Good Enough Shrink

In this episode, we are skimming the surface of this vast and important field of perinatal mental health. Whether you are an expecting mother, father, partner, concerned family member or friend, or a mental health professional, we hope to leave you with a sense of hope that there are many options for treatment and that you are not alone. **Content in this podcast is not direct medical advice. Please always seek your own psychiatrist, physician, or licensed mental health professional for individually recommended treatments.** Topics Discussed: Perinatal and Postpartum Mental Health ConditionsAnxietyBaby Blues vs. Postpartum DepressionOCDPTSDBipolar disorderPsychosisCauses of Perinatal and Postpartum Mental Health ConditionsBiological, psychological, and social factorsTreatmentsTherapy first!!SSRIsAntipsychotics Neurosteroids TMS, ECTPaternal Mental HealthSpecial Cases: Infertility, Miscarriages, NICU staysResources: https://womensmentalhealth.org/https://postpartum.net/Lacmed: https://www.ncbi.nlm.nih.gov/books/NBK501922/https://postpartum.net/professionals/certification/Have questions for us, or feedback about our podcast? Send us a message!

Hello listeners! This episode, I was inspired by conversations with my closest friends on what exactly it means to endure suffering. I wanted to demonstrate what it actually looks like to "weather the storm" or "ride the wave" as they call it. If you are typically a person who has the answers and currently at a loss, this episode is for you.*Trigger warning on a brief discussion of suicideTopics Discussed:Important introduction to set the stageWhat happens to your brain and body in chronic stress?Story time Processing your emotions one by oneClinical depression and antidepressants Have questions for us, or feedback about our podcast? Send us a message!

As we continue to see violence, political conflict, and distressing news in the world, we  bring to you this episode to help guide parents on how to talk to their kids about difficult news. The physical and mental effects of high stress-states, trauma, and disasters are devastating, and we are right here figuring this out with you. Core concepts to share with your kidsCase 1: Your 7 year-old is scared of school shootingsCase 2: Your 14 year-old is afraid for attacks on the LGBTQ+ communityCase 3: Your 20 year-old is wanting to participate in ICE protestsResources:https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Disaster_Resource_Center/Home.aspxhttps://www.aap.org/en/patient-care/disasters-and-children/?srsltid=AfmBOoo0r1lGRsII7rhW3dc2X6_bLPxh8jxYpIs5H3TDfS77dcQK0lQQHave questions for us, or feedback about our podcast? Send us a message!

As you face the new year (and possibly Sunday blues today), you might be questioning your sense of purpose, direction, and life’s meaning. This is an episode to help you through this time of transition, which often feels crushingly paralyzing. Inspired by none other than the great psychiatrist and Holocaust survivor, Dr. Viktor Frankl, sit back and explore with me the world of existentialism. Topics Discussed:Why finding your life’s purpose is importantWhat does having purpose mean?Viktor Frankl’s logotherapyPhilosophers: Nietzsche, Dostoevsky, SchopenhauerJacques Lacan’s meaning of LoveLove your failuresHave questions for us, or feedback about our podcast? Send us a message!

This time of year, severe mental health conditions like bipolar disorder can worsen. In this episode, we discuss the evolution of bipolar disorder and how it came to be understood. We start with adult bipolar disorder and dive into pediatric bipolar disorder, especially its diagnostic challenges. This is a highly debated topic, so sit back, ponder, send us any questions or comments! Topics Discussed:Statistics of Pediatric Bipolar DisorderHistory of Manic Depressive Illness to Bipolar DisorderDementia praecox & manic depressive insanityDSM-1 through DSM-5Diagnostic Challenge of Pediatric Bipolar Disorder The Question of DMDD vs. Bipolar DisorderDifferential Diagnoses of Bipolar Disorder:ADHD, major depression, psychosis/schizophrenia, autism spectrum disorder, PTSD, borderline personality disorder, TBI, hyperthyroidismPharmacological TreatmentsPsychosocial Treatments Resources:APA: https://www.apa.org/topics/bipolar-disorderAACAP: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Bipolar-Disorder-In-Children-And-Teens-038.aspx Have questions for us, or feedback about our podcast? Send us a message!

