My Three Shrinks show

My Three Shrinks

Summary: Three psychiatrists (with private practice, forensic, and consultation-liaison perspectives) from the Shrink Rap blog -- Dinah, Clinkshrink and Roy -- talk about topics related to psychiatry, mental illness, neurology & brain disease, while trying not to make it too boring. The blog and podcast are aimed at a psychiatrist audience, but are often interesting to a lay audience or other health professionals. Common topics are psychotherapy, depression & bipolar disorder, anxiety, antidepressants and other psychiatric medications or drugs, forensics, psychology, and patient rights. We also discuss fellow health care bloggers' recent posts.

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Podcasts:

 My Three Shrinks 54: Tell me! Information and Technology | File Type: audio/x-m4a | Duration: 00:34:51

November 23, 2010: #54 Tell Me! Information and Technology We talk about the new Maryland Health Information Exchange, a survey of job satisfaction among psychiatrists, psychiatrists and social media, and doctors who write about their patients. Finally, Clink tears her hair out helping Dinah edit this podcast. To quote Edgar Allan Poe, Nevermore! Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 53: URAC? My Rac? You're Sure? | File Type: audio/x-m4a | Duration: 00:27:22

October 10, 2010: #53 URAC? My Rac? You're Sure? The latest episode of three psychiatrists talking about whatever....We talk about Dr. Gary Small and Gigi Vorgan's book The Naked Lady Who Stood on Her Head, koro, whether people like obnoxious TV doctors, the first movie ever about serial killers, and URAC, an insurance accrediting company. Roy would like a reader to create a Wiki page for us and ClinkShrink invites listeners to review our podcast on iTunes. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 52: The Friendly Skies | File Type: audio/x-m4a | Duration: 00:36:40

April 25, 2010: #52 The Friendly Skies We talk about the new FAA policy regarding pilots on psychotropics, the role cell phones play in therapy, pharmacology of traumatic memories, psychiatric diagnosis and college students. Finally, the Book, the Book, the Book. We are almost done with our Book. (We need a title for it. Please email mythreeshrinksATgmail.com!!) Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 51: Vegan Gingerbread Cookies | File Type: audio/x-m4a | Duration: 00:34:19

April 12, 2010: #51 Vegan Gingerbread Cookies We talked about informed consent and how much information a physician is required to disclose about his personal or professional background. We talk about human behavior and computer models used to explain suicide epidemics. Finally, Dinah takes her dog Max to the office. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 50: More About Geeks | File Type: audio/x-m4a | Duration: 01:02:13

March 21, 2010: #50 More About Geeks: Conversations with Dr. Pat Barta Dr. Pat Barta of the Adventures in Telepsychiatry blog joins us again to continue our conversation about technology in psychiatry. We talk about electronic health information systems, patient health records, electronic prescribing and who has a right to our health information. Roy brings us up to date on proposed health care record standards. Dinah talks about psychiatric emergencies and what should be considered an emergency. Finally, we touch on the issue of medical marijuana. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 47: Genital Retraction Syndrome | File Type: audio/x-m4a | Duration: 00:26:04

Podcast #47: Genital Retraction Syndrome: civil commitment, cholesterol and depression, witch and genital retraction syndrome. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 48: Grand Rounds - iPhone 3G Edition | File Type: audio/x-m4a | Duration: 01:05:57

June 24, 2008: #48 GRAND ROUNDS: The Apple iPhone 3G Edition We are hosting the weekly medical Grand Rounds this week, with about 45 fantastic submissions from the medical blogosphere. This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our CLICKY iPHONE, which will let you visually navigate this week's Grand Rounds submissions (yes, the buttons on the phone really work). This year, since the anticipated release of the Apple iPhone 3G is just around the corner (July 11), we asked for submissions to have some connection to the iPhone, no matter how twisted the logic is to make the connection. The medical blogosphere obliged. So we are including, free of charge, our Clicky iPhone, which will let you visually navigate this week's Grand Rounds submissions (yes, the buttons on the phone really work). Of course, below that is the regular text for you old-schoolers. And if you have low vision or prefer to LISTEN to your Grand Rounds, you can get our PODCAST of it HERE. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 46: Fugetaboutit! | File Type: audio/x-m4a | Duration: 00:42:55

June 1, 2008: #46 Fugetaboutit! Topics include: • PTSD. A Psychiatrist Who Learned From Veterans commented that "A really towering paper in the Posttraumatic Stress Disorder literature deals with the excessive stickiness of memory in PTSD. The data comprises case reports of the month long use of Cortisol (Cortef) 10 mg a day, this is a low dose of glucocorticoid, by Amanda Aerni. R Greene at the Dallas VA has a nice paper using rats in a related paper; impressive statistics in the latter." These papers are discussed in the podcast, and mentioned in more detail below. • Cortisol for PTSD. Amanda Aerni, et al., published "Low-Dose Cortisol for Symptoms of Posttraumatic Stress Disorder" in the August 2004 American Journal of Psychiatry. This was a 3-month observation study on three people with chronic PTSD, using a low-dose of cortisol in a double-blind, placebo-controlled manner. They found "cortisol-related reductions of at least 38% in one of the daily rated symptoms of traumatic memories, as assessed by self-administered rating scales." • Memory "Erasure".  Wen-Hui Cai, et al., published "Postreactivation Glucocorticoids Impair Recall of Established Fear Memory" in the September 2006 Journal of Neuroscience.  This study exposed mice to a trauma (loud noise).  After developing mousie PTSD, exposure to glucocorticoids at some later time after the traumatic memory is being triggered caused the fear response to be much less. • More PTSD Talk.  Pink Freud commented that "On the surface, I find the thought of preventing the formation of memories (traumatic or otherwise) to be repugnant. It's experiencing, working through, and ultimately making meaning of what life deals us that defines the human condition."  Here follows lots of discussion about what is a "trauma" (such as being hit by a flying, flaming toilet seat (Youtube) from the space shuttle, as in the show Dead Like Me) and how some people are at increased risk for developing PTSD given similar traumas.  Also, discussion about reducing the strength of the connection between a traumatic memory and a pathologic fear response. • Dinah's Flomax (tamulosin).  Dinah discusses the discrepancy between the focus on benign prostate conditions and other more serious ones. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 45: Guest Dr Ray DePaulo on Treatment-Resistant Depression | File Type: audio/x-m4a | Duration: 00:54:07

April 13, 2008: #45 Guest Dr Ray DePaulo on Treatment-Resistant Depression Topics include: # Treatment-Resistant Depression. How is it defined (~10:00 min into the podcast)? Is there a magic bullet? Treatment strategies (don't give up; remember lithium; use proven agents; get 2nd and 3rd opinions; do psychotherapy). # Nellie, the Hypothetical Patient. Let her know what we know about treatment and what we don't. # "Alternative" Treatments. St. John's wort; SAMe (s-adenosylmethionine); omega-3 fatty acids; ketamine; vagal nerve stimulation (VNS); deep brain stimulation (DBS); psychosurgery (cingulotomy). # Cognitive Therapy. Many different types. # Words which are Unliked by the Podcasters. Alternative treatment. Mood stabilizer. Antidepressant. Antipsychotic. Hallucinogen. Psychosis. Neurosis. Organic. Schizophrenia. Nervous breakdown. Mood Swings. # Quotations We Like. "There's only two types of music: good music and bad music," by Fran Liebowitz. "Eighty percent of success is showing up," by Woody Allen. For the rest of the quotes, see the Show Notes at mythreeshrinks.com. # Drugs in the Drinking Water. Brief mention of last month's AP story finding all sorts of pharmaceuticals in numerous municipal water supplies. # Books we are reading. -Ray: "Saint Augustine", by Garry Wills. -Roy: "Valis", by Philip K. Dick. (Ben was reading it on "Lost".) -Clink: Listening to an opera about Carmen, a famous female sociopath. -Dinah: "How Doctors Think", by Jerome Groopman. Dr. DePaulo's most recent book is Understanding Depression. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 44: Guest J. Raymond DePaulo, MD | File Type: audio/x-m4a | Duration: 00:39:10

March 30, 2008: #44 Guest J. Raymond DePaulo, MD, Chair of Psychiatry at Johns Hopkins Topics include: * NYT: The Ethics of Artificial Brain Enhancement, by Benedict Carey. On using cognitive enhancers, like Adderall, Vyvanse, and Provigil, to perform better. The article quotes NIDA's Nora Volkow, who wrote, "Even though stimulants and other cognitive enhancers are intended for legitimate clinical use, history predicts that greater availability will lead to an increase in diversion, misuse and abuse." Dr. DePaulo addresses the treatment of symptoms (eg, inattention in pilots) vs diagnoses, on the bases of functional impairment and subsequent consequences. Be sure to listen to the part around 24 minutes, where we discuss the ethics of a hypothetical drug that increases IQ by 30 points. * Diagnosis in Psychiatry. Also some comments on ADHD vs Bipolar diagnosis, which led into an interesting discussion about the nature of diagnosing psychiatric "syndromes" in the absence of a definitive diagnostic aid, like a blood test or brain scan. Other references and topics mentioned by Dr DePaulo: Kraepelin. // Quote from Paul McHugh: "A good clinician in Psychiatry is someone who makes prudent decisions based on insufficient information." // Judy Rapoport's 1978 study of stimulants in normal kids. // The history of "ADHD" and "minimal brain dysfunction". // Labels and diagnoses. // William Styron // Kraepelin's Manic-Depressive Insanity. * Prison Health Care. Clink compares correctional psychiatry capabilities with those in free society and wonders why care can be provided in jails and prisons yet we are the only country still without some sort of national health care. * JAMA: Loss of Serendipity in Psychopharmacology, by Donald Klein. Article in the March 5 issue of JAMA. "This Commentary on the psychopharmacological revolution focuses on 2 mysteries: fostering medication discovery and finding out how they work." Dr. DePaulo's most recent book is Understanding Depression. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 43: How Doctors Think | File Type: audio/x-m4a | Duration: 00:42:45

March 18, 2008: #43 How Doctors Think Topics include: • My Three Shrinks: The Book. We've been talking about writing a book which explains how psychiatrists go about thinking about approaching problems, such as selecting medications or diagnosing illness. We are debating about how to format the chapters in the book. One option is for each of us to write individual chapters about various topics. Another is to maintain the conversational tone so that we each would have some back-and-forth commentary within each chapter. What do you think? Let us know in the comments below, or email us. • NYT: Time Off From Electronics. Mark Bittman had an article in last week's New York Times called "I Need a Virtual Break. No, Really." The article talks about forgoing today's electronic trappings for one day each week, similar to some business' "email-free Fridays." No cell phone. No voicemail. No Blackberry. No internet. This provoked anxiety for Dinah (and "what's the point" from Clink and me), who speculates further about "internet addiction" and the risk of death by videogame. Addiction vs compulsion. • PT: Why Psychiatrists Should Read the Humanities. Clinkshrink discusses a Psychiatric Times article from the Feb 2008 issue by Cynthia M.A. Geppert, suggesting that more humanities should be taught to medical students and residents. Dinah remembers my first blog post about Tom Cruise. • Female Sociopaths in Literature.  Clink lists a number of female sociopaths portrayed in operas, books, and other literary works. • Brain Maturation Delayed in ADHD.  Also in the Feb 2008 issue of Psychiatric Times is this article by Arline Kaplan, describing research suggesting that the brains of kids with ADHD mature a little later than others, bringing into question the medication treatment of this disorder, rather than more behavioral and "tincture of time" methods. • How Doctors Think, book by Jerome Groopman MD.  Dinah is reading this now and notes that Dr Groopman chose not to discuss how psychiatrists think, because this is "beyond [his] abilities."  (We really need to get our book written.) • How Psychiatrists Think.  Once again, we are starting a book and would like some feedback from our listeners and readers.  The question is about the style of writing.  Option 1 would be for each of us to take on topics and write a short (1-5 pages) chapter on a given topic.  Option 2 would be for each of us to chime in within each topic/chapter, thus more resembling a discussion.  Option 1 is more traditional.  Option 2 would sound more like our podcast, at the risk of confusing the reader about who is "talking" at any given point. Email us with your thoughts about these options at mythreeshrinksATgmailDOTcom. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 42: The Benzo Wars (or, Xanax Reloaded) | File Type: audio/x-m4a | Duration: 00:34:39

February 16, 2008: #42 The Benzo Wars Topics include: * Round 1: Why Docs Don't Like Xanax (or, Xanax Reloaded). This is what started it. Then there was Xanax Blues in Podcast 19. Also, this one from Oct 10. * Round 2: Dose Dependence. Our blog commenters dissent. * Round 3: Just Say No! Clink offers sage advise to fellow prescribers. * Round 4: The Trouble with Tapering. How slow can you go? See Perchance to Dream. * Round 5: Need It Versus Want It. Is there a difference? * Final Round: Last Shrink Standing. What are the situations where you feel very uncomfortable prescribing benzodiazepines? Roy wraps things up by quoting from his Jan 12 comments from Dose Dependent. [some transcription...] 15:06 Dinah: So, shut up a minute! 17:20 Roy: Benzo's modulate GABA receptors... You've got glutamate, which is an excitatory amino acid, and you've got GABA, which is an inhibitory amino acid. So, they kinda balance each other. If you have too much glutamate, that's bad, you can have ... seizures... If you have too much GABA, that's bad because then your brain is s-o s-l-o-w-e-d d-o-w-n that you can't do anything. 17:45 Dinah: What's his point? 18:00 Roy: So, benzo's effectively increase the role that GABA plays in the brain. So does alcohol. In fact, for the most part, your brain can't tell the difference between alcohol and a benzo. 20:20 Roy: You can be dependent but not addicted. 21:00 Clink: Why is it that this [coming off Xanax] is so bothersome to you? 21:22 Clink: When you start hearing that 'this is the only thing that works', then the red flags should go up. 22:20 Clink: I see the addictions that are started by physicians, and we need to address this as a reality. 24:00 Dinah: We have this dilemma... is this a medicine that this person needs versus is this somebody who's addicted? 24:20 Dinah: There are circumstances where I encourage people to take benzos, and I'll tell you what they are... 24:27 Roy: Like now! Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 41: Chris Kraft on Conversion Therapy | File Type: audio/x-m4a | Duration: 00:50:40

January 27, 2008 #41: Chris Kraft on Conversion Therapy * Top 10 Podcasts of 2007. Chris' first guest podcast, Chris Kraft on Gender Identity Issues (#21), was the 6th most downloaded podcast for 2007 (out of over 100,000 downloads for all podcasts for the year). * Conversion Therapy. Chris Kraft, Ph.D., talks with us for most of the podcast about the idea of using the therapy process to convert someone from being gay to being straight. References to Richard von Krafft-Ebbing (coined the term "homosexuality"), One Nation Under God, Exodus International, and Monday at the Charm (Dinah's book). * "Go to iTunes and Write a Review". Reviewer #21, St. Louis Doc, wrote on iTunes, "I am a psychiatrist and very much enjoy [the podcast]. ... About professional isolation: I've heard (and experienced) that psychiatrists/therapists are especially susceptible to becoming isolated and insulated in their own world. Because of confidentiality and because we don't tend to work in groups when we are doing therapy... So, your podcast, along with being educational and entertaining, is one partial antidote to this isolation. Through your podcasts, we psychiatrists can hear how other psychiatrists think in a way that is not censored or biased by the psychopharm industry. Please keep up the good work." St. Louis Doc, thank you for the kind words. I hadn't thought of this issue when it comes to podcasts, but isolation is indeed an occupational hazard. * Savage Love. Chris plugs Dan Savage's column and podcast on sexuality. * How Drugs Get Their Name. Roy talks about his recent post on the secret cabal of 5 people who grant all the generic names for new drugs. * Well: Tara Parker-Pope on Health. Dinah plugs this excellent column on health issues (while fantasizing that Tara gets her material from us). Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 40: Happy New Year! | File Type: audio/x-m4a | Duration: 00:43:20

January 1, 2008 #40: Happy New Year! * Roy's Leopard Troubles. All is not well in Mac-land. WARNING: Do NOT install Leopard if you are using Filevault. Turn off your Filevault first (of course, if you have 60GB of files in your Filevault, you will need 60GB of empty hard drive space to decrypt it, not the 5GB which I have). * New Year's Resolutions. We all discuss our resolutions (or lack thereof). * Top 25 Posts of 2007. Check out the most viewed Shrink Rap posts of 2007. * Roy's Favorite Searches of 2007. Also check out Roy's quirky list of top 10 weird and funny Google searches. (Hint: oompaloompas) * Hanns-G 28-inch LCD Monitor. Roy got a new monitor. Clink has screen-envy. * Q&A: Drug Interactions. Do multiple psychotropic drugs sometimes counteract each other? * Q&A: Seasonal Affective Disorder (SAD). Long discussion about SAD, lightboxes, melatonin, depression, and suprachiasmatic nucleus. * iTunes Reviews. We read some of the 20 reviews we have on iTunes. We are NOT related to the Shrink Rap Radio podcast (which is also very good and worth listening to, but not nearly as entertaining as we are, IMHO.) Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

 My Three Shrinks 37: Poop-Out | File Type: audio/x-m4a | Duration: 00:44:06

December 9, 2007: #37 Poop-Out # SSRI Poop-out (a.k.a. tachyphylaxis). This is the phenomenon where a drug is working, then seems to wear off or stop working after some period of time. (see also How a Shrink Picks an Antidepressant, Family Intervention Overcomes Poop-Out, and Stassen's article on resilience.) (I also referred to the use of gestures when speaking.) Also discussed placebo response, light therapy, and Dinah's shpiel.# Google Ads. We discuss issues about our minimal use of ads on the blog.# Q&A from Tony. Refer back to Questions for the Doctor.# Clink's Opera Post. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

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