When I was a consultation-liaison psychiatrist I taught trainees in different ways. One of them was what I called the Dirty Dozen slide sets. They were on various basic topics that are important for psychistrists to know. I tried to put the most important points on only a dozen powerpoint slides.
After I started blogging about C-L Psychiatry around 13 years ago, the WordPress blogging platform started offering a way to post slide presentations using what is called shortcode. Presumably, you didn’t really have to know anything about coding language but the instructions weren’t very helpful.
I think I started trying to make slides using shortcode shortly after it was first introduced around 2013. I had to contact WordPress support because I couldn’t learn shortcode. A lot of bloggers had the same problem.
I think my main reason for getting interested in shortcode was so I could cut down on how many powerpoint slides I had to convert to images, which can take up a lot of space on a blog site after a while.
Anyway, in the past few days I tried to pick up the shortcode but couldn’t get the hang of it again. I finally found a WordPress help forum in which I found a blogger’s solution. She made it so clear.
Anyway, the Dirty Dozen on Delirium is below. A few pointers: click in the lower right hand corner of the slide if you want to view the slides full size. Use the directional arrows on your keyboard to click through the slides. You can also just use the arrow handles on the slides if you don’t want to see them full size. . When you click the URLs on the delirium websites, right click and open them in a new tab.
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Reminder: NAMIWalks May 4, 2024 in Iowa City
Don’t forget to register for the Johnson and Linn County NAMIWalks on May 4, 2024. See registration and location info below:
The University of Iowa Role in the Science Behind Psilocybin for Psychiatric Treatment
On April 9, 2024, the University of Iowa educational podcast, Rounding@Iowa presented a discussion about the study of the use of psilocybin in the treatment of psychiatric and addiction disorders. You can access the podcast below. The title is “Psilocybin Benefits and Risks.” The format involves an interview by Dr. Gerard Clancy, MD, Senior Associate Dean for External Affairs, Professor of Psychiatry and Emergency Medicine with distinguished University of Iowa faculty and clinician researchers.
In this presentation, the guest interviewees are Dr. Michael Flaum, MD, Professor Emeritus in Psychiatry, University of Iowa Carver College of Medicine, and Dr. Peggy Nopoulos, MD, Chair and Department Executive Officer for the University of Iowa Department of Psychiatry, Professor of Neurology, Pediatrics, and Psychiatry, University of Iowa Carver College of Medicine.
All three of these highly respected and accomplished faculty taught me when I was a trainee in the psychiatry department and afterward were esteemed colleagues.
The link icon adjacent to the title of the podcast takes you to the podcast website. The link to the article in Iowa Magazine about the psilocybin research at University of Iowa Health Care tells you more about Dr. Peggy Nopoulos and her role as principal investigator in the study.
There is also a link to the National Library of Medicine Clinical Trials web site where you can find out more details about the study design. You’ll notice a banner message which says: “The U.S. government does not review or approve the safety and science of all studies listed on the website” along with another link to a disclaimer with more details.
Cat-astrophizing About the Association Between Cats and Schizophrenia Risk
It seems like every few years there is a spate of news stories about the supposed risk of developing schizophrenia from having a pet cat. The bottom line is that there is no direct link, but you can’t tell a reporter that. I mentioned the issue in a blog post about a feral cat in our neighborhood last year.
The research about this often has limitations, some of which are pointed out in this web article. A Psychiatric News article published in 2017 presented a reasonable position which apparently no reporters have read.
I’m allergic to cat dander. On the other hand, some cats are important enough to be entrusted with carrying an entire galaxy around their belts, reported in the Men in Black documentary which is in large part about a cat named Orion.
NAMIWalks Johnson and Linn Counties 2024
There is a National Alliance on Mental Illness (NAMI) walk scheduled for May 4, 2024 at Terry Trueblood Recreation Area. See the announcement here.
The Changing Role of the Psychiatrist in Managing Depression with Medical Illness
This post is mainly a reminiscence about my days as a consultation-liaison psychiatrist. I often evaluated patients who had chronic hepatitis C. The liver disease itself and the treatment (interferon alfa) often led to patients struggling with depression.
The impetus for this came from noticing a couple of items. One is the recent l blog post about treatment of depression by George Dawson, MD (“Are Medication Trials for Depression Too Long in Duration?”). The other is a Psychiatric Times article about the Star-*D depression treatment study published in Psychiatric Times (“Star*D: It’s Time to Atone and Retract” by Nicolas Badre, MD and Jason Compton, MD).