Hello listeners! Münchausen Syndrome or factitious disorder is a fascinating yet devastating topic that we’ve taken a few recordings to discuss, especially in light of the recent Florida appeals court ruling on the famous case of Maya Kowalski. As child psychiatrists, we hope to share with you that we are relentlessly searching for answers in conditions like this, and not giving up on the pursuit despite our own vulnerabilities. Topics Discussed:History of Münchausen SyndromeDiagnosis of ExclusionDifferential Diagnoses: malingering, somatic symptoms disorder, functional neurological symptom disorder Clues to Diagnosis Theories Behind Münchausen Syndrome & Münchausen by ProxyStatistics on Münchausen Syndrome & Münchausen by ProxyCase 1: Gypsy-Rose BlanchardCase 2: Maya KowalskiHow families can cope with someone with possible Münchausen Syndrome Treatment Approaches: Team Effort Countertransference Vulnerability as Physicians **Disclaimer: Any discussion or commentary regarding the mentioned public cases is only intended for educational or illustrative purposes. No confidential or privileged information is being disclosed, and any statements made do not constitute a clinical, psychiatric nor medical evaluation or diagnosis. Have questions for us, or feedback about our podcast? Send us a message!

Hello listeners! We are so excited to share this episode with you. We get into the nitty gritty of treatment for PTSD in both psychotherapy and medications. **This information is for general knowledge and does not substitute for professional medical advice, diagnosis, or treatment. Please always consult your own healthcare provider for your care.**PsychotherapyTrauma-Focused CBTEMDRCPT, Prolonged Exposure, Narrative Exposure, Psychoanalytic  psychotherapy (very brief, this shall be its own episode!)Somatic TherapyMedicationsSSRIs: sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil)SNRIs: CymbaltaAlpha 1 antagonists: prazosinBeta-Blockers: propranolol2nd Generation Antipsychotics: risperidone (Risperdal), quetiapine (Seroquel)Other antidepressants: trazodone, TCAs, MAOIs, zuranolone, lamotrigine, Topamax Interventional PsychiatryTMSVNSNeurofeedbackHallucinogens & Psychedelics KetaminePsilocybin, MDMALSD, ayahuascaMedications NOT RecommendedBenzodiazepinesHigh-dose stimulantsNovel ResearchHydrocortisone & neuroinflammationOpioids & pain controlPTSD Treatment Decision Aid by the VA: https://www.ptsd.va.gov/apps/decisionaid/Have questions for us, or feedback about our podcast? Send us a message!

In this episode, we discuss how trauma symptoms present in children, the challenges of diagnosing and treating trauma in children, including the limitations of current diagnostic systems, and the neurobiology of trauma response. Lastly, we discuss marginalized groups to emphasize the most important part of recovery from trauma: not feeling alone. Topics Discussed:How trauma symptoms present in children Developmental Trauma Disorder and why it did not make it into the DSMThe Perspectives Approach to differential diagnosis in psychiatry Neurobiology of trauma responseTheories behind trauma that make senseThe crucial role of a support system in healing from traumaHave questions for us, or feedback about our podcast? Send us a message!

Hello listeners! We are tackling the enormous topic of trauma. We start with how trauma response was stigmatized in history, PTSD's diagnostic criteria, overlap with other conditions such as cPTSD and borderline personality disorder, and the curious roles of memory in trauma. Enjoy!Topics discussed:Shellshock, stigma of traumaDiagnosis based on the DSMDiagnoses not based on the DSMPrevalenceResources from the VAHere is the phenomenal resource by the VA on PTSD: https://www.ptsd.va.gov/Have questions for us, or feedback about our podcast? Send us a message!

In this episode, we invite our good friend and colleague, Dr. Michael Couse, to discuss a recent paper that he and Dr. Kelly published in the academic journal, Journal of the American Academy of Child and Adolescent Psychiatry. The paper discusses the highly complicated (and often avoided) topic of electroconvulsive therapy (ECT) for youths with serious mental illness, especially in California. There are many fears and myths surrounding ECT, and we hope to share this story with you to bring to light how lifesaving this procedure can be. Topics Discussed:Case presentation of a 15 year-old boy diagnosed with catatoniaObtaining substitute consent for a child who is catatonicIssues with California laws on ECT Requirements for obtaining ECT treatment for youths in CaliforniaThe stigma of ECT preventing access to careThe psychiatrist's role in educating ourselves and in advocacy Of note, full consent to discuss this case was obtained from the patient and the patient's family prior to publication of the case. Reference: Couse, M., Makhinson, M., & Kelly, P. (2024). Regulatory and Service System Challenges in Accessing Electroconvulsive Therapy for Catatonia in the Presence of Autism Spectrum Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 63(3), 293–295. https://doi.org/10.1016/j.jaac.2023.09.540 https://pubmed.ncbi.nlm.nih.gov/37778726/ Have questions for us, or feedback about our podcast? Send us a message!

