Managing Extrapyramidal Symptoms: Clinical Pointers
Play • 8 min

In this episode, we discuss the diagnosis and management of extrapyramidal symptoms.

Here are some questions Dr. Pontone addresses:

  • Are there any biomarkers or neuroimaging studies that help us differentiate drug-induced EPS from Parkinson’s disease?
  • What can you do after you identify extrapyramidal symptoms? What should be your first step?
  • Is it okay to use anticholinergic agents prophylactically?
  • What is the prognosis for extrapyramidal symptoms?
  • How long does it typically take for extrapyramidal symptoms to remit?

Faculty: Greg Pontone, M.D.

PsychEd: educational psychiatry podcast
PsychEd: educational psychiatry podcast
PsychEd
PsychEd Episode 30: Anti-black Racism and Mental Health with Dr. Kwame McKenzie
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers anti-black racism and mental health with Dr. Kwame McKenzie. Dr. McKenzie is an international expert on the social causes of illness, suicide and the development of effective, equitable health systems. He is a Professor of Psychiatry at University of Toronto and a staff psychiatrist and Director of Health Equity at the Centre of Addiction and Mental Health. The learning objectives: By the end of this episode, you should be able to… * Understand the history and legacy of racism and mental health in the black community * Understand the current state of racism towards black people and the impacts on their mental health. * Explore how healthcare workers can be anti-racist in providing mental health care and how the system can change to improve the mental health of black people. Host(s): Anita Corsini (social worker), Dr. Alex Raben (staff psychiatrist), and Rebecca Marsh (CC4) Produced by: Anita Corsini, Rebecca Marsh, Randi Wang (CC4), and Dr. Alex Raben Guest experts: Dr. Kwame McKenzie, staff psychiatrist Resources: Manual for Cognitive-Behavioural Therapy for English-Speaking People of Caribbean Origin The City of Toronto has curated a list of Mental Health Resources for Black Communities. Organizations include: * Across Boundaries * Black Creek Community Health Centre * Caribbean African Canadian Social Services * Rexdale Community Health Centre * TAIBU Community Health Centre * The Black Health Alliance * Women’s Health in Women’s Hands Community Health Centre References: * Adelman, J. (2003). Study in Blue and Grey, Police Interventions with People with Mental Illness: A Review of Challenges and Responses [Ebook]. Canadian Mental Health Association. Retrieved 7 October 2020, from https://cmha.bc.ca/wp-content/uploads/2016/07/policereport.pdf. * Bailey, R. K., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: current perspectives. Neuropsychiatric disease and treatment, 15, 603–609. https://doi.org/10.2147/NDT.S128584 * Bor, J., Venkataramani, A., Williams, D., & Tsai, A. (2018). Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study. The Lancet, 392(10144), 302-310. https://doi.org/10.1016/s0140-6736(18)31130-9 * Bresnahan, M., Begg, M., Brown, A., Schaefer, C., Sohler, N., & Insel, B. et al. (2007). Race and risk of schizophrenia in a US birth cohort: another example of health disparity?. International Journal Of Epidemiology, 36(4), 751-758. https://doi.org/10.1093/ije/dym041 * Chakraborty, A., McKenzie, K., & King, M. (2009). Discrimination, ethnicity and psychosis — a qualitative study. Ethnicity And Inequalities In Health And Social Care, 2(1), 18-29. https://doi.org/10.1108/17570980200900004 * Fernando, S. (2014). Racism in psychiatry. In R. Moodley & M. Ocampo (Eds.), Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando in Clinical Practice (pp. 22-32). Taylor & Francis. * Kirkmayer, L. J. (2014). Critical psychiatry in Canada. In R. Moodley & M. Ocampo (Eds.), Critical Psychiatry and Mental Health: Exploring the Work of Suman Fernando in Clinical Practice (pp. 170-181). Taylor & Francis. * Kuper, A. (2018). Cultural Safety & Equity [Lecture PDF]. Retrieved from University of Toronto Faculty of Medicine. * Maynard, R. (2017). Policing Black Lives: State Violence in Canada from Slavery to the Present. Fernwood. * McKenzie, K. (2002). Does racial discrimination cause mental illness?. European Psychiatry, 17, 84. https://doi.org/10.1016/s0924-9338(02)80385-6 * McKenzie, K., & Bhui, K. (2007). Institutional racism in mental health care. BMJ, 334(7595), 649-650. https://doi.org/10.1136/bmj.39163.395972.80 * MCRRT - St. Joseph's Healthcare Hamilton. St. Joseph's Healthcare Hamilton. (2020). Retrieved 7 October 2020, from https://www.stjoes.ca/health-services/mental-health-addiction-services/mental-health-services/coast/mcrrt. * Richardson, L. (2019). Diversity and Advocacy [Lecture PDF]. Retrieved from University of Toronto Faculty of Medicine. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com. For more information visit our website: psychedpodcast.org.
