influenced by sleep, food, stress, exercise, drugs, medications, and long term, through epigenetic phenomenon.
If there is damage to the structure of the brain, it can permanently lowered.
It is a slope, which we all move up and down on, based on our baseline, but then also influenced by many factors.
In your 20s and 30s you are very far on the left side of the line. If you get stressed, sleep deprived, starving, maybe have a small infection, you may still be able to think, but just less clearly. If you did those same things to an elderly person, they would be sent into a full delirium, hallucinating, throwing things, yelling, seeing spiders on the wall, and looking psychotic. In this way it is common for an elderly person with dementia, they can be more confused in the evening then in the morning, they call this "sundowning".
We all have a baseline level of brain function, and this can be optimized by several factors like good sleep, good amounts of exercise, good mental functions (like reading), meaningful relationships, good spiritual practice, and meaningful work.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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Personal Website: www.DavidPuder.com
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A Journey Learning Psychotherapy, with Randy Stinnett, Psy.D
13 februari 2018 · 33 min
This week David Puder, M.D., has a discussion with Randy Stinnett, Psy.D, regarding his journey to become an excellent therapist. Randy shares aspects of his journey and insights. His enthusiasm is contagious. He discusses formative influences including Habib Davanloo, Donald Kalsched, and Todd Burley. Please follow the link to the website for Randy Stinnett's list of 5 recommendations for someone aspiring to be an excellent therapist. Lees meer
By listening to this episode, you can earn 0.5 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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Link to Randy Stinnett, Psy.D Short CV
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Inpatient Child and Adolescent Suicidality, "Culture of death", "13 Reasons Why" with Dr. Britt
6 februari 2018 · 52 min
In this episode I will be interviewing William Britt, PhD level clinical psychologist, an expert in cognitive behavioral therapy, object relations therapy, EMDR and a board certified neuropsychologist. He runs cognitive rehabilitation groups and neuropsychological assessments, and supervises neuropsychological fellows and interns. He also works closely with the psychiatric residents teaching about suicide. Lees meer
In this episode, Dr. William Britt explores his experiences running an inpatient psychiatric group for 5 to 13 year olds who are being treated for violence or attempted suicide, using uses a method based on Irving Yalom's inpatient group psychotherapy technique.
We discuss how the trend of teen suicide has increased over the years and the typical causes of depression. We also cover common bullying tactics and how cyber bullying has changed society. We then discuss how to use the group's support to help each other move away from being suicidal. We explore how the Netflix TV series "Thirteen Reasons Why" has influenced young minds and the new terms the patients are using.
In the end, Dr. Britt and Dr. Puder answers how we adapt and recover from trauma, and how we find meaning and value within stress.
By listening to this episode, you can earn 0.75 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
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CV of Dr. Britt
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Psychopathy with Michael A. Cummings M.D.
29 januari 2018 · 57 min
In this episode, Dr. Cummings and I discuss psychopathy: the fearless, empathyless people, who see others as objects, and have the inability to attach within relationships. Dr. Michael Cummings recently contributed to a book called "Violence in Psychiatry," detailing the biological aspects of psychopathy, edited by Stephen Stahl. Dr. Cummings works at Patton State Hospital, one of the biggest forensic hospitals in the world. He is the Yoda of the psychiatric world, with many other psychiatrists bringing him their most complex and difficult cases. Lees meer
In this episode we cover:
History of psychopathy
Influence of early life traumas
Prosocial careers of psychopaths
Biological components in psychopathy
The emotion psychopaths fail to see
BDNF (brain-derived neurotrophic factor)
Prefrontal area (the parent of the brain that warns us "that is not a good idea")
Amygdala
Why psychopathy has not been bred out of existence
Advice when you are in a relationship with a psychopath
What drugs make someone look psychopathic
Effect of alcohol andmethamphetamines on the brain
Influence of cocaine on the brain
Why more men are violent psychopaths
And treatment of this group of people (clozapine's influence on glutamate)
The Story of Phineas Gage
We also wrestle with how to increase the percentage of psychopaths that end up helping society vs percentage that become criminals.
Warburton, K and Stahl S (Editors). Violence in Psychiatry. The Neurobiology of Psychopathy. Cambridge University Press 2016), pp. 200-05
CV of Dr. Michael A. Cummings
By listening to this episode, you can earn 1 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David on Instagram: dr.davidpuder
Twitter: @DavidPuder
Facebook: DrDavidPuder
Editor: Trent Jones
*This podcast is for informational purposes only and is the opinions of the people on this episode. For full disclaimer go here.
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Cognitive Distortions and Practicing Truth
23 januari 2018 · 36 min
This week we discussed cognitive distortions with Adam Borechy. Usually cognitive behavioral therapists deal with cognitive distortions by helping their clients identify habitual negative thoughts and and putting those thoughts on trial. We don't have to accept every thought that passes through our brains as truth. When we have distressing thoughts, it can be helpful to consider if we might be telling ourselves the full truth about a situation. Lees meer
We refer to common cognitive distortions—depression, anxiety, feelings of failure, negative thoughts when interacting with people, social anxiety—and we see how they are applying to our thought process.
For a PDF of the cognitive distortions and a 8 days journal task towards better identifying them in your life, please see my resource page. In this 8 day journey you will better identify your own troubling thoughts and move towards gratitude.
Here are a list of the cognitive distortions:
All or nothing thinking: things are black and white, completely without shades of gray. For example, you may think, "If I am not perfect, I should not try at all, because then I would fail completely." Or you might think, "My significant other is completely evil." And then the next day, "My significant other is perfect."
Overgeneralization: generalizations are made without context, experience or evidence. "I am always alone." Or "Everyone hates me." "I never win." Always? Never? Everyone? It happens absolutely all the time, without exceptions? In the moment, it can feel like that, but those statements are actually rarely true. Speaking truth to yourself in this case might look like: I am sometimes alone, several people are upset at me, I win sometimes, even if I didn't this time.
Mental Filter: focusing on the negative rather than the whole picture. After receiving multiple positive statements and one negative statement, all you focus on is the negative statement.
Disqualifying the positive: When you do something good like get a compli…
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The Basics of the Psychiatric Interview Part 1
16 januari 2018 · 59 min
In this first episode, I talk about my approach to seeing a new patient for the first time. I go over the importance of empathy and psychological safety in the first interview. I then go into how to do some of the components of a psychiatric history. I go into details on what parts are important and why. Please see my resource page for a full PDF of my notes and also the PDF of the document I give to patients prior to their first appointment with me. Lees meer
By listening to this episode, you can earn 1 Psychiatry CME Credits.
Link to blog.
Link to YouTube video.
Join David and post your comments for this episode on Instagram: dr.davidpuder
Twitter: @DavidPuder
Facebook: DrDavidPuder
Editor: Arvy Wuysang
*This podcast is for informational purposes only and is the opinions of the people on this episode. For full disclaimer go here.