Three psychiatrists from the Shrink Rap blog -- Dinah, Clinkshrink and Roy -- talk about topics related to psychiatry, psychology, mental health, neurology and brain disease, while trying not to make it too boring. http://psychiatrist-blog.blogspot.com en-us Copyright 2006 to 2012 Mon, 04 July 2011 10:03:00 -0500 Mon, 04 Dec 2006 01:44:00 -0500 http://blogs.law.harvard.edu/tech/rss mythreeshrinks@gmail.com Shrink Rap By Psychiatrists for Psychiatrists. All patient vignettes are confabulated; the psychiatrists, however, are mostly real. 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. Shrink Rap blog mythreeshrinks@gmail.com No http://psychiatrist-blog.blogspot.com/2006/12/my-three-shrinks-podcast-1.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks1.m4aDec. 3, 2006: This is our first podcast attempt. We'll be talking about a 60 Minutes show on beta-blockers to prevent PTSD and reduce traumatic memories, future cardiac risk after post-heart attack new-onset depression, and NHSBlogDoc's John Crippen's post about England's idea of requiring psychiatric evaluations for hospice and "assisted dying" patients.PodcastsMon, 04 Dec 2006 01:44:00 -0500Shrink RapNoPTSD & Beta-blockers; cardiac depression, and Crippen's hospice post.December 3, 2006-Tip of the hat to Leo Laporte's This Week in Tech (TWiT) podcast (twit.tv)-Also a nod goes to Dr Dave Van Nuys at shrinkrapradio.com, who kindly pointed out he was doing a Psychology podcast of the same name way before us. Check it out, it's very well done-Dr Anonymous is not mentioned even once in this podcast-60 Minutes: Beta-blockers to prevent PTSD and reduce traumatic memories?-Cardiac risk after post-heart attack depression-Shrink Rap Post: Go Red for Women-NHSBlogDoc's John Crippen's post about England's idea of requiring psychiatric evaluations for hospice and "assisted dying" patients check out our blog at http://psychiatrist-blog.blogspot.com00:24:04depression, cardiac, MI, heart attack, propranolol, Inderal, dying, assisted suicide, health, drugs, medicine http://psychiatrist-blog.blogspot.com/2006/12/my-three-shrinks-podcast-2-roots.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks2.m4aDec. 10, 2006: Our 2nd podcast (actually, the 2nd half of the first one). Thorazine legal immunity, FDA SSRI-suicide Black Box hearing, gay marriage adoptions, gender dysphoria.PodcastsSun, 10 Dec 2006 15:40:00 -0500Shrink RapNoThorazine legal immunity, FDA SSRI-suicide Black Box hearing, gay marriage adoptions, gender dysphoria, social phobia.December 10, 2006-Thank Dr A for the "bumpers" idea-Thorazine Immunity: Clink reviews a 1992 case in which a prisoner sued the on-call psychiatrist for involuntarily medicating him with chlorpromazine due to violent, self-injurious behavior... but without going through any hearing panels for forced meds-Dinah brings a duck-FDA holds a hearing on Dec 13 about putting "black box" warnings on SSRI antidepressants (Paxil, Prozac, etc) for suicide-also, Corpus Callosum link and Finnish study-Social phobia and alcohol-Psychlogists discuss adoptions in gay marriages-NYT on gender dysphoric children-brief bits on SSRI-related withdrawal symptoms, sexual dysfunction and SSRIs, and psilocybin mushrooms for OCDGo to http://psychiatrist-blog.blogspot.com/2006/12/my-three-shrinks-podcast-2-roots.html for links00:33:24gay, antidepressant, psychiatrist, suicide, health, drugs, medicine, forensic, side effects http://psychiatrist-blog.blogspot.com/2006/12/my-three-shrinks-podcast-3-wii-three.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks3.m4aDec 24: New Snowball USB microphone; listener comments; Timothy's law; Nintendo Wii aggression; Bobo dolls; Dinah's theory on video games and violence; Wii have a problem.PodcastsSun, 24 Dec 2006 15:20:00 -0500Shrink RapNoSnowball USB microphone; listener comments; Timothy's law; Nintendo Wii aggression; Bobo dolls; Dinah's theory on video games and violence; Wii have a problem.December 24, 2006-Roy's new USB microphone: the SNOWBALL, made by Blue. Recommended.-Listener comments.-New York's TIMOTHY'S LAW: since we recorded this, Governor Pataki signed the bill into law, which provides for parity insurance coverage for mental illnesses. We also discuss a newspaper editorial which links this issue to post-incarceration treatment of sexual predators. I believe the original requirement to include addictions was removed due to cost concerns raised by insurance companies. That makes no sense.-Clinkshrink provided a spontaneous discourse on the history of using hospitals to house and treat SEXUALLY VIOLENT OFFENDERS.-Reports of NINTENDO WII-related injuries, property damage, and aggression were discussed.-This led to some discussion about Bandura's classic 1960's studies on the EFFECT OF WITNESSED VIOLENCE on actual violence, including his piece on children and BOBO DOLLS.-Which led to Dinah's Theory on VIDEO GAMES AND VIOLENCE in youngsters.-And we wrapped it up with the website for posting Wii-related misbehavior at WIIHAVEAPROBLEM.COM.Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:16:36Timothy's Law, parity, violence, Wii, Snowball, videogame, Bobo doll, sexual predator, psychiatrist, blog, insurance, Nintendohttp://psychiatrist-blog.blogspot.com/2007/01/my-three-shrinks-podcast-4-gifts_01.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks4.m4aDec 31: Informed consent and emergencies; Dr A's 6-month blogiversary; Fat Doctor on gift grief; bad gifts; Starbucks vs Dunkin' Donuts; psychology of gifts; hey foo; Hopkins' civility stand; sex offenders; Tiihonen study on antidepressants and suicide (again); Happy New Year! PodcastsSun, 31 Dec 2006 23:12:00 -0500Shrink RapNoInformed consent and emergencies; Dr A's 6-month blogiversary; Fat Doctor on gift grief; bad gifts; Starbucks vs Dunkin' Donuts; psychology of gifts; hey foo; Hopkins' civility stand; sex offenders; Tiihonen study on antidepressants and suicide December 31, 2006: Gifts Topics include:-INFORMED CONSENT and emergencies: New Jersey Supreme Court may require consent before providing emergency procedures (American Medical News)-DOCTOR ANONYMOUS' 6-month anniversary: Dr A celebrated 6 months of blogging on Dec 18. (That's twice as long as the average blog lasts.) Congrats!-FAT DOCTOR on GIFT-GIVING GRIEF (or, Why she kinda hates Christmas)-What to get your psychiatrist-BAD GIFTS-GIFTCARDS: Starbucks vs Dunkin' Donuts, iTunes vs eMusic (thx, ABF)-NPR: on the Dec 11 Talk of the Nation, economist Kevin Hassett talks about the PSYCHOLOGY OF GIFTS-Shout out to FOOFOO5, who's been under the weather-HEALTH CARE RENEWAL's Poses about JOHNS HOPKINS' handling of student's uncivil Facebook party invitation-Finding pictures of SEX OFFENDERS in your neighborhood-Tiihonen study on ANTIDEPRESSANTS and suicide (again)HAPPY NEW YEAR! from Dinah, Clinkshrink, and Roy Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:23:54informed consent, psychiatrist, gifts, presents, holidays, Christmas, Hannukah, Hopkins, antidepressants, depression, suicide, meat thermometer http://psychiatrist-blog.blogspot.com/2007/01/my-three-shrinks-5-sex-lies-and.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks5.m4aJan 9: Neuroeconomics; spotting liars; fMRI as lie detector; wet cell phones; MTS' favorite podcasts. PodcastsTue, 09 Jan 2007 02:30:00 -0500Shrink RapNoNeuroeconomics; spotting liars; fMRI as lie detector; wet cell phones; MTS' favorite podcasts. January 9, 2007: Sex, Lies, and Neuroeconomics Topics include: * New Yorker Magazine (Sep 18, 2006): Mind Games: What NEUROECONOMICS tells us about money and the brain, by John Cassidy. The neuroanatomy and functional connectivity that lies behind our economic decisions and risk aversion. As measured by functional MRI imaging (fMRI), the constant tug-of-war between the orbitofrontal lobe, the amygdala, and the insular cortex mediates everyday economic decisions. Related links include the Neuroscience Marketing blog, New York University's Center for Brain Imaging, Google "neuroeconomics", and the Omnibrain blog (one of our favorites). * Book "Paving Wall Street: Experimental Economics and the Quest for the Perfect Market", by Dinah's brother, Ross Miller. * Dinah refers back to a Shrink Rap post on COMPULSIVE BLOGGING and to another one on a combination Wellbutrin (bupropion)/Revia (naltrexone) pill called Contrave for WEIGHT LOSS. * The Interview Room, a novel by forensic psychiatrist Roderick Anscombe, provides insight into how the brain betrays people's LIES. His website provides 14 tips on how to spot the liar (very interesting reading). * Washington Post (Oct 30, 2006): Using fMRI machines to DETECT LIES. See also website for No Lie MRI. * Be nice to Dinah, who had a BAD DAY. * Clink's Favorite Podcasts: BusinessWeek, NPR, State Department Press Briefings, Slash Dot Review, Byzantine Emperors. * Roy's Favorite Podcasts: Comic Strip Live, FLOSS Weekly, Futures in Biotech, Inside the Net (now net@nite), NEJM, This Week in Tech (TWiT). * Dinah's Favorite Podcasts: "Umm, why would I want to listen to podcasts, anyway?" Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:23:45neuroeconomics, psychiatrist, lying, lie detector, fMRI, podcasts, psychiatry, psychology http://psychiatrist-blog.blogspot.com/2007/01/my-three-shrinks-podcast-6-advice-on.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks6.m4aJan 14: Emergency calls; phone messages; top 10 searches for 2006; OmniBrain; Beta Blogger Blues. PodcastsSun, 14 Jan 2007 13:30:00 -0500Shrink RapNoEmergency calls; phone messages; top 10 searches for 2006; OmniBrain; Beta Blogger Blues. January 14, 2007: Advice on Manipulating Your Psychiatrist Topics include: * EMERGENCY CALLS: what constitutes an emergency, and how do psychiatrists handle after-hours calls? * PHONE MESSAGES: what do shrink-types put on their voice mail greeting, instructing patients what to do in an emergency? * TOP 10 FAVORITE SEARCH PHRASES for 2006: includes such classics as "how to worry your psychiatrist", "advice on manipulating your psychiatrist", "sex with fish", "how to talk to your shrink so he will listen", and "how to get cats from under the floorboards". * OMNIBRAIN KUDOS. * BETA BLOGGER BLUES. Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:18:17psychiatrist, podcasts, psychiatry, psychology, phone, messages, emergencies, top ten http://psychiatrist-blog.blogspot.com/2007/01/my-three-shrinks-podcast-7-fireside.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks7.m4aJan 24: First snow; worried well and well-off worried; paying for psychotherapy; health care hostage on the job; Idiocracy (the movie); national health care system. PodcastsWed, 24 Jan 2007 23:45:00 -0500Shrink RapNoJan 24: First snow; worried well and well-off worried; paying for psychotherapy; health care hostage on the job; Idiocracy (the movie); national health care system. January 24, 2007: Fireside Chat Topics include: * Dinah's post on the "WELL-WORRIED WELL" provokes dissension amongst the Shrink Rappers. Are folks who go to high-end hospital units, such as The Retreat at Sheppard Pratt, just the worried well, or are they "rich people with mental illness"? * PAYING FOR PSYCHOTHERAPY: "That's the problem with reimbursement for psychotherapy. How do you decide what is and isn't valid psychotherapy?" * BusinessWeek, 1/29/07: "HELD HOSTAGE BY HEALTH CARE", by Michelle Conlin. Article about people who stay in jobs they hate due to fear of losing their health insurance coverage. * Movie: IDIOCRACY [IMDB link] from Roy's post of YouTube video, Hospital of the Future. * NATIONAL HEALTH CARE SYSTEM. Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:33:02psychiatrist, podcasts, psychiatry, psychology, worried well, psychotherapy, Idiocracy, national healthcare http://psychiatrist-blog.blogspot.com/2007/01/my-three-shrinks-podcast-8-positively.