PsyDactic

Dr. O'Leary discusses his critical perspective on Oppositional Defiant Disorder (ODD) and argues that ODD is not a primary diagnosis but rather a risk syndrome, a set of symptoms (defiance, irritability, and vindictiveness) resulting from various underlying conditions like ADHD, anxiety, or trauma. He explains that conceptualizing ODD as a stand-alone disorder often leads to the risky treatment pathway of off-label antipsychotic medication, whereas recognizing it as a syndrome necessitates an etiology-focused approach to treat the true root cause, typically with safer, condition-specific interventions. Dr. O'Leary traces the evolution of ODD criteria through the DSM manuals and urges clinicians to use comprehensive evaluations rather than relying on simple screeners, especially when an ODD diagnosis is present.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Neuroplasticity is a real thing that is shrouded in mythology and used by companies to market products, but what do we actually know about neuroplasticity?Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. Grant Brenner joins Dr. O'Leary to explore the fascinating intersection of human psychology, physics, psychotherapy and artificial intelligence.  We discuss Active Inference and The Free Energy Principle along side how babies develop a sense of self and so much more.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Is it possible to house multiple alternate selves within the same brain?  Dr. O'Leary argues that it is not only possible, but under certain conditions it is likely to happen.  Dissociative Identity Disorder is discussed not as a "shattering of the self,"  but instead as a failure to integrate the self during development.  Dr. O'Leary explores different biologically and computationally plausible models to explain how the self might fail to integrate during the normal process children go through in order to distinguish the self from others and others from others, as they build a (usually) coherent model of themselves.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary explores the neuroscience of dissociation, defining it as a degenerate concept that refers to a wide range of functional disconnections within the brain rather than a single clinical entity. The discussion moves from the standard medical definitions—such as depersonalization, derealization, and amnesia—toward a broader view of dissociation as a neurobiological defense mechanism that uses sensory attenuation to manage background noise and overwhelming trauma. By examining how specific regions like the temporal parietal junction and the default mode network integrate our sense of self and environment, Dr. O'Leary compares how disruptions in these areas lead to the fragmented reality experienced in various psychiatric conditions. This discussion aims to shift the listener's perspective of dissociation from a vague symptom to a complex breakdown of mental integration that can be induced by drugs, trauma, or even intentional meditative practices.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In December 2025, the FDA authorized  the Flow F100, an innovative at-home wearable headset that utilizes transcranial direct current stimulation (tDCS) to treat major depressive disorder. Unlike traditional pharmaceuticals that act systemically, this device targets the dorsolateral prefrontal cortex with localized electricity to modulate neuronal excitability and address the asymmetry hypothesis of depression. While the Empower study that evaluated this technology demonstrated statistically significant improvements in response and remission rates, the FDA approved it with a moderate level of uncertainty regarding its true efficacy due to a clinically insignificant 2.3-point difference on the average improvement using the Hamilton scale and potential unblinding bias in the trial. By contrasting frequentist and Bayesian statistical frameworks, Dr. O'Leary encourages a skeptical but curious evaluation of whether this technology represents a genuine clinical breakthrough or a temporary trend in the long history of electrotherapy.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