1 hr 5 min
Psychcast
Psychcast
Medscape Professional Network
Dr. Dorothy Lewis of 'Interview with a Serial Killer' and 'Crazy, Not Insane' on a lifetime in psychiatry
Guest host Eva Ritvo, MD, interviews Dorothy Otnow Lewis, MD, about her more than 40-year career in studying death row inmates as examined in the HBO documentary “Crazy, Not Insane.” Dr. Lewis is clinical professor of psychiatry at Yale University, New Haven, Conn. She has no disclosures. Dr. Ritvo is a psychiatrist in private practice in Miami Beach, Fla. She has no disclosures. Take-home points * Dr. Lewis has an extensive archive of taped interviews with death row inmates that she has used to inform her work as an expert witness. * While doing her child psychiatry training at the Yale Child Study Center and sitting in at the juvenile court, she began to see that some of the children had psychiatric and neurologic problems that had not been addressed. * The parents of these children sometimes had psychotic or bipolar disorders. After seeing these themes, Dr. Lewis started a clinic at the court. * Dr. Lewis and her team were able to study approximately 15 inmates in four states, including Texas and Florida, both of which had the greatest number of condemned juveniles. One key theme that emerged is that all of the inmates had been sentenced to death as juveniles. * Eventually, the Supreme Court ended the death penalty for convicted killers who committed their crimes before age 18. * Digging deeper and asking more questions of child and adolescent patients who commit violent acts can help clinicians identify environmental stressors that might underlie behavior that is aggressive and antisocial. In some cases, the psychiatric and neurologic impairments identified are treatable. * Dr. Lewis would like to study whether identifying child abuse early might prevent future violence. References Yaeger CA, Lewis DO. Mental illness, neuropsychologic deficits, child abuse and violence. Child Adolesc Psychiatr Clin N Am. 2009;(4):793-813. Lewis DO. Ethical Implications of what we know about violence. Child Adolesc Psychiatr Clin N Am. 2000 Oct 9(4):833-91. Lewis DO et al. Ethics questions raised by the neuropsychiatric, neuropsychological, educational, developmental, and family characteristics of 18 juveniles awaiting execution in Texas. J Am Acad Psychiatry Law. 2004;32(4):408-29. Griffith EEH et al. Re: Ethics questions raised by characteristics of 18 juveniles awaiting execution in Texas. J Am Acad Psychiatry Law. 2006;34(2):143-4. Lewis DO et al. Some evidence of race bias in the diagnosis and treatment of the juvenile offender. Am J Orthopsychiatry. 1979 Jan;49(1):53-61. Lewis DO. Guilty by Reason of Insanity: A Psychiatrist Explores the Minds of Killers. New York: Fawcett Columbine, 1998. Roper v. Simmons, 543 U.S. 551 (2005). Thompson v. Oklahoma, 487 U.S. 815 (1988) . For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com
56 min
The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
#251 What the USPSTF? Preventive Medicine Updates with Dr. Amber-Nicole Bird
