Residency Episodes

In this episode we're doing another journal club, this time reviewing the first randomized clinical trial comparing image-guided TMS to the traditional method using scalp targeting for depression. We walk through how TMS works, why targeting matters, what the study found at one month, and where the limitations are before this becomes standard of care.

In today’s episode, Preston and Margaret discuss the psychotherapy paper The Theory of the Crunch, by Paul Libby, a psychoanalyst. In this episode and in the paper, the idea of creating a containing environment, repetition compulsion, and ways of navigating difficult interpersonal dynamics are discussed. In this episode, a more expansive, compassionate frame will be introduced both for the therapist and patient to understand how to make it through confusing and sometimes painful clinical work.

In this episode, Margaret and I take on the en vogue topic of GLP-1s. They have been utilized for T2DM for several years and just recently took center stage in the zeitgeist for weight loss (medically indicated or otherwise). Today, we will break down possible risks to mental health in patients using these medications and, on the flipside, potential areas where we could possibly use GLP-1s primarily to treat mental illness.

In this episode, Margaret and Preston present how two psychiatrists think about prescribing medications for depression. Using different common clinical scenarios, they discuss standard clinical guidelines, navigating weight gain and loss with SSRIs, augmentation of SSRI’s, and sexual side effects.

In today’s episode, Margaret and Preston are joined by pediatrician and child psychiatrist Elizabeth Pinsky, MD. Dr. Pinsky works as a pediatric consult-liaison psychiatrist at Massachusetts General Hospital and her clinical interests lie at the intersection of child mental and physical health, including childhood trauma associated with medical care, fostering resilience in medically ill children, and climate change. In this episode, we discuss the current understanding of climate change on mental health and wellbeing for all, why “climate anxiety” locates the problem in the wrong place, and how healthcare workers can help in collective action to improve the climate’s health to improve all our health.

Laugh all you want (please laugh it’s supposed to be funny), Preston has been doing improv from the last year and he has some thoughts. Not just “yes ands” about how it makes him a better doctor, and he is dragging Margaret into the mix starting off with some improv style warm ups and ending with a philosophical commentary about the stage we all perform on. I don’t know why I am talking about Preston like I am not the one writing this. Hi it’s me, Preston. Enjoy the episode!

Margaret is back and today our episode pulls themes from Carol Dweck’s work and book Growth Mindset, as well as a favorite sophisticated film: Kung Fu Panda. In this episode, Margaret and Preston discuss a frame to make sense of the obstacles we meet as we change levels of training, weather you’re starting med school, doing a post doc, or changing jobs. We walk through phases of growing, including failing, flailing, and flourishing, and give examples along the way from our growth-minded Panda friend.

In this Preston-led episode, we take a deep dive into the history of lithium and its use in psychiatry. But because Preston is very literal, we are starting at the very beginning, inside of stars where lithium was formed at the beginning of the universe. Then we will follow this wonderful atom through history and past its FDA approval in 1970 to where we are today.

Today we'll talk through this one study from 2010 out of the Oxford Department of Experimental Psychology, "Task-related default mode network modulation and inhibitory control in ADHD: effects of motivation and methylphenidate", that I want to walk you through, because the way it reframed ADHD for me as a resident is one of the more useful brain-flips I've had this year.

We're going back to one of our oldies but besties. This is our motivational interviewing episode from season one, which Margaret and I both agree is probably the best episode we made that whole first run. And it holds up, maybe even better now that we're further along in training and have actually used a lot of these tools in real clinical work. If you're a trainee, an educator, or just someone who's ever tried to gently move a person you love toward a change they keep half-saying they want, start here.

We're doing a throwback! This was our second episode ever, way back when I was at the beginning of fourth year of med school and Margaret and I were still figuring out the rhythm of this whole podcast thing. I'm now at the end of my first year of child fellowship, and somehow attachment theory keeps coming back around no matter what lens I try to look through, existential therapy, child psych, even our death anxiety episode. Pretty much every road leads back to it. So we wanted to bring it back, dust it off, and let y'all hear where we started.

In this episode we are joined by my co-resident, @undercoverdoc who has a special interested in fitness culture and bodybuilding. With the protein intake, food weighing and gym discipline also comes “extracurriculars,” or anabolic steroids. Rob describes his observations being in the fitness space as both an athlete and a physician and we discuss the impact of steroid use, its prevalence and what it can actually look like.

In this episode, Margaret and I are joined by the legendary host of the podcast Psychiatry Bootcamp, Dr. Mark Mullen. As a clerkship director of the psychiatry rotation himself, Dr. Mullen adds his insights as we discuss the “high yield” (if you will) tips to learning and transitioning into residency. We share our triumphs and failures as interns and indulge you with our new segment called “5-minute chalk talks!”