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks8.m4aJan 30: Lost begins in 1 week; optimism; positive psychology; police interrogations and psychiatry; stalkers; Maconochie; chocolate. PodcastsTue, 30 Jan 2007 23:45:00 -0500Shrink RapNoJan 30: Lost begins in 1 week; optimism; positive psychology; police interrogations and psychiatry; stalkers; Maconochie; chocolate. January 30, 2007: Positively Lost Topics include: * Lost. 8 more days (good collection of media snippets at LostHatch.com). * NYT: Optimism. "You Are What You Expect" by Jim Holt in the Jan 21 issue. The NYT Magazine also ran a story on Jan 7 about positive psychology (the link is actually to The Huffington Post's post about this), and talks about one of the field's founders, Marty Seligman, who runs the Positive Psychology Center at UPenn (you can also participate in some quick online research there). Link to My Thought Coach on iTunes. "Expect more of yourself, and less of others." * AAPL: Lies and Coercion: Why psychiatrists should not participate in police and intelligence interrogations, by Jeffrey S. Janofsky. History and ethics of psychiatrist involvement in police interrogations. * Book: Maconochie's Experiment, by John Clay. Clink: "This is the fellow who invented our modern parole system." * Shrink Stalker Jailed 9 Years. Woman stalked psychiatrist, attempted to blow up his houseboat. * Book: I Know You Really Love Me: A Psychiatrist's Account of Stalking and Obsessive Love, by Doreen Orion. Clink: "Psychotic killers are easier to treat than non-psychotic killers." Qu'est que c'est?Next week: Biochemical effects of chocolate on mood. Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:37:19psychiatrist, podcasts, psychiatry, psychology, Lost, optimism, police interrogations, stalker, parole, obsession, forensic http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-9-my-three.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks9.m4aFeb 4: genetics of depression; anonymous blogs and identity; Dr A; public psychiatry; iTunes reviews; email us questions. PodcastsSun, 04 Feb 2007 16:30:00 -0500Shrink RapNoFeb 4: genetics of depression; anonymous blogs and identity; Dr A; public psychiatry; iTunes reviews; email us questions. February 04, 2007: My Three Chromosomes Topics include: * AJP: Genetics of depression. Two related articles in this month's Green Journal are from the GenRED study (Genetics of Recurrent Early-onset Major Depression). The Levinson article reports significant linkage for an area on chromosome 15 in 631 families with recurrent early-onset major depression ("early onset" less than 40 yrs old). The Holmans article reports results of a genome scan in 656 families, finding significant linkage in areas of chromosomes 8, 15, and 17. * Mandatory screening for depression? Clink conducts a thought exercise. * Blogs and Identity. We talk about Dr. Anonymous' recent troubles after Fox News brands his one of 5 great medical blogs, and our feelings about blogging behind anonymous names (or not). See Dr A's post on the Myth of Anonymous Blogging. Moof's post is also worth reading on this topic. (We suspect his video blog may have given away his identity.) We look forwards to the congressional hearings on who leaked his identity and how high up this thing goes. * Whither Public Psychiatry? Where have all the public sector psychiatrists gone? The number of HPSAs (Health Professional Shortage Areas) have decreased, while there seems to be less physician trainees who accept partial payment of their educational costs in return for a pledge to work in a HPSA after completing their training. But, Maryland has the most psychologists per capita in the US. (Search for Maryland psychiatrists at mdpsych.org.) * Questions for us? Email at mythreeshrinksATgmailDOTcom. We'll answer some starting with Podcast #11 (in two weeks). * Feel free to write us a review on iTunes. Next week: Biochemical effects of chocolate on mood (we really mean it this time). Also false positive drug tests, and children of psychiatrists.Last week's musical snippet was from the 1986 release, Modigliani (Lost in Your Eyes), from their eponymous album by Book of Love (lyrics). Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:30:13psychiatrist, podcast, public psychiatry, psychology, genetics, depression, blogs, identity, health care http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-10-be-mine.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks10.m4aFeb 11: Valentine edition; chocolate and mood; physician suicide rate; children of psychiatrists. PodcastsSun, 11 Feb 2007 02:30:00 -0500Shrink RapNoFeb 11: Valentine edition; chocolate and mood; physician suicide rate; children of psychiatrists. February 11, 2007: Be Mine Topics include: * AJP: False positive drug tests on Effexor XR (venlafaxine) (positive for PCP, or phencyclidine). * Chocolate and Mood [PubMed]: a look at chemicals in chocolate which affect mood, such as theobromine, caffeine, phenylethylamine (PEA), and anandamide. * First study mentioned by Clink, on chemicals in chocolate. * Second study, about mood modulation by food. * Third study, about chocolate and atypical depression. * Green M-and-M's. Also, design your own M-and-M's, even what is printed on them. * Dogs: Don't eat the chocolate. * Children of Psychiatrists (The Last Psychiatrist). Do psychiatrists have crazier children? (See Dinah's post) * Suicide risk in physicians. A European study (Hawton 2001) found that female doctors, and not male doctors, had increased suicide risk. Furthermore, specialties at highest risk included anesthesiology, generalists, and psychiatrists. A meta-analysis (Schernhammer 2004) found that physicians in general were 1.4 (men) and 2.3 (women) times more likely to commit suicide than the general population. * Questions for us? Email at mythreeshrinksATgmailDOTcom. We'll answer some starting with Podcast #11.Next week: Black market price of psych meds; side effects of psychotherapy.Last week's musical snippet was from 1983 release, Genetic Engineering, from the Dazzle Ships album by Orchestral Manoeuvres in the Dark (OMD). Go to http://psychiatrist-blog.blogspot.com for show notes with links.00:36:34psychiatrist, podcast, public psychiatry, psychology, venlafaxine, Effexor, chocolate, suicide, physicians, health care, theobromine, caffeine http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-11-lovely-spam.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks11.m4aFeb 18: FDA, antidepressants, and suicide; Zyprexa documents; schizoid personality; autism and amygdala size. PodcastsSun, 18 Feb 2007 23:45:00 -0500Shrink RapNoFeb 18: FDA, antidepressants, and suicide; Zyprexa documents; schizoid personality; autism and amygdala size. February 18, 2007:Topics include: * FDA Antidepressants Hearing, Revisited. We had previously blogged about suicide and antidepressants, followed by Roy's first-hand account of the December 2006 FDA hearing which Roy attended, where the committee voted to expand the black box warnings on antidepressants to indicate the risks of untreated depression and to mention the protective effects that antidepressants appear to have on older folks. The FDA has now released two transcripts of the hearing (Transcript 1 and Transcript 2), as well as the slide presentations from some of the speakers. These are excellent resources if you want to find out more on the subject. The recommended changes (see summary) to the black box include text to highlight the following: o increased risk of antidepressant-associated suicidal thoughts and behaviors up to around age 25 o protective effect of antidepressants against suicidal thoughts and behaviors for older folks, particularly seniors o balancing language which points out the increased risks associated with NOT treating depression (eg, suicide rates have increased for children since the 2004 decision to add black box warnings for antidepressants) * Finland, Finland, Finland. The Finnish study that Dinah mentioned is discussed here. The Monty Python audio was found here. * The Zyprexa Documents. The FuriousSeasons blog details the concerns that Lilly is holding out on important information about its antipsychotic drug. * NYT: Bipolar toddler dead from medications. Raises questions about diagnosing severe mental illness in very young children. * Lovely Spam. on YouTube. * QandA at mythreeshrinksATgmailDOTcom. Schizoid personality disorder: Is it real and does it predispose to schizophrenia? By Seamonkey. Diagnostic criteria. Pubmed review. * Amygdala size and eye contact in Autism. * Asperger's syndrome.Next week: Side effects of psychotherapy; evolutionary psychopathology; what happens in Vegas.Last week's musical snippet was from the 2000 release, Strangelove Addiction, from the self-titled album by Supreme Beings of Leisure. Go to http://mythreeshrinks.com for show notes with links.00:50:48psychiatrist, podcast, public psychiatry, psychology, antidepressants, suicide, schizoid, autism http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-12-bilingual.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks12.m4aFeb 25: Evolutionary significance of depression; Mental Health Parity Act of 2007; blogs by Saminkie and Michelle Tempest. PodcastsSun, 25 Feb 2007 22:45:00 -0500Shrink RapNoFeb 25: Evolutionary significance of depression; Mental Health Parity Act of 2007; blogs by Saminkie and Michelle Tempest. February 25, 2007: Topics include: * Evolutionary Psychopathology. LA Times article, The Mind as it Evolves, by Julia M. Klein, about a developing area that theorizes that the illness of depression developed as an evolutionary strategy, which helped signal and stabilize social ranking. Very interesting reading. See also the journal article, The evolutionary significance of depressive symptoms, by Matthew Keller and Randolph Nesse from VCU. * Mental Health Parity Act of 2007. Well, we have been trying to get this passed for years (see NAMI's review), despite popular bipartisan support. It passed the Senate, and will hopefully pass the House for the president's signature. We also talk about Maryland's 1993 landmark parity legislation. * Psych Blog: Psychiatry for All, by Saminkie. A psychiatry resident in Baghdad who writes about learning psychiatry while having to deal with bullets, explosions, no electricity and other war-related problems. (Sent to us by DrivingMissMolly.) * The Psychiatrist Blog, by Michelle Tempest. A UK psychiatrist, and author of The Future of the NHS, blogs about psychiatry, health and politics.Next week: Could be anything. Send us your questions at mythreeshrinksATgmailDOTcom.Last week's musical snippet was from Monty Python -- Spam; and Finland, Finland, Finland. Go to http://mythreeshrinks.com for show notes with links.00:18:31psychiatrist, podcast, public psychiatry, psychology, depression, evolution, mental health, parity, legislation, blogs http://psychiatrist-blog.blogspot.com/2007/03/my-three-shrinks-13-lost-it-in-space.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks13.m4aMar 4: psychiatric emergencies in outer space; NASA's procedures for handling acute psychosis and suicidal behavior; not guilty by reason of brain damage; forced treatment of sexual offenders. PodcastsSun, 04 Mar 2007 12:00:00 -0500Shrink RapNoMar 4: psychiatric emergencies in outer space; NASA's procedures for handling acute psychosis and suicidal behavior; not guilty by reason of brain damage; forced treatment of sexual offenders. March 4, 2007: Topics include: * How does NASA handle psychiatric emergencies in space? The recent 'astronaut goes wild' headlines get us talking about NASA's procedures for handling acute psychotic breaks and suicidal behavior in space. Also, go to page 847 of the above-linked document to see the list of medications which are kept on the ISS (International Space Station). Listen to the podcast to find out which antidepressant is the SSRI of choice for NASA. * Q&A: Sandra, a prolific, Canadian Barbie Doll (it's true, look at her picture) from Omni Brain and NeuroFuture sent in a multi-part question: "Do you agree that neurological factors may diminish legal responsibility (but not excuse it) in ways not currently considered by the legal system, i.e., that don't fall in line with the McNaughton insanity defence, and the legal system should change in accordance? In what ways, based on what you see in the population you treat? Also, in cases like compulsive sexual offenders, do you support chemical castration and similar means of crime prevention?" This is obviously a Clinkshrink question, but we have a spirited discussion about these areas. Next week: Visitor survey; Top 25 crimes of the last century; What do psychiatrists do to prepare for the next session (thanks, DrivingMissMolly); NHS fiasco. Send us your questions at mythreeshrinksATgmailDOTcom.Last week's musical snippet was from Suzanne Vega's 1987 release of Language from the album, Solitude Standing. (Also, you've gotta check out this Tom's Diner-inspired I Dream of Jeannie video.) Go to http://mythreeshrinks.com for show notes with links.00:35:18psychiatrist, podcast, antidepressants, psychology, suicide, space, mental health, forensics, antipsychotics, blogs, space http://psychiatrist-blog.blogspot.com/2007/04/my-three-shrinks-podcast-14-no-april.