PsyDactic
A resource for psychiatrists and other medical or behavioral health professionals interested in exploring the neuroscientific basis of psychiatric disorders, psychopharmacology, neuromodulation, and other psychiatric interventions, as well as discussions of pseudoscience, Bayesian reasoning, ethics, the history of psychiatry, and human psychology in general. This podcast is not medical advice. It strives to be science communication. Dr. O'Leary is a skeptical thinker who often questions what we think we know. He hopes to open more conversations about what we don't know we don't know.
Episodes
Oppositional Defiant Disorder is a Syndrome, not a Primary Disorder
Dr. O'Leary discusses his critical perspective on Oppositional Defiant Disorder (ODD) and argues that ODD is not a primary diagnosis but rather a risk syndrome, a set of symptoms (defiance, irritability, and vindictiveness) resulting from various underlying conditions like ADHD, anxiety, or trauma. He explains that conceptualizing ODD as a stand-alone disorder often leads to the risky treatme
Neuroplasticity - What is it?
Neuroplasticity is a real thing that is shrouded in mythology and used by companies to market products, but what do we actually know about neuroplasticity?Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expre
Psychoanalysis, Active Inference, Artificial Intelligence, and Human Development with Dr. Grant Brenner
Dr. Grant Brenner joins Dr. O'Leary to explore the fascinating intersection of human psychology, physics, psychotherapy and artificial intelligence. We discuss Active Inference and The Free Energy Principle along side how babies develop a sense of self and so much more.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and readings (w
Dissociated Identities (aka Alters) - How are they formed?
Is it possible to house multiple alternate selves within the same brain? Dr. O'Leary argues that it is not only possible, but under certain conditions it is likely to happen. Dissociative Identity Disorder is discussed not as a "shattering of the self," but instead as a failure to integrate the self during development. Dr. O'Leary explores different biologically and computa
Dissociation - What is it really?
Dr. O'Leary explores the neuroscience of dissociation, defining it as a degenerate concept that refers to a wide range of functional disconnections within the brain rather than a single clinical entity. The discussion moves from the standard medical definitions—such as depersonalization, derealization, and amnesia—toward a broader view of dissociation as a neurobiological defense mechanism th
Can hooking your head up to a fancy battery (tDCS) cure depression?
In December 2025, the FDA authorized the Flow F100, an innovative at-home wearable headset that utilizes transcranial direct current stimulation (tDCS) to treat major depressive disorder. Unlike traditional pharmaceuticals that act systemically, this device targets the dorsolateral prefrontal cortex with localized electricity to modulate neuronal excitability and address the asymmetry hypothesis
Game Theory for Parents and Other Humans with Kevin Zollman
PsyDactic welcomes The Game Theorist's Guide to Parenting co-author, Kevin Zollman who discusses game theory as the science of strategic thinking. We explore how mathematical models like the Prisoner’s Dilemma and mechanism design can be used to manage family dynamics by creating win-win solutions rather than competitive, zero-sum outcomes. The conversation highlights practical techniques suc
Childhood Deficit Disorder and the Atrophy of American Childhood
Dr. O'Leary proposes Childhood Deficit Disorder as a way to conceptualize the rise in mental health issues among modern youth, exploring how systemic changes in culture and environment contribute. He contrasts the "free-range" parenting style prior to the 1980s, which fostered autonomy and resilience, with the modern trend of intensive, managerial parenting driven by economic anxiet
Clozapine - Beyond the Basics
Dr. O'Leary explores the history of clozapine, highlighting its initial revolutionary impact as the first atypical antipsychotic, followed by a ban on its use, followed by its re-emergences as a strictly monitored medication, and then culminating in new recommendations that greatly encourage its use. The discussion details the severe side effects that led to its initial discontinuation, and
Therapeutic Ultrasound with Dr. Michael Canney PhD
