Seroquel (Quetiapine) - Drugs, Sex, Money and Psychopharm
PsyDactic - Residency
by T. Ryan O'Leary
15h ago
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 20 ..read more
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In a Word - Confabulation
PsyDactic - Residency
by T. Ryan O'Leary
3w ago
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. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions ex ..read more
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Serious Mental Illness in America with Dr. Zac Brooks
PsyDactic - Residency
by T. Ryan O'Leary
2M ago
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. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.b ..read more
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HIV, PrEP, and Mental Health with Dr. Jon Lindefjeld
PsyDactic - Residency
by T. Ryan O'Leary, Jon Lindefjeld
2M ago
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. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. A ..read more
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Perspectives on the Borderline: The Most Disordered Personality
PsyDactic - Residency
by T. Ryan O'Leary
2M ago
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 treatment ..read more
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The Ghost of Personality Disorders Future
PsyDactic - Residency
by T. Ryan O'Leary
2M ago
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 ..read more
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Tattoos, Stigma, Racists, and Psychiatry
PsyDactic - Residency
by T. Ryan O'Leary
2M ago
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. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout ..read more
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Attractor Networks and the Bayesian Brain
PsyDactic - Residency
by T. Ryan O'Leary
3M ago
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. References and readings (when available) are post ..read more
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Serotonin - Jack of All Trades, Master of None
PsyDactic - Residency
by T. Ryan O'Leary
3M ago
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 her 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. References and readings (when availa ..read more
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Antipsychotics and their discontents
PsyDactic - Residency
by T. Ryan O'Leary
4M ago
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-Driv ..read more
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