Mdedge Psychcast

Christine Moutier, MD, joins Lorenzo Norris, MD, to discuss how clinicians can scale up interventions to reduce suicide rates amid the pandemic. Dr. Moutier is chief medical officer of the American Foundation for Suicide Prevention. She reported no disclosures. Dr. Norris also reported no disclosures. Take-home points Death by suicide is a health outcome, which means that there is always a place to intervene, whether clinically, socially, or through research. Risks for suicide during the pandemic are known to increase; however, it is not a foregone conclusion that suicide deaths will rise during or afterward. Mental health diagnoses are a risk factor for suicide, and there will be interplay with stressors such as unemployment, financial stress, grief, and socioeconomic disparities. The basics of suicide prevention include screening for suicidal ideation at behavioral health appointments. If a change in risk is identified, clinicians should use a patient-centered intervention, such as a safety plan. Summary

Philip Resnik, PhD, returns to the Psychcast, this time with his research partner and wife, Rebecca Resnik, PsyD, to discuss the interface between language, psychiatry, psychology, and health. Dr. Philip Resnik appeared on the show previously to discuss artificial intelligence, natural language processing, and mental illness. He is a professor in the department of linguistics at the University of Maryland, College Park, and has a joint appointment with the university’s Institute for Advanced Computer Studies. Dr. Philip Resnik has disclosed being an adviser for Converseon, a social media analysis firm; FiscalNote, a government relationship management platform; and SoloSegment, which specializes in enterprise website optimization. Some of the work Dr. Philip Resnik discusses has been supported by an Amazon AWS Machine Learning Research Award. Dr. Rebecca Resnik is a licensed psychologist in private practice who specializes in neuropsychological assessment. In 2014, she served as cofounder of the Computational

Dr. Renee Kohanski discusses how important personal and professional development is among physicians in the workplace. Is your current job worth it? Clinical Correlation is a bi-monthly drop on the Psychcast feed. You can email the show at [email protected] and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast  

Sanjay Gupta, MD, conducts a Masterclass on treating geriatric patients with symptoms of dementia, particularly amid the restrictions tied to COVID-19. Dr. Gupta is chief medical officer at BryLin Hospital in Buffalo, N.Y. He is also is a clinical professor in the department of psychiatry at the State University of New York, Syracuse, and is affiliated with SUNY at Buffalo. Dr. Gupta attends at 8-10 nursing homes. He disclosed serving on the speakers’ bureaus of AbbVie, Acadia, Alkermes, Intra-Cellular Therapies, Janssen, and Otsuka. Take-home points Common neuropsychiatric symptoms in patients with dementia include agitation, aggression, delusions, insomnia, anxiety, and depression. One-third of community-dwelling elders and between 60%-80% of nursing facility patients have these neuropsychiatric symptoms. The most common medication class Dr. Gupta uses is antipsychotics. The use of these medications in individuals with dementia is off label. The Food and Drug Administration maintains a black-box warning on

David Henry, MD, host of the Blood & Cancer podcast, joins Psychcast host Lorenzo Norris, MD, to discuss steps clinicians can take to alleviate the distress associated with receiving a diagnosis of cancer. Dr. Henry is clinical professor of medicine at the University of Pennsylvania, Philadelphia. He has no disclosures. Dr. Norris is director of consult liaison psychiatry at George Washington University, Washington. He has no disclosures. Take-home points Cancer patients have always been susceptible to developing depression and anxiety after receiving their distressing diagnoses. During the COVID-19 pandemic, the risk for depression and anxiety are even greater because patients face separation from their oncology treatment teams and for some, delays in treatment. Major depressive disorder (MDD) occurs in up to one-third of cancer patients, and any depressive disorder can be seen in about half. Another concern is how to screen for depression in the context of cancer. Dr. Norris suggests using the Patient

Dr. Renee Kohanski, MD, uses a proverb to discuss how she talks to patients about face masks, and how she talks to patients with face masks on. What's hiding behind the mask? *  *  * Clinical Correlation is a bi-monthly drop on the Psychcast feed. You can email the show at [email protected] and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast  