This episode includes a fascinating interview with a researcher in ultrasound, Dr. Michael Canney who is an acoustics researcher the chief scientific officer at a French company named Carthera (https://carthera.eu/) and they make ultrasound devices that can disrupt the blood-brain barrier in order to let medicines into the brain that otherwise could only get through in very small amounts.We talk m
Pediatric Bipolar vs Disruptive Mood Dysregulation Disorder
This PsyDactic podcast episode, hosted by Dr. O'Leary, delves into the complex and often controversial topic of diagnosing Pediatric Bipolar Disorder and its differentiation from other conditions, particularly Disruptive Mood Dysregulation Disorder (DMDD). Dr. O'Leary, a Child and Adolescent Psychiatry Fellow, explores the DSM-5-TR diagnostic framework, the history of Pediatric Bipolar d
Gambling Disorder - Rarely Diagnosed, Highly Prevalent
Gambling disorder may be the most under-diagnosed disorder in the DSM. This is an exhaustive treatment of the neurobiological, psychological, and societal aspects of gambling addiction, featuring discussions on the brain's reward system, cognitive distortions, and the impact of advertising and the design of gambling products.Please leave feedback at https://www.psydactic.com or send any comm
Functional Neurological Disorder, Predictive Processing and Active Inference
Functional Neurological Disorder was previously called Conversion Disorder or psychogenic neurological symptoms and is a condition in which a patient develops any number of neurological symptoms (such as loss of ability to move or seizure like episodes or inability to feel parts of their body or phantom pain) that cannot be explained by a clear lesion in the nervous system. It was called conversi
Behaviorism Part 1 - Classical Conditioning
Dr. O'Leary introduces PsyDactic - Child and Adolescent Board Study edition by sharing the first of two episodes on behaviorism, that field of psychology that took the radical stance of completely ignoring the fact that we have a mind.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and readings (when available) are posted at the end
Nicotinic Receptors, Anxiety, and PTSD - an A.I. generated discussion
-- Dr. O'Leary explores how an artificial intelligence tool summarizes recent data on the use of nicotinic receptor modulators for the treatment of anxiety and PTSD. Please send any comments to feedback@psydactic.com.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and readings (when available) are posted at the end of each episode
An extraordinary perspective on Suicide Risk Assessments from Dr. Tyler Black via Psychiatry Boot Camp
"People are 14 times more likely to die during a hospital stay than outside of hospital for inpatient psychiatry." In the last episode, I shared an episode of Psychiatry Boot Camp, which is a podcast created by Dr. Mark Mullen to help medical students and junior residents hone their psychiatric skills. Mark interviews some of the most competent and amazing psychiatrists our country has
Dr. Mark Mullen interviews Dr. Awais Aftab and Dr. Allen Frances on Psychiatry Boot Camp
In the last episode, Dr. O'Leary interviewed the creator and host of the Psychiatry Bootcamp Podcast, Dr. Mark Mullen, who is currently a psychiatry clerkship director at St. Louis University School of Medicine. He created this podcast after discovering a dearth of resources available for medical students and junior psychiatry residents to prepare them for their transition to practice. He gr
Meet the Psychiatry Bootcamp Podcast brought to you by Dr. Mark Mullen
Dr. O'Leary is excited to introduce you to Psychiatry Boot Camp (PBC), a podcast created by Dr. Mark Mullen during his psychiatry residency to help prepare medical students for psychiatry residency. It covers fundamental topics in psychiatry and inspires young psychiatrists to think critically about their approach to the field. The curriculum is based on published literature on psychiatry cr
In a Word - Agonist
--In today's episode, Dr. O'Leary explores agonists, inverse agonists, partial agonists, and antagonists. These terms describe how molecules bind to receptors and either increase, decrease, or prevent changes in receptor signaling. Agonists increase receptor activity, with full agonists like dopamine and serotonin raising activity to its maximum. Partial agonists can increase activity in
In a Word - Transference (with a dash of neuroscience)
--Dr. O'Leary discusses the term Transference, and if you listen until the end, he relates it to some computational neuroscience. Transference is a historically loaded term. Transference is supposed to be an unconscious process, so it can not really be observed, only inferred, so this means that both the definition of transference and any instance of it in psychotherapy is dependent upon t
