Psychiatry Boot Camp

In this insightful discussion, Dr. Anne O'Melia, Chief Clinical Officer at ERC Pathlight, and Dr. Patricia Westmoreland, forensic psychiatry expert, explore the complexities of eating disorders. They address how to identify when disordered eating requires clinical attention, detailing anorexia, bulimia, and ARFID. The conversation covers prevalence rates, high-risk populations, and emphasizes the urgent need for compassionate care and empathy in treatment. Listeners gain valuable insights into navigating levels of care and the critical role of building therapeutic alliances.

In this episode, I sit down with Dr. Mira Zein, clinical associate professor at Stanford and co-author of the APA Resource Document on Decisional Capacity Determinations, to break down one of the most frequent and misunderstood consults in psychiatry.We go deep into the Appelbaum–Grisso criteria and discuss how they apply to real-world cases where the answer isn’t always clear. Dr. Zein walks us through difficult scenarios, from life-saving refusals to medically complex delirium cases, highlighting how to think, document, and communicate clearly when capacity is in question. This episode will help you shine on rounds, guide your primary team through their own assessments, and remind you that capacity isn’t about saying “yes” or “no”, it’s about respecting autonomy while protecting patients at their most vulnerable. Takeaways: Capacity is decision-specific and time-specific. It’s not a global judgment, and it can fluctuate with illness, treatment, or environment.The Appelbaum–Grisso framework defines the process. Every evaluation should include communication, understanding, appreciation, and reasoning.Primary teams can and should do their own assessments. Psychiatrists are consultants, not gatekeepers; the best work happens through collaboration.Delirium, dementia, and psychosis are common culprits. Each affects different aspects of capacity, requiring tailored interventions and re-evaluation.Documentation is key. Define the specific decision, describe your assessment of each criterion, and explain your reasoning clearly for the record. Key resources: 1) APA Resource Document on Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist (2019) 2) Seminal Article on Appelbaum-Grisso Criteria (Appelbaum 1988) 3) Evaluating Capacity: Appelbaum’s Framework Interpreted Diagrammatically (Bari 2023) SUPPORT OUR PARTNERS: ⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Organ transplantation isn’t just a medical miracle, it’s a psychological marathon. In this episode, I talk with Dr. Paula Zimbrean, Yale psychiatrist and pioneer in Transplant Psychiatry, about what really happens when mind and medicine intersect at the edge of life and death. We walk through the evolution of psychiatry’s role on transplant teams,  from risk gatekeeping to long-term integration, and explore what pre-transplant evaluations truly aim to uncover. Dr. Zimbrean shares how to assess risk, capacity, and motivation in patients preparing for transplant, and what it means to treat not just the organ recipient, but their family and support system as well. We also discuss the unseen emotional toll of the transplant journey, from steroid-induced mood changes to post-traumatic stress symptoms, and why empathy is as vital as immunosuppression. Takeaways: Transplant psychiatry has evolved. It began with managing post-op delirium and psychosis, but now focuses on enhancing long-term outcomes through integrated psychiatric care.Pre-transplant evaluations go beyond “yes” or “no.” They assess diagnosis, prognosis, capacity, adherence potential, and the patient’s understanding of lifelong treatment demands.Psychiatrists aren’t gatekeepers, they’re collaborators. The goal is to identify modifiable risks, optimize mental health, and align medical decisions with patient values.The journey is psychologically intense. From waiting list uncertainty to post-op PTSD and steroid-induced mood shifts, every stage requires active psychiatric support.The future is integration. As patients live longer post-transplant, psychiatry’s role will increasingly involve ongoing care, research, and improving quality of life beyond survival. Selected references: Transplant Psychiatry: A Case-Based Approach to Clinical Challenges Transplant Psychiatry: An Introduction SUPPORT OUR PARTNERS: ⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Tyler Black, a child and adolescent psychiatrist at the University of British Columbia, dives into the critical topic of suicide risk assessment. He debunks common myths and emphasizes the necessity of empathetic communication during evaluations. The discussion highlights the emotional burden felt by both patients and healthcare providers. Black categorizes suicidal motivations using a sociological framework and stresses the importance of tailored interventions. He also navigates the complexities of patient autonomy versus safety in mental health care.

