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-- 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/.

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References 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.

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- - 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.

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References 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.

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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/znxs5

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References 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.

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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.

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References 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.

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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.

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References 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.

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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.

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References 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.

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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.

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References 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.

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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?

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References 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.