PsyDactic welcomes The Game Theorist's Guide to Parenting co-author, Kevin Zollman who discusses game theory as the science of strategic thinking. We explore how mathematical models like the Prisoner’s Dilemma and mechanism design can be used to manage family dynamics by creating win-win solutions rather than competitive, zero-sum outcomes. The conversation highlights practical techniques such as "I cut, you pick" for fairness, the importance of making credible threats that parents are actually willing to execute, and ways to make honesty more profitable than lying through strategic questioning. While children may be impulsive and at times difficult to predict, applying game theory helps parents influence behavior by understanding their children's incentives and fostering a predictable environment built on reciprocity and trust.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary proposes Childhood Deficit Disorder as a way to conceptualize the rise in mental health issues among modern youth, exploring how systemic changes in culture and environment contribute. He contrasts the "free-range" parenting style prior to the 1980s, which fostered autonomy and resilience, with the modern trend of intensive, managerial parenting driven by economic anxiety and a "culture of fear" fueled by media. Dr. O'Leary explores how children's independent mobility has plummeted due to these shifts and in response to a built environment hostile to pedestrians, leading to a loss of key socialization spaces.  Digital media, including social media, both actively displaced healthy social spaces and filled the void created by anxious, fearful parenting, and poor urban design. Childhood Deficit Disorder (CDD) is a framework—not a clinical diagnosis—to describe the developmental consequences of chronic deprivation of autonomous play, independent movement, and connection to the physical world, often exacerbated by the "digital colonization of childhood."For references and a more in depth discussion: https://sciencebasedpsych.blogspot.com/2025/12/childhood-deficit-disorder-and-atrophy.htmlPlease leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary explores the history of clozapine, highlighting its initial revolutionary impact as the first atypical antipsychotic, followed by a ban on its use, followed by its re-emergences as a strictly monitored medication, and then culminating in new recommendations that greatly encourage its use. The discussion details the severe side effects that led to its initial discontinuation,  and then emphasizes other critical but often overlooked adverse effects, such as metabolic syndrome, sialorrhea, and especially severe gastrointestinal hypomotility, which can be life-threatening. Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode includes a fascinating interview with a researcher in ultrasound, Dr. Michael Canney who is an acoustics researcher the chief scientific officer at a French company named Carthera (https://carthera.eu/) and they make ultrasound devices that can disrupt the blood-brain barrier in order to let medicines into the brain that otherwise could only get through in very small amounts.We talk more broadly about the explosion of various applications of ultrasound beyond imaging, including things like tissue ablation (or basically cooking highly focussed loci of tissue inside your body), or cavitation (where ultrasound causes tiny bubbles to rapidly expand inside cells or vessels), and I end with a brief discussion of the potential of ultrasound for neuromodulation.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This PsyDactic podcast episode, hosted by Dr. O'Leary, delves into the complex and often controversial topic of diagnosing Pediatric Bipolar Disorder and its differentiation from other conditions, particularly Disruptive Mood Dysregulation Disorder (DMDD). Dr. O'Leary, a Child and Adolescent Psychiatry Fellow, explores the DSM-5-TR diagnostic framework, the history of Pediatric Bipolar diagnosis, the debate surrounding irritability as a diagnostic criterion, and the challenges of distinguishing it from ADHD, Autism Spectrum Disorder, and trauma-related disorders. Using case vignettes and drawing on both personal knowledge and AI-assisted research, the episode aims to provide a comprehensive and nuanced understanding of this challenging area of child psychiatry.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Gambling disorder may be the most under-diagnosed disorder in the DSM.  This is an exhaustive treatment of the neurobiological, psychological, and societal aspects of gambling addiction, featuring discussions on the brain's reward system, cognitive distortions, and the impact of advertising and the design of gambling products.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Functional Neurological Disorder was previously called Conversion Disorder or psychogenic neurological symptoms and is a condition in which a patient develops any number of neurological symptoms (such as loss of ability to move or seizure like episodes or inability to feel parts of their body or phantom pain) that cannot be explained by a clear lesion in the nervous system.  It was called conversion disorder because it was previously thought that repressed emotions or desires had been converted into neurological symptoms as a defense against those emotions or desires.  Therefore, the symptoms were "psychogenic" instead of neurological or biological.  Even though emotional states contribute to neurological function, we now know that this model is incorrect.  The most compelling new models of functional neurological symptoms come from the theories of the Bayesian brain, predictive processing, and active inference.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary introduces PsyDactic - Child and Adolescent Board Study edition by sharing the first of two episodes on behaviorism, that field of psychology that took the radical stance of completely ignoring the fact that we have a mind.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

-- Dr. O'Leary explores how an artificial intelligence tool summarizes recent data on the use of nicotinic receptor modulators for the treatment of anxiety and PTSD.  Please send any comments to [email protected] leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

