PsyDactic - Residency

PsyDactic - Residency

A resource for psychiatry residents, medical students, physicians or interested others to expand their knowledge of neuroscience, psychopharmacology, neuromodulation, psychotherapy, and other psychiatric interventions, as well as discussions of ethics, the history of psychiatry, and human psychology in general. This podcast is not medical advice. Find transcripts with show-notes and references at . You can leave feedback at


March 13, 2023 24 min

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 ...

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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...

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January 13, 2023 21 min

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.

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January 8, 2023 15 min

You may have heard that Dr. Google now has some serious competition.  It comes from artificial intelligence. Chat GPT is a text generating program that was trained to respond to prompts from users like you and me.  What will it say to our psychiatry patients?  I gave it some prompts to find out.

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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. Jake Goodman who posed with a pill ...

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December 3, 2022 30 min

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 th...

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November 2, 2022 29 min

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 worthlessnes...

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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...

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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 bot...

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September 10, 2022 14 min

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 an...

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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).

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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 on in the brains of humans who quali...

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July 28, 2022 17 min

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, Ka...

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June 24, 2022 12 min

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.

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June 14, 2022 20 min

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.

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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 desc...

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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.

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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.

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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 References and readings (when available) are posted at the end of each episode transcript, located at p...

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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 interaction with the world.

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