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks14.m4aApr 1: Pedophilia; ephebophilia; civil commitment; jail vs prison; judges defining normal behavior (The Brain on the Stand); 24; walk like a psychiatrist; humor and medicine. PodcastsMon, 02 Apr 2007 23:30:00 -0500Shrink RapNoApr 1: Pedophilia; ephebophilia; civil commitment; jail vs prison; judges defining normal behavior (The Brain on the Stand); 24; walk like a psychiatrist; humor and medicine. April 1, 2007:Topics include: * Q&A: Midwife with a Knife, an OB/GYN, asks us about whether pedophilia is a disease or something else, and what we think about civil (as opposed to criminal) commitment for it. Clink uses one of her 50-cent words on us (ephebophilia, a term that Clink says was coined by John Money in his book, Love Maps). See also The Last Psychiatrist's posts on this here and here. * NYT article: "The Brain on the Stand", by Jeffrey Rosen. Clink talks about this article about brain diseases being put on trial to explain bad behavior. * Q&A: Dr Anonymous wants us to say more about our recent posts (here and here) on humor and medicine. This whole discussion (and the numerous comments on the blog) was started by Roy's lyrics to "Walk Like a Psychiatrist." Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:36:01psychiatrist, podcast, pedophilia, psychology, brain, neuroscience, mental health, forensics, blogs, humor, laughter, medicine http://psychiatrist-blog.blogspot.com/2007/04/my-three-shrinks-podcast-15-potus.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks15.m4aApr 8: treatment contracts; Dinah rants against insurance companies; mentally ill Presidents; Goldwater rule; reader poll results: Who reads Shrink Rap? PodcastsSun, 08 Apr 2007 23:30:00 -0500Shrink RapNoApr 8: treatment contracts; Dinah rants against insurance companies; mentally ill Presidents; Goldwater rule; reader poll results: Who reads Shrink Rap? April 8, 2007:Topics include:* Q&A: from Gerbil, who asks, "I'd love to hear your thoughts on treatment contracts. My specialty is self-injury, and I often give talks on this subject. Invariably, at least one of my attendees will share that he/she has clients agree that they will be discharged if they hurt themselves between sessions. I've heard others talk about making similar contracts regarding substance use, gambling, and other high-risk behaviors. This makes no sense to me--why make the goal of therapy the condition for receiving therapy? ... I was interested in your opinions, especially because of the settings in which you work." * Dinah rants about Insurance Companies. * Article on Mentally Ill Presidents from Mental Healthworks Newsletter. Nearly half have had mental illnesses. This leads into a discussion about the validity of doing psychological autopsies, or diagnosing someone without personal examination. The Goldwater Rule is discussed in this context (re: Presidents of The United States, or POTUS), as are the APA's Principles of Medical Ethics. * Who Reads Shrink Rap? Reader Poll Results: 20% are physicians (13% psychiatrists, 7% others); 9% nurses; 7% social workers; 7% psychologists; ~30% patients; and ~30% others. So more than one-third are mental health professionals, and close to one-half are health care professionals (nearly 200 readers voted). Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:36:46psychiatrist, podcast, psychology, mental health, blogs, ethics, insurance, president, medicine, psychiatry http://psychiatrist-blog.blogspot.com/2007/04/my-three-shrinks-podcast-16.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks16.m4aApr 17: Top crimes of the 20th century; psychotherapy sessions; NHS; bipolar in kids. PodcastsTue, 17 Apr 2007 08:00:00 -0500Shrink RapNoApr 17: Top crimes of the 20th century; psychotherapy sessions; NHS; bipolar in kids. April 17, 2007: ClinkShrink here. I volunteered to help Roy by editing one of our podcasts--heaven help me, I did the best I could. Be patient, I'm using Windows. This is podcast number 16 which was actually podcast number 14 taped about a month ago and taken out of order for no particular reason.Topics include: * First up are the TOP 25 CRIMES OF THE CENTURY, a topic that could only be mine. It's a Time article that lists some of the most infamous or unusual crimes, but I have a couple bones to pick about their choices. Roy and Dinah just think I'm weird for even knowing this stuff. [Listen in to find out Clink's favorite crime. -Roy] * Next we ANSWER A QUESTION from Driving Miss Molly regarding how much and what kind of preparations psychiatrists do before their patients' appointments. * Finally we do the Shrink Rap BLOG ROLLCALL, where Shiny Happy Person deals with medical training in the UK and under the NHS, Roy flirts with the Girl with the Blue Steth, and Intueri talks about bipolar disorder in kids. Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:34:40psychiatrist, podcast, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain, psychiatry http://psychiatrist-blog.blogspot.com/2007/04/my-three-shrinks-podcast-17-happy.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks17.m4aApr 22: 1-year blog anniversary for Shrink Rap; Virginia Tech killings; social catastrophe; this week in history (other bad events); mental health parity bills; US Anatomy Museum; 1000 medical students to enter Psychiatry residencies. LISTEN TO NEXT WEEK'S GRAND ROUNDS PODCAST! PodcastsSun, 22 Apr 2007 23:30:00 -0500Shrink RapNoApr 22: 1-year blog anniversary for Shrink Rap; Virginia Tech killings; this week in history; mental health parity bills; US Anatomy Museum; 1000 medical students to enter Psychiatry. LISTEN TO NEXT WEEK'S GRAND ROUNDS PODCAST! April 22, 2007: This podcast comes out the day after the 1-year anniversary of our blog. Thank you to all of our well-wishers. It's not always easy to keep something like this, and the podcast, going. But having friends like Dinah and Clink make it easy. Note that next week will be a special podcast, where we will discuss many of the submissions for our May 1 Grand Rounds. Send us your submissions by Saturday, April 28, 2007, at midnight at mythreeshrinksATgmailDOTcom. We'll even include some brief audio comments about your post (attach a 20-30 sec .m3). Topics include: # A lot of silly talk about our anniversary, gifts, ducks, and chocolate. # VIRGINIA TECH TRAGEDY. Most of the podcast is about this and related offshoots. We discuss some comments on Dinah's post, Unspeakable. We also point out two past posts, Suicidal Students and Let's Talk About Suicide. # This CBS News story discusses the struggle of BALANCING PRIVACY AND SAFETY on college campuses. # Dr. Michael Welner, a forensic psychiatrist consulting for ABC News, CRITICIZED THE MEDIA for showing the videotapes from Cho Seung-Hui (more here). (What is "Ismail Ax"?) # NAMI has some useful links related to this tragedy. # Clink lists OTHER BAD EVENTS which have happened in the third week of Aprils past, including things to do with Hitler, Lincoln, Oklahoma City, Waco, and Columbine. # There are two MENTAL HEALTH PARITY BILLS before congress. Please let your U.S. Representatives and Senators know you want these passed unamended. # Psychiatric News reports that the number of medical students choosing CAREERS IN PSYCHIATRY is holding steady at 1000 entering psychiatry residencies this summer.Send us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:40:55psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/05/grand-rounds-at-shrink-rap.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks18.m4aMay 1: Bring Your Own Brains. MTS presents this week's Grand Rounds, with 50 of some of the best medical blogs in the blogosphere.PodcastsTue, 01 May 2007 00:01:00 -0500Shrink RapNoMay 1: Bring Your Own Brains. MTS presents this week's Grand Rounds, with 50 of some of the best medical blogs in the blogosphere. BRING YOUR OWN BRAINS May 1, 2007: This is our GRAND ROUNDS podcast. Check out this week's Grand Rounds post, containing 50 medicine-related posts from all corners of the blogosphere (actually, that would be a blogocube, wouldn't it?). I'm not even going to try to put everything here, but I will list the blogs that made submissions... A Chronic DoseAn American Medic in BritainAnxiety, Addiction and Depression TreatmentsClinical CasesDiabetes MineDr AnonymousDr Marc GreensteinDr Val and the Voice of ReasonEmergiblogEnoch ChoiER NurseyHealth Business BlogHealth PsychHealthLineHighlight HealthHospital ImpactInsureBlogInterested ParticipantKevin, M.D.Knocking From InsideLiverpool LeftoversMidwest Med Student Meets East Coast PoliticsMonash Medical StudentMovin' MeatNurse Ratched's PlaceNY Emergency MedicineNY Personal Injury LawyerOdysseys of GeorgeOne Version of ThingsPixelRNRachel's Wide Word of LunacyRickety Contrivances of Doing GoodScienceRollSharpBrainsSix Until MeTales of an Emergency Room NurseTangent 90 DegreesTech MedicineTeen Health 411The Blog That Ate ManhattanThe Differential: Medscape Med Students BlogsThe Doctor BloggerThe Fitness FixerThe Snarky GerbilThe Tangled NeuronTSCDUniversal HealthVitum MedicinusWandering VisitorSend us your questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:35:03psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/05/my-three-shrinks-podcast-19-xanax-blues.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks19.m4aMay 7: emailing patients; asexuality; Xanax issues; Munchausen's; DID; denying care; California forensics; digital gas.PodcastsMon, 07 May 2007 01:30:00 -0500Shrink RapNoMay 7: emailing patients; asexuality; Xanax issues; Munchausen's; DID; denying care; California forensics; digital gas. Xanax Blues May 7, 2007: * Q&A: Emailing patients * Q&A: What is Psychiatry doing about asexuality? * Q&A: Talk about Munchausen's disease and Dissociative Identity Disorder (DID). * Is denying care malpractice? * California forensic psychiatry staffing problems * More troubles with Xanax Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:37:55psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/05/my-three-shrinks-podcast-20-mother.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks20.m4aMay 13: Mother's Day; Talkshoe; malpractice; gender identity; Medicare Part D; ethics; space; Tarasoff; child abuse reporting; Dinah's crystal ball.PodcastsSun, 13 May 2007 14:30:00 -0500Shrink RapNoMay 13: Mother's Day; Talkshoe; malpractice; gender identity; Medicare Part D; ethics; space; Tarasoff; child abuse reporting; Dinah's crystal ball. May 13, 2007: Topics include: # Happy Mother's Day! # Turkewicz law blog a hit with Clinkshrink. Her recommendations? Malpractice Primer and Economics. # Q&A: Zoe Brain asks "Is there a Standard of Care for GIDNOS in the case where the patient is intersexed? And does the degree of intersex affect the therapeutic regime, and if so, how? I'm familiar with the WPATH (Formerly HBIGDA) v6 SOC for GID. But once a diagnosis of GIDNOS is established, the SOC does not appear to apply."Answer: Huh? (We did the best we could.) Also, see Farmer v. Brennan. # APA says people with Medicare Part D having trouble getting their psychiatric medications. Also, discussion of the "donut hole." # Medical Truth in Advertising bill: Is your "doctor" really a doctor? # Ethical conundrums: trains and Tarasoffs and guns (oh my!). Also, Maryland's problematic law requiring reporting of childhood abuse, even if you are now 90 or you don't know who the perpetrator is. And, what do you do with a dead astronaut on the way to Mars? # If Dinah had Lost It in Space, she Wishes she would have a Crystal Ball. # A shrink like me? Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:43:16psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/05/my-three-shrinks-podcast-21-chris-kraft.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks21.m4a(Remix of) May 20: Guest Speaker on Intersex Disorders, Chris Kraft PhD, head of the Sexual Behaviors Consultation Unit and the Center for Sexual Health. Also, our friend, Victor. Segways. (Thanks for the idea, Lily... Remixed with bits of King Missile's Detachable Penis... Hope John and the KM gang don't mind)PodcastsSun, 20 May 2007 02:00:00 -0500Shrink RapNo(Remix of) May 20: Guest Speaker on Intersex Disorders, Chris Kraft PhD, head of the Sexual Behaviors Consultation Unit and the Center for Sexual Health. Also, our friend, Victor. Segways. (Remixed with bits of King Missile's Detachable Penis) May 20, 2007: Topics include: # Intersex disorders: This is where one is born with ambiguous genitalia, and one is raised a gender which is different from one's genetic gender. It is a rare condition. Dr. Kraft discusses the many complications that this can cause. This is part of an answer to Zoe Brain's question, continued from last week's podcast. # What is a "mother"? A Maryland court has determined that a surrogate mother can have her name removed from a baby's birth certificate, like fathers have been capable of for years. Can a child be born with no parents on its birth certificate? See Show Notes for links to the King Missile song, Detachable Penis, on eMusic and YouTube. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:40:58psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/05/my-three-shrinks-podcast-22.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks22.m4aMay 27: Physician-assisted executions; pharmacogenomics report; dopamine, genetics, and stressor in ADHD; outpatient commitment in PA; funniest joke; National Duckling Month.PodcastsSun, 27 May 2007 19:00:00 -0500Shrink RapNoMay 27: Physician-assisted executions; pharmacogenomics report; dopamine, genetics, and stressor in ADHD; outpatient commitment in PA; funniest joke; National Duckling Month. May 27, 2007 Topics include: * Physician-Assisted Executions. The American Medical News had a story by Kevin B. O'Reilly about how some states are trying to force physicians to participate in executions. The ethics of such activities are debated. * Realizing the Promise of Pharmacogenomics. A draft federal report is available for public comment (by June 1) about the development of pharmacogenetics and the impact of genomic medicine on the future of health care. You can find the report and comment form here. "The report identifies a number of challenges for the development of pharmacogenomics and its effective integration into health care practice, including the need to improve the health-information infrastructure, to provide education and training for practitioners, and to maintain the confidence of all stakeholders by effectively addressing ethical, legal and social issues arising from pharmacogenomics." * Dopamine, Genetics, and Environmental Stressors in ADHD. As an example of the above, this month's Archives of General Psychiatry has an article by Manfred Laucht, et al., showing evidence of an interaction between a mutation in the Dopamine Transporter (DAT) gene and severe environmental stress (e.g., abuse) triggering symptoms of ADHD. Also mentioned in the podcast is data suggesting that certain Serotonin Transporter Promoter (5HTTP) mutations predict one's response to SSRI antidepressants, the development of side effects to these drugs, and the propensity to develop psychiatric symptoms. * Forced Outpatient Treatment in PA. Liz Spikol, who writes the blog and newspaper column, Trouble with Spikol, for the Philadelphia Weekly, writes about Pennsylvania Senate Bill 226, which would make it easier to make people with severe mental illness who are "unlikely to survive safely in the community without supervision." A long debate on the podcast ensues (half the 'cast) about the ethics and practicality of such tactics. * Don't miss Roy's telling of the official (according to psychologist, Richard Wiseman) funniest joke in the world (around the 25 minute mark). Just to be on the safe side, be sure you aren't driving when you listen to it.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:47:10psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/06/my-three-shrinks-podcast-23-loons-lefse.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks23.m4aJun 3: Flea's troubles; transference; rules for bloggers; movie review; Dr Phil next week.PodcastsSun, 03 Jun 2007 23:00:00 -0500Shrink RapNoJun 3: Flea's troubles; transference; rules for bloggers; movie review; Dr Phil next week. June 3, 2007 Topics include:# Doctor Anonymous to be guest on June 17 podcast. # Clink brings back notepads with loons on them and cinnamon lefse from the midwest.# Flea's medical blog affects his malpractice trial. This is a fascinating story, which is well-summarized and explained on Eric Turkewitz's legal blog. We're waiting for Flea's (Dr. Lindeman's) book to come out.# Dinah talks about transference. Also see prior post on Transference to the Blog.# Rules for Bloggers. In response to Flea's troubles, ClinicalCases suggests Five Rules for Blogging: 1-Write as if your boss and your patients are reading your blog every day 2-Comply with HIPAA 3-Do not blog anonymously. List your name and contact information 4-If your blog is work-related, it is probably better to let your employer know 5-Use a disclaimer# We mention a survey of medical bloggers that was done last year. Anyone have a link?# Movie Review: Away From Her. Clink thought this movie about a woman with dementia was very good.# Oh, remember... check out next week's podcast, when Dr. Phil will be joining us for a brief interview. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:30:06psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/06/my-three-shrinks-podcast-24-dr-phil.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks24.m4aJun 10: Dr Phil plays a joke on Dinah; genetics of cocaine-induced paranoia; pt desire vs EBM; dark tourism; Dr A joins us next week; Dr Who mashup.PodcastsSun, 10 Jun 2007 02:00:00 -0500Shrink RapNoJun 10: Dr Phil plays a joke on Dinah; genetics of cocaine-induced paranoia; pt desire vs EBM; dark tourism; Dr A joins us next week; Dr Who mashup. June 10, 2007: Dr. Phil on Skype Topics include: * Genetics of Cocaine-Induced Paranoia. Roy talks about a recent article in Biological Psychiatry by Kalayasiri which suggests that a particular mutation (C1021T) in the dopamine beta-hydroxylase (DBH) gene was associated with significantly increased paranoia in a small group of cocaine abusers. Genetics is playing an increasing role in understanding how we respond to drugs AND to our environment. * Dinah wins an award for her writing. * Expectation vs Evidence-based Medicine. We get into a detailed discussion about how patients' perceptions and expectations get in the way of evidence-based medicine (with examples from Flea's post on admitting children and direct-to-consumer advertising). "Doc, my friend got better with DrugX so I want to try it." "It goes back to 'who deserves care'." * Dr. Phil visits My Three Shrinks. THIS IS A MUST-LISTEN SEGMENT! Clink and I play a trick on Dinah by "calling" Dr. Phil on Skype and he "interviews" us. This is a riot!! Dinah is such a good sport. [link to DrPhil Soundboard] * Dark Tourism. After reading a NYT piece on touring prisons, Clink discusses the concept of dark tourism, where people seek out notorious sites to see (like cemeteries and prisons). She sent us a humongous scholarly piece on the subject (see Clink's Travelogue for more fun).Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:52:49psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/06/my-three-shrinks-podcast-24-dr-phil.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks-drphil.m4aJun 15: This is just the Dr Phil gag from podcast #24, as well as the mashup from the soundboard plus the rockin KLF song, Doctorin the Tardis.PodcastsFri, 15 Jun 2007 00:30:00 -0500Shrink RapNoJun 15: This is just the Dr Phil gag from podcast #24, as well as the mashup from the soundboard plus the rockin KLF song, Doctorin the Tardis. June 15, 2007: Dr Phil gag w/KLF Mashup * Dr. Phil visits My Three Shrinks. THIS IS A MUST-LISTEN SEGMENT! Clink and I play a trick on Dinah by "calling" Dr. Phil on Skype and he "interviews" us. This is a riot!! Dinah is such a good sport. [link to DrPhil Soundboard] (this is the prank from podcast #24... without all the other stuff...if you've already heard it, there is nothing new here so just delete it... or post it all over the internet, as Dinah would be oh-so-appreciative).Go to http://mythreeshrinks.com for show notes with links.00:18:24psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/06/my-three-shrinks-podcast-25-sibling.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks25.m4aJun 17: iPod hallucinations; Paris Hilton; sibling relationships and depression risk factors; Goldwater Rule; Sopranos.PodcastsSun, 17 Jun 2007 23:00:00 -0500Shrink RapNoJun 17: iPod hallucinations; Paris Hilton; sibling relationships and depression risk factors; Goldwater Rule; Sopranos. June 17, 2007: Sibling Reveille Topics include: * Clink wonders if iPOD USERS have more musical auditory hallucinations. But, can deaf people get auditory hallucinations, or do they hallucinate people signing at them? "Yes, We Have No Bananas" seems to be a popular musical hallucination with older folks. Wonder if "Reveille" is heard by folks who were in the military? This is clearly a wake-up call for all you iPod users. * KevinMD placed us on his "Power 8" list of medical blogs with an "exceptional week" of blogging, particularly noting Clink's post on forensic psychiatry issues raised by the latest PARIS HILTON SAGA, which also leads to a discussion of the Goldwater Rule, of high profile cases (like Cho... see Face to Face and Unspeakable), and of freedom of speech. * Dinah talks a bit about Dr Melfi's firing of TONY SOPRANO. * We talk at length about a June 2007 AJP article by Waldinger, Vaillant, and Orav, entitled "CHILDHOOD SIBLING RELATIONSHIPS AS A PREDICTOR OF MAJOR DEPRESSION IN ADULTHOOD: A 30-Year Prospective Study." This is an amazing study in that they followed a group of some 229 men from age 20 to age 50, doing lots of interviews and tests along the way. In this analysis, they looked at the quality of their sibling and parental relationships, as well as family history of mood disorder, and made a surprising finding. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:34:39psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/06/my-three-shrinks-podcast-26-black-box.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks26.m4aJun 24: side effects of psychotherapy; depression, kids, and the FDA black box (June AJP); wellness vs illness; is inpatient psychotherapy an oxymoron?PodcastsSun, 24 Jun 2007 20:00:00 -0500Shrink RapNoJun 24: side effects of psychotherapy; depression, kids, and the FDA black box (June AJP); wellness vs illness; is inpatient psychotherapy an oxymoron? June 24, 2007: Black Box Reloaded Topics include: * Side Effects of Psychotherapy. Sharon Begley from Newsweek wrote an article entitled, "Get Shrunk at Your Own Risk." We discuss this particularly in reference to grief and bereavement, PTSD, and CISD. * Discussion at Cheryl Fuller's Jung at Heart about therapy as a treatment for an illness vs. as a tool to improve one's life. And here's an afterthought. * The Impact of the FDA's SSRI Black Box on the Decline in Depression Treatment in Kids. We discuss the June 2007 AJP article by Libby et al. showing that there was a 58% drop in expected number of antidepressant prescriptions for this population after the black boxes went up, and that the proportion of depressed children who remained untreated with antidepressants increased some three-fold. Other data has showed an increase in the suicide rate if this population afterwards. In the graph below, the black line represents the percentage of kids with major depression who were prescribed no antidepressant. * Q&A: "In my neck of the woods there is pretty much NO 'talk' therapy in short term inpatient settings. I know of many depressed individuals who have decompensated in these settings, and have had their depression actually increase on their departure. Any thoughts?"Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:34:37psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/07/my-three-shrinks-podcast-27-shrinks-on.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks27.m4aJul 01: Dr A.; docs getting pharma dough; zyprexa lawsuit; yakkity yak (don't talk back); Q-APodcastsSun, 01 Jul 2007 23:30:00 -0500Shrink RapNoJul 01: Dr A.; docs getting pharma dough; zyprexa lawsuit; yakkity yak (don't talk back); Q&A July 1, 2007: Shrinks on the Take Topics include: * Doctor Anonymous has new Podcast, where he talks about chatty doctors, nursing home patients, and discovers BlogTalk Radio (similar to TalkShoe). * Vermont Shrinks Rolling in Pharma Dough. The New York Times reported on doctors who get money from drug companies, finding that in Vermont the #1 specialty to cash in is Psychiatry. Vermont has a law requiring the reporting of such income, and the story misleading suggests that the average Vermont psychiatrist gets $45,000 from drug companies. Closer reading shows that there were 11 psychiatrists who received an average of $45,000. Still. What are they getting paid for? Here's some insight from a #2 specialty: Endocrinologists. A US Senator has suggested that all such income get reported, just like they have to do (makes sense to me). * Zyprexa Class Action Lawsuit for Fraudulent Marketing Zips Ahead. CL Psych informs us that a judge is allowing this suit to go forwards, based on allegations that Lilly engaged in fraudulent marketing of Zyprexa for unapproved uses. See also the March FDA Drugs for an FDA warning against Provigil. We launch into a wider discussion about off-label prescribing and combination medications. Listen to find out the #1 prescribed drug which is FDA-approved for bipolar depression (hint: it's not an SSRI). * Doctors Who Talk Too Much. The Archives of Internal Medicine has an article by McDaniel et al., which has been in the news. They sent fake patients into participating physician offices over the course of a year and recorded the interactions, categorizing the utterances in various ways. One-third of the visits contained physician "self-disclosures" (talking about themselves), with 85% of these not being useful. It doesn't seem that they asked the pretend patients how useful these discussions were. I view the study's conclusions with suspicion. I would like to see compliance rates and outcome measures compared between a group of patients whose physicians self-disclose and one whose physicians do not (ideally, assignment would be randomized, and a physician would have patients in both groups). * Q&A: Can you have a mental disorder and still become a mental health professional? Listen in as we address this question from a listener.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:39:54psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/07/my-three-shrinks-podcast-28-can-you.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks28.m4aJul 9: Panetti-competence to be executed; therapist disclosure; female interns; physician stress and burnout; iPhone apathy; MTS iTunes contest; prison sex change; Pristiq.PodcastsMon, 09 Jul 2007 23:30:00 -0500Shrink RapNoJul 9: Panetti-competence to be executed; therapist disclosure; female interns; physician stress and burnout; iPhone apathy; MTS iTunes contest; prison sex change; Pristiq. July 9, 2007: Can You Hear Me Now? Topics include: * Panetti v. Quarterman. Clink talks about a hot-off-the-press, landmark Supreme Court case about COMPETENCY TO BE EXECUTED and death penalty cases for people with mental illness. She also refers to the Ford v. Wainwright case. "It's a hint that, down the road, we will probably not have a death penalty for mentally ill people, just like we no longer have a death penalty for juveniles or mentally retarded people." * Dinah goes back to Podcast #27 and refers to Dr. Kay Redfield Jamison's book, An Unquiet Mind, talking about therapists' DISCLOSURE to patients about their own mental health issues (which was blogged about here). * ON BEING A FEMALE INTERN. Clink rants against DrCrippen's (NHS Blog Doctor) rant about part-time doctors (mostly mothers): DrC: "You need to grow up a little. You can't expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? ... If you won't do the hours, you can't have job... Just because you are a girlie, you can't expect medical training to be turned on its head." * PHYSICIAN STRESS & BURNOUT. This discussion transitions into talk of a 2004 article (IC McManus, et al.) on physician stress and burnout, finding that the consequences of physician training stress has more to do with how one handles stress in general. * iPHONE aPATHY. Roy mentions his iPhone post. Who cares? * iTUNES REVIEWS. Clink asks our listeners to do more reviews of our podcast, and we offer to mention the next 3 reviewers (good or bad) on our next podcast (whoopee!). * SEX CHANGE OPERATIONS IN PRISON?. Clink talks about a recent case of many thousands of dollars being spent litigating a case of a prisoner requesting a sex change operation. * PRISTIQ. Desvenlafaxine (a metabolite of Effexor or venlafaxine) is up for final approval at the FDA (I misspoke in the podcast... Pristiq is not an extended release of Effexor, but rather a metabolite of it).Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:36:25psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/07/my-three-shrinks-podcast-29-suicidal.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks29.m4aJul 22: Ambien-induced sleep-eating; breast implants and increased suicides; psychotherapy angst; archetypewriting; hircine; long-term antidepressant use.PodcastsSun, 22 Jul 2007 11:30:00 -0500Shrink RapNoJul 22: Ambien-induced sleep-eating; breast implants and increased suicides; psychotherapy angst; archetypewriting; hircine; long-term antidepressant use. July 22, 2007: Suicidal Breast Implants Topics include: * Brief discussion about iTUNES. We hit #6 in the MEDICINE SECTION in iTunes last week, thanks in part to KevinMD blogging about our last podcast. We are now getting about 8-9000 podcast downloads per month, which we all find rather amazing. Of course, after the U.S., the country we get the most hits from is China, so we figure there must be Chinese people somewhere trying to learn English from us (big mistake). For the handful of psychiatrists out there (Chinese or otherwise), perhaps we'll release one of those Dummies books about how to make podcasts. * CURBING NOCTURNAL BINGES IN SLEEP-RELATED EATING DISORDER. Clink talks about this article from Current Psychiatry, about eating in your sleep, particularly after taking AMBIEN, or zolpidem. Clink read us a related poem: My Grandma had a habit Of chewing in her sleep. She chewed on Grandpa's whiskers, And called it Shredded Wheat. The article lists weird things people eat in their sleep, including coffee grounds, cat food, and buttered cigarettes (yum!). [I don't think it mentioned eating your own placenta.] * YOU'RE SUPPOSED TO GET BETTER. Dinah's post about how to know when you are making progress in therapy, and when to move on. (On the blog, this led to a series of emotional posts and comments about therapy, the power inequity between therapist and patient, and the differences between docs blogging about pts and vice versa. Go here, here, and there to read more.) * ARCHETYPEWRITING.COM. Dinah provides an unsolicited (and unpaid) advertisement for this website ("The Fiction Writer's Guide to Psychology") about injecting believable shrinkiness into your fiction, while Clink shows off her new nerdy book (2000 Most Challenging and Obscure Words, by Norman W. Schur) by declaring the word of the day to be HIRCINE. * COSMETIC BREAST AUGMENTATION AND SUICIDE. Dinah reviews this article from the July issue of AJP, from David B. Sarwer, et al., which finds "Across the six studies, the suicide rate of women who received cosmetic breast implants is approximately twice the expected rate based on estimates of the general population." I guess we need a black box warning on silicone breast implants now. (We had a post a year ago about the Good Breast; this one is obviously the Bad Breast.) * Q&A: "Is chronic antidepressant use harmful in the long term?" We don't really do this topic justice, but Dinah refers to a prior post here. * Coming up on the NEXT PODCAST: 3 AJP articles on suicide and depression treatment; federal parity laws; managing agitated patients in your office.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:38:19psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/08/my-three-shrinks-podcast-30-parity.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks30.m4aAug 17: insurance parity; mind-body dualism; Pink Floyd's Barrett; 3 AJP articles on suicide by Simon; Posner; and Gibbons. (See Show Notes for graphs and tables.)PodcastsFri, 17 Aug 2007 01:00:00 -0500Shrink RapNoAug 17: insurance parity; mind-body dualism; Pink Floyd's Barrett; 3 AJP articles on suicide by Simon; Posner; and Gibbons. (See Show Notes for graphs and tables.) August 17, 2007: Parity Feels Like a Bird Topics include: * MENTAL HEALTH INSURANCE PARITY LEGISLATION. 20-minute discussion about some of the current legislation (mind you this was recorded before the revisions made in early August to SB 558). Go to this link to see recent parity-related posts. This leads into a brief discussion of... * MIND-BODY DUALISM. Why are there different rules for brain stuff than for body stuff? Isn't the brain part of the body? Will we still be having this debate in yet another 2400 years? * PINK FLOYD'S SYD BARRETT. Brief mention of my post last month, [Shine On, You Crazy Diamond], which, in turn, points to the "Images in Psychiatry" section of the July, 2007, issue of AJP, a tribute written by Paolo Fusar-Poli. "Nobody knows where you are, How near or how far." * THREE ARTICLES ON SUICIDE in the July 2007 AJP. The first, by Simon & Savarino, is a well-done study looking at the relationship between the initiation of depression treatment (medication or psychotherapy) and suicide attempts by looking at outpatient insurance claims of a half-million members. They found that suicide attempt rates were highest in the month before treatment initiation, and that the patterns were similar for medications and psychotherapy. See below image. Most of the people (some 90% or so) were being treated by their primary care physicians. Those with the highest risk appeared to have been referred on to therapists or psychiatrists. Regardless (and not surprisingly), the patterns were the same. As stated by David Brent in his editorial, "it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior." * 2ND SUICIDE ARTICLE by Posner et al about Classifying Suicidal Events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) is explained, in an attempt to standardize the disparate definitions currently in use across treatment trials. Click here to see examples of difficulties in defining injurious behaviors as adverse events. Click here to see the Table of C-CASA definitions and training examples. * 3RD SUICIDE ARTICLE by Gibbons et al about the Relationship Between Antidepressant Initiation and Suicide Attempts in a Large Veteran Population. This group found that SSRI antidepressants had a protective effect. "Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not..."The last few seconds is from Astronomy Domine, from Pink Floyd's album, Pipers at the Gate of Dawn, can be purchased at iTunes.The next podcast, or podette, will be a brief one (for us) which I will post this weekend (yes, two podcasts in as many days... we have to make up for lost time somehow) prior to our next regular podcast, which we will record on Aug 19, probably between 3-5 pm ET. If any other psychiatrist listeners can join in at that time via Skype or Talkshoe, let us know and we might include you as a guest on the show. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:42:47psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/08/my-three-shrinks-podcast-31-biteproof.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks31.m4aAug 20: Q&A from Midwife With a Knife about managing an agitated, psychotic patient in the office.PodcastsMon, 20 Aug 2007 23:30:00 -0500Shrink RapNoAug 20: Q&A from Midwife With a Knife about managing an agitated, psychotic patient in the office. August 20, 2007: Biteproof Gloves * Q&A: from Midwife with a Knife: Short version: How would you manage an agitated, aggressive patient in your OB/GYN office? [Okay, here's the long version: Let's say I have this patient who's clearly distressed and obviously psychotic (if I can tell, it's pretty obvious) who's caretaker reports that they're seriously considering hurting themselves or others, clearly the patient needs to be sent to the psych ed/crisis center/whatever hospital equivalent for evaluation by an actual mental health provider... So, after the caretaker says to us, "I'm worried about taking her back to the group home, I'm think she's planning to hurt someone there.", and I talk with the patient who says something to the effect of, "I know that woman's planning to take my baby, and I'm going to hurt her before she gets the chance." I make the decision that she needs to be emergently evaluated. I try to talk her into going voluntarily (mostly by saying things like, "You seem pretty upset, I think it might help if you went and talked with the doctors downstairs", she refuses, and security is called to escort her down to the psych ED. Eventually, (I think triggered by the stress of that situation and the chaos of a busy clinic and the security officer's arrival), and in an attempt to leave the room (I happened to be sitting between her and the door), she kind of half tackled/half grabbed/half pushed me (Maybe to push me out of the way? I think she was just trying to leave. I don't think she was really trying to hurt me), the security officer grabbed her, she bit him (although he was wearing biteproof gloves) and she eventually was taken to psych. My question for you guys is, How do you psychiatrists recommend those sorts of situations be handled? So, we answer the question in the podcast. We also speculate about "bite-proof gloves."Oh, and if you want to see a funny but very strange rendition of Zappa's Peaches and Regalia -- with a man using his ungloved but cupped hands as a musical instrument -- then do check out this YOUTUBE VIDEO (turn down your volume first). I could not stop laughing. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:16:00psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/09/my-three-shrinks-podcast-32-doctor.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks32.m4aSep 2: guest blogger Doctor Anonymous; overdiagnosis of depression; BMJ articles.PodcastsSun, 02 Sep 2007 12:30:00 -0500Shrink RapNoSep 2: guest blogger Doctor Anonymous; overdiagnosis of depression; BMJ articles. September 2, 2007: Doctor Anonymous on Depression Overdiagnosis Topics include: * DrA on Skype (not a soundboard). Dinah relished the memory of Podcast #24. Check out DrA's blog, doctoranonymous.blogspot.com. * Is Depression Overdiagnosed? We discuss two point-counterpoint pieces in the August 18 2007 issue of BMJ (British Medical Journal). The YES piece is written by Gordon Parker, who believes there is a trend to turn "sadness" into a medical condition: "The ease of assigning a diagnosis of clinical depression, even of major depression, has rebounded on psychiatry, blunting clarification of causes and treatment specificity." The NO piece is written by Ian Hickie, who argues that despite the benefits of increased rates of diagnosis, many people with depression continue to go unrecognized, untreated, and impaired: "The increased rate of diagnosis has had other benefits, including reduced stigma, removal of structural impediments to employment and health benefits, increased access to life insurance, improved physical health outcomes, reduced secondary alcohol and drug misuse, and wider public understanding of the risks and benefits of coming forward for care." Find online comments on these articles at BMJ's website here. * Further discussion about the symptoms of major depression, subsyndromal depression, dysthymia, substance abuse, the influence of the pharmaceutical industry, depression screening, access-to-care problems, inpatient bed capacity problems, per capita psychiatrists and psychologists, stigma about mental illness, primary care management of depression, emergency evaluations. * We digress into hot McDonald's coffee, Twinkies, and chocolate. Also, check out DrA's new talk show at doctoranonymous.com. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:47:50psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/09/my-three-shrinks-podcast-33-inane.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks33.m4aSep 16: Q&A; turning off shrink think; American Visionary Art Museum (AVAM); medicating incompetent defendants; Earley's book on criminalization of mentally ill; Dinah reads her email.PodcastsSun, 16 Sep 2007 14:00:00 -0500Shrink RapNoSep 16: Q&A; turning off shrink think; American Visionary Art Museum (AVAM); medicating incompetent defendants; Earley's book on criminalization of mentally ill; Dinah reads her email. September 16, 2007: Inane Banter Topics include: * Q&A from Jennifer: "In your relationships with the greater world, do you find that you are more compassionate and understanding when it comes to putting up with the foibles of people since you have a greater understanding of the brain? When you see people in traffic driving like they own the road, do you still simmer and think dark thoughts like the rest of us, or do you think, 'well there goes a person who clearly has issues of narcissism (or whatever), and I just hope he doesn't smash into anyone'? Do you find the inane banter of teenage girls less headache inducing because you know the stage is only one of a thousand they will go through on their way to the grave and Oblivion? If a really religious neighbor keeps bugging you about your lack of faith and tries to nag you into going to church with her, would you just smile and thank your stars that you are free of 'invisible friend' delusions? If any of these scenarios are true, I think I may need to go into psychiatry." We do a decent job of answering these questions. * American Visionary Arts Museum (AVAM). Clink discusses her observations about this Baltimore museum and some critical comments noted about the squelching of creativity by Psychiatry. * Involuntarily medicating an "incompetent" defendant. Clink discusses a Baltimore Sun story (couldn't find link) about changes in Maryland created by "the Kelly case". It has now become harder to medicate defendants who are not competent to stand trial. * Q&A from Emily: "Have you read the book called 'Crazy: A Father's Search Through America's Mental Health Madness' by Pete Earley? It is about the criminalization of the mentally ill. When I read it, my mind was opened to the phenomenon of mentally ill people who commit crimes while under the 'influence' of their symptoms, and are punished by being imprisoned rather than getting adequate mental health care assistance. A few questions for you: -Do you feel that prisoners who require mental health care are able to be receive adequate assistance while locked up? -How do you feel about mentally ill prisoners? For example, a paranoid schizophrenic who committed acts such as breaking & entering, destruction of private property, etc while hearing voices instructing him to do so, and winds up in prison rather than a psychiatric hospital. Do you treat people in similar circumstances? -Something else that the book talks about is mentally ill people who are arrested and put in jail, then deemed incompetent to stand trial and sent to psychiatric hospitals until they can be stabilized, then sent back to the jail where they rapidly decline again for a number of reasons before they can stand trial. And the cycle goes on and on. -So I was wondering how much of this you witness in your daily work. How often do you see people that you think should be in a psychiatric facility instead of a prison? How big of an issue do you think it is, or what do you think should be done differently?" Clink addresses these questions, and also her contact with Pete Earley, and about another book of his, Hothouse, about Leavenworth Prison.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:23:04psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/09/my-three-shrinks-podcast-34-guest-mark.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks34.m4aSep 26: Guest Psychiatrist Mark Komrad MD discusses portrayal of psychiatrists in film; prison tattoo database; med student questions; NAMI.PodcastsWed, 26 Sep 2007 23:30:00 -0500Shrink RapNoSep 26: Guest Psychiatrist Mark Komrad MD discusses portrayal of psychiatrists in film; prison tattoo database; med student questions; NAMI. September 26, 2007: Guest Mark Komrad, MD This week we have a special guest, Dr. Mark Komrad, who is an old hat at discussing psychiatric issues on broadcast media. Mark had a live, two-hour, coast-to-coast, nationally syndicated talk radio show for about 5 years. He also had a regular gig on Channel 2 with Rudy Miller, and continues to be a regular guest on NPR. Mark is the Ask-a-Doctor on the NAMI site, and also has a book coming out. Mark was a guest blogger in July, when he posted on Ethics and Continuing Education for the Psychiatrist. (And Monkey the parakeet joins in.) Topics include: # Prison Tattoo Database. Clink informs us about Maryland's tattoo database. Dr. Komrad talks about Match.com's inclusion of tattoos in their matching database. We also talk a bit about the psychology of getting tattoos, in general.# Q&A: I am a second-year medical student in Canada who is considering psychiatry. I have a few questions that hopefully you haven't already addressed elsewhere.Firstly, do you get many negative responses from other medical professionals and the general public for being psychiatrists. If so, how do you deal with it?Secondly, can you discuss some of the differences you know of in practicing psychiatry in Canada versus the US?# Dr. Komrad discusses how he got into Psychiatry, and the images of Psychiatrists in the movies and in Hollywood. (Mentions Irving Goffman here.) Mark points out that only 3% of Americans have even been to a psychiatrist, and so most people learn about what Psychiatry is about from movies. Movies and shows discussed include The Sopranos, Dark Shadows, Beauty and the Beast, Prince of Tides... more on Podcast #35.# Check out NAMI's Ask-the-Doctor column that Mark writes, also his website at www.komrad.yourmd.com.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:44:52psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/10/my-three-shrinks-podcast-35-shrinks-on.