Back in the day, I thought it made sense to use depression rating scales in my clinic practice. I use the term “clinic practice” reservedly because in actual practice I was too often running the hospital psychiatry consultation service to see outpatients regularly.
There has been a recent call to retract the Star*D study. I wasn’t involved in the study, of course. I was too busy running around the hospital responding to consultation requests. I noticed the criticism in the Psychiatric Times article by Badre and Compton of the specific depression rating scale, the QIDS-SR (which stands for Quick Inventory of Depressive Symptomatology (Self-Report).
I tried to integrate into my practice the QIDS-SR as well as the Clinically Useful Depression Outcome Scale (CUDOS). The latter was designed by psychiatrist Dr. Mark Zimmerman around 2008. I believed in the principle of measurement-based assessment of psychiatric symptoms and did my level best to integrate them into my practice.
It was very difficult to do. My patients were typically suffering from both medical and psychiatric illness. Often, they had physical symptoms that you could attribute to either the medical problem itself or “depression”—or both. This is a common challenge in consultation psychiatry.
Returning to my experience with patients who had chronic hepatitis C, in my early career, some of them who were on interferon alfa would not uncommonly develop depressive symptoms during treatment. Sometimes that meant stopping the treatment. Moreover, they sometimes had other side effects including thyroid function abnormalities, which can also cause mood disturbance.
There have been debates about whether to count physical symptoms in depression because of the overlapping symptoms: fatigue, appetite loss, trouble sleeping and the like. There’s also what has been called the “fallacy of good reasons.” Wouldn’t you be depressed too if you were sick and tired of being sick and tired? This could lead to undertreatment of depression. Some diagnostic models suggested counting all symptoms regardless of etiology.
Some randomized controlled trials of antidepressants in the past showed antidepressants were effective in the medically ill with depression. Others showed they were not better than placebo.
Nowadays there is a new pharmacologic approach to treating hepatitis C and those are in the category of direct-acting antivirals (DAA). According to fairly recent literature, the DAAs offer a better chance of cure of hepatitis C and less psychiatric side effects. That doesn’t mean psychiatrists are no longer needed. The common issues such as comorbid substance use and cognitive disorders, highlighting the ongoing need for collaborative care between medicine and psychiatry.
The FDA Announcement on Kratom
Just in case you missed it, the FDA posted an announcement about Kratom in February this year. According to the FDA:
“Kratom is a tropical tree (Mitragyna speciosa) that is native to Southeast Asia. Products prepared from kratom leaves are available in the U.S. through sales on the Internet and at brick-and-mortar stores. Kratom is often used to self-treat conditions such as pain, coughing, diarrhea, anxiety and depression, opioid use disorder, and opioid withdrawal.”
The other day as we were driving home on Highway 1 through Iowa City, I saw a sign advertising Kratom on a small store. I thought that might be illegal, but when I checked the Iowa Office of Drug Control and Policy, I found out it’s currently legal in the state.
Opinions vary about risks of using Kratom. The DEA tried to place in on the Schedule I, but the American Kratom Association and other supporters apparently prevented that simply by protesting it. The pharmacist who wrote the article (link above) raised a note of irony by questioning why marijuana is still regulated as a Schedule I drug.
The legality of Kratom also varies across the country. There is a very detailed review article about it that attempts to examine the use of Kratom from both the medical practitioner and patient points of view.
Picture Credit: By Psychonaught – Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=8255742
Remember The Calling
I recommend Dr. George Dawson’s recent posts on seeing the practice of medicine as a calling and his passing a big milestone with 2 million reads on his blog.
I wrote a post entitled “Remembering Our Calling: MLK Day 2015.” It was republished in a local newspaper, the Iowa City Press-Citizen on January 19, 2015. And I reposted it in 2019 on this blog.
The trainees I taught also taught each other about psychiatry and medicine when they rotated on the consultation-liaison service at the hospital. We put them into the format of short presentations. I called mine the Dirty Dozen. The trainees and I also presented the Clinical Problems in Clinical Psychiatry (CPCP).
There were many of those meetings, which were necessarily short and to the point because the service was busy. We got called from all over the hospital. We answered those calls and learned something new every time.
I posted a lot of the trainees’ presentations in my previous blog, The Practical C-L Psychiatrist, which was replaced by this present blog. I haven’t posted the presentations partly because I wanted to give the younger teachers their due by naming them as they did on their title slides. But I would want to ask their permission first. They are long gone and far flung. Many are leaders now and have been for many years. I still have their slides. I’m very proud of their work. When they were called, they always showed up.