What the USPSTF?! It’s time for some preventive medicine updates on: screening for unhealthy drug use, cervical cancer, hepatitis C and draft recs for colorectal cancer; plus how to interpret USPSTF screening recs. Dr. Amber-Nicole Bird @ABirdMD (https://twitter.com/ABirdMD) (Penn Medicine (https://www.pennmedicine.org/providers/profile/amber-nicole-bird) ) refreshes our love for preventive medicine, with updates on the newest recommendations. She reviews how to appropriately interpret and adopt guidelines for our patients, being cognizant of the source. We shine light on the mechanism of USPSTF, including how their guidelines differ from others, so we can understand the value and context when utilizing the guidance in the clinic. Episodes (https://thecurbsiders.com/episode-list) | Subscribe (https://anchor.fm/s/4108bcf4/podcast/rss) | Spotify (https://open.spotify.com/show/3SKlzOLxyztvA1BkJfnf67) | Swag! (https://www.teepublic.com/user/kashlakmemorial) | Top Picks (https://thecurbsiders.com/top-picks) | Mailing List (https://thecurbsiders.com/knowledgefood) | thecurbsiders@gmail.com (mailto:thecurbsiders@gmail.com) | Free CME! (http://curbsiders.vcuhealth.org/) Credits Produced and Written by: David Madick MD; Peter Wikoff MD; Paul Williams MD, FACP Infographic: Beth Garbitelli Cover Art: Chris Chiu MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto, MD (Show notes); Clair Morgan of nodderly.com (https://www.nodderly.com/) Guest: Amber-Nicole Bird, MD Sponsor: The American College of Physicians Join us for ACP Internal Medicine Meeting 2021: Virtual Experience for 3 days of interactive, livestreaming education and events April 29 through May 1—plus on-demand post-meeting access to CME credit for up to 3 years. “Early Bird” members get an additional $80 registration discount on top of their member discount. Visit annualmeeting.acponline.org (https://annualmeeting.acponline.org/?utm_source=curbsiders&utm_medium=banner&utm_campaign=MD0020-6) and use the code IM21CURB. Register now (https://annualmeeting.acponline.org/?utm_source=curbsiders&utm_medium=banner&utm_campaign=MD0020-6) —Early Bird savings end January 31st! Sponsor: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education (https://cme.vcuhealth.org/) to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org (http://curbsiders.vcuhealth.org/) .
1 hr 6 min
Medgeeks Clinical Review Podcast
Medgeeks Clinical Review Podcast
Medgeeks
Psilocybin assisted therapy, mental health, and how we doubled the size of our company
It’s been a very long time since I have jumped on the Medgeeks podcast. But, every year I share and reflect everything I have learned with the community...and this year is no different! This episode is heavily focused on mental health and the pandemic. Much of what I discuss today is based off my personal experience, which is what shaped the growth of our company. Today, I’ll be discussing: * The Pandemic * My experience with psilocybin * Why I started therapy and how it’s helped shape Medgeeks * How our company doubled in size and brought on many full time employees in a time when many businesses were laying people off. * The #1 mistake PAs and NPs make after graduation * The secret to being the absolute best clinician you can be * 4 main takeaways I learned in 2020 that changed my life It’s my hopes that I can do my small part to help squash the stigma behind mental health. After all, my fiance is a marriage and family therapist :). At the end of the episode, I ask to see if anyone is interested in discussing business and/or personal growth. If that’s you, just click the link below to sign up. If there’s enough interest, I'll hold a free virtual session, where we can work together to help you get ahead. I have nothing to sell. This is just my way of giving back: https://medgeeks.co/business-talk Talk soon! - Andrew p.s. The future podcast episodes will not be like this. We’ll continue to focus on evidence based medicine to help you master medicine. But, it’s my podcast and I wanted to share haha. Happy New Year!