"People are 14 times more likely to die during a hospital stay than outside of hospital for inpatient psychiatry."  In the last episode, I shared an episode of Psychiatry Boot Camp, which is a podcast created by Dr. Mark Mullen to help medical students and junior residents hone their psychiatric skills.  Mark interviews some of the most competent and amazing psychiatrists our country has to offer.  I am excited that Mark let me share his interview with Dr. Tyler Black, who talks about evaluating suicidal patients.  I have never heard any advice about suicide assessments as insightful and compassionate as what Tyler Black has to offer.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In the last episode, Dr. O'Leary interviewed the creator and host of the Psychiatry Bootcamp Podcast, Dr. Mark Mullen, who is currently a psychiatry clerkship director at St. Louis University School of Medicine.  He created this podcast after discovering a dearth of resources available for medical students and junior psychiatry residents to prepare them for their transition to practice. He graciously allowed PsyDactic to include a couple of his episodes in this feed as a way to spread the good news about Psychiatry Boot Camp.  This is his introductory episode where he sets the tone of PBC by interviewing Dr. Awais Aftab, Clinical Professor of Psychiatry at Case Western University,  and Dr. Allen Frances, Chair of the DSM-4 Task Force and Chair Emeritus at Duke.Check out Psychiatry Boot Camp!https://linktr.ee/psychbootcamphttps://pubmed.ncbi.nlm.nih.gov/38724723/https://podcasts.apple.com/us/podcast/psychiatry-boot-camp/id1671902940https://open.spotify.com/show/4Vjlz4CO0G5D6nGo74O0jEhttps://www.audible.com/podcast/Psychiatry-Boot-Camp/B0BVK4HYLWhttps://x.com/markrmullenPlease leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary is excited to introduce you to  Psychiatry Boot Camp (PBC), a podcast created by Dr. Mark Mullen during his psychiatry residency to help prepare medical students for psychiatry residency. It covers fundamental topics in psychiatry and inspires young psychiatrists to think critically about their approach to the field. The curriculum is based on published literature on psychiatry crash courses and boot camps, and features interviews with experts in the field.   Some specific PBC episodes that are discussed include those introducing students to psychiatry as a discipline with unique challenges, including interviews with Dr. Awais Aftab, Clinical Professor of Psychiatry at Case Western University,  and Dr. Allen Frances, Chair of the DSM-4 Task Force and Chair Emeritus at Duke.  We also discuss Dr. Mullen's eye-opening interview with Dr. Tyler Black, a suicidologist and child psychiatrist at British Columbia Children's Hospital who provides the best foundational discussion of the suicide assessment that Dr. O'Leary has ever encountered.Enjoy this interview and afterward, please check out Psychiatry Boot Camp.https://pubmed.ncbi.nlm.nih.gov/38724723/https://podcasts.apple.com/us/podcast/psychiatry-boot-camp/id1671902940https://open.spotify.com/show/4Vjlz4CO0G5D6nGo74O0jEhttps://www.audible.com/podcast/Psychiatry-Boot-Camp/B0BVK4HYLWhttps://x.com/markrmullenPlease leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

--In today's episode, Dr. O'Leary explores agonists, inverse agonists, partial agonists, and antagonists. These terms describe how molecules bind to receptors and either increase, decrease, or prevent changes in receptor signaling. Agonists increase receptor activity, with full agonists like dopamine and serotonin raising activity to its maximum. Partial agonists can increase activity in the absence of full agonists but decrease it in their presence. Inverse agonists reduce the baseline activity of receptors. Antagonists block receptor activity without changing the baseline rate. We also discussed the complex interactions between these molecules and how their effects can vary depending on the presence of other molecules and the specific receptors involved. Below are a couple of helpful references:https://pmc.ncbi.nlm.nih.gov/articles/PMC2804881/https://link.springer.com/article/10.2165/00023210-199605050-00007 Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