Catatonia in Autism and Neuroatypical Patients - Easy to miss, Harder to Treat
-- More recently I have faced the diagnostic conundrum of catatonia in autism, and that is what I want to explore in more excruciating detail today. There is surprisingly little literature on the subject, and that is concerning because being able to identify and treat catatonia can be life-saving, not to mention life-altering for patients and their caretakers. Misidentifying catatonia as mere
Mindhunting with Forensic Psychiatrist Dr Michael Schirripa
-- Dr. O’Leary interviews forensic psychiatrist and author Dr. Michael Schirripa about his career as a forensic psychiatrist, the release of his first thriller, Mindhunt, and his podcast Mindhunting. Dr. Shirripa explores how his love of literature influenced his decision to pursue forensic psychiatry and ultimately resulted in his creation of an international thriller with an ambitious forens
Psychedelics - A skeptical approach to MDMA aka Ecstasy
- - In the world of psychotropic medication, the question is not just whether it works or not, but whether it works better than a placebo and whether the effect size is clinically significant and the benefits outweigh the risks. In the case of MDMA (aka molly or ecstasy), the effect size for improving post-traumatic stress disorder symptoms reported by researchers has been very large. Often it i
The Narrative Fallacy in Psychological and Psychiatric Clinical Practice with Dr. Alexey Tolchinsky, PsyD
The Narrative Fallacy describes our tendency to find meaning, connections, and causal relationships where they do not necessarily exist. In this episode, Dr. O'Leary had the pleasure of interviewing Dr. Alexey Tolchinsky.He recently published a paper called “Narrative fallacy and other limitations of psychodynamic case formulation.” Dr. Tolchenski did not invent the idea of the Narrative Fa
Psychometrics - The Dangers of Rating Scales and Screeners
Dr. O'Leary discusses a variety of concerns that all clinicians should have in mind when using psychometrics. In the end, he hopes you come away with some level of agreement with the statement: “Our primary concern should not be with the quantity of data, but with the quality of the data.” Statistics are conceptual machines that will produce results no matter what you feed them. These res
In a Word - Aphasia
In this episode, Dr. O'Leary discusses a word that he has struggled to understand since medical school. The word is aphasia. The root “phasia” comes from the Greek phanai which means “to speak.” When aphasia is used medically, it refers to an inability to speak, although not always. More generally it is often used to mean a failure to understand or produce language, but it gets complicate
WTF Cerebellum - Little Brain, Big Deal
I did not until recently even consider the cerebellum when thinking about psychiatric conditions, but the more I read, the more I wonder why the cerebellum is not considered a potential important player in nearly every psychiatric disorder. Although it can be said that all brain regions primarily function to make predictions, the cerebellum is especially active at refining impromptu predictions t
WTF - Thalamus
The thalami are bilaterally symmetrical structures in the subcortical part of the brain that are cradled by the basal ganglia. They are major hubs of pretty much everything your brain does and all of the sensory information coming into the brain with the exception of smell.More primitive models of the brain visualized it as a bunch of relatively isolated modules, each specialized to perform a sin
Seroquel (Quetiapine) - Drugs, Sex, Money and Psychopharm
In this episode, I discuss a medication that patients who saw a psychiatrist or their primary care provider between about 1997 and 2015 were very likely to find themselves prescribed. More recently, it has been taken down a notch or two on prescribers lists of preferred meds. This medication is quetiapine, marketed as Seroquel by AstraZeneca in the US. Whether you were diagnosed with schizophre
In a Word - Confabulation
This episode continues an intermittent series called “In a Word.” Past episodes have explored words like Akathisia, Dissociation, Perseveration, and even the difference between Impulsive and Compulsive. This episode explores Confabulation, including some of the brain circuits involved, and what might differentiate confabulation from other kinds of false or implanted memories or delusions.Please
How guilty are adolescents for their crimes?
