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 more broadly about the explosion of various applications of ultrasound beyond imaging, including thi...
Jun 11, 2025•44 min•Ep. 75
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 diagnosis, the debate surrounding irritability as a diagnostic criterion, and the challenges of distinguishing ...
May 16, 2025•1 hr 2 min•Ep. 74
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 comments to [email protected]. References and readings (when available) are posted at the end of each e...
Mar 27, 2025•35 min•Ep. 73
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 conversion disorder because it was previously thought that repressed emotions or desires had been converted i...
Mar 20, 2025•25 min•Ep. 72
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 [email protected]. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com . All opinions expressed in this podca...
Mar 10, 2025•24 min•Ep. 71
-- 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 [email protected]. Please leave feedback at https://www.psydactic.com or send any comments to [email protected]. 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...
Feb 23, 2025•16 min•Ep. 70
"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 to offer. I am excited that Mark let me share his interview with Dr. Tyler Black, who talks about evaluating su...
Jan 31, 2025•1 hr 47 min•Ep. 69
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 graciously allowed PsyDactic to include a couple of his episodes in this feed as a way to spread the good n...
Jan 09, 2025•1 hr 9 min•Ep. 68
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 crash courses and boot camps, and features interviews with experts in the field. Some specific PBC episodes ...
Jan 09, 2025•27 min•Ep. 67
--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 the absence of full agonists but decrease it in their presence. Inverse agonists reduce the baseline activity...
Dec 27, 2024•24 min•Ep. 66
--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 the therapist’s model and their particular way of interpreting that model. But what exactly is this elusive b...
Aug 18, 2024•30 min•Ep. 65
-- 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 aggression or highly limited interests in autism can result in exactly the wrong medication being given ...
Aug 11, 2024•36 min•Ep. 64
-- 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 forensic psychiatrist as the main character. We explore topics like medical ethics, medical education, popul...
Jul 23, 2024•56 min•Ep. 63
- - 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 is found to be two to three times higher than is often found for serotonin reuptake inhibitors, which a...
Jul 12, 2024•32 min•Ep. 62
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 Fallacy, but he is working to apply this idea to his own clinical practice. We could all benefit from recogn...
Jul 01, 2024•55 min•Ep. 61
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 results can be truly helpful and informative. But statistics are also poop in poop out machines, and adding more...
Jun 26, 2024•32 min•Ep. 60
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 complicated. Dr. O'Leary reviews the brain regions responsible for various kinds of aphasia and how to identity them. P...
Jun 09, 2024•37 min•Ep. 59
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 through short periods of time as sensory data changes to help us better navigate the world, not only i...
May 04, 2024•33 min•Ep. 58
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 single task when queried and able to send that information to wherever it should go. More modern ideas ...
Apr 24, 2024•23 min•Ep. 57
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 schizophrenia, bipolar disorder, depression, anxiety, an eating disorder, insomnia, PTSD, borderline personality ...
Apr 12, 2024•25 min•Ep. 56
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 leave feedback at https://www.psydactic.com or send any comments to [email protected]. Reference...
Mar 20, 2024•14 min•Ep. 55
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 friend then decided to set fire to the home to cover up the evidence. This resulted in the man’s death....
Mar 03, 2024•30 min•Ep. 54
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 variable results. Please leave feedback at https://www.psydactic.com or send any comments to feedback@...
Feb 16, 2024•46 min•Ep. 53
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 interactions. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psyd...
Feb 09, 2024•47 min•Ep. 52
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 made progress) in our understanding of this disorder over the next 75 years. As usual, Dr. O'Leary also wa...
Feb 02, 2024•40 min•Ep. 51
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. Proposed criteria include a Personality Disorder - Trait Specified diagnostic category that permits dia...
Jan 26, 2024•23 min•Ep. 50
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 individuals. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic...
Jan 22, 2024•26 min•Ep. 49
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 compulsive disorder, and how our various treatments might work to stabilize these networks. Please leave feedbac...
Jan 16, 2024•58 min•Ep. 48
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 motivate ourselves to reach our goals, and, sometimes, convince us that we are fusing bodies with a t...
Dec 31, 2023•33 min•Ep. 47
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 whether they were discovered prior to 1980 or not. A few weeks ago, I was lucky enough to encounter a paper that was publish...
Dec 15, 2023•22 min•Ep. 46
