Episodes

In this episode, Margaret and Preston talk about Margaret’s experience halfway into child and adolescent psychiatry fellowship. Margaret discusses the general requirements or parts in child training, discerning child training indications versus other training paths, and how her child training impacts her care for adult psychiatry patients.

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.

The Greeks described two kinds of madness, and both are fun to talk about on our pod. Inspired by the recent hullabaloo around The Odyssey, we are going to be breaking down the DSM-V diagnoses we see in the series and run through the historical roots and the stories of what we see today in mental health.

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 week's throwback episode to Season 1, Episode 15, Preston and Margaret open a bottle—of questions, stories, and science—about alcohol use disorder. What do we get wrong about “moderate” drinking? Why is detox more dangerous than most people realize? And how does alcohol quietly reshape identity, relationships, and the brain itself? With their signature blend of honesty and humor, they explore the unexpected ways drinking shows up in medicine, the myths that keep us stuck, and the messy, meaningful path to redefining recovery.

In today’s episode we bring on Dr. Campbell Sullivan, PsyD to discuss the interesting field of neuropsychology, a complicated niche that focuses on eliciting deficits in cognition across patterns of disease. We discuss the triumphs of her field as they collaborate with both psychiatry and neurology and then get into the places she sees room for improvement, particularly in how we assess and treat cognition in the aging female brain.

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.

In this episode of historical psychiatric diagnoses we continue the “arc” (get it) with the story of a young girl with vivid hallucinations who galvanized the French army and a wise king who lost his sanity late in life. The interesting thing about these cases, however, is that they may have more underlying medical issues and in fact, the psychospiritual and somatic issues of the past are just as intertwined as they are today. Even to the point where we have to correct ourselves and realize that we may have been calling these incorrectly for a while.

We're pulling a throwback from season two for this one, and it's the episode I will go to the mat for as one of the most clinically useful hours of psychiatry content we've ever put out. Margaret literally calculates QTc off this episode every time she's on call and her CL attending called her out for it the other day, like, "Look at her recalculating." So when she said we should bring this one back, I didn't argue. If you're a resident, an attending who consults psych in the hospital, or a patient or family member trying to understand what it means to live after a cardiac event, start here.

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.

I figured we'd do something I've been wanting to do for a while: story time. Specifically, the kind where I take some of history's most famous figures, walk you through what actually happened to them, and then put on my psychiatry resident hat and try to figure out what we'd actually diagnose them with today. We will be analyzing King of France, Charles VI and Mary Todd Lincoln. Get ready to hear me yap about psychiatric history!

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.