PsychRounds: The Psychiatry Podcast

Discussion of tardive dyskinesia presentation and underlying dopamine changes. Explanation of how VMAT2 inhibition reduces presynaptic dopamine to improve movements. Comparison of valbenazine and deutetrabenazine pharmacokinetics, dosing, and metabolism. Review of side effect profiles, drug interactions, and safety concerns. Practical considerations for choosing between the two medications.

Dr. Allen Frances, Professor Emeritus of Psychiatry at Duke and former DSM‑IV chair, reflects on the history and consequences of psychiatric diagnosis. He discusses how diagnostic criteria were created, unintended spikes in autism and bipolar diagnoses, the roles of industry and users in rising rates, and the promises and pitfalls of AI and chatbots in mental health.

A concise run-through of topiramate’s psychiatric roles and origins. They cover its FDA history, mechanisms, dosing and interactions. Listeners hear trial data on alcohol use disorder, eating disorders, and antipsychotic-related weight mitigation. Cognitive and other notable adverse effects are highlighted, plus where evidence is mixed or lacking.

Mark Ruffalo, MSW, DPsa, a psychotherapist and psychiatry educator, challenges how we decide what counts as psychiatric illness. He critiques reliance on the DSM and explains diagnostic validators. He explores diagnostic hierarchy, risks of false comorbidity, debates around medication in borderline personality, and presents the PRISM tool for more parsimonious diagnosis.

Welcome back! Today we are at the highly prescribed and popular benzodiazepine Lorazepam, also known as Ativan. We look at its uses in psychiatry, especially catatonia. But despite anecdotal efficacy, does the evidence hold up? References:https://www.ncbi.nlm.nih.gov/books/NBK532890/https://pubmed.ncbi.nlm.nih.gov/36805317/https://pubmed.ncbi.nlm.nih.gov/6120058/https://pubmed.ncbi.nlm.nih.gov/10229064/https://psychopharmacologyinstitute.com/section/catatonia-diagnosis-the-lorazepam-challenge-2911-5899/

Welcome back! Today we are embarking into the first of hopefully several episodes on the importance of vitamins and minerals in mental health. We will specifically be looking at the role of iron deficiency in psychiatry and do an overview on some of the recent research that's been published. References: https://www.ncbi.nlm.nih.gov/books/NBK557376/https://www.sciencedirect.com/science/article/pii/S0268960X25000827#bb0165https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823909https://www.sciencedirect.com/science/article/pii/S1389945717315599https://pubmed.ncbi.nlm.nih.gov/40841680/https://pubmed.ncbi.nlm.nih.gov/1677067/https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00463-7/fulltexthttps://pmc.ncbi.nlm.nih.gov/articles/PMC6139360/

Dr. Laura Lachance, a psychiatrist and researcher focused on nutritional psychiatry, dives into the fascinating link between diet and mental health. She explains the Antidepressant Food Score, highlighting nutrient-rich foods like leafy greens and seafood. Lachance discusses the EASE-GAD trial, revealing how omega-3s can help alleviate anxiety, and the cost-effectiveness of the Mediterranean diet. She emphasizes the importance of tailored nutrition approaches and advocates for incorporating these principles into clinical practice for better mental health outcomes.

Join Dr. Robert Sapolsky, an esteemed Stanford professor and expert in neuroendocrinology, as he unravels the complexities of stress and its impact on behavior. He explains how chronic stress can harm brain function and shape psychiatric responses. Sapolsky highlights the role of genes and environment in resilience, and explores cultural influences on mental health norms. Delve into provocative ideas about determinism and the implications for justice, urging compassion over blame. This enlightening conversation offers valuable insights into the biological roots of our choices.

The hosts celebrate a milestone while revisiting SSRIs, diving into their historical roots and the evolution of antidepressants. They explore the limitations of the serotonin theory and discuss SSRIs' broader impacts on the gut and neuroplasticity. Adverse effects, such as sexual dysfunction and weight changes, are highlighted, along with concerns about youth suicidality and cautious use in bipolar disorder. The conversation wraps up with reflections on SSRIs' role in modern psychiatry and the implications of overprescription.

This discussion dives into the history of Xanax, tracing its approval for anxiety and panic in the '80s. The hosts explore its rapid effects on the GABA-A receptor and highlight safety concerns, including addiction and withdrawal risks. They emphasize its suitable use for acute anxiety rather than long-term treatment. Intriguingly, they touch on its potential antidepressant effects and regulatory challenges, including a denied depression indication. Comparative efficacy against other medications offers more insight into its role in anxiety management.