Welcome to Season 2 of Good Enough Shrink! It has such a fun ride this past year. We are kicking off the new season with a topic that remains controversial in some areas of the country, electroconvulsive therapy (ECT). We want to dispel misunderstandings about this treatment, and provide accurate information for anyone who is wanting to learn more about ECT, which can often be lifesaving. Topics discussed:Stigma of ECTWhat is ECT and what is it for?Safety of ECTState laws surrounding ECTHave questions for us, or feedback about our podcast? Send us a message!

Hello listeners! In this episode, I bring together neuroscience and everyday life  to present tips on how to communicate when you are feeling at your worst. Whether you are in an argument with your partner, a power struggle with your kid, or a disagreement with friends/coworkers, these concepts are universal and work in any situation. So if you feel like you are constantly in conflict with people, as life goes, take a listen! Topics discussed:What we do when we run into conflict Neuroscience: Default Mode NetworkFrontoparietal NetworkSalience Network How to calm down and practice the embodied mindWhat is validation?How exactly do we validate How to place a boundarySources:Yeshurun, Y., Nguyen, M. & Hasson, U. The default mode network: where the idiosyncratic self meets the shared social world. Nat Rev Neurosci 22, 181–192 (2021). https://doi.org/10.1038/s41583-020-00420-wMarek, S., & Dosenbach, N. U. F. (2018). The frontoparietal network: function, electrophysiology, and importance of individual precision mapping. Dialogues in clinical neuroscience, 20(2), 133–140. https://doi.org/10.31887/DCNS.2018.20.2/smarekSchimmelpfennig, J., Topczewski, J., Zajkowski, W., & Jankowiak-Siuda, K. (2023). The role of the salience network in cognitive and affective deficits. Frontiers in human neuroscience, 17, 1133367. https://doi.org/10.3389/fnhum.2023.1133367Have questions for us, or feedback about our podcast? Send us a message!

In this episode, our goal is to bring you tools to understand and destigmatize addiction. We discuss the complexity of addiction at the biological, psychological and societal levels. So if you are ready to explore this complex topic, take a listen!Topics Discussed: Past and present definitions of addictionDSM-5's "Substance Use Disorder" - more than a checklistBiological, genetic, chemical aspects of addiction Psychological, emotional, experiential aspects of addictionSocietal, political, economic aspects of addictionWHY the addictive behavior is hard to stopTrauma and addiction ACE study Stress response system Treatment ApproachesMotivational InterviewingCaregiver burnoutNormalizing addictionHave questions for us, or feedback about our podcast? Send us a message!

This episode starts with the various ways social media has changed how we view ourselves and others. We then discuss the sobering link between cyberbullying and suicide rates among young people. Finally, we bring you practical tips and ideas about how to fight bullying at the individual, school, state, and systems levels. You are not alone in this fight!Topics discussed:Social media and its socio-cultural revolution Bullying and cyberbullyingCyberbullying and suicide ratesWhat can we do about this?How to talk to your child How to talk about screen time How to talk to the school Anti-bullying laws How to handle bullying as a family unitResources:https://www.stopbullying.gov/https://cyberbullying.org/AACAP Bullying Resource Center: https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Bullying_Resource_Center/Home.aspx Have questions for us, or feedback about our podcast? Send us a message!

Hello! We are back after a busy month at the clinic! In this episode, we discuss a very niche topic -- the different levels (or continuum) of care in mental health treatment. These acronyms can be so confusing for parents and families, so we hope to clarify them for you as you navigate what is the appropriate level of care for you or your loved ones. Topics Discussed:Overview of mental health continuum of careThe importance of the least restrictive treatment environment Emergency and crisis facilities Intensive Outpatient Program (IOP), Partial Hospitalization Program (PHP), Residential Treatment Center (RTC) in detail What are RTCs like?What it means to be voluntary What about wilderness programs? Questions to ask the programs to assess goodness of fitResources:Questions to ask before hospitalization: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/11-Questions-To-Ask-Before-Psychiatric-Hospitalization-Of-Your-Child-Or-Adolescent-032.aspx#:~:text=When%20can%20I%20see%20my,the%20plans%20for%20ongoing%20treatment%3FContinuum of Care: https://www.aacap.org/AACAP/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Continuum-Of-Care-For-Children-And-Adolescents-042.aspxResidential Treatment Programs: https://www.aacap.org/AACAP/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Residential-Treatment-Programs-097.aspxHave questions for us, or feedback about our podcast? Send us a message!