--Dr. O'Leary discusses the term Transference, and if you listen until the end, he relates it to some computational neuroscience.   Transference is a historically loaded term.  Transference is supposed to be an unconscious process, so it can not really be observed, only inferred, so this means that both the definition of transference and any instance of it in psychotherapy is dependent upon the therapist’s model and their particular way of interpreting that model.  But what exactly is this elusive but data rich unconscious process?Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

  -- More recently I have faced the diagnostic conundrum of catatonia in autism, and that is what I want to explore in more excruciating detail today.  There is surprisingly little literature on the subject, and that is concerning because being able to identify and treat catatonia can be life-saving, not to mention life-altering for patients and their caretakers.  Misidentifying catatonia as mere aggression or highly limited interests in autism can result in exactly the wrong medication being given or no medication being given and a worsening of the condition. --Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

  --  Dr. O’Leary interviews forensic psychiatrist and author Dr. Michael Schirripa about his career as a forensic psychiatrist, the release of his first thriller, Mindhunt, and his podcast Mindhunting.  Dr. Shirripa explores how his love of literature influenced his decision to pursue forensic psychiatry and ultimately resulted in his creation of an international thriller with an ambitious forensic psychiatrist as the main character.  We explore topics like medical ethics, medical education, popular culture, mental health stigma, Australian football, and how people react when we tell them we are psychiatrists.  Learn more about Michael at https://michaelschirripa.com/.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

- - In the world of psychotropic medication, the question is not just whether it works or not, but whether it works better than a placebo and whether the effect size is clinically significant and the benefits outweigh the risks.  In the case of MDMA (aka molly or ecstasy), the effect size for improving post-traumatic stress disorder symptoms reported by researchers has been very large.  Often it is found to be two to three times higher than is often found for serotonin reuptake inhibitors, which are currently the first line therapy for PTSD.  On the surface this is super exciting.  A deeper look will reveal why excitement may need to be tempered, and why an independent panel recommended that the FDA not approve this medication.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

The Narrative Fallacy describes our tendency to find meaning, connections, and causal relationships where they do not necessarily exist.  In this episode, Dr. O'Leary had the pleasure of interviewing Dr. Alexey Tolchinsky.He recently published a paper called “Narrative fallacy and other limitations of psychodynamic case formulation.”  Dr. Tolchenski did not invent the idea of the Narrative Fallacy, but he is working to apply this idea to his own clinical practice. We could all benefit from recognizing the ways that Narrative Fallacy plays out in our lives.  The great thing about these ideas is that they are so generalizable.  The Narrative fallacy is not limited to medicine or science, but can be applied, for example in how we explain to ourselves why our neighbor seems to hate us.Tolchinsky, A. (2023). Narrative fallacy and other limitations of psychodynamic case formulation. Practice Innovations.https://osf.io/preprints/psyarxiv/znxs5Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary discusses a variety of concerns that all clinicians should have in mind when using psychometrics.  In the end, he hopes you come away  with some level of agreement with the statement: “Our primary concern should not be with the quantity of data, but with the quality of the data.”  Statistics are conceptual machines that will produce results no matter what you feed them.  These results can be truly helpful and informative.  But statistics are also poop in poop out machines, and adding more malarky does not magically convert the results into something other than BS.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In this episode, Dr. O'Leary discusses a word that he has struggled to understand since medical school.  The word is aphasia.  The root “phasia” comes from the Greek phanai which means “to speak.”  When aphasia is used medically, it refers to an inability to speak, although not always.  More generally it is often used to mean a failure to understand or produce language, but it gets complicated.  Dr. O'Leary reviews the brain regions responsible for various kinds of aphasia and how to identity them.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

I did not until recently even consider the cerebellum when thinking about psychiatric conditions, but the more I read, the more I wonder why the cerebellum is not considered a potential important player in nearly every psychiatric disorder.  Although it can be said that all brain regions primarily function to make predictions, the cerebellum is especially active at refining impromptu predictions through short periods of time as sensory data changes to help us better navigate the world, not only in physical space, but our entire internal space.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