In 2012 the Supreme Court heard two related cases involving adolescents convicted of murder and sentenced to life in prison without parole because of mandatory minimum sentencing guidelines in their states. One of the boys, Evan Miller along with an accomplice, had beat a man unconscious with a baseball bat after a fight that ensued when the man awoke to find Miller robbing him. Miller and his f
Serious Mental Illness in America with Dr. Zac Brooks
I am lucky today to be able to bring you an interview with Dr. Zac Brooks who is passionate about serious mental illness (SMI). “What is serious mental illness?” you might ask. That is one of the things we are going to discuss, and you may be surprised when Dr. Brooks explains how it was first formally defined. We also discuss the numerous ways the US has tried to reform how SMI is treated with
HIV, PrEP, and Mental Health with Dr. Jon Lindefjeld
PsyDactic welcomes Dr. Jon Lindefjeld for a discussion of the history of HIV and AIDS. In particular, we discuss the development of effective antiretroviral therapies, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), highlighting the CDC guidelines for use and monitoring, need to treat psychiatric com-morbidities, and the importance of monitoring adherence and drug i
Perspectives on the Borderline: The Most Disordered Personality
Dr. O'Leary discusses some of the history of the borderline personality, how different perspectives have attempted to explain its origin, how to treat it and how not to treat it. He starts in 1947 with some colorful descriptions of patients living with borderline personality disorder that would never get published today, and highlights some of the ways in which we have made progress (or not
The Ghost of Personality Disorders Future
Our current diagnostic criteria for personality disorders have failed to demonstrate validity or reliability. The DSM 5 encouraged psychiatrists to start considering a broad range of personality features adapted from the Five Factor Model. These are combined with global functioning measures to build a personality inventory for any patient who is having dysfunction related to their personality. P
Tattoos, Stigma, Racists, and Psychiatry
Humans have a history of tattooing that stretches millennia into prehistory. The western ban on tattoos by the early church resulted in a systematic effort to paint tattooed individuals as pagan, primitive, vulgar, criminal, and mentally ill. Psychiatrists have historically contributed to this characterization but are in a position to help reframe how citizens and policymakers view tattooed indi
Attractor Networks and the Bayesian Brain
The brain understands the world by building models that predict the future. One of the ways that it does this is by utilizing attractor networks. These small world networks are constantly trying to determine what is a true signal from the constant noise in the neural net. Dr. O'Leary explores how attractor networks have been hypothesized to explain psychosis, depression, and obsessive comp
Serotonin - Jack of All Trades, Master of None
When I started to make this episode, I thought I would try to do a comprehensive review of all of the various functions of serotonin across its 15 or more receptor types, but I soon found myself overwhelmed. More importantly, I found that some stories are more interesting to tell than others, so here I discuss serotonin and focus on how a few 5-HT receptors can not only help us survive, but also
Antipsychotics and their discontents
Frequently I have complained that the terms "typical and atypical" or "first generation and second generation" antipsychotics were not very helpful. When I give chalk talks to junior residents and interns about antipsychotics, this is one of the first things that I note. It is the medicines relative affinities for different receptors that appear to make the difference, not wh
Extrapyramidal Side Effects and Tardive Dyskinesia for Super Nerds
This episode explores side effects of antipsychotics at the molecular level. It starts by exploring receptors and their ligands and takes a turn into the dorsal striatum where dopamine, acetylcholine, serotonin, and glutamate work together to help us dance the mamba. Dr. O'Leary explores what happens when the complex pathways of the cortico-striatal-thalamo-cortical tract are disrupted by a
The STAR*D Trial: Scientifically Flawed or Scientific Fraud?
The authors of the famous sequenced treatment alternatives to relieve depression trial or STAR*D reported that about two-thirds or 67% of patients had achieved remission after 4 trials of antidepressant medication. This remission rate has been questioned over the years and in October of 2023, the journal BMJ Open published an article that reports to have reanalyzed the date from STAR*D using the
Dopamine Networks and Psychosis
This episode is about dopamine. In episode 32, I discussed the pseudoscientific trend of the “dopamine detox” or "dopamine fasting." Instead of talking about pseudoscience in this episode, I discuss the actual science surrounding dopamine and its relationship with the neuroleptics or antipsychotics as they are more commonly known. The effects and side effects of antipsychotics are r
In a Word - Impulsive vs Compulsive
In this Episode, I continue an intermittent series called “In A Word.” The difference between prior episodes and this one is that today I have two words. I chose these words because I don’t really know the difference between them, and even after reading and trying to understand the difference, I am not sure that there is a clear difference. The two words are Impulsive and Compulsive.Please lea
Traumatic Brain Injury - How Severe Was It?
I discuss something that is likely to present itself to a physician long after the fact: a single mild brain injury. This episode focuses on how to classify the severity of a single brain injury. While working in a brain injury unit, I noticed that some providers used the term severe brain injury when referring patients to neurology or neuropsychiatry, and this communicates something very speci
The Medial Prefrontal Cortex
This episode continues a series on the prefrontal cortex, a complex region of the brain that gives us the ability to have the kinds of thoughts no other species on earth is known to have. The medial (or mesial) prefrontal cortex is especially important for emotional and autonomic regulation, attention and goal-directed behaviors (including addiction), and building our sense of self (that is our
The Orbitofrontal Cortex - Our built-in Economist
In this episode, I am sliding down and under the front part of the brain and consider the orbital frontal cortex, that part of the brain right above and a little behind your eyes. It is much smaller than the lateral gyri on the prefrontal cortex, but appears to be an important probability generator in our brain when we need to consider different options that can result in different rewards or in
The Dorsolateral Prefrontal Cortex - Our Executor and Speech Writer
We seem to understand the specializations of the the dorsolateral prefrontal cortex on the left better than the right side of our brain. That is because most of us do a lot more language processing on the left or dominant side. The more inferior and caudal parts of the dorsolateral PFC on the left side are more specialized for speech. The more superior parts are more involved in working memory,
The Prefrontal Cortex - An Introduction to What Makes Us Human
Besides being relatively hairless apes, there are some things about humans that make us special among animals. In the past we have noted things like, “We have big brains and we use tools,” or “We contemplate the future and our own mortality,” or “We use a truly complex language both verbal and written to communicate complex ideas.” These are things we have and do, but what is it about our brains
Psychological versus Neuropsychological Testing
This episode is about how to decide whether to send a patient to get neuropsychological or just psychological testing, and this decision is determined by at least two things. The first is the question that you are trying to answer. The second is, what can the service that I am referring to provide for the patient? In this episode, I will focus primarily on the first consideration: the questi
In a Word - Validity
Today I discuss the term “validity.” Let’s say we wanted to develop a test that identifies pathological character traits or quantifies depression symptom burden on a patient. A good test is going to do more than simply list the diagnostic criteria for various diagnoses and then ask the patient if they think that sounds like them. A test needs to have a few things. First it needs to have a defi
Guns - Starting the Conversation
Today I talk about guns. More specifically, I talk about talking about guns.Please leave feedback at https://www.psydactic.com or send any comments to feedback@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 n
In a Word - Akathisia
Today I am continuing an intermittent series called, “In a Word,” and the word that I chose for today is akathisia. Akathisia is broadly defined as an inability to remain still. If you ask someone with Akathisia to stop moving, they will likely become very uncomfortable, but while they are moving, they experience at least some relief.Please leave feedback at https://www.psydactic.com or send any
Dopamine Detox and Pseudoscience
There is a narrative wave in popular psychology and neuroscience that has taken a small amount of very basic science and twisted it into a fantastic narrative of feast and famine. Its central character is dopamine. The Dopamine Detox also known as dopamine fasting is a pseudoscientific treatment that at best illustrates how magnificently strange and evidence-less some claims about dopamine can b
Artificial Intelligence and Psychiatry
I have recently added some artificial intelligence produced answers to psychiatry questions in my past episodes in an effort to try to understand what it is that AI text generators can do and what value they might add to my future as a psychiatrist versus what problems it might introduce into my practice. I realized that since I have opened this pandora's box, I need to provide some more cont
What is a placebo?