Psychcast host Lorenzo Norris, MD, talks with members of the Group for the Advancement of Psychiatry’s Media Committee about how to help patients navigate the uncertainties associated with educating K-12 and college students during the pandemic. The discussion is moderated by Jack Drescher, MD. Dr. Norris is assistant professor of psychiatry and behavioral sciences and assistant dean of student affairs at George Washington University in Washington. He also serves as medical director of psychiatric and behavioral sciences at George Washington University Hospital. Dr. Norris has no conflicts of interest. Dr. Drescher is clinical professor of psychiatry at Columbia University in New York, adjunct professor at New York University, and a training and supervising psychoanalyst at the William Alanson White Institute. He has no conflicts of interest.  Joining Dr. Norris and Dr. Drescher are Carol Bernstein, MD; Jeffrey Freedman, MD; Gail Saltz, MD; and Peter Kramer, MD. None of the guests have a conflict of interes

Richard Balon, MD, returns to the Psychcast, this time to conduct a Masterclass on the impact of marijuana use on patients, particularly adolescents. Dr. Balon is professor of clinical psychiatry and anesthesiology and associate chair of education at Wayne State University in Detroit. He has no disclosures. Take-home points Marijuana remains a controversial topic as potential legalization looms large in public policy and various groups espouse the positive benefits of marijuana. Current marijuana formulations are more potent than formulations used in previous years. Formulations used today have a higher tetrahydrocannabinol content, with up to 80% THC content achieved through artificial selection. Clinicians are rightly concerned about the well-established negative effects of marijuana on specific populations, particularly adolescents. They also worry about the effect of marijuana on brain development, which could affect educational outcomes, and the significant risk of developing psychosis and/or schizophre

Introducing Clinical Correlation, a new podcast drop from the Psychcast. Renee Kohanski, MD, began producing observational segments for the Psychcast since its inception in April 2018. Clinical Correlation episodes will be published on Mondays twice per month. In this first edition, Dr. Kohanski recalls a poignant moment during her training when her mentor and then director, Donald Morgan, MD (https://bit.ly/35PAqY6), reconsidered his opinion prior to testifying in a court of law based on a simple question from a trainee. For Dr. Kohanski, this moment emphasized the importance of honest and open conversations.  You can email the show at [email protected] and you can learn more about the show at https://www.mdedge.com/podcasts/psychcast   

Jeffrey R. Strawn, MD, talks with host Lorenzo Norris, MD, about assisting children and adolescents with anxiety and anxiety disorders, particularly during the COVID-19 pandemic. Dr. Strawn, a previous Psychcast guest, discusses ways for mental health clinicians to think about proportionate anxiety versus anxiety that is severe, continual, and persistent. He is director of the anxiety disorders research program at Cincinnati Children’s Hospital Medical Center and an associate professor of psychiatry at the University of Cincinnati. Dr. Strawn has received research support from several pharmaceutical companies and from the National Institute of Mental Health. He also has received royalties from Springer. Dr. Norris is assistant dean of student affairs, and assistant professor of psychiatry and behavioral sciences at George Washington University, Washington. He has no conflicts of interest. Take-home points Anxiety is a normal emotional reaction critical to survival. Yet, when the emotions become extreme, anx

Psychcast host Lorenzo Norris, MD, talks with Peter Yellowlees, MBBS, MD, about the changes to clinical practice forced by the COVID-19 pandemic and the likelihood that many of these changes are here to stay. Dr. Yellowlees is a professor of psychiatry and chief wellness officer at the University of California, Davis. He has no disclosures. Dr. Norris is director of consult liaison psychiatry at George Washington University, Washington. He has no disclosures. Take-home points Prior to the COVID-19 pandemic, 1%-2% of psychiatric consultations occurred on telepsychiatry modalities. During the pandemic, however, telepsychiatry has become the norm for psychiatric patient encounters. With the pandemic, the federal government relaxed many regulations that limited the use of telehealth. For many, telepsychiatry is now a preferred modality, because it confers high patient satisfaction, and many view it as more egalitarian, convenient, and less intimidating. Some even consider it more private, because the patient do