The thalami are bilaterally symmetrical structures in the subcortical part of the brain that are cradled by the basal ganglia.  They are major hubs of pretty much everything your brain does and all of the sensory information coming into the brain with the exception of smell.More primitive models of the brain visualized it as a bunch of relatively isolated modules, each specialized to perform a single task when queried and able to send that information to wherever it should go.  More modern ideas propose a more integrated picture, with various regions of the brain contributing to a more diffuse process through parallel connections with other network communities and hubs.  It appears that nearly every integrated process in the brain is influenced at some level by thalamic modulation.  You could characterize the Thalamus as a brain wide gateway to the cortex, modulator and mediator of inputs, coordinator of feedback, relay between higher cognitive areas, manager of brainstem nuclei, and facilitator of attention.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In this episode, I discuss a medication that patients who saw a psychiatrist or their primary care provider between about 1997 and 2015 were very likely to find themselves prescribed.  More recently, it has been taken down a notch or two on prescribers lists of preferred meds.  This medication is quetiapine, marketed as Seroquel by AstraZeneca in the US.  Whether you were diagnosed with schizophrenia, bipolar disorder, depression, anxiety, an eating disorder, insomnia, PTSD, borderline personality disorder, obsessive compulsive disorder, and many others it appeared in the mid 2000s that Quetiapine was just the thing for you.  Was it ever?Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode continues an intermittent series called “In a Word.”  Past episodes have explored words like Akathisia, Dissociation, Perseveration, and even the difference between Impulsive and Compulsive.  This episode explores Confabulation, including some of the brain circuits involved, and what might differentiate confabulation from other kinds of false or implanted memories or delusions.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In 2012 the Supreme Court heard two related cases involving adolescents convicted of murder and sentenced to life in prison without parole because of mandatory minimum sentencing guidelines in their states.  One of the boys, Evan Miller along with an accomplice, had beat a man unconscious with a baseball bat after a fight that ensued when the man awoke to find Miller robbing him.  Miller and his friend then decided to set fire to the home to cover up the evidence.  This resulted in the man’s death.  The second petitioner, Kuntrell Jackson, had accompanied two other boys to a convenience store in order to rob it.  During the robbery, one of the boys, not Jackson, shot and killed the clerk.  Both boys were convicted and were sentenced according to minimum sentencing guidelines to life in prison without parole.  The decision that the court was asked to make was not whether the boys should have been convicted, but instead, whether the sentencing guidelines that resulted in them being given life without parole constituted cruel and unusual punishment.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

I am lucky today to be able to bring you an interview with Dr. Zac Brooks who is passionate about serious mental illness (SMI).  “What is serious mental illness?” you might ask.  That is one of the things we are going to discuss, and you may be surprised when Dr. Brooks explains how it was first formally defined.  We also discuss the numerous ways the US has tried to reform how SMI is treated with variable results.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

PsyDactic welcomes Dr. Jon Lindefjeld for a discussion of the history of HIV and AIDS.  In particular, we discuss the development of effective antiretroviral therapies, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), highlighting the CDC guidelines for use and monitoring, need to treat psychiatric com-morbidities, and the importance of monitoring adherence and drug interactions.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary discusses some of the history of the borderline personality, how different perspectives have attempted to explain its origin, how to treat it and how not to treat it.  He starts in 1947 with some colorful descriptions of patients living with borderline personality disorder that would never get published today, and highlights some of the ways in which we have made progress (or not made progress) in our understanding of this disorder over the next 75 years.  As usual, Dr. O'Leary also waxes philosophical about science or the lack thereof in certain perspectives or treatments.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Our current diagnostic criteria for personality disorders have failed to demonstrate validity or reliability.  The DSM 5 encouraged psychiatrists to start considering a broad range of personality features adapted from the Five Factor Model. These are combined with global functioning measures to build a personality inventory for any patient who is having dysfunction related to their personality.  Proposed criteria include a Personality Disorder - Trait Specified diagnostic category that permits diagnosticians to accommodate the new formulation.  Criterion A considers the salient aspects of personality functioning while Criterion B catalogs which of the Big 5 Factors are notably deranged.  Dr. O'Leary reviews the basics of these criteria and explores why our current formulations are in such dire need of reform.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Humans have a history of tattooing that stretches millennia into prehistory.  The western ban on tattoos by the early church resulted in a systematic effort to paint tattooed individuals as pagan, primitive, vulgar, criminal, and mentally ill.  Psychiatrists have historically contributed to this characterization but are in a position to help reframe how citizens and policymakers view tattooed individuals. Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

