Tag: Psychiatry

Great Rounding@Iowa Podcast on Preventing & Managing Heat-Related Illness

The Rounding@Iowa podcast has many fascinating and helpful episodes, not the least of which is this one on heat-related illness. The days are getting hotter and we need to pay close attention to what happens in our bodies when exposed to excessive heat.

69: Heat-related illnesses: Risks, Prevention, Early Intervention and Emergency Resuscitation Measures – Rounding@IOWA

Join Dr. Clancy and Dr. Donaldson as they discuss heat-related illnesses-prevention, early interventions out in the field, and diagnostic and emergency resuscitation measures.   CME Credit Available:  https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=66600  References/Resources:  Association of Extreme Heat with All-Cause Mortality in the Contiguous US, 2008-2017. Jama Netowrk Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792389 Trends in heat related illness: Nationawide observational cohort at the US Department of Veteran Affairs. The Joural of Climate Change and Health. https://www.sciencedirect.com/science/article/pii/S2667278223000561 Heatstroke. New England Journal of Medicine. https://doi.org/10.1056/nejmra1810762 https://www.ready.gov/heat Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guest: Melvin Donaldson, MD, PhD Fellow in Emergency Medicine University of Iowa Department of Emergency Medicine Financial Disclosures:  Dr. Gerard Clancy, his guests and the members of the planning committee for Rounding@IOWA have no relevant financial relationships to disclose. CME Credit Designation: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurses: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 0.5 ANCC contact hour. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)  
  1. 69: Heat-related illnesses: Risks, Prevention, Early Intervention and Emergency Resuscitation Measures
  2. 68: Vaping and Dabbing
  3. 67: Psilocybin Benefits and Risks
  4. 66: Evidenced-Based Orthopedic Regenerative Medicine
  5. 65: Best Practice – Goals of Care Conversations

Svengoolie Movie: The Tingler!”

We saw the 1959 movie “The Tingler” starring Vincent Price on the Svengoolie show last Saturday. Price plays a prison pathologist, Dr. Warren Chapin, who’s trying to scientifically study a parasitic creature called the tingler (tingles up and down your spine means you’re scared right out of your mind!).

It sits on your spine and feeds on fear by clamping down on it, eventually breaking it unless you scream. Then it’ll just let go. However, if you’re mute, scared speechless, or it grabs you by the throat—you’re done. So, the tingler lives on fear, although if you express fear vocally by screaming, you escape it.

OK, so I’m going to spoil the opening scene, which shows a prisoner being dragged to the electric chair, screaming all the way until the executioner throws the switch. When Dr. Chapin does an autopsy, he finds the prisoner’s spine is cracked. He says it wasn’t caused by the electrocution, but by the tingler.

Huh? But the prisoner screamed bloody murder (murder was why he got the death penalty by the way) hardly stopping to take a breath. Shouldn’t that have weakened or killed the tingler? You can find examples of inconsistencies like this in any cheesy movie, but where’s the fun in that?

One web article says the tingler creature was modeled after the velvet worm, which looks pretty creepy. In reality, the velvet worm is harmless to humans, but is a predator of many invertebrates. Just keep telling yourself, “I’m a vertebrate.”

You can watch the full movie on the Internet Archive. The most interesting part of it for me was the use of what was called “acid,” (meaning the hallucinogen LSD) by Dr. Chapin. He wanted to experience and record the actual experience of being scared by the tingler, just to see what it’s like apparently. He mainlines himself with a fairly stiff dose of LSD although I can’t remember how much.

Incidentally, an article in JAMA notes, “Doses of 20μg/kg of body weight are known to have been taken without a lethal outcome.” (Materson BJ, Barrett-Connor E. LSD “Mainlining”: A New Hazard to Health. JAMA. 1967;200(12):1126–1127. doi:10.1001/jama.1967.03120250160025). I don’t know how much Dr. Chapin weighs.

This was about the same time as a lot of people in the U.S. were experimenting with the hallucinogen in various ways, including mainlining it. There are web references to psychiatrists using LSD recreationally (this was when it was legal). Bad trips were and still are common, although there is a growing body of clinical studies that involve using the psychedelics as adjuncts in psychotherapy. It’s not for everybody, although tinglers might have a different opinion.

Anyway, Dr. Chapin has a bad trip, gets really scared of hallucinations and screams. Web articles say that killed his tingler, but I didn’t see it flop out of his mouth.

There you have it. Another really cheesy and fun Svengoolie movie. I’m a vertebrate.

Another Look at the C-L Psychiatry Pecha Kucha

Back in 2018, one of my emergency room staff physicians asked me to do a Pecha Kucha on what a consultation-liaison psychiatrist does. If you know what a pecha kucha is, you can understand why it was challenging for me to put it together and present it.

Although you may have seen the video I made of the pecha kucha 5 years ago on this blog, I think it’s OK to present it here again.

Briefly, PechaKucha is Japanese for “chitchat.” It’s a presentation format using 20 slides displayed for 20 seconds each. It took a while to rehearse to get it right.

I think it’s also worth emphasizing because most of the ideas in it are still relevant to consultation-liaison psychiatry. See what you think.

Reblogging The Good Enough Psychiatrist Latest Post, “How to Love”

I haven’t seen any posts from The GoodEnoughPsychiatrist in a while. This one was posted yesterday-just in time.

How to Love

Dirty Dozen on Interpersonal Psychotherapy in WordPress Shortcode

Hey, because May is Mental Health Month, this is another one of my Dirty Dozen lectures. It’s on Interpersonal Psychotherapy.

It’s in WordPress shortcode. 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. If you see weblinks, right click the links to open them in a new tab.

This slideshow could not be started. Try refreshing the page or viewing it in another browser.

Svengoolie Movie Trilogy of Terror!

Last Saturday we watched the movie Trilogy of Terror on the Svengoolie show. Well, we tried anyway. There were a lot of interruptions from severe weather warnings. We didn’t mind them because you ignore them at your peril. It’s hard to forget the 2020 derecho in Iowa, which affected a lot of Iowans, including us.

Trilogy of Terror had some psychiatric aspects to it that reminded me how Hollywood frequently gets it wrong when portraying them in films—but sometimes hits the nail on the head.

Although we missed parts of the first and second parts of the movie, it wasn’t difficult to figure out the psychological angle. Both “Julie” and “Millicent and Therese” made me think of antisocial personality disorder (ASPD). The male college graduate student was a pretty good example of a predatory guy lacking any conscience and feeling no remorse for his bad behavior against his apparently meek and defenseless teacher, Julie.

But then the tables were turned and it was Julie who was actually the convincing, coldly calculating and remorseless psychopathic serial killer. She kept a scrapbook of the newspaper stories about her many victims.

One of my colleagues wrote the book about ASPD. Dr. Donald Black, MD, is the author of Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy). In it he recounts the story of serial killer John Gacy. He was diagnosed with ASPD at the University of Iowa. He collected a great deal of data about antisocial men and also acknowledges that women can be diagnosed with ASPD. He has also co-edited and published the Textbook of Antisocial Personality Disorder.

The “Millicent and Therese” part of the movie displayed how a woman can be diagnosed with ASPD. This was the character Therese—who was also Millicent, a very strait-laced alter personality, which makes this also a case of what you could call dissociative identity disorder (DID), which may be related to severe trauma. This used to be called multiple personality disorder. What was interesting about this part of the movie was that both identities were being managed somehow by a family physician, not a psychiatrist—which is not at all plausible.

The last part of Trilogy of Terror is “Amelia,” in which Amelia buys a Zuni fetish doll (named “He Who Kills”) which she intends to give to her boyfriend. However, she’s in a hostile, dependent relationship with her mother who controls her and interferes with every aspect of her life. Of course, the doll comes to life and tries to kill her.

The struggle between Amelia and the doll makes me think about her internal struggle with angry and probably murderous feelings about her controlling mother. Amelia finally internalizes the doll’s rage (actually her own) when he emerges from the oven where she shoved him in an apparently futile attempt to burn him to a crisp. What it looks like is that she inhaled the smoke, finally owning her own rage by internalizing the doll’s smoky remains. This transforms her into a vengeful killer (now grinning with the sharp teeth of the doll) who calls her mother to invite her over to her apartment with the obvious plan to cut her to pieces with a large knife.

This is probably not a movie for kids or sensitive adults, which Svengoolie acknowledges several times during the show. This is why I like the segment with Kerwyn, the dad joke telling chicken with teeth who is voiced by Rich Koz, who also plays Svengoolie. Usually during that segment he tells a series of jokes, repeating the lines a couple of times, seemingly in an effort to teach you how to tell dad jokes. There’s also a Kerwyn joke of the week event, in which he tells a joke submitted by a fan. The joke video takes a few seconds to load, so be patient.

Bootless II: Dr. Russell Ledet’s Story

Recall that I had been checking to see if the Distinguished Education Lecture given by Dr. Russell Ledet, MD, PhD on January 17, 2024 during the MLK Celebration of Human Rights would be available for the general public. While somebody may be working on that, I managed to find Dr. Ledet’s YouTube, entitled “Bootless II.” I think it’s a great distillation of his major theme.

Food for Thought

I’m giving a shout-out to a couple of child psychiatrists, one I know only from a blog, The Good Enough Psychiatrist. The other is an assistant professor in the University of Iowa Child Psychiatry Dept. I’ve never met her.

Since Jenna gives her name in the About Me section of her blog, I’m going to call her that because it’s easier. Jenna writes many thought-provoking posts, but I really admire the one titled “Amae.”

Dr. Ashmita Banerjee, MD wrote an essay titled “The Power of Reflection and Self-Awareness.” It’s published on line in the Mental Health at Iowa section of The University of Iowa web site.

As a relatively recently retired consultation-liaison psychiatrist who is also a writer, I feel a strong connection to them. In addition to being very glad that extremely talented persons are filling the ranks of a specialty which suffers from a serious manpower shortage, I get a big kick out of reading what really smart people write.

Here’s where a geezer retired psychiatrist starts kidding around. Jenna, a fellow blogger, is used to my habit of deploying humor, admittedly often as a defense. Dr. Banerjee doesn’t know me.

What is it about these essays that reminds me of the X-Files episode “Hungry”? It’s a Monster of the Week episode from the monster’s perspective. This monster looks like a human but sucks brains out of people’s skulls. He’s conflicted about it and even sees a therapist. But in the end his dying words were, as Agent Mulder shoots him down, “I can’t be something I’m not.”

If you read Dr. Banerjee’s essay and followed one of the links, you would have caught the clue that I actually read it because I consciously substituted the word “What” for “Why” in the previous paragraph. I could have as easily asked why instead of what—but it’s less helpful in gaining self-awareness.

And I haven’t sucked anybody’s brains out of their skulls in, what, over two weeks now! Upon reflection, I’m very aware of being incorrigible. Food for thought.

Jenna’s description of the Japanese concept of the word “amae” and Dr. Banerjee’s examination of the Japanese word “kintsukuroi” fascinated me. What made both writers consider human emotions using a language which captures the nuances so deftly?

I was a first-generation college student. There was a time in my life that a path to medical school seemed impossible. At times I probably thought I was trying to be something I’m not.

I’m just grateful for the new generation.

Should Doctors Be Funny?

I ran across an interesting Medscape article, “Should Doctors Be Funnier? These MDs Are Real Comedians.” I don’t know if they should be funny, but it probably wouldn’t hurt.

I think a sense of humor is a good thing for anyone to have and it’s probably not that hard to develop. There’s even a Wikihow article on how to develop a sense of humor.

I usually look for the funny edge in most things that happen to me. I was always very nervous about presenting Grand Rounds when I was on staff at the hospital. I would try to come up with a good case example illustrating both medical and psychiatric features. It was pretty challenging.

I often used humor to help me get through my stage fright. I didn’t tell jokes, but I did clown around a bit. One day, I arrived too early for the Psychiatry Dept. Grand Rounds and accidentally walked in on another scheduled event in the conference room that was obviously not for psychiatrists—only not immediately obvious to me. I got a few chuckles from the audience just from having to back out. Later, during the real Grand Rounds I clowned about my mistake as a sort of opener to my presentation.

Unfortunately, I then had to stumble through my PowerPoint slides (every presenter’s worst nightmare) because I evidently had not organized them correctly. I survived by joking about it. That resulted in a digital award from the residents for being “Improviser of the Year.”

Humor can get you through some pretty sticky situations.

The Thing About Identity

I was searching on the web for something about my co-editor, Robert G. Robinson, MD, for our book Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry, published in 2010.

The reason I was searching for something about him was that I’ve had difficulties finding anything on the web lately about doctors I had worked with years ago and admired—and the search revealed they had died. It has been a little jarring and got me thinking about my own mortality.

My search didn’t turn up any obituary about Dr. Robinson, but I found a couple of interesting items. One of them is, of all things, a WordPress blog item, the About section. It’s dated April 2012. I’ve seen it before. It’s supposedly about a person named Dr. Robert G. Robinson, MD and the only thing on it is his name and affiliation with The University of Iowa Carver College of Medicine. Every WordPress blog has an About section. I have one and I’ve been blogging since 2010.

There’s no entry in the About section for him on WordPress. However, there was another item on the web that looked like it was a blog (It’s another blogging site called About.me), and it was labeled as an About section.  It was a biographical summary of his academic and scientific career. Of course, it was impressive. At first, it looked like he was planning to write a blog, which could have been very educational because he’s an extremely accomplished psychiatrist with a very long bibliography of published articles about psychiatric research, a lot of it about post-stroke syndromes.

But when I looked at the social media links on the WordPress page, it led to a picture of someone who is definitely not the Robinson I know. This person was a “Certified Rolfer.” Remember Rolfing? It’s a form of deep tissue massage developed in the 1970s. The Dr. Robinson I know was never involved in Rolfing.

I’m not sure what happened with the WordPress and other blog items, but it looked the WordPress section was a case of mistaken identity. The most recent genuine item on the web about him is a 2017 University of Iowa article about his receiving the Distinguished Mentor Award.

I hope somebody doesn’t get confused by that WordPress mistake.

Then, I happened to come across an article that, at first, I didn’t recognize. The link on the search page listed Dr. Robinson’s name. It’s on the Arnold P. Gold Foundation website for humanism in medicine. The title is “Are doctors rude? An Insider’s View.” It didn’t have my byline under it. It took me a minute, but I soon recognized that I wrote it in 2013. At the bottom of the page, I was identified as the author.

At first, I thought it was a mistake; there was a place for an icon that at one time had probably contained a photo of me, but it was missing. It’s my reflection about a Johns Hopkins study finding that medical interns were not doing basic things like introducing themselves to patients and sitting down with them.

This was not a case of mistaken identity. But I got a little worried about my memory for a few seconds.

Anyway, I was reminded of my tendency to have trainees find a chair for me so I could sit down with patients in their hospital rooms. I later got a camp stool as a gift from one of my colleagues on the Palliative Care consult service. It was handy, but one of my legs always got numb if I sat too long on it. It broke once and I landed flat on my fundament one time in front of a patient, family, and my trainees. The patient was mute and we had been asked to evaluate for a neuropsychiatric syndrome called catatonia. The evidence against it was the clear grin on the patient’s face after my comical pratfall—and because of the laughter that we could see but not hear.

One of the points of this anecdote is that it’s prudent to be skeptical about what you see on the internet. The other point is that parts of your identity can hang around on the web for a really long time, so it’s prudent to be skeptical about how permanent your current identity is.