Psychcast host Lorenzo Norris, MD, meets Renee Kohanski, MD, to announce the launch of Clinical Correlation. In Clinical Correlation, which will be released every other Monday, starting Sept. 14, Dr. Kohanski will expand on her “Dr. RK” segment and explore issues of interest to the practicing psychiatrist. And later, we will revisit four of Dr. Kohanski’s “Best of” segments. Next week, Dr. Norris will return with an interview with Peter Yellowlees, MD, about clinicians’ embrace of telepsychiatry during the pandemic. They also discuss whether many of the COVID-19–related changes – including those tied to reimbursement – are here to stay. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: [email protected]

Anique K. Forrester, MD, joins host Lorenzo Norris, MD, to discuss the importance of continuing to work in academic medicine. Dr. Forrester is assistant professor at the University of Maryland, Baltimore. She also serves as director of the consultation-liaison psychiatry fellowship at the university. Dr. Norris and Dr. Forrester have no conflicts of interest. Take-home points Dr. Forrester recently wrote an article in the New England Journal of Medicine discussing minority underrepresentation in academic medicine and the persistent labor of love required to stay in departments that do not explicitly value diversity. Underrepresented minority colleagues leave for many reasons, and Dr. Forrester highlights the issues of invisibility, lack of mentorship and support, and burden of microaggressions. Dr. Forrester focused her article on why she stays in academic medicine, feeling that it is critical her voice is heard; she knows her presence has changed the tone and outcome of issues. As she says: “One of the thin

Philip Resnik, PhD, joins host Lorenzo Norris, MD, to discuss the use of AI and natural language processing to help clinicians identify patterns in the behaviors of patients with mental illness. Dr. Resnik is a professor in the department of linguistics at the University of Maryland, College Park. He also has a joint appointment with the university’s Institute for Advanced Computer Studies. Dr. Resnik has disclosed being an adviser for Converseon, a social media analysis firm; FiscalNote, a government relationship management platform; and SoloSegment, which specializes in enterprise website optimization. Some of the work Dr. Resnik discusses has been supported by an Amazon AWS Machine Learning Research Award. Dr. Norris disclosed having no conflicts of interest.  And don’t miss the “Dr. RK” segment, with Renee Kohanski, MD.  Take-home points  Artificial intelligence (AI) refers to the effort to get computers to develop capabilities that humans would consider intelligent when people do them. For example, a “s

Abigail Kay, MD, MS, joins host Lorenzo Norris, MD, to discuss the treatment of patients with substance use disorders. Dr. Kay is an addiction psychiatrist at Thomas Jefferson University Hospital in Philadelphia and is associate dean of academic affairs and medical student education at Sidney Kimmel Medical College. Dr. Norris is assistant dean of student affairs, and assistant professor of psychiatry and behavioral sciences at George Washington University, Washington. Dr. Kay disclosed no conflicts of interest for the past year. Before that, she reported receiving payment from the American Society of Addiction Medicine, through a grant from the Substance Abuse and Mental Health Services Administration, to teach a free training to clinicians to be certified to prescribe buprenorphine. Dr. Norris, who also serves as medical director of psychiatric and behavioral sciences at George Washington University Hospital, disclosed no conflicts. Take-home points Substance use disorders have genetic and environmental f

Derek M. Griffith, PhD, joints host Lorenzo Norris, MD, to discuss different ways to look at men’s health within the context of COVID-19. Dr. Griffith is founder and director of the Center for Research on Men’s Health at Vanderbilt University, Nashville, Tenn. He also serves as professor of medicine, health, and society at the university. Neither Dr. Griffith nor Dr. Norris have disclosures. And do not miss Renee Kohanski, MD, who offers a message of hope in the “Dr. RK” segment. Take-home points The confluence of the COVID-19 pandemic, the death of civil rights leader Rep. John Lewis, and the death of Herman Cain from COVID-19 requires us to reflect on race, gender, personal identity, and our own vulnerability. Sometimes denial in the form of thinking “that won’t happen to me” is a trope within masculinity, especially black masculinity, and can lead to men delaying preventive treatments and interventions, which makes them more vulnerable to excess morbidity and mortality from preventable diseases. Some r

Episode 128 interview: Philip G. Janicak, MD, joins MDedge Psychiatry Editor in Chief Lorenzo Norris, MD, to discuss device-based therapies for psychiatric patients. Dr. Janicak is adjunct professor of psychiatry and behavioral sciences at Northwestern University in Chicago. He serves as an unpaid consultant to Neuronetics and has a financial relationship with Otsuka. Dr. Norris, medical director of psychiatric and behavioral services at George Washington University Hospital in Washington, has no disclosures. Take-home points  Therapeutic neuromodulation, including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), refers to the use of device-based therapies that alter neurocircuitry implicated in the pathophysiology of psychiatric disorders. Most available evidence is from studies in major depressive disorder, though more research is emerging for bipolar disorder and other diagnoses The advantage of TMS is minimal cognitive adverse effects, compared with ECT.  Dr. Janicak recomme

Dmitry M. Arbuck, MD, joins host Lorenzo Norris, MD, to discuss ways psychiatrists can help patients with treatment-resistant chronic pain. Dr. Arbuck is clinical assistant professor of psychiatry and medicine at Indiana University, Indianapolis. Dr. Arbuck also serves as president and medical director of Indiana Polyclinic, a multispecialty pain management facility, and is an associate editor of Current Psychiatry. Both Dr. Arbuck and Dr. Norris disclosed having no conflicts of interest. And do not miss the “Dr. RK” segment, where Renee Kohanski, MD, discusses part 2 of her examination of the constructs of medicine. Take-home points Acute and chronic pain are mediated by different mechanisms and therefore must be treated differently. Acute pain is caused by tissue damage leading to nociception, and it should heal. Chronic pain is the chronification of acute pain and more of an emotional state with sensations of pain without clear tissue damage. Many neurotransmitters are involved in pain, including dopamine

Roger S. McIntyre, MD, returns the Psychcast, this time to talk with host Lorenzo Norris, MD, about the mental health hazards of COVID-19 and what clinicians can do to help protect patients. Dr. McIntyre is professor of psychiatry and pharmacology, and head of the mood disorders psychopharmacology unit at the University Health Network at the University of Toronto. He disclosed receiving research or grants from the Stanley Medical Research Institute and the CIHR/GACD/National Natural Science Foundation of China. Dr. McIntyre also disclosed receiving consultation/speaker fees from several pharmaceutical companies. Dr. Norris has no disclosures.  Take-home points Uncertainty tied to the COVID-19 pandemic threatens to undermine mental health and exacerbate problems for those with mental illness. U.S. suicide rates, which were already rising after the Great Recession of 2007-2009, are likely to climb further because of the impact of COVID-19. Clinicians can take steps to prevent some of the negative mental health

Jack Rozel, MD, MSL, returns to the Psychcast, this time to discuss with host Lorenzo Norris, MD, how to think about guns, gun violence, and the intersection with mental health. Dr. Rozel is medical director of resolve crisis services at the University of Pittsburgh Medical Center/Western Psychiatric Hospital and president of the American Association for Emergency Psychiatry. He has no conflicts of interest but has worked for a gun dealer to teach sales staff how to recognize people in crisis – rather than sell a gun. Dr. Norris has no disclosures.   Take-home points In the United States, more guns were sold in the month leading up to the COVID-19 pandemic than were ever sold in 1 month since gun sales were recorded. Suicide risk with a new gun in the home peaks in the first days to weeks of ownership and then trails off, but there is a measurable difference in risk of suicide in the 5 years after the purchase. Any surge in gun sales leads to greater accidental deaths and homicides from firearms. Rozel remi