In this episode, I talk with Dr. George Grossberg, a pioneer in geriatric psychiatry, about the neuropsychiatric symptoms of dementia and what they look like, why they happen, and how to approach them with empathy and strategy. We walk through the most common behavioral disturbances in dementia, including apathy, depression, psychosis, and agitation. Dr. Grossberg shares how to think through these cases, when to reach for medication, when to hold back, and how to anchor every decision in an understanding of who the patient truly is. Takeaways: Neuropsychiatric symptoms are nearly universal in dementia. Expect them, don’t be surprised by them.Apathy and depression aren’t the same. Treating apathy like depression often fails; gentle engagement works better than antidepressants.Start with environment and empathy. Music, structure, exercise, and caregiver education should come before medication.Use medication sparingly and strategically. When needed, match the drug to the symptom, and always reassess risk versus relief.Knowing the person changes everything. Understanding a patient’s history, preferences, and rhythms is as therapeutic as any pharmacologic plan. Selected References: ⁠Progress in Pharmacologic Management of Neuropsychiatric Syndromes in Neurodegenerative Disorders: A Review (Cummings 2024) Neuropsychiatric Symptoms of Dementia and their nonpharmacological and pharmacological management (Tampi 2022)⁠ Management of BPSD Algorithm (Chen with Osser 2021)⁠ Atypical Antipsychotics for Aggression and Psychosis in Alzheimer's disease (Ballard 2006) Efficacy and Adverse Effects of Atypical Antipsychotics for Dementia (Schneider 2006) Sequential Drug Treatment Algorithm for Agitation and Aggression in Alzheimer's and Mixed Dementia (Davies 2018) SUPPORT OUR PARTNERS: ⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Catatonia isn’t just mysterious, it’s one of the most treatable yet misunderstood syndromes in psychiatry. In this episode, I continue my conversation with Dr. Mark Oldham, diving deep into what to actually do when you suspect catatonia. We talk through the Lorazepam challenge, what a “positive” response really means, and why sometimes a single dose can look like a miracle. We also dig into the gray zones—how to approach patients who don’t respond, when to move to ECT, and what to do when catatonia overlaps with delirium or psychosis. Dr. Oldham shares his framework for identifying special cases, from benzodiazepine withdrawal to clozapine discontinuation, and explains why history-taking, not algorithms, is psychiatry’s most powerful diagnostic tool. Takeaways: Start simple, but think deeply. Lorazepam remains first-line for catatonia, but the absence of RCTs means clinical reasoning still leads the way. ECT is definitive and underused. For refractory or malignant catatonia, ECT is often curative, but access and consent barriers remain a major challenge. Not all catatonia is the same. Withdrawal states, chronic schizophrenia, and periodic catatonia each demand tailored interventions. Delirium and catatonia can coexist. Treat both cautiously, start low, go slow, and always look for autoimmune or neurological causes. History is your best guide. Behind every catatonic presentation is a story, missing it can mean missing the cure. Selected references: ⁠British Association for Psychopharmacology Guidelines⁠ ⁠⁠Rochester Catatonia Assessment Resources⁠⁠ ⁠NEJM Review on Catatonia⁠ ⁠Nature Review on Catatonia⁠ ⁠Schizophrenia Research Volume on Catatonia⁠ ⁠Describing the Features of Catatonia (Oldham)⁠ SUPPORT OUR PARTNERS: ⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠Beat the Boards⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠Sales@Human-Content.Com⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