In this episode, we explore the impact of the Los Angeles wildfires on families and the individual person, emphasizing trauma-informed care and support for those affected by disasters. We also cover practical tips for disaster psychiatry, psychological first aid, and how to start an honest conversation with your kids about traumatic exposures.Topics discussed:What is a disaster? What is trauma? Acute stress disorder vs PTSD Risk factors for PTSD Goal of psychological first aid + trauma therapyWarning/concerning signs of trauma How to talk to your kids about a traumatic eventResources:National Institute of Mental Health: https://www.nimh.nih.gov/sites/default/files/documents/health/publications/helping-children-and-adolescents-cope-with-disasters-and-other-traumatic-events/helping-children-and-adolescents-cope-with-traumatic-events.pdfSAMHSA: https://www.samhsa.gov/mental-health/trauma-violence/child-traumaAACAP: https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Disaster_Resource_Center/Home.aspxNAMI: https://namialamedacounty.org/resources/about-mental-illness/mental-health-first-aid/Have questions for us, or feedback about our podcast? Send us a message!

In this episode, we discuss the challenges in dealing with the recent executive orders against the LGBTQ+ community. We go over the emotional toll of political rhetoric, the need for access to gender-affirming care in youth, and how important it is to slow down and examine gender dysphoria in children (and adults!) from a compassionate and open-minded perspective. We get personal talking about our struggles with the current political climate, and we hope you join us in keeping the advocacy alive. Topics discussed:What does an executive order mean?Understanding gender dysphoria Understanding gender-affirming careFinding your community Have questions for us, or feedback about our podcast? Send us a message!

This is a long-awaited episode! We talk about the difference between feeling lonely and being alone, and the biological mechanisms that drive humans to connect with each other. After we intellectualize it all (as doctors do), we get to the root of the problem in loneliness -- the importance of fostering a sense of safety. Join us in this exploration on how loneliness is deeply rooted in your attachment experience! Topics Discussed:What is loneliness?Biological mechanisms involved in connection: mirror neurons, oxytocin, stress response system Physical impact of loneliness on the body How insecure attachment styles lead to loneliness What to do when you're feeling lonely Explanation of therapy approaches Have questions for us, or feedback about our podcast? Send us a message!

This week, we explore the curious and unnerving world of artificial intelligence (AI) and mental health. We discuss its potential benefits in healthcare for both psychiatrists and patients, as well as risks such as harmful content, liability issues, privacy issues, and blurring the line between what is real and fake. We are excited and wary of this new technology that is inevitably going to be in every aspect of our lives. Join us in the discussion! Have questions for us, or feedback about our podcast? Send us a message!

Welcome to the new year! This episode is about how to approach making a change in your life. Your ambivalence, values, fears, and goals are all crucial parts of what makes you you. It's also important to just take a pause sometimes in this ever-changing world today. So I hope this quick episode will give you that pause and reflection to propel you toward what matters the most in your life! Have questions for us, or feedback about our podcast? Send us a message!

Hello there! This episode is a dense one. We discuss neurosis and anxiety from the perspective of childhood and growth. We go over concepts of “basic anxiety” and “neurotic pride”, reflecting on healthy and unhealthy narcissism fueling anxiety as proposed by the psychoanalyst, Karen Horney. We explore how the DSM anxiety disorders are categorized, the importance of a holistic approach to treatment, and the use of medication in managing anxiety. Lastly, we emphasize the need for us to do our own inner work to understand and manage one's own anxiety to better assist patients. Have questions for us, or feedback about our podcast? Send us a message!

We are back! In this episode, we discuss the nitty gritty, fascinating details of schizophrenia and psychosis. We explore the devastating stigma associated with schizophrenia, the challenges of diagnosing and managing severe mental illnesses, and the importance of honoring the patient as a human being. Join us, as we three child psychiatrists chat about how to build trust and collaboration in mental health care, and keep the hope alive. Topics discussed:Stigma associated with schizophrenia Comorbidity and shortened life expectancy Definitions and causes of schizophrenia or psychosisCannabis and its link to schizophrenia Autism and its link to schizophrenia Treatment approaches for schizophrenia Have questions for us, or feedback about our podcast? Send us a message!