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks35.m4aOct 5: Guest Mark Komrad MD talks about portrayal of psychiatrists in the movies; 3 psychiatrist archetypes: Drs Dippy, Darling, and Dangerous; psychiatrists and religion; Leona Helmsley's $12M dog.PodcastsFri, 05 Oct 2007 17:30:00 -0500Shrink RapNoOct 5: Guest Mark Komrad MD talks about portrayal of psychiatrists in the movies; 3 psychiatrist archetypes: Drs Dippy, Darling, and Dangerous; psychiatrists and religion; Leona Helmsley's $12M dog. October 05, 2007: Guest Mark Komrad, MD Last week, we had our guest, Dr. Mark Komrad, join us and begin to discuss the portrayal of psychiatrists in the movies. Mark used to have a live, two-hour, coast-to-coast, nationally syndicated talk radio show, and is a regular guest on NPR. He is also the Ask-a-Doctor on the NAMI site, and also has a book coming out. Mark was a guest blogger back in July, when he posted on Ethics and Continuing Education for the Psychiatrist.This week Mark continues to discuss how Hollywood likes to portray psychiatrists in film. You can find him at www.komrad.yourmd.com. (Unfortunately, Monkey the parakeet gets sidelined in this podcast.) Topics include: # Leona Helmsley's dog, Testamentary capacity, and Psychological Autopsies. ClinkShrink discusses how one starts to address the question of competency to being able to make the decsion to leave $12 million to one's dog. Bounty and one's natural heirs. # Irv Schneider's 3 Psychiatric Archetypes: Doctors Dippy, Darling & Dangerous. These are the three categories of psychiatrists most frequently played in the movies and television. -DR. DIPPY: Bob Newhart Show; What About Bob? (Richard Dreyfuss); High Anxiety (Mel Brooks); Analyze This (Billy Crystal) -DR. DARLING: Equus (Richard Burton); The Sopranos (Dr. Melfi); Sixth Sense (Bruce Willis); Good Will Hunting (Robin Williams); Prince of Tides (Barbra Streisand); Ordinary People (Judd Hirsch); K-PAX (Jeff Bridges) -DR. DANGEROUS: Silence of the Lambs (Anthony Hopkins); Terminator 2: Judgment Day (Dr. Silberman); Dressed to Kill (Michael Caine); Beauty and the Beast (Belle's father)See My Patient, Myself. How we must "neutralize" the negative images of psychiatrists in the media, "like your podcast." How the movie, Lovesick, affected the idea of psychiatrists falling in love with their patients.# Psychiatric Services: Religion and Psychiatry. We have an interesting talk about the role that a physician's religious background may play in the likelihood of referring a patient with complicated grief to clergy versus a psychiatrist. See Roy's upcoming post on Religion and Psychiatry for more info. Briefly:-Psychiatric physicians were more likely to be Jewish or non-religious than nonpsychiatric physicians.-Protestant physicians were twice as likely as other physicians to refer the example patient to clergy rather than a psychiatrist.# Washington Post: Roy briefly mentions his recent post on the final report on the Virginia Tech tragedy and the potential impacts on privacy of health care information, willingness of college students to get help, and liability. Dinah suggests readers go back to look at our prior posts about college mental health, Suicidal Students and Let's Talk About Suicide. This also led to a discussion about outpatient commitment.# Correction: Dinah corrects her reference in Podcast 34 to Reign Over Me. The movie she was actually discussing was The Departed.# Check out NAMI's Ask-the-Doctor column that Mark writes, also his website at www.komrad.yourmd.com.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.01:04:22psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/10/my-three-shrinks-podcast-36-just-do-it.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks36.m4aOct 8: Clink's 25th Anniversary; restoring competence to stand trial; response to NYT Ethicist Randy Cohen about using Adderall for an academic edge; Dinah tries to get antidepressant prices for Medicaid drugs. Next: Poop-out.PodcastsMon, 08 Oct 2007 01:30:00 -0500Shrink RapNoOct 8: Clink's 25th Anniversary; restoring competence to stand trial; response to NYT Ethicist Randy Cohen about using Adderall for an academic edge; Dinah tries to get antidepressant prices for Medicaid drugs. Next: Poop-out. October 08, 2007: Just Do It * Crisis in the Treatment of Incompetence to Proceed to Trial. In the recent Online AAPL Journal, an article by Wortzel about problems with assessing defendants who are not competent to stand trial and restoring them to competence. [hmm, wonder whose topic this one is] At any given time, these people occupy about 10% of our nation's state psychiatric hospital beds. A complicated discussion ensues about who pays for forensic mental health care and how the system results in decreasing access to care for uninsured non-forensic patients. * We respond to a question to the NYT Ethicist column, by Randy Cohen, which you can read here (as well as his answer). [Note: we last saw Randy when he stopped by to respond to a discussion about a previous column of his about suicidal people making wills.] The question involves whether it is okay for a physician, who is a psychiatrist, to prescribe a stimulant (Adderall) to his college kid for the purpose of improving test-taking performance. (We discussed the practice of treating family members in a prior post, My Patient, Myself.) A secondary question involves that kid sharing the medication with a friend. We also discuss the issue of using performance-enhancing amphetamines for non-illnesses, in addition to the potential for a performance-reducing effect due to side effects (which is also taken up on Gawker's Unethicist). (We also ask for help from any DEA agent listeners.) * Clink celebrates her 25th Running Anniversary. She's been just doing it for a quarter century. * Price Transparency for Psychotropic Drugs. Dinah discusses her post about the list of prices for antidepressants. Roy unsuccessfully looks for the prices of these drugs on the Maryland Medicaid website. Coming up in Podcast #37... SSRI Poop-out (aka tachyphylaxis) and other good stuff. Oh, and here's a pic from my Vegas conference trip. Yummy!Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:37:17psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/10/my-three-shrinks-on-blogtalkradio.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks36a-btr.m4aOct 18: Three psychiatrists converge on Dr Anonymous on his call-in show on Blog Talk Radio (blogtalkradio.com/doctoranonymous). We talk about fear and Halloween.PodcastsWed, 24 Oct 2007 23:30:00 -0500Shrink RapNoOct 18: Three psychiatrists converge on Dr Anonymous on his call-in show on Blog Talk Radio (blogtalkradio.com/doctoranonymous). We talk about fear and Halloween. October 24, 2007: Dr Anonymous' BlogTalkRadio Show On Thursday night, October 18, the three shrinks called into Dr A's call-in internet radio show (invited) and we talk about general stuff and answer LIVE questions from the listening audience. Most of the questions seemed to be about Halloween (including favorite candy received at Halloween... I feel another Dinah sidebar poll coming on.) You can check out Dr A's talk show every Thursday night from 10-11pm ET at blogtalkradio.com/doctoranonymous. Go to http://mythreeshrinks.com for show notes with links.01:11:21psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/11/my-three-shrinks-podcast-38-new.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks38.m4aNov 11: Our first podcast with the new sound equipment... let us know how we sound (mythreeshrinksATgmailDOTcom). Neuroimaging and the Law; AAPL; delirium; chocolate; online CBT; telepsychiatry.PodcastsSun, 11 Nov 2007 11:00:00 -0500Shrink RapNoNov 11: Our first podcast with the new sound equipment... let us know how we sound (mythreeshrinksATgmailDOTcom). Neuroimaging and the Law; AAPL; delirium; chocolate; online CBT; telepsychiatry. November 11, 2007: New & Improved! * MacArthur Foundation Grant: Decision-making, substance abuse, and brain abnormalities. Developing guidelines for judges about neuroimaging and brain function. * On our Shrink Rap blog, Clink blogs about What She Learned (Part 1, Part 2, and Part 3) at her AAPL conference. * Delirium. Roy discusses delirium, or encephalopathy, what it is and recent findings about longer term damage. * Shrink-proof containers. Clink brings back a hotel bottle of mouthwash that she could not open. * Q&A: Gerbil brings up recent study on chocolate lovers. * Online CBT for Depression. Study finds it helpful for mild-moderate depression. Eliza. * Telepsychiatry. We just chat about some of the issues. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:42:05psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2007/12/my-three-shrinks-podcast-37-poop-out.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks37.m4aDec 9: (this is the last lo-fi podcast... we promise.) SSRI poop-out or tachyphylaxis; placebo response; Google ads; Aida.PodcastsSun, 09 Dec 2007 22:30:00 -0500Shrink RapNoDec 9: (this is the last lo-fi podcast... we promise.) SSRI poop-out or tachyphylaxis; placebo response; Google ads; Aida. 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.00:44:06psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/01/my-three-shrinks-podcast-40-happy-new.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks40.m4aJan 1: Happy New Year! Leopard problems; resolutions; 2007 Top 25 Posts; 28-inch monitor; drug interactions; Braverman; SAD; iTunes. (note: #39 is forthcoming)PodcastsTue, 01 Jan 2008 23:30:00 -0500Shrink RapNoJan 1: Happy New Year! Leopard problems; resolutions; 2007 Top 25 Posts; 28-inch monitor; drug interactions; Braverman; SAD; iTunes. (note: #39 is forthcoming) 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.00:43:20psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/01/my-three-shrinks-podcast-41-chris-kraft.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks41.m4aJan 27: Guest Chris Kraft PhD on conversion therapy for gays and lesbians; iTunes review on professional isolation; Savage Love; how drugs get their names; Well's Tara Parker-Pope.PodcastsSun, 27 Jan 2008 23:30:00 -0500Shrink RapNoJan 27: Guest Chris Kraft PhD on conversion therapy for gays and lesbians; iTunes review on professional isolation; Savage Love; how drugs get their names; Well's Tara Parker-Pope. 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.00:50:40psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/02/my-three-shrinks-podcast-42-benzo-wars.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks42.m4aFeb 16: The shrinks duke it out about Benzodiazepines; how Xanax works; GABA and glutamate; dependence and addiction; tapering; when to avoid.PodcastsSat, 16 Feb 2008 22:30:00 -0500Shrink RapNoFeb 16: The shrinks duke it out about Benzodiazepines; how Xanax works; GABA and glutamate; dependence and addiction; tapering; when to avoid. 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.00:34:39psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/03/my-three-shrinks-podcast-43-how-doctors.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks43.m4aMar 18: Our book; electronic time-outs; reading humanities; female sociopaths; ADHD brain maturation; labels; email us about the writing style in our book at mythreeshrinksATgmailDOTcom.PodcastsTue, 18 Mar 2008 08:00:00 -0500Shrink RapNoMar 18: Our book; electronic time-outs; reading humanities; female sociopaths; ADHD brain maturation; labels; email us about the writing style in our book at mythreeshrinksATgmailDOTcom. 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.00:42:45psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/03/my-three-shrinks-podcast-44-guest-j.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks44.m4aMar 30: Guest Dr J Raymond DePaulo, Chair of Psychiatry at Johns Hopkins joins us; ethics of giving drugs to improve cognition; diagnosis in psychiatry; what is ADHD, really?; prison health care; loss of serendipity in psychopharmacology.PodcastsSun, 30 Mar 2008 23:30:00 -0500Shrink RapNoMar 30: Guest Dr J Raymond DePaulo, Chair of Psychiatry at Johns Hopkins joins us; ethics of giving drugs to improve cognition; diagnosis in psychiatry; what is ADHD, really?; prison health care; loss of serendipity in psychopharmacology. 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.00:39:10psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/04/my-three-shrinks-podcast-45-guest-dr.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks45.m4aApr 13: Guest Dr. Raymond DePaulo from Hopkins again; treatment-resistant depression; alternative treatments; drugs in the drinking water; words we hate; favorite quotes; books.PodcastsSun, 13 Apr 2008 11:30:00 -0500Shrink RapNoApr 13: Guest Dr. Raymond DePaulo from Hopkins again; treatment-resistant depression; alternative treatments; drugs in the drinking water; words we hate; favorite quotes; books. 