The brain understands the world by building models that predict the future.  One of the ways that it does this is by utilizing attractor networks.  These small world networks are constantly trying to determine what is a true signal from the constant noise in the neural net.  Dr. O'Leary explores how attractor networks have been hypothesized to explain psychosis, depression, and obsessive compulsive disorder, and how our various treatments might work to stabilize these networks.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

When I started to make this episode, I thought I would try to do a comprehensive review of all of the various functions of serotonin across its 15 or more receptor types, but I soon found myself overwhelmed.  More importantly, I found that some stories are more interesting to tell than others, so here I discuss serotonin and focus on how a few 5-HT receptors can not only help us survive, but also motivate ourselves to reach our goals, and, sometimes, convince us that we are fusing bodies with a tree.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Frequently I have complained that the terms "typical and atypical" or "first generation and second generation" antipsychotics were not very helpful.  When I give chalk talks to junior residents and interns about antipsychotics, this is one of the first things that I note.  It is the medicines relative affinities for different receptors that appear to make the difference, not whether they were discovered prior to 1980 or not.  A few weeks ago, I was lucky enough to encounter a paper that was published in April of 2023 by McCutcheon et al in Biological Psychiatry titled "Data-Driven Taxonomy for Antipsychotic Medication: A New Classification System."  In this episode, I use their results to guide a discussion of variability in target effects and side effects of different groups of antipsychotics.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode explores side effects of antipsychotics at the molecular level.  It starts by exploring receptors and their ligands and takes a turn into the dorsal striatum where dopamine, acetylcholine, serotonin, and glutamate work together to help us dance the mamba.  Dr. O'Leary explores what happens when the complex pathways of the cortico-striatal-thalamo-cortical tract are disrupted by antipsychotics both in the short term and after many months or years of use.  As the title suggests, there is a ridiculous amount of detail, so let's get our nerd on!Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

The authors of the famous sequenced treatment alternatives to relieve depression trial or STAR*D reported that about two-thirds or 67% of patients had achieved remission after 4 trials of antidepressant medication.   This remission rate has been questioned over the years and in October of 2023, the journal BMJ Open published an article that reports to have reanalyzed the date from STAR*D using the original study design.  This re-analysis found much much lower rates of remission.  It reported the cumulative remission rate as only 35 percent.  How do two different sets of researchers using the same data set get a result that is just half of what the other researchers reported?  That is the mystery that I report on today.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode is about dopamine.  In episode 32, I discussed the pseudoscientific trend of the “dopamine detox”  or "dopamine fasting."  Instead of talking about pseudoscience in this episode, I discuss the actual science surrounding dopamine and its relationship with the neuroleptics or antipsychotics as they are more commonly known.   The effects and side effects of antipsychotics are related to the function of the major dopamine networks of the brain: the mesolimbic, mesocortical, nigrostriatal, and tuberoinfundibular pathways.  Dopamine levels in each of these pathways can be regulated also by serotonin receptors, and so this episode contains a discussion of how first generation, second generation, and novel antipsychotics affect dopamine by affecting serotonin receptors.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In this Episode, I  continue an intermittent series called “In A Word.”  The difference between prior episodes and this one is that today I have two words.  I chose these words because I don’t really know the difference between them, and even after reading and trying to understand the difference, I am not sure that there is a clear difference.  The two words are Impulsive and Compulsive.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