Hello! We are continuing our conversation on psychosis. In this episode, we focus on differential diagnoses for psychosis, including medical and psychiatric conditions that can often be confused with a truly psychotic disorder like schizophrenia. Specifically, trauma is a big one, leading us to lose ourselves in the imbalance of imagination and reality. Especially in kids! Lastly, we talk about treatment of psychosis, our approach to antipsychotics, and non-pharmacological treatment like individual therapy and family support. This is a really really tough condition to navigate through, and we hope to share our experiences so you don’t feel alone in this journey. Have questions for us, or feedback about our podcast? Send us a message!

Hello! This week, we delve into the fascinating history of how we conceptualize psychosis and schizophrenia. All those with schizophrenia have psychosis, but not all those with psychosis have schizophrenia. From a psychological framework to a biological one, the field of psychiatry has gone back and forth between the two and really struggled to understand schizophrenia. Now, we are just starting to see the interplay between genetic, epigenetic, environmental, and psychological factors at play in the risk of developing schizophrenia. Join us in this whirlwind of conversation by two child psychiatrists trying to tackle this colossal topic! Have questions for us, or feedback about our podcast? Send us a message!

School is back in full swing, and so is everyone's anxiety! We discuss the challenges kids, teens and parents face as they reintegrate back to school after the summer break. We delve into the various reasons for school avoidance and refusal, which are critical in understanding what is actually behind it. We conclude with a discussion on what to do about it -- mainly the importance of early preparation, open communication, accessing school resources, and when necessary, use of therapy and medications for depression and anxiety in children and adolescents. Resource Links: AACAP Facts for Families on Schools: https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Schools_Resource_Center/Home.aspx Do's and Don'ts of School Avoidance: https://schoolavoidance.org/advice-from-a-fellow-school-refusal-parent-on-how-to-help-them-get-back-to-school/ IEP Request Template Letter: https://www.disabilityrightsca.org/publications/template-letter-for-a-request-for-assessmentHave questions for us, or feedback about our podcast? Send us a message!

*Trigger warning for content on self-harm, suicide and eating disorders. Please feel free to opt out and prioritize your sense of safety if you need to do so.*This is a tough one. The positive effects of social media on mental health can be lifesaving, yet its negative effects may lead to a life taken far too early. We have a nuanced discussion on social media's pros and cons, and how to help your child or someone who may be addicted to it. There is a dire need for change, and it starts with all of us. We list out specific recommendations for social media use in kids and teens, and how to have a conversation with them to develop a family media plan. Resources: AACAP: https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Screen_Media_Resource_Center/Home.aspxAAP: https://www.aap.org/en/patient-care/media-and-children/center-of-excellence-on-social-media-and-youth-mental-health/#:~:text=What%20We%20Do,protect%20youth%20mental%20health%20onlineHave questions for us, or feedback about our podcast? Send us a message!

 We are back! In this episode, we talk about attachment theory from a neuroscientific and neurobiological perspective. We highlight how talking about our emotions can help us regulate them, and make room for empathy and "mentalizing" other people's experiences. We also discuss how attachment trauma can disrupt brain development, and how mindfulness and staying attuned to your body can mitigate this. Finally, we discuss the categorization of attachment experience in the DSM, and the importance of understanding the etiological basis of mental health conditions for effective treatment. Have questions for us, or feedback about our podcast? Send us a message!

In this episode, we take a quick break from attachment theory and dive into a very real, current problem we face today: the stimulant medication shortage for the treatment of ADHD. We explore the complex regulatory systems surrounding stimulants, including supply chain issues and being lumped into the category of Schedule II medications monitored by the Drug Enforcement Agency (DEA) to fight the Opioid Epidemic. The pressures from many layers of control fall on the shoulders of the pharmacist, and worst of all, the patients. Lastly, we discuss how to mitigate this shortage issue for patients, and the need for patient advocacy amongst clinicians. Have questions for us, or feedback about our podcast? Send us a message!

Welcome back! In this episode, we discuss the significance of the humanistic approach to psychiatry, and the importance of relationships and the environment in child development. We talk about core concepts in attachment theory, such as the Strange Situation by Mary Ainsworth, adult attachment interview by Mary Main, and mentalization by Peter Fonagy. We emphasize that attachment serves as its own biological and motivational system, and that attachment trauma can be healed through exploring your internal and external worlds with another. Have questions for us, or feedback about our podcast? Send us a message!

Welcome to our first episode of the podcast! In this episode, we talk about how attachment theory is an important foundation for our work, and the history of developmental psychology and child psychiatry. But of course, not without a little play along the way! Have questions for us, or feedback about our podcast? Send us a message!