So, you’ll just have to put up with my work and my cornball jokes.
The Good and the Not So Good About Mental Health Treatment
Sometimes I write “depressing” blog posts. On the other hand, I have both good and bad news today.
I found out that, according to the Treatment Advocacy Center, Iowa’s state psychiatric hospital bed availability is dismal according to 2023 figures. That’s actually not new. Although we rate last in the nation for this, we still get a Grade B overall. I’ll have more to say later about it. You can check your own state’s grade on the web site’s map graphic.
And a recently published article about antidepressant prescribing for young people is sort of depressing, there are ways to address the likelihood that adolescent females are being prescribed antidepressants more often than adolescent males.
I tend to agree with the author of another article on adopting a more nuanced perspective on what is often called “depression” in young people. Not everybody who is distressed is depressed.
Even if we are depressed, there are healthy activities we can engage in to heal. We don’t all necessarily need antidepressants. That’s the point of a recent systematic review and meta-analysis on the role of exercise for managing depression. Exercise is effective either by itself or in addition to psychotherapy and antidepressant.
Iowa actually seems to be putting a lot of hard work in mental health outreach, such as Your Life Iowa. It’s funded by the Iowa Dept of Health and Human Services under the Division of Behavioral Health.
I’d say that’s pretty positive, overall.
“Our Hidden Conversations” is a Very Tough Book to Read
As I approach the end of the book “Our Hidden Conversations” by Michele Norris, I find myself doing what I often do when I feel uncomfortable emotionally. I start to deploy my sense of humor.
As a psychiatrist (now retired since 2020), I learned early in my residency training that humor can be thought of as a “mature” psychological defense.
Given the painful memories that the book evokes, I find that I self-edit my usual habit of turning pain into comedy. Maybe it’s not always mature.
On the other hand, there are times when facing what is nowadays called my “lived experience” about racism and identity in the era my wife and I grew up in, while not funny, can be peeked at most safely from the funny edge.
So, with that in mind I took a look at the web page of the National Association of Black Social Workers (NABSW) which summarizes the organization’s position on white adoption of black children. I first read about it in Ms. Norris’s book, in the chapter “Black babies cost less to adopt.”
I was surprised to see the actual document, which has been posted since 2013. Sections of the position paper titled “Transracial Adoption Statement (c) 1972” are underlined. It expresses clearly an opposition to placing black and transracial adoptees with white parents. I might have missed it, but I don’t see another position statement that modifies it.
There are 30 state chapters of the NABSW. Iowa is not listed.
There is no National Association for White Social Workers. There is a website for the National Association of Social Workers (NASW). When I typed in “National Association of Black Social Workers” in the search field on the NASW website, almost 800 results were returned. When I applied the filter for ethnicity and race, there were 5 results attesting to the NASW efforts in countering racism. I didn’t see any mention of the NABSW. Maybe I just missed it.
I lived for a brief time in an African American foster home eons ago. I can’t think of anything funny to write about it. Has there ever been an opportunity for cross talk between the NASW and the NABSW? I’m not judging anyone here. I’m just asking.
Moving right along, I have again searched the web using the term “African American psychiatrists in Iowa.” I’ve posted about this before, looking at it from the funny edge (this allows me to take a deep breath). I still find my former colleague, Dr. Donald Black, MD listed. The only thing black about him is his name. And my 2019 blog post is the 3rd link down from the top, preceded by two from Psychology Today.
Most of the mental health care providers from the Psychology Today lists are Nurse Practitioners who are black. One of them does not look black. She looks white. She’s a psychiatrist. I’ve worked with her in the past and don’t recall her ever identifying as black. But because I’m reading the race card stories in “Our Hidden Conversations,” and because I’ve been around a little while, I’ve learned that some black people can look white. You can’t always judge a book by its cover.
A good black psychiatrist is hard to find. In fact, a black psychiatrist of any quality is hard to find. However, in general, there are notable black psychiatrists in our history. One of them was Chester Middlebrook Pierce, MD. Among his many accomplishments, he was the founding president of the Black Psychiatrists of America in 1969, which was one year after the NABSW was established. Dr. Pierce was also the president of the American Board of Psychiatry and Neurology in 1978. I didn’t learn about him until today. How is that possible?
There is a website for the Black Psychiatrists of America and you can try the search field to look for a black psychiatrist there. I couldn’t find any listed in Iowa. Most of them seem to be in Texas. I had a little trouble applying the search filters.
Those are my thoughts for now about “Our Hidden Conversations” by Michele Norris. This is not a funny book.
Go Retire Psychiatrist 