38 min
Bedside Rounds
Bedside Rounds
Adam Rodman, MD, MPH, FACP
60 - Santa's Salmonella
For a special holiday treat, we’re going to explore two tales of salmonella disease detectives -- the first about Mary Mallon (“Typhoid Mary”) and the birth of the genre; and the second about a mysterious salmonella outbreak at Massachusetts General Hospital solved with the assistance of a very jolly patient. Along the way, we’ll talk about clinical epidemiology, the long-lasting influence of Berton Roueché, and the joys of being an internist! You can sign up for the Digital Education conference at cmeregistration.hms.harvard.edu/digitaleducation. Sources: * Buckle GC, Fischer Walker CL, and Black RE, Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010.J Glob Health. 2012 Jun; 2(1): 010401. * Marineli F et al, Mary Mallon (1869-1938) and the history of typhoid fever.Ann Gastroenterol. 2013; 26(2): 132–134. * Soper GA, The Curious Career of Typhoid Mary, read on May 10, 1939 before the Section of Historical and Cultural Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911442/pdf/bullnyacadmed00595-0063.pdf * Norrington B, Cochineal: A Little Insect Goes a Long Way, UCSB Geography. * Roueche B, The Santa Claus Culture, The New Yorker, Aug 27, 1971. * Lang DJ et al, Carmine as a Source of Nosocomial Salmonellosis, NEJM. Apr 13, 1967. * You can buy Medical Detectives here: https://www.amazon.com/Medical-Detectives-Collection-Award-Winning-Investigative/dp/0452265886
38 min
American Journal of Psychiatry Audio
American Journal of Psychiatry Audio
American Journal of Psychiatry
January 2021: Brain Activation and Symptom Reduction in OCD Following CBT
Executive Editor Michael Roy speaks with Luke J. Norman, Ph.D., and Kate D. Fitzgerald, M.D., about their article examining whether brain activity is associated with treatment response to cognitive-behavioral therapy (CBT) in adolescents and adults with obsessive-compulsive disorder (OCD), and whether any associations are treatment specific relative to an active control psychotherapy (stress management therapy; SMT). Dr. Luke Norman was recently a neuroscience postdoctoral fellow at the University of Michigan. He is now affiliated with the National Institutes of Health. His research has looked at treatment for obsessive-compulsive disorder and attention deficit hyperactivity disorder. Dr. Kate Fitzgerald is the Phil F. Jenkins Research Professor of Depression and associate professor in the Department of Psychiatry at the University of Michigan. She is the academic director for child and adolescent psychiatry and co-director of the Pediatric Anxiety Disorders Clinic. She is also an adjunct associate professor in the Department of Psychology. Her work has examined pediatric anxiety and obsessive-compulsive disorders, and currently, she is interested in looking for biomarkers of pediatric anxiety disorders that may represent options for novel, targeted treatments. She also has done work focusing on the use of cognitive-behavioral therapy in schools. * How the authors became interested in this area of research [2:42] * How prevalent obsessive-compulsive disorder (OCD) is among the general population, and its conventional treatment approaches [5:50] * Comparing cognitive-behavioral therapy (CBT) with a control psychotherapy called stress management therapy (SMT) [8:42] * Details about two neural networks that have been implicated in OCD (the cingulo-opercular network and the orbito-striato-thalamic network) [12:04] * Makeup of study participants, and methods the authors used to analyze the data [14:07] * Comparison of symptom change between the group who received CBT relative to the group who received SMT [17:39] * Details from functional MRI scans [18:23] * Differences by age [20:40] * Other notable study results [21:25] * Limitations of the study [22:21] * Implications that this work has for the understanding and treatment of OCD [23:30] * Key points for researchers, clinicians, and other mental health professionals [24:50] * Recommendations for further research [26:07] Be sure to let your colleagues know about the podcast, and please rate and review it on Apple Podcasts, Google Podcasts, Stitcher, Spotify, or wherever you listen to it. Subscribe to the podcast here. Listen to other podcasts produced by the American Psychiatric Association. Browse articles online. Watch Deputy Editor Daniel S. Pine, M.D., present highlights from the January 2021 issue. Follow the journals of APA Publishing on Twitter. E-mail us at ajp@psych.org
29 min
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