As you face the new year (and possibly Sunday blues today), you might be questioning your sense of purpose, direction, and life’s meaning. This is an episode to help you through this time of transition, which often feels crushingly paralyzing. Inspired by none other than the great psychiatrist and Holocaust survivor, Dr. Viktor Frankl, sit back and explore with me the world of existentialism.

Topics Discussed:

• Why finding your life’s purpose is important
• What does having purpose mean?
• Viktor Frankl’s logotherapy
• Philosophers: Nietzsche, Dostoevsky, Schopenhauer
• Jacques Lacan’s meaning of Love
• Love your failures

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This time of year, severe mental health conditions like bipolar disorder can worsen. In this episode, we discuss the evolution of bipolar disorder and how it came to be understood. We start with adult bipolar disorder and dive into pediatric bipolar disorder, especially its diagnostic challenges. This is a highly debated topic, so sit back, ponder, send us any questions or comments!

Topics Discussed:

• Statistics of Pediatric Bipolar Disorder
• History of Manic Depressive Illness to Bipolar Disorder
  • Dementia praecox & manic depressive insanity
  • DSM-1 through DSM-5
• Diagnostic Challenge of Pediatric Bipolar Disorder
• The Question of DMDD vs. Bipolar Disorder
• Differential Diagnoses of Bipolar Disorder:
  • ADHD, major depression, psychosis/schizophrenia, autism spectrum disorder, PTSD, borderline personality disorder, TBI, hyperthyroidism
• Pharmacological Treatments
• Psychosocial Treatments

Resources:

APA: https://www.apa.org/topics/bipolar-disorder

AACAP: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Bipolar-Disorder-In-Children-And-Teens-038.aspx

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Hello listeners! Münchausen Syndrome or factitious disorder is a fascinating yet devastating topic that we’ve taken a few recordings to discuss, especially in light of the recent Florida appeals court ruling on the famous case of Maya Kowalski. As child psychiatrists, we hope to share with you that we are relentlessly searching for answers in conditions like this, and not giving up on the pursuit despite our own vulnerabilities.

Topics Discussed:

1. History of Münchausen Syndrome
2. Diagnosis of Exclusion
3. Differential Diagnoses: malingering, somatic symptoms disorder, functional neurological symptom disorder
4. Clues to Diagnosis
5. Theories Behind Münchausen Syndrome & Münchausen by Proxy
6. Statistics on Münchausen Syndrome & Münchausen by Proxy
7. Case 1: Gypsy-Rose Blanchard
8. Case 2: Maya Kowalski
9. How families can cope with someone with possible Münchausen Syndrome
10. Treatment Approaches: Team Effort
11. Countertransference
12. Vulnerability as Physicians

**Disclaimer: Any discussion or commentary regarding the mentioned public cases is only intended for educational or illustrative purposes. No confidential or privileged information is being disclosed, and any statements made do not constitute a clinical, psychiatric nor medical evaluation or diagnosis.

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Hello listeners! We are so excited to share this episode with you. We get into the nitty gritty of treatment for PTSD in both psychotherapy and medications.

**This information is for general knowledge and does not substitute for professional medical advice, diagnosis, or treatment. Please always consult your own healthcare provider for your care.**

Psychotherapy

• Trauma-Focused CBT
• EMDR
• CPT, Prolonged Exposure, Narrative Exposure, Psychoanalytic psychotherapy (very brief, this shall be its own episode!)
• Somatic Therapy

Medications

• SSRIs: sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil)
• SNRIs: Cymbalta
• Alpha 1 antagonists: prazosin
• Beta-Blockers: propranolol
• 2nd Generation Antipsychotics: risperidone (Risperdal), quetiapine (Seroquel)
• Other antidepressants: trazodone, TCAs, MAOIs, zuranolone, lamotrigine, Topamax

Interventional Psychiatry

• TMS
• VNS
• Neurofeedback

Hallucinogens & Psychedelics

• Ketamine
• Psilocybin, MDMA
• LSD, ayahuasca

Medications NOT Recommended

• Benzodiazepines
• High-dose stimulants

Novel Research

• Hydrocortisone & neuroinflammation
• Opioids & pain control

PTSD Treatment Decision Aid by the VA: https://www.ptsd.va.gov/apps/decisionaid/

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In this episode, we discuss how trauma symptoms present in children, the challenges of diagnosing and treating trauma in children, including the limitations of current diagnostic systems, and the neurobiology of trauma response. Lastly, we discuss marginalized groups to emphasize the most important part of recovery from trauma: not feeling alone.

Topics Discussed:

• How trauma symptoms present in children
• Developmental Trauma Disorder and why it did not make it into the DSM
• The Perspectives Approach to differential diagnosis in psychiatry
• Neurobiology of trauma response
• Theories behind trauma that make sense
• The crucial role of a support system in healing from trauma

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Hello listeners! We are tackling the enormous topic of trauma. We start with how trauma response was stigmatized in history, PTSD's diagnostic criteria, overlap with other conditions such as cPTSD and borderline personality disorder, and the curious roles of memory in trauma. Enjoy!

Topics discussed:

• Shellshock, stigma of trauma
• Diagnosis based on the DSM
• Diagnoses not based on the DSM
• Prevalence
• Resources from the VA

Here is the phenomenal resource by the VA on PTSD: https://www.ptsd.va.gov/

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In this episode, we invite our good friend and colleague, Dr. Michael Couse, to discuss a recent paper that he and Dr. Kelly published in the academic journal, Journal of the American Academy of Child and Adolescent Psychiatry. The paper discusses the highly complicated (and often avoided) topic of electroconvulsive therapy (ECT) for youths with serious mental illness, especially in California. There are many fears and myths surrounding ECT, and we hope to share this story with you to bring to light how lifesaving this procedure can be.

Topics Discussed:

• Case presentation of a 15 year-old boy diagnosed with catatonia
• Obtaining substitute consent for a child who is catatonic
• Issues with California laws on ECT
• Requirements for obtaining ECT treatment for youths in California
• The stigma of ECT preventing access to care
• The psychiatrist's role in educating ourselves and in advocacy

Of note, full consent to discuss this case was obtained from the patient and the patient's family prior to publication of the case.

Reference:

Couse, M., Makhinson, M., & Kelly, P. (2024). Regulatory and Service System Challenges in Accessing Electroconvulsive Therapy for Catatonia in the Presence of Autism Spectrum Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 63(3), 293–295. https://doi.org/10.1016/j.jaac.2023.09.540 https://pubmed.ncbi.nlm.nih.gov/37778726/

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Welcome to Season 2 of Good Enough Shrink! It has such a fun ride this past year. We are kicking off the new season with a topic that remains controversial in some areas of the country, electroconvulsive therapy (ECT). We want to dispel misunderstandings about this treatment, and provide accurate information for anyone who is wanting to learn more about ECT, which can often be lifesaving.

Topics discussed:

• Stigma of ECT
• What is ECT and what is it for?
• Safety of ECT
• State laws surrounding ECT

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