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 w
In a Word - Dissociation
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 f
Adult ADHD and Bayesian Reasoning
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 or send any comme
Artificial Challenges for Physician Mental Health
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.
Neuropsychiatry - Huntington Disease
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 chore
Neuronal Networks: Depression
It is unlikely that any model of major depressive disorder is likely to find universal signals among those diagnosed because the symptoms are so diverse. However, it does seem likely that models, such as brain-network models, will be able to identify common dysfunctions among those with similar symptom burdens (for example, those with primarily anhedonic symptoms, dysphoria, or with excessive rum
Treating Bipolar Depression with Dr. Tom DePietro
Bipolar disorder is a complex, often debilitating and potentially life threatening illness in which the patient goes from episodes of depression to episodes of mania or hypomania, most often with periods of relative euthymia in between these episodes. The most common way to conceptualize the treatment of bipolar disorder is by phase. The ideal goal would be preventing the distinct manic and depre
Neuronal Networks: The Central Executive Network... and some philosophy
In previous episodes I have tried to draw pictures in your mind (using those fat crayons that babies like to chew on) of some of the brain networks that are important in many mental illnesses. We have talked specifically about the Default Mode Network (that is concerned with imaginal thoughts and self-referential thoughts and memories), the Dorsal and Ventral Attention Networks (that help us to i
Neuronal Networks: The Salience Network
What is salience? Fundamentally it is a value judgment that determines where your brain will place its limited resources. There are a lot of things that could draw our attention. The world is full of sights, sounds, smells, pressures, temperatures, stretches. Our mind is full of thoughts. Without a salience network, we wouldn’t know what matters and what doesn’t. We would just randomly scan
Neuronal Networks: The Attention Networks
Today, I am going to explore the Attention Networks, which are the parts of our brain that get really excited when, for example, we see something that we have never seen before, something that appears to be moving on its own volition (and might harm us), something that appears out of place (like an eyeball on the floor), or something that reminds us of something we really want (I’ll let you pick t
Neuronal Networks: The Default Mode Network
Behaviors are complex. We have networks of neurons functioning in systems, some of which ramp other systems up, and some of which dampen others down. This ballet of correlation (when increased activity in one network predicts increased activity in another) and anticorrelation (when increased activity in one network predicts decreased activity in another) can help us to understand what is going o
The Noradrenergic Paradox
One of the most influential models in psychiatry’s history for understanding brain dysfunction is the monoamine hypothesis. In short, it proposes that deficiencies or excess of certain neuromodulating agents, in particular the monoamines serotonin, dopamine, and norepinephrine (AKA noradrenaline) drive many psychiatric disorders. The paper I will primarily reference is a publication by the same
Gender Language and the DSM 5-TR
This is an episode to report updates in the DSM 5-TR that can be practice changing. I will also divulge a little about myself and how my philosophy and values have changed. In particular, I am reminded of how I have struggled to understand transgendered and other gendered individuals.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and r
Catatonia Diagnosis - Bush Francis versus the DSM
I originally promised a review of the Bush Francis Catatonia Rating Scale, but while reviewing it, I came across some questions that I think are even more interesting. I will discuss Bush Francis, but I want to do it in a larger context of the challenges that Psychiatrists face with diagnosis in general.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.
