NYU Langone Insights on Psychiatry

Dr. Robert Findling is Chair of the Department of Psychiatry at the Virginia Commonwealth University School of Medicine. Here he discusses recent advances in pediatric mental health, including his own research on aggression and schizophrenia in young people. Dr. Findling also shares his thoughts on the crisis of teen suicide, the lingering impact of COVID-19 on children’s mental health, and the need for early and collaborative interventions.

00:00 Introduction
00:46 Clinical and Research Journey
02:56 Aggression with impulsivity and reactivity (AIR)
06:48 Precision Pediatric Psychiatry
15:34 Schizophrenia
20:31 What Kids Need to Thrive
23:10 Teen Suicide
25:09 Role of Schools and Primary Care
30:58 Loneliness Epidemic Among Children
32:32 Improving Access to Pediatric Mental Health Care
40:00 Bipolar Disorder
43:24 Future Research and Hope for Young Patients
45:11 Conclusion: Importance of Early Intervention

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Podcast producer: Jon Earle

Dr. Charles Nemeroff is Chair of the Department of Psychiatry and Behavioral Sciences at the University of Texas-Austin's Dell Medical School. He is also co-director of the Center for Psychedelic Research and Therapy, and director of the Institute for Early Life Adversity Research. His research is focused on the pathophysiology of mood and anxiety disorders with a focus on the role of child abuse and neglect as a major risk factor.

00:00 Introduction
00:52 Dr. Nemeroff's Research Journey
01:55 Childhood Maltreatment as Risk Factor
04:53 Advances and Challenges in Precision Psychiatry
07:33 Psychedelic Medicine (incl. blinding issues and potential adverse events)
20:50 How Psychedelics Disrupt the "Circle of Hell"
30:00 Psilocybin as Potential Treatment for Anorexia Nervosa
38:32 Screening for Childhood Maltreatment
41:30 Transcranial Magnetic Stimulation (TMS)
44:14 Focused Ultrasound
46:32 Prescribing MAOIs
49:34 Conclusion

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Podcast producer: Jon Earle

Dr. Helen Riess is Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of Empathy Research and Training in the Psychotherapy Research Group at Massachusetts General Hospital. She is also Founder and Chief Executive Officer at Empathetics, a company that provides science-based empathy and interpersonal skills training for healthcare professionals. Her research focuses on improving empathy and relational skills in physicians.

00:00 Introduction
01:14 Defining Empathy
03:38 Empathy and Burnout
05:00 Care for the Caregiver
07:52 Exquisite Empathy and Burnout
09:18 Building Empathy and Avoiding Overburden
10:45 Developing Boundaries in Clinical Practice
11:45 Training and Teaching Empathy
13:42 Model for Recognizing Emotion in Others
15:11 Becoming Emotion Detectives
19:31 Leadership's Role in Creating Supportive Workplaces
23:22 Benefits of Empathy Training
29:07 Technology and Empathy Training
34:18 Research on MDMA-Assisted Psychotherapy
37:43 Building Empathy and Compassion
40:07 Taking Small Steps Towards Empathy
42:32 Resources for Building Empathy
43:28 Future of Empathy Training

The Empathy Effect (Dr. Riess's book)
The Power of Empathy (TEDx Talk)

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Podcast producer: Jon Earle

Dr. Christopher Pittenger is a Professor of Psychiatry at the Yale School of Medicine and Director of the Yale OCD Research Clinic. In this episode, he discusses the neurobiology, symptomology, and treatment of Obsessive-Compulsive Disorder (OCD), including potential new treatments such as psychedelics, neurofeedback, glutamate modulators, and transcranial magnetic stimulation (TMS). 

00:00 Introduction
00:41 Why is OCD Underdiagnosed?
02:19 Impact of OCD on Individuals
03:40 Taboo Nature of OCD Thoughts
06:10 Biomarkers
08:06 Neurobiology
14:20 Serotonin
16:48 Heterogeneity of OCD
24:00 Glutamate Modulators
29:33 Ketamine
33:13 Psilocybin
38:23 Neurofeedback
44:01 Transcranial Magnetic Stimulation (TMS)
47:22 Relationship Between Depression and OCD
50:24 Future of OCD Treatment

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Podcast producer: Jon Earle

Dr. Richard Davidson is the William James and Vilas Professor of Psychology and Psychiatry at the University of Wisconsin–Madison and Founder & Director of the Center for Healthy Minds.  In this episode, he discusses the current state of research on mindfulness and meditation as mental health interventions.

00:00 Introduction
02:15 Focus areas in current research
04:37 Well-being as a universal intervention
06:21 Beyond mindfulness: other forms of meditation
07:24 Four pillars of well-being: awareness, connection, insight, and purpose
13:04 Healthy Minds Program and the impact of short daily meditation practices
17:05 Comparison of Mindfulness-Based Stress Reduction (MBSR) and the Healthy Minds Program, focusing on accessibility and time commitment
20:55 The potential for structural changes in the brain with meditation
26:24 Integrating mindfulness and meditation into clinical practice
28:06 Micro-supports for everyday well-being
33:27 Mindfulness and social connection
35:06 Future research directions, including the concept of a flourishing city

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Podcast producer: Jon Earle

Dr. Ronald Kessler is the McNeil Family Professor of Health Care Policy at Harvard Medical School. His groundbreaking work on the social determinants of mental health, studied from an epidemiological perspective, has made him the most widely cited psychiatric researcher in the world.  In this wide-ranging conversation, he talks about precision psychiatry's enormous potential and incremental development, delving into his own efforts to better identify at-risk patients and predict treatment efficacy. Dr. Kessler stresses the need for better data and bigger studies, and envisions a future of AI-supported clinicians.