I discuss something  that is likely to present itself to a physician long after the fact: a single mild brain injury.  This episode focuses on how to classify the severity of a single brain injury.  While working in a brain injury unit, I noticed that some providers used the term severe brain injury when referring patients to neurology or neuropsychiatry, and this communicates something very specific that they may not realize they are communicating. Those of us seeing a patient after a brain injury may not know the specific terminology to use, so this episode is meant to help the listener understand how brain injury experts classify these injuries.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode continues a series on the prefrontal cortex, a complex region of the brain that gives us the ability to have the kinds of thoughts no other species on earth is known to have.   The medial (or mesial) prefrontal cortex is especially important for emotional and autonomic regulation, attention and goal-directed behaviors (including addiction), and building our sense of self (that is our identity as a thing separate from the world around us), and considering salient aspects of the social context we are in and what others might be thinking (among many other things).Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

In this episode, I am sliding down and under the front part of the brain and consider the orbital frontal cortex, that part of the brain right above and a little behind your eyes.  It is much smaller than the lateral gyri on the prefrontal cortex, but appears to be an important probability generator in our brain when we need to consider different options that can result in different rewards or in order to avoid aversive stimuli.  The most basic kinds of rewards that neuroscientists can study are for food, because lab animals will respond to those, and while the OFC is definitely intimately related to food, in humans, its powers of prognostication are much more generalized.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

We seem to understand the specializations of the the dorsolateral prefrontal cortex on the left better than the right side of our brain.  That is because most of us do a lot more language processing on the left or dominant side.  The more inferior and caudal parts of the dorsolateral PFC on the left side are more specialized for speech.  The more superior parts are more involved in working memory, attention control, and task switching.  The entire DLPFC is extensively connected to other cortical regions that pass information to it for consideration, and the DLPFC is extensively connected to the supplementary and motor regions that help to plan actions, and the striatum, which helps coordinate those actions.   It is also intimately involved with motivation and helps us to control our emotions.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Besides being relatively hairless apes, there are some things about humans that make us special among animals.  In the past we have noted things like, “We have big brains and we use tools,” or “We contemplate the future and our own mortality,” or “We use a truly complex language both verbal and written to communicate complex ideas.”  These are things we have and do, but what is it about our brains that makes that possible.  More and more we are identifying crucial hubs or nodes within our brain that specialize in various tasks, but none of these work alone. I am going to start by discussing that big blob of gooey mush on the front of our brains called the prefrontal cortex, and in subsequent episodes, I will discuss how these regions function in tandem with deeper structures within the brain to create what we think of when we say “human.”Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

This episode is about how to decide whether to send a patient to get neuropsychological or just psychological testing, and this decision is determined by at least two things.  The first is the question that you are trying to answer.   The second  is, what can the service that I am referring to provide for the patient?  In this episode, I will focus primarily on the first consideration:  the question that you are asking.  As a referring provider, then, it is helpful to know what kinds of tests a psychologist or neuropsychologist can administer, because these are designed to answer very specific questions. Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.

Today I discuss the term “validity.”  Let’s say we wanted to develop a test that identifies pathological character traits or quantifies depression symptom burden on a patient.  A good test is going to do more than simply list the diagnostic criteria for various diagnoses and then ask the patient if they think that sounds like them.  A test needs to have a few things.  First it needs to have a defined purpose.  Is it to be used for diagnosis in a clinic or for research?  Is it going to measure symptoms in already diagnosed patients and track their response to therapy?  Is it meant to predict if a person would be a good candidate for something like being an astronaut or a member of the military?  Once the purpose is determined, then you need to define something called a construct, and then you have to determine the validity of that construct.Please leave feedback at https://www.psydactic.com or send any comments to [email protected] and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com.  All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else.  We reserve the right to be wrong.  Nothing in this podcast should be treated as individual medical advice.