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 antipsychotics both in the short term and after many months or years of use. As the title suggests, there is...
Dec 14, 2023•37 min•Ep. 45
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 original study design. This re-analysis found much much lower rates of remission. It reported the cum...
Dec 11, 2023•22 min•Ep. 44
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 related to the function of the major dopamine networks of the brain: the mesolimbic, mesocortical, nigrostriatal, an...
Dec 03, 2023•32 min•Ep. 43
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 leave feedback at https://www.psydactic.com or send any comments to [email protected]. References an...
Nov 11, 2023•29 min•Ep. 42
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 specific that they may not realize they are communicating. Those of us seeing a patient after a brain injury...
Oct 18, 2023•25 min•Ep. 41
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 identity as a thing separate from the world around us), and considering salient aspects of the social ...
Aug 07, 2023•15 min•Ep. 40
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 order to avoid aversive stimuli. The most basic kinds of rewards that neuroscientists can study are f...
Jul 18, 2023•26 min•Ep. 39
W e 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, attention control, and task switching. The entire DLPFC is extensively connected to other cortical re...
Jul 17, 2023•36 min•Ep. 38
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 that makes that possible. More and more we are identifying crucial hubs or nodes within our brain tha...
Jul 14, 2023•20 min•Ep. 37
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 question that you are asking. As a referring provider, then, it is helpful to know what kinds of tests a psychol...
Jul 12, 2023•40 min•Ep. 36
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 defined purpose. Is it to be used for diagnosis in a clinic or for research? Is it going to measure symptoms...
Jul 11, 2023•26 min•Ep. 35
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 [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 those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this ...
Jun 08, 2023•30 min•Ep. 34
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 comments to [email protected]. References and readings (when available) are posted at the end o...
May 17, 2023•23 min•Ep. 33
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 be. Please leave feedback at https://www.psydactic.com or send any comments to [email protected]. ...
May 04, 2023•29 min•Ep. 32
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 context. Please leave feedback at https://www.psydactic.com or send any comments to [email protected]. R...
Apr 13, 2023•27 min•Ep. 31
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 worse after they received some kind of treatment. It seems strange that there is something that can tak...
Mar 13, 2023•25 min•Ep. 30
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 future. Dissociation is a word that has frustrated me. I have heard it used to describe everything fro...
Feb 26, 2023•26 min•Ep. 29
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 comments to [email protected]. References and readings (when available) are posted at the end of each epis...
Jan 13, 2023•22 min•Ep. 28
S ociety 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. Jake Goodman who posed with a pill on his tongue in a TIC TOC post to demonstrate that even as a physician, he ...
Jan 04, 2023•14 min•Ep. 26
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 choreiform or dance-like movements of the extremities which earned it the moniker “Huntington’s Chorea." Huntingt...
Dec 03, 2022•30 min•Ep. 25
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 rumination over their own worthlessness), and then help identify how various modalities may be more or l...
Nov 03, 2022•29 min•Ep. 24
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 depressive episodes. This is done mostly with medications although psychotherapy, lifestyle modifications ...
Oct 23, 2022•39 min•Ep. 23
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 identify and pick out details of both our environment and our thoughts and memories), and the Salience...
Oct 05, 2022•20 min•Ep. 22
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 our thoughts and the environment and hope what we are noticing at any point in time is what will help keep...
Sep 10, 2022•14 min•Ep. 21
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 the example). Please leave feedback at https://www.psydactic.com or send any comments to feedback@psy...
Aug 24, 2022•13 min•Ep. 20
B ehaviors 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 on in the brains of humans who qualify for psychiatric diagnoses, and can help us to develop better ta...
Aug 10, 2022•15 min•Ep. 19
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 name in 2016 by Montoya, Bruins, Katzman, and Blier in Neuropsychiatric Disease and Treatment . Its ba...
Jul 29, 2022•17 min•Ep. 18
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 [email protected]. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buz...
Jun 25, 2022•12 min•Ep. 17
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 [email protected]. References and readings (when available) are posted at the end of each episode transcript, loca...
Jun 14, 2022•21 min•Ep. 16
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 arbitrary use of the term agitation to describe patients. Please leave feedback at https://www.psydactic.com or...
May 21, 2022•13 min•Ep. 15