When a patient stops moving, stops speaking, or stares through you like you’re not there, it’s easy to miss what’s really happening. In this episode, I’m joined again by Dr. Mark Oldham, one of the leading voices on catatonia, to break down what this strange, often misunderstood syndrome actually looks like in the real world. We walk through the diagnostic features step-by-step, how to assess, what to ask, and what’s too often overlooked. From the history of the disorder to modern DSM confusion, from the meaning of “waxy flexibility” to the haunting truth about patients who are fully aware but trapped inside their bodies, this conversation will completely change the way you think about motor symptoms and psychiatric emergencies. Takeaways: Catatonia is common, but underrecognized. It’s not just “psychiatric immobility.” It spans a spectrum from stupor to hyperactivity. Diagnosis starts with curiosity. Learn to test for features like mutism, posturing, and negativism systematically. Many patients are aware. Always treat them with dignity and assume comprehension, even when they can’t respond. It’s treatable and rapidly reversible. A single dose of lorazepam can sometimes unlock a frozen mind and body. Malignant catatonia kills. When autonomic instability appears, it’s a medical emergency that demands immediate escalation and often ECT. Selected references: British Association for Psychopharmacology Guidelines ⁠Rochester Catatonia Assessment Resources⁠ NEJM Review on Catatonia Nature Review on Catatonia Schizophrenia Research Volume on Catatonia Describing the Features of Catatonia (Oldham) SUPPORT OUR PARTNERS: ⁠⁠SimplePractice.com/bootcamp⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠Beat the Boards⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠Sales@Human-Content.Com⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Mark Oldham, Associate Professor of Psychiatry at University of Rochester Medical Center, President-Elect of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry, further explores delirium. This episode covers the pathophysiology of delirium including predisposing and precipitating factors, neurocircuitry, and neurotransmitters. We then discuss conceptual frameworks for management of delirium, the importance of identifying and addressing the underlying cause, and strategies for managing specific neuropsychiatric disturbances in delirium. References can be found on the ⁠episode website.⁠ SUPPORT OUR PARTNERS: ⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Mark Oldham, a consult psychiatrist and president-elect of the American Delirium Society, dives into the world of delirium. He explores its clinical features, emphasizing the need for accurate diagnosis, particularly distinguishing it from encephalopathy. Oldham discusses the alarming prevalence of delirium in hospitalized patients, especially the elderly, and its terrifying consequences, such as increased mortality rates. Furthermore, he sheds light on the vital role psychiatry plays in managing delirium, stressing the interplay between psychiatric symptoms and medical conditions.

When you think about core topics in consultation-liaison psychiatry, “supportive psychotherapy” probably isn’t the first thing that comes to mind. But maybe it should be. In this episode, I sit down with Dr. John C. Markowitz, Columbia psychiatrist, researcher, and co-author of Supportive Psychotherapy: A Guide, to talk about the therapy that “gets no respect.” Dr. Markowitz explains how this deceptively simple approach, built on empathy, affect, and alliance, rivals more “sophisticated” treatments for depression. We explore why the most powerful interventions often come down to being present, listening well, and helping patients feel understood. And we talk about the threat facing psychotherapy itself and what we stand to lose if psychiatrists give it up. Takeaways: Supportive psychotherapy works and evidence shows it can be just as effective as CBT or IPT for depression. Common factors like alliance, empathy, affect focus, and ritual account for much of what makes any therapy succeed. Following affect matters emotions are uncomfortable, but they’re not dangerous, and they guide the healing process. Less is often more letting patients lead, listening actively, and resisting the urge to “fix” can create deeper insight. Psychotherapy is under siege and preserving its human core may be psychiatry’s most important act of resistance. Selected references: What is Supportive Psychotherapy? (Markowitz 2014) Brief Supportive Psychotherapy (2022) Psychiatrist Effects in the Psychopharmacological Treatment of Depression (McKay 2006) SUPPORT OUR PARTNERS: ⁠⁠SimplePractice.com/bootcamp⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠Beat the Boards⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠Sales@Human-Content.Com⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices