PsychEd Episode 72: Psychiatric Case Presentation with Dr. Justin Delwo

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers the psychiatric case presentation with Dr. Justin Delwo, a staff psychiatrist at Toronto Western Hospital where he works in the emergency department and urgent care settings.The learning objectives for this episode are as follows:What is the goal of a psychiatric case presentation?What are some ground rules for a case presentation?What are the key sections of a case presentation and what should you include under each? How can you tailor your case presentation to the settingGuest: Dr. Justin DelwoHosts: Dr. Matt Cho (PGY1), Dr. Daamoon Ghahari (PGY2), and Dr. Angad Singh (PGY2)Audio editing: Dr. Angad Singh (PGY2)Episode evaluation: Shelly Palchik (MS4)Time Stamps:(1:50) - Goals of a case presentation(4:49) - Ground rules for presenting(7:56) - General overview(19:44) - Identifying Data(23:16) - Chief complaint and reason for referral(25:42) - History of presenting illness(38:38) - Review of systems(42:16) - Safety(49:42) - Past psychiatric history(53:54) - Medications(55:55) - Past medical history(59:14) - Allergies(1:00:13) - Family psychiatric history(1:02:07) - Personal history(1:06:23) -  Mental status exam(1:09:45) - Impression(1:14:20) - Plan(1:18:43) - Tailoring to different settingsFor more PsychEd, follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at [email protected] and visit our website atpsychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This short episode covers how to take a substance use historyHosts: Dr. Andrew Nguyen, Dr. Zakia Hussain, Jo Kikukawa, and Dr. Kate Braithwaite.Audio editing: Dr. Kate BraithwaiteResources:Chapter 4: Substance Use and Addictive Disorders. In Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral SciencesMeta:Phi Resource LibraryTen Domains of De-escalation to Prevent Behavioural Emergencies (from Alberta Health Services)References:American Psychiatric Association Publishing. (2022). Substance-Related and Addictive Disorders. In Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Revision: DSM-5-TR (5th ed., pp. 481-590). American Psychiatric Association Publishing. Boland, R.J., Verduin, M.L., & Ruiz, P. (2022). Chapter 4: Substance Use and Addictive Disorders. In Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (12th ed., pp. 269 - 336). Wolters Kluwer. Porter, L.D. Getting to the Good Part: How to Take an Engaging SUD History. [Presentation Transcript]. University of California, Los Angeles Integrated Substance Use and Addictions Programs. https://www.uclaisap.org/clinicalproviderquicktips/docs/La-Donna-Porter/Porter_LD_Transcript_Clean.pdf Welsh, C.J. “Trapped”: A Mnemonic for Taking a Substance Use History. Acad Psychiatry 27, 289 (2003). https://doi.org/10.1176/appi.ap.27.4.289For more PsychEd, follow us on Instagram (⁠@psyched.podcast⁠),  Facebook (⁠PsychEd Podcast⁠), X (⁠@psychedpodcast⁠), and Bluesky (⁠@psychedpodcast.bsky.social‬⁠). You can email us at ⁠[email protected]⁠ and visit our website at⁠ ⁠⁠psychedpodcast.org⁠.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers Functional Neurological Disorder with Dr. Patricia Rosebush. Dr. Rosebush is a Professor in the Department of Psychiatry & Behavioural Neurosciences at McMaster University. She is the distinguished author of numerous articles on clinical neuroscience, including considerable work on mitochondrial disorders in mental illness and over 30 papers on catatonia, and practices consultation-liaison psychiatry at St. Joseph’s Healthcare Hamilton.The learning objectives for this episode are as follows:Provide a definition and conceptual approach to FNDIdentify clinical signs and patient histories relevant to a diagnosis of FNDDescribe an approach to the treatment of FNDUnderstand the special challenges of communication and collaboration in this illnessGuest: Dr. Patricia RosebushHosts: Dr. Alastair Morrison, Dr. Kate BraithwaiteAudio editing: Dr. Alastair MorrisonShow notes: Dr. Kate BraithwaiteInterview content:(02:39) Learning objectives(03:09) Conceptualization of FND(08:30) Underlying psychological processes(09:35) Difference between FND and factitious disorder/malingering(14:54) Alexithymia(16:51) Common symptomatic presentations(18:00) Types of underlying stressors(19:17) Other risk factors for FND(22:12) Communicating with patients to address stigma(24:32) Psychotherapy in FND(29:36) Referral pathways for patients with FND(31:15) Prognosis of FND(33:09) Social media and FNDResources:Functional Neurological Disorder Society. Functional Neurological Disorder Society (FNDS). Includes a podcast and courses for physiciansFunctional Neurological Disorder (FND) – A Patient's Guide to FNDReferences:Hull, M., & Parnes, M. (2021). Tics and TikTok: Functional Tics Spread Through Social Media. Movement disorders clinical practice, 8(8), 1248–1252. https://doi.org/10.1002/mdc3.13267National Institute for Neurological Disorders and Stroke. (2024, July.) Functional Neurological Disorder.  U.S. Department of Health and Human Services, National Institutes of Health. Functional Neurologic Disorder | National Institute of Neurological Disorders and StrokePsychDB. (2024, April). Conversion Disorder (Functional Neurological Disorder. Conversion Disorder (Functional Neurological Disorder) - PsychDBRosebush, P. I., & Mazurek, M. F. (2011). Treatment of conversion disorder in the 21st century: have we moved beyond the couch?. Current treatment options in neurology, 13(3), 255–266. https://doi.org/10.1007/s11940-011-0124-yScamvougeras, A., & Castle, D. (2024). Functional Neurological Disorders: Challenging the Mainstream Agnostic Causative Position. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 69(7), 487–492. https://doi.org/10.1177/07067437241245957For more PsychEd, follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at [email protected] and visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers metabolic monitoring for patients on antipsychotic medications.Hosts: Grant Yao (MS4) and Dr. Angad Singh (PGY2)Audio editing: Dr. Angad Singh (PGY2)Timestamps:(0:21) - Background(2:22) - Monitoring for metabolic side effects(6:16) - Managing metabolic side effects(9:50) - SummaryReferences:Agarwal, S. M., Stogios, N., Faulkner, G. E., & Hahn, M. (2023). Pharmacological interventions for the prevention of antipsychotic-induced weight gain in people with schizophrenia: A Cochrane systematic review and meta-analysis. Schizophrenia Bulletin, 49(4), 833-835.Carolan, A., Hynes-Ryan, C., Agarwal, S. M., Bourke, R., Cullen, W., Gaughran, F., ... & O’Donoghue, B. (2024). Metformin for the prevention of antipsychotic-induced weight gain: guideline development and consensus validation. Schizophrenia bulletin, sbae205.Cooper, S. J., Reynolds, G. P., With expert co-authors (in alphabetical order):, Barnes, T. R. E., England, E., Haddad, P. M., ... & Smith, J. (2016). BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. Journal of Psychopharmacology, 30(8), 717-748.DeJongh, B. M. (2021). Clinical pearls for the monitoring and treatment of antipsychotic induced metabolic syndrome. Mental Health Clinician, 11(6), 311-319.Stogios, N., Humber, B., Agarwal, S. M., & Hahn, M. (2023). Antipsychotic-induced weight gain in severe mental illness: risk factors and special considerations. Current Psychiatry Reports, 25(11), 707-721.For more PsychEd, follow us on Instagram (⁠@psyched.podcast⁠),  Facebook (⁠PsychEd Podcast⁠), X (⁠@psychedpodcast⁠), and Bluesky (⁠@psychedpodcast.bsky.social‬⁠). You can email us at ⁠[email protected]⁠ and visit our website at⁠ ⁠⁠psychedpodcast.org⁠.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode is part of the PsychEd Book Club, a forum where we discuss books of interest to psychiatry learners from a variety of disciplines. We invite you to read along with us and contribute to our discussion.This short introductory episode gives you a heads-up about our upcoming book club on Healing: Our Path from Mental Illness to Mental Health by Thomas Insel. Stay tuned for a longer episode in a few months where we’ll share our thoughts on the book.If you’d like to share your thoughts or questions about the book, email us at [email protected] or reach out on social media.Hosts: Dr. Kate Braithwaite, Dr. Sophie Gregoire-Mitha, Dr. Gaurav SharmaAudio editing by: Dr. Gaurav SharmaFor more PsychEd, follow us on Instagram (⁠@psyched.podcast⁠),  Facebook (⁠PsychEd Podcast⁠), X (⁠@psychedpodcast⁠), and Bluesky (⁠@psychedpodcast.bsky.social‬⁠). You can email us at ⁠[email protected]⁠ and visit our website at⁠ ⁠⁠psychedpodcast.org⁠.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers goals of care conversations.Our guest for this episode is Dr. Tavis Apramian, a clinician-investigator in the Department of Family & Community Medicine (DFCM) at the University of Toronto and scientist in the Office of Education Scholarship. He works as a palliative care physician at St. Michael’s Hospital and at Kensington Hospice. His largely qualitative program of research is focused on advance care planning; workplace-based learning and assessment; palliative care in family medicine; medical assistance in dying; and inequity in end-of-life care. His primary focus is on telling rich stories of learner and patient experiences to spark conversation about socioculturally complex educational and clinical problems in serious illness.The learning objectives for this episode are as follows:Describe a palliative approach to care and its relevance across different contextsDemonstrate a structured and compassionate approach to goals of care conversationsApply effective communication strategies to build therapeutic alliance, navigate difficult conversations, and involve multiple actors in the palliative contextRecognize and manage challenges in goals of care conversationsGuest: Dr. Tavis ApramianHosts: Dr. Daamoon Ghahari (PGY2) and Dr. Angad Singh (PGY2)Audio editing: Dr. Angad Singh (PGY2)Timestamps:(1:07) - Journey to palliative care(5:07) - What is palliative care(14:47) - Understanding patient values(33:47) - Structuring goals of care conversations(44:16) - Communication strategies(57:05) - Navigating family meetings(77:25) - Reflections on MAiD for sole mental illnessResources:Roth, H. (2024). Hearing the unspoken. Canadian Family Physician, 70(10), 642-642. https://pmc.ncbi.nlm.nih.gov/articles/PMC11477260/pdf/0700642.pdfReferences:Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: a review and synthesis of best practices. JAMA internal medicine, 174(12), 1994-2003.Gross, J., & Koffman, J. (2024). Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review. PLoS One, 19(3), e0299933.Scheunemann, L. P., Ernecoff, N. C., Buddadhumaruk, P., Carson, S. S., Hough, C. L., Curtis, J. R., ... & White, D. B. (2019). Clinician-family communication about patients’ values and preferences in intensive care units. JAMA internal medicine, 179(5), 676-684.You, J. J., Downar, J., Fowler, R. A., Lamontagne, F., Ma, I. W., Jayaraman, D., ... & Canadian Researchers at the End of Life Network (CARENET). (2015). Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians. JAMA Internal Medicine, 175(4), 549-556.For more PsychEd, follow us on Instagram (⁠@psyched.podcast⁠),  Facebook (⁠PsychEd Podcast⁠), X (⁠@psychedpodcast⁠), and Bluesky (⁠@psychedpodcast.bsky.social‬⁠). You can email us at ⁠[email protected]⁠ and visit our website at⁠ ⁠⁠psychedpodcast.org⁠.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This short episode covers the basics of electroconvulsive therapy.Hosts: Ravi Bhindi (CC3), Dr. Angad Singh (PGY2)Audio Editing: Dr. Angad Singh (PGY2)Show Notes: Dr. Angad Singh (PGY2)Time Stamps:(0:36) - What is ECT?(2:18) - Indications and efficacy(4:35) - Treatment course(4:32) - Combination treatment(6:33) - Medications to discontinue(8:16) - Contraindications(9:40) - Side effects(11:52) - Procedure(16:03) - SummaryResources:https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/electroconvulsive-therapyhttps://sunnybrook.ca/content/?page=psychiatry-electroconvulsive-therapy-ect-faqReferences:Andrade, C., Arumugham, S. S., & Thirthalli, J. (2016). Adverse Effects of Electroconvulsive Therapy. The Psychiatric clinics of North America, 39(3), 513–530.Brakemeier, E. L., Merkl, A., Wilbertz, G., Quante, A., Regen, F., Bührsch, N., van Hall, F., Kischkel, E., Danker-Hopfe, H., Anghelescu, I., Heuser, I., Kathmann, N., & Bajbouj, M. (2014). Cognitive-behavioral therapy as continuation treatment to sustain response after electroconvulsive therapy in depression: a randomized controlled trial. Biological psychiatry, 76(3), 194–202.Espinoza, R. T., & Kellner, C. H. (2022). Electroconvulsive therapy. New England Journal of Medicine, 386(7), 667-672.Gill, S., Hussain, S., Purushothaman, S., Sarma, S., Weiss, A., Chamoli, S., ... & Loo, C. K. (2023). Prescribing electroconvulsive therapy for depression: Not as simple as it used to be. Australian & New Zealand Journal of Psychiatry, 57(9), 1202-1207.Janjua, A. U., Dhingra, A. L., Greenberg, R., & McDonald, W. M. (2020). The efficacy and safety of concomitant psychotropic medication and electroconvulsive therapy (ECT). CNS Drugs, 34(5), 509-520.Jelovac, A., Kolshus, E., & McLoughlin, D. M. (2013). Relapse following successful electroconvulsive therapy for major depression: a meta-analysis. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 38(12), 2467–2474.Kolshus, E., Jelovac, A., & McLoughlin, D. M. (2017). Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, 47(3), 518-530.Lam, R. W., Kennedy, S. H., Adams, C., Bahji, A., Beaulieu, S., Bhat, V., ... & Milev, R. V. (2024). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. The Canadian Journal of Psychiatry, 69(9), 641-687.Luchini, F., Medda, P., Mariani, M. G., Mauri, M., Toni, C., & Perugi, G. (2015). Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. World journal of psychiatry, 5(2), 182–192.Tess, A. V., & Smetana, G. W. (2009). Medical evaluation of patients undergoing electroconvulsive therapy. New England Journal of Medicine, 360(14), 1437-1444.Zolezzi M. (2016). Medication management during electroconvulsant therapy. Neuropsychiatric disease and treatment, 12, 931–939.For more PsychEd, follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at [email protected] and visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers exercise as a treatment for depression. Our guest for this episode is Dr. Nicholas Fabiano, a third-year psychiatry resident at the University of Ottawa. His research focuses on the overlap between mental and physical health, particularly lifestyle measures that can be used to improve mental health, including exercise, diet, and sleep.The learning objectives for this episode are as follows:Understand the evidence supporting the antidepressant effects of exercise Explore the mechanisms underlying the benefits of exerciseLearn how to prescribe exercise as a treatment for depressionIdentify the risks and caveats of prescribing exercise for depressionGuest: Dr. Nicholas Fabiano (PGY3)Hosts: Dr. Wendy MacMillan-Wang (PGY4) and Dr. Angad Singh (PGY1)Audio Editing: Dr. Angad Singh (PGY1)Timestamps:(2:55) Origins of the interest in exercise(6:22) Evidence of antidepressant effects(14:05) Considerations in special populations(18:00) Overlap of mental and physical health(20:37) Mechanism of action(26:18) Exercise prescription(33:10) Exercise as addiction and self-harm(36:42) Counselling and mitigating harm(39:30) Combining with other lifestyle interventions(41:41) Evidence for other mental illnessesReferences:Fabiano N, Gupta A, Fiedorowicz JG, Firth J, Stubbs B, Vancampfort D, Schuch FB, Carr LJ, Solmi M. The effect of exercise on suicidal ideation and behaviors: A systematic review and meta-analysis of randomized controlled trials. Journal of affective disorders. 2023 Jun 1;330:355-66.Fabiano, N., Puder, D., & Stubbs, B. (2024). The evidence is clear, exercise is not better than antidepressants or therapy: it is crucial to communicate science honestly. Journal of Physical Activity and Health, 1(aop), 1-2.Heissel, A., Heinen, D., Brokmeier, L. L., Skarabis, N., Kangas, M., Vancampfort, D., ... & Schuch, F. (2023). Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British journal of sports medicine, 57(16), 1049-1057.Hird, E. J., Slanina-Davies, A., Lewis, G., Hamer, M., & Roiser, J. P. (2024). From movement to motivation: a proposed framework to understand the antidepressant effect of exercise. Translational Psychiatry, 14(1), 273.Verhoeven, J. E., Han, L. K., Lever-van Milligen, B. A., Hu, M. X., Révész, D., Hoogendoorn, A. W., ... & Penninx, B. W. (2023). Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. Journal of affective disorders, 329, 19-29.For more PsychEd, follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at [email protected] and visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This short episode covers the mental status exam.Hosts: Dr. Matthew Cho (PGY1) and Dr. Angad Singh (PGY2)Audio editing: Dr. Angad Singh (PGY2)Episode Evaluation: Shelly Palchik (MS4)Timestamps:(0:20) Basics of the mental status exam(2:05) Appearance(4:00) Behaviour(5:00) Cooperation(6:20) Speech(7:18) Emotions(9:12) Perception(10:15) Thought process(12:35) Thought content(13:28) Insight(14:10) Judgement(14:46) CognitionReference: Donnelly, J., Rosenberg, M., & Fleeson, W. P. (1970). The evolution of the mental status—past and future. American Journal of Psychiatry, 126(7), 997-1002.Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198.Norris, D. R., Clark, M. S., & Shipley, S. (2016). The mental status examination. American family physician, 94(8), 635-641.PsychDB. (2024, Jan 18). Mental Status Exam. https://www.psychdb.com/teaching/mental-status-exam-mseVoss, R., & Das, J. (2024). Mental status examination. StatPearls.If you want to learn more about the mental status exam, check out our longer episode about this topic: https://www.psychedpodcast.org/blog/mseFor more PsychEd, follow us on Instagram (@psyched.podcast),  Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at [email protected] and visit our website at psychedpodcast.org.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.This episode covers South Asian mental health with Dr. Farooq Naeem, a senior scientist with the Institute for Mental Health Policy Research and a psychiatrist at the Centre for Addiction and Mental Health. He is also a professor of psychiatry at the University of Toronto.Dr. Naeem pioneered techniques for culturally adapting CBT. These techniques have been used to adapt CBT in South Asia, North Africa, Middle East, Kenya and China. His research areas include CBT, psychosis, and culture, with an overall aim to improve access to CBT. He has also published on issues related to health services and quality improvement. He works with a team of IT experts and has developed a CBT-based therapy program — called eGuru — that can be delivered through web and smartphone apps.The learning objectives for this episode are as follows:By the end of this episode, you should be able to…Recognize the unique mental health challenges and barriers faced by South Asian communitiesUnderstand how cultural nuances shape mental health presentations and assessmentsDescribe culturally adapted CBT and its benefits for South Asian patientsIdentify initiatives and future directions in transcultural psychiatry for South AsiansGuest: Dr. Farooq NaeemHosts: Hira Ahmad, Gurvir Rai, Nikhita SinghalAudio editing by: Nikhita SinghalShow notes by: Nikhita SinghalResources:PsychEd Episode 29: Cultural Psychiatry with Dr. Eric JarvisCulturally Adapted Cognitive Behavioural Therapy for Canadians of South Asian OriginSouth Asian Canadian Mental Health FoundationSociety for the Study of Psychiatry and CultureReferences:Gadalla, T.M. (2010). Ethnicity and seeking treatment for depression: a Canadian national study. Canadian Ethnic Studies 41(3), 233-245. https://doi.org/10.1353/ces.2010.0042Karasz, A., Gany, F., Escobar, J., Flores, C., Prasad, L., Inman, A., Kalasapudi, V., Kosi, R., Murthy, M., Leng, J., & Diwan, S. (2019). Mental health and stress among South Asians. Journal of Immigrant and Minority Health, 21(S1), 7–14. https://doi.org/10.1007/s10903-018-0790-4Kumar, A., & Nevid, J. S. (2010). Acculturation, enculturation, and perceptions of mental disorders in Asian Indian immigrants. Cultural Diversity and Ethnic Minority Psychology, 16(2), 274–283. https://doi.org/10.1037/a0018352Lai, D. W. L., & Surood, S. (2008). Socio-cultural variations in depressive symptoms of ageing South Asian Canadians. Asian Journal of Gerontology and Geriatrics, 3(2), 84-91.Leung, P., Cheung, M., & Tsui, V. (2011). Asian Indians and depressive symptoms: Reframing mental health help -seeking behavior. International Social Work, 55(1), 53–70. https://doi.org/10.1177/0020872810372801Masood, N., Okazaki, S., & Takeuchi, D. T. (2009). Gender, family, and community correlates of mental health in South Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 15(3), 265–274. https://doi.org/10.1037/a0014301Vakil, K., Desse, T. A., Manias, E., Alzubaidi, H., Rasmussen, B., Holton, S., & McNamara, K. P. (2023). Patient-centered care experiences of first-generation, South Asian migrants with chronic diseases living in high-income, Western countries: systematic review. Patient Preference and Adherence, 17, 281–298. https://doi.org/10.2147/PPA.S391340For more PsychEd, follow us on Instagram (@psyched.podcast), Facebook (PsychEd Podcast), X (@psychedpodcast), and Bluesky (@psychedpodcast.bsky.social‬). You can email us at [email protected] and visit our website at psychedpodcast.org.