Catatonic Signs - Echolalia, Echopraxia, and Agitation
Dr. O discusses the remaining hyperactive or “excited” signs of catatonia including echolalia, echopraxia, and agitation. In previous episodes, Dr. O discussed other hyperactive or “excited” signs, including mannerisms and stereotypy. All of these signs share the common feature that the patient is doing something odd, repetitive, or unexpected. Dr. O also gets on his soap box about the arbitrar
Catatonic Signs - Catalepsy, Postering, Grimacing and Waxy Flexibility
In this episode, I discuss Catalepsy, Postering, Grimacing and Waxy Flexibility. I grouped the diagnostic signs that I am going to cover today because they are all similar. Your patient acts like a wax statue.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and readings (when available) are posted at the end of each episode transcript, l
Catatonic Signs - Stupor, Mutism, and Negativism
Stupor, Mutism, and Negativism on the surface appear to have some overlapping features. Of all the features of catatonia that non-experts might be able to describe, stupor and mutism are like the ones. They are also the most common signs. A patient is not entirely unconscious, but they don’t move, they stare forward, they don’t talk, and they don’t follow commands.Please leave feedback at https
Catatonic Signs - Stereotypy and Mannerisms
In the last episode, I promised [or threatened] to get into more of the nitty-gritty of the symptoms of catatonia. Well, like it or not, that is what I am going to do in this episode. Today I will focus on Mannerisms and Stereotypy, two of the potential signs of catatonia.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.References and readings (wh
Catatonia - Introduction and Overview
In this episode, I introduce a diagnosis that is not a diagnosis. By that, I mean that it is a condition that we may find our patients in, but it is not considered to be a diagnosis by itself, like major depressive disorder or schizophrenia are considered to be diagnoses. I am talking about catatonia, a condition characterized by either a lack of interaction with the world or as purposeless inte
In a Word - Perseveration
This episode is a quick take in a new intermittent series I am calling “In a Word,” and in this series I hope to dig down into some neuropsychiatric terms that we use every day, but maybe don’t really understand very well. The first word I am taking on is PERSEVERATION. The reason I chose PERSEVERATION is because I see it written in psych notes by med studs and residents frequently, but for you
Those other obsessive and compulsive disorders
My last three episodes focussed on classical cases of Obsessive Compulsive Disorder, but the DSM 5 has included a few other related diagnoses in the same chapter including body dysmorphic disorder (BDD), hoarding disorder, trichotillomania, and excoriation disorder. Each of these have distinct obsessional components and compulsions, age of onset, degree of insight, and chronic course. Hence, the
OCD - Treatments
I briefly explore how to treat patients with OCD. Choosing first-line treatment is relatively straight-forward, but there is less clarity on how to proceed if my patient does not respond. It is imperative, then, to make sure that I understand my patient’s symptoms and their goals very well.Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.Reference
OCD - Brain space
This episode explores the brain space of obsessive compulsive disorder (OCD) with a creative journey through neuroanatomy and brain circuitry. I try to make it much less boring than it sounds. After listening to this episode, it is my goal that the listener will understand the complex interactions of the cortico-striatal-thalamo-cortical (CSTC) circuit and have a fuller appreciating of how the b
OCD - A brief history
In previous episodes, I’ve hacked a path through Electroconvulsive Therapy and Transcranial Magnetic Stimulation, trying to reveal some of the secrets in those jungles. Now I am turning my machete to a different landscape: Obsessive Compulsive Disorder or OCD for short. The name is confusing, because the writers of the DSM decided to name a personality disorder Obsessive Compulsive Personality D
TMS - Intermittent Theta Bursts and the SAINT Trial
This episode is dedicated to all the med studs and residents who cringe every time they have to go to journal club. I report the results of an initial trial of a special kind of Transcranial Magnetic Stimulation of the brain that might be the future of depression treatment, at least for the treatment resistant or severe varieties. I also use this as an opportunity to explain a little more about h
TMS - A brief history
I wanted to do this episode, because when I did my episodes on electroconvulsive therapy (or ECT), I feel like I sounded a tiddly-bit dismissive of it, and I wanted to clarify what I meant when I said, “TMS, short for Transcranial Magnetic Stimulation of the Brain, as of yet is not nearly as efficacious as ECT.” If you haven’t listened to the ECT episodes, you should still be able to follow this
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