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.00:54:07psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/06/my-three-shrinks-podcast-46.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks46.m4aJun 1: PTSD; got trauma?; cortisol for PTSD (Aerni 2004); erasing memories in mousie PTSD (Cai 2006); Flomax; Dead Like Me.PodcastsSun, 01 Jun 2008 10:00:00 -0500Shrink RapNoJun 1: PTSD; got trauma?; cortisol for PTSD (Aerni 2004); erasing memories in mousie PTSD (Cai 2006); Flomax; Dead Like Me. 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.00:42:55psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2009/11/my-three-shrinks-podcast-47-genital.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks47.m4aWomen and civil commitment, cholesterol and depression, koro delusion and mass hysteriaPodcasts26 Nov 2009 08:00:00 -0500Shrink RapNoThanksgiving Day podcast 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.00:26:04psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2008/06/grand-rounds-iphone-3g-edition.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks48.m4aJun 24: GRAND ROUNDS edition w/Apple iPhone 3G theme.PodcastsWed, 25 Jun 2008 08:00:00 -0500Shrink RapNoJun 24: GRAND ROUNDS edition w/Apple iPhone 3G theme. 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.01:05:57psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2010/03/my-three-shrinks-podcast-49-pixelated.htmlhttp://podcast.mythreeshrinks.com/mythreeshrinks49.m4aMar 07: Telepsychiatry with Pat Barta, MDPodcasts07 Mar 2010 08:00:00 -0500Shrink RapNoMar 07: Telepsychiatry with Dr. Pat Barta. March 07, 2010: #49 Pixelated Psychiatrists: Telepsychiatry with Dr. Pat Barta Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.00:47:32psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2010/03/my-three-shrinks-podcast-50-more-about.html http://podcast.mythreeshrinks.com/mythreeshrinks50.m4a Mar 21: Telepsychiatry with Pat Barta, MD Podcasts 21 Mar 2010 08:00:00 -0500 Shrink Rap No Mar 21: More About Geeks. 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. 01:02:13 psychiatrist, psychology, ethics, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2010/04/my-three-shrinks-podcast-51-vegan.html http://podcast.mythreeshrinks.com/mythreeshrinks51.m4a April 12: Is it malpractice to lie? Podcasts 12 Apr 2010 08:00:00 -0500 Shrink Rap No April 12: Vegan Gingerbread Cookies 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. 00:34:19 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2010/04/my-three-shrinks-podcast-52-friendly.html http://podcast.mythreeshrinks.com/mythreeshrinks52.m4a April 25: The Friendly Skies Podcasts 25 Apr 2010 08:00:00 -0500 Shrink Rap No April 25: The Friendly Skies 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. 00:36:40 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2010/10/podcast-number-53-urac-my-rac-youre.html http://podcast.mythreeshrinks.com/mythreeshrinks53.m4a October 10: URAC? Podcasts 10 Oct 2010 08:00:00 -0500 Shrink Rap No Oct 10: URAC? 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. 00:27:22 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2010/11/podcast-54-tell-me-information-and.html http://podcast.mythreeshrinks.com/mythreeshrinks54.m4a November 23: Tell Me! Podcasts 23 Nov 2010 08:00:00 -0500 Shrink Rap No Nov 23: Tell Me! 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. 00:34:51 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/01/podcast-number-55-what-happens-to.html http://podcast.mythreeshrinks.com/mythreeshrinks55.m4a January 25: What Happens to Shooters? Podcasts 25 Jan 2011 08:00:00 -0500 Shrink Rap No Jan 25: What Happens to Shooters? January 25, 2011: #55 What Happens to Shooters? The Shrink Rappers talk about what happens to people with mental illnesses when they commit violent crimes. They explain competency assessments, insanity evaluations and what happens to insanity acquittees. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:30:35 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/01/podcast-56-its-all-your-mothers-fault.html http://podcast.mythreeshrinks.com/mythreeshrinks56.m4a February 10: It's All Your Mother's Fault Podcasts 10 Feb 2011 08:00:00 -0500 Shrink Rap No Feb 10: It's All Your Mother's Fault February 10, 2011: #56 It's All Your Mother's Fault The Shrink Rappers talk about parenting: Amy Chua's book "Battle Hymn of the Tiger Mom", Susan Klebold and being the parent of a suicidal teen. Why we don't know what makes a good parent and how children survive bad parents. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:21:12 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/03/podcast-57-matter-of-national-security.html http://podcast.mythreeshrinks.com/mythreeshrinks57.m4a April 5: A Matter of National Security Podcasts 5 April 2011 08:00:00 -0500 Shrink Rap No April 5: A Matter of National Security April 5, 2011: #57 A Matter of National Security Psychiatrists and national security clearance, in light of the anthrax investigation and the expert behavioral analysis panel report on Dr. Bruce Ivins. Pregnancy and opiate addiction. Finally: our fifth anniversary! Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:31:32 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/04/podcast-58-i-need-new-drug-and-happy.html http://podcast.mythreeshrinks.com/mythreeshrinks58.m4a April 28: I Need A New Drug Podcasts 28 April 2011 08:00:00 -0500 Shrink Rap No April 28: I Need A New Drug April 28, 2011: #58 I Need A New Drug We talk about all kinds of new medications on the market: Viibryd, Silenor, Contrave and Swiffer (oh wait, that last one wasn't a medication!). Are the latest and greatest meds really the greatest? We also celebrate our fifth anniversary! Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:27:14 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/07/podcast-59-brief-chat.html http://podcast.mythreeshrinks.com/mythreeshrinks59.m4a July 4: A Brief Chat Podcasts 04 July 2011 08:00:00 -0500 Shrink Rap No July 4: A Brief Chat July, 4: #59 A Brief Chat Doctors who write, suicidal students and a social media curriculum for medical residents. Happy Fourth of July! Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:18:17 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/07/podcast-60-on-verge.html http://podcast.mythreeshrinks.com/mythreeshrinks60.m4a July 14: On The Verge Podcasts 14 July 2011 08:00:00 -0500 Shrink Rap No July 14: On The Verge July, 14: #60 On The Verge Questions from our listeners: Do psychiatrists know how to work with people who have autism? What is a nervous breakdown? Who was the original Nervous Nellie? How getting charged with a crime will increase the risk of suicide even if the person is acquitted and never incarcerated. If that weren't enough, we also talk about Dexter and the psychology of medical social media. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:27:36 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/08/podcast-61-stay-safe.html http://podcast.mythreeshrinks.com/mythreeshrinks61.m4a August 31: Stay Safe Podcasts 31 August 2011 08:00:00 -0500 Shrink Rap No August 31: Stay Safe August 31: #61 Stay Safe Our recent earthquake, pets with PTSD, mental health parity and the true meaing of misprision. Also, what made the elephants hold each other by the trunk. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:27:36 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/10/podcast-62-sooner-rather-than-later.html http://podcast.mythreeshrinks.com/mythreeshrinks62.m4a August 31: Stay Safe Podcasts 11 October 2011 08:00:00 -0500 Shrink Rap No October 11: Soon Rather Than Later October 11: #62 Sooner Rather Than Later Physicians and social media, AMA social media guidelines. Psychiatric illness and early mortality. Join Shrink Rap on Google Plus---if it is still around three months from now. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:45:36 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/11/podcast-63-bystander-effect.html http://podcast.mythreeshrinks.com/mythreeshrinks63.m4a December 4: The Bystander Effect Podcasts 4 December 2011 08:00:00 -0500 Shrink Rap No December 4: The Bystander Effect December 4: #63 The Bystander Effect Why people fail to act when the see violent crimes. Mandatory reporting laws. Discussion and review of apps for depression. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:30:58 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2011/12/podcast-64-brain-freeze.html http://podcast.mythreeshrinks.com/mythreeshrinks64.m4a December 22: Brain Freeze Podcasts 22 December 2011 08:00:00 -0500 Shrink Rap No My Three Shrinks 64: Brain Freeze December 22: #64 Brain Freeze Public speaking and the neuroscience of brain freeze, Siri answers our questions: who is the best psychiatrist and when will the world end? Is prison nutraloaf cruel and unusual punishment? Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:32:35 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2012/01/podcast-65-copyrighting-brain.html http://podcast.mythreeshrinks.com/mythreeshrinks65.m4a January 8: Copyrighting the Brain Podcasts 8 January 2012 08:00:00 -0500 Shrink Rap No My Three Shrinks 65: Copyrighting the Brain January 8: #65 Copyrighting the Brain The American Psychiatric Association election. Copyrighting the Mini-Mental State Examination and the problem with open-access tests. More about the electronic health care system and developing a consensus about what should be in a note. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:32:35 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2012/02/podcast-66-professional-shrink-rap.html http://podcast.mythreeshrinks.com/mythreeshrinks66.m4a January 24: Professional Shrink Rap Podcasts 24 January 2012 08:00:00 -0500 Shrink Rap No My Three Shrinks 66: Professional Shrink Rap January 24: #66: Professional Shrink Rap Top ten search terms for Shrink Rap in 2011. Does Angry Birds make you depressed? Ethics and distracted doctors: calling in sick versus going to work annoyed. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:35:12 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2012/07/podcast-67-things-get-flighty.html http://podcast.mythreeshrinks.com/mythreeshrinks67.m4a July 15: Things Get Flighty Podcasts 15 July 2012 08:00:00 -0500 Shrink Rap No My Three Shrinks 67: Things Get Flighty July 15: #67: Things Get Flighty Electronic health records and the weird potential for felony fraud. Dinah, her latest books and FINALLY, the winner of our random drawing! Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:38:52 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2012/08/podcast-68-supermax-health-exchanges.html http://podcast.mythreeshrinks.com/mythreeshrinks68.m4a August 6: SuperMax, Health Exchanges and Statins Podcasts 6 August 2012 08:00:00 -0500 Shrink Rap No My Three Shrinks 68: SuperMax, Health Exchanges and Statins August 6: #68: SuperMax, Health Exchanges and Statins Clink talks about a recent class action suit, Baycote v BOP, against the Federal SuperMax facility. Roy talks about the Affordable Care Act, the Mental Health Parity Act and what this all actually means for patients. Dinah discusses cholesterol, statins and depression. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:56:17 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain http://psychiatrist-blog.blogspot.com/2012/10/podcast-69-partnering-with-patients.html http://podcast.mythreeshrinks.com/mythreeshrinks69.m4a October 22: Partnering With Patients Podcasts 22 October 2012 08:00:00 -0500 Shrink Rap No My Three Shrinks 69: Partnering With Patients October 22: #69: Partnering With Patients We talk about the meaning of Shrink Rap, Partnership With Patients, Health Camp, Patient Pod, and how patients test their doctors. We talk about the Massachusetts inmate who successfully sued to get sex reassignment surgery. Send us your general questions at mythreeshrinksATgmailDOTcom. Go to http://mythreeshrinks.com for show notes with links. 00:49:14 psychiatrist, psychology, mental health, blogs, shrinkrap, shrink wrap, medicine, brain