00:00 Introduction
00:53 Dr. Kessler's Journey to Precision Psychiatry
02:45 The Importance of Data
04:14 Risk Factors and Treatment Optimization
10:42 Successes and Challenges
13:23 The Importance of Baseline Information
23:46 Machine Learning in Veterans Health
24:27 Determining Suicide Risk
25:35 Interventions and Cost-Effectiveness
26:16 Esketamine Trials and Response Prediction
27:07 Risk Models and Comparative Risk Models
27:15 Insomnia Treatment in Military Personnel
29:36 Cost-Benefit Analyses
35:45 AI in Medicine and Patient Response
42:21 Future of Precision Psychiatry
45:51 Closing Remarks

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Podcast producer: Jon Earle

Dr. Petros Levounis is President of the American Psychiatric Association and a leader in addiction research. He joins host Thea Gallagher, PsyD, to talk about the latest in addiction medicine, the state of the opioid crisis, the growing problem of technology addiction, and the promise and risks of psychedelic medicine. He also shares his hopes for the future of psychiatry, including better integration of diagnoses, treatments, and outcomes for people with mental health disorders.

00:00 Introduction to NYU Langone Insights on Psychiatry
00:16 Dr. Levounis's role and priorities as APA president
00:46 The State of Addiction Medicine
02:12 Neurobiology of Addiction
03:37 Interplay Between Mental Health and Addiction
06:03 Potential and Challenges of Psychedelic Medicine
08:37 Cannabis and Tech Addictions
10:11 Addressing the Opioid Crisis: Strategies and Solutions
15:28 Addressing Technological Addictions
28:55 The Future of Psychiatry: Goals and Aspirations
35:47 Conclusion and Final Thoughts

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Podcast producer: Jon Earle

Starting this fall, we're releasing 12 more conversations with the best minds in psychiatry. Subscribe wherever you're listening, so you won't miss an episode.

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Podcast producer: Jon Earle

Dr. Carla Nasca is an Assistant Professor in the Department of Psychiatry and the Department of Neuroscience and Physiology at NYU Langone, where she studies epigenetic mechanisms of neuroplasticity to stress. Dr. Nasca's work led to the discovery of acetyl-L-carnitine (LAC), a metabolite found in the mitochondria, as a promising biological marker of depression.

Topics:

• acetyl-L-carnitine (LAC) and major depressive disorder
• How stress changes the brain on a structural/molecular level
• Risk factors for stress-induced disorders
• Machine learning

More information: https://www.cdr.rfmh.org/research/nasca-lab/

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Podcast producer: Jon Earle

Dr. Tanya Sippy is an Assistant Professor in the Department of Psychiatry and the Department of Neuroscience and Physiology at NYU Langone. She’s also Principal Investigator at the Sippy Lab and Associate Director of the Psychedelic Medicine Research Training Program. Her research explores the neural mechanisms that underlie how sensory stimuli become associated with goal-directed behavior.

 Topics:

• How learning changes sensory representation (with implications for understanding addiction, etc.)
• Recent research on the functions of dopamine and serotonin
• Hype vs reality of psychedelics
• Regulation of ketamine clinics

 More information: https://www.sippylab.com/

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Podcast producer: Jon Earle

Dr. Andrew Nierenberg is a Professor of Psychiatry at Harvard Medical School and Director of the MGH Dauten Family Center for Bipolar Treatment Innovation. He completed his residency in psychiatry at New York University/Bellevue Hospital.

Topics:

• Lithium vs antipsychotics
• SMART BD (Sequential Multiple Assignment of Randomized Treatment)
• Bipolar Learning Health Network
• Medication concordance

More information:
https://brain.harvard.edu/?people=andrew-nierenberg

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Podcast producer: Jon Earle

Dr. Alan Schatzberg is a Professor of Psychiatry and Behavioral Sciences at Stanford Medicine, and Director of the Stanford Mood Disorders Center. His research examines the biology and psychopharmacology of depressive disorders. An NYU School of Medicine alumnus, Dr. Schatzberg was President of the American Psychiatric Association from 2009-2010.

Topics:

• Ketamine and Esketamine (incl. mechanisms of action)
• Ketamine and obsessive-compulsive disorder
• Opioids
• Psychedelic medicine

For more information:
https://med.stanford.edu/profiles/alan-schatzberg

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Podcast producer: Jon Earle

Dr. Michael Bogenschutz is a Professor of Psychiatry at the NYU Grossman School of Medicine, and Director of the NYU Langone Center for Psychedelic Medicine.

Topics:

• Psilocybin-assisted psychotherapy for alcohol use disorder
• MDMA-assisted psychotherapy for PTSD
• Psychedelic medicine for the "worried well"
• The role of the mystical experience
• Comparing different psychedelic medicines
• Mechanisms of action
• Treatment protocols
• Safety and risk-mitigation
• Topics for further investigation

Cited:

• Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder (August 2022)

For more information:
https://centerforpsychedelicmedicine.org/

Visit our website for more insights on psychiatry.

Podcast producer: Jon Earle

Dr. Omonigho M. Bubu is an Assistant Professor of Psychiatry and Population Health at the NYU Grossman School of Medicine, where he studies the connection between sleep and neurodegenerative diseases, as well as social determinants of health as they relate to cognitive health. In this interview, he discusses the importance of sleep, especially for people at higher risk of developing Alzheimer’s disease.

Topics:

• Alzheimer’s disease (AD)
• Associations between sleep and increased AD risk
• Sleep patterns in minoritized communities
• Obstructive sleep apnea
• Dementia and cognitive decline
• Social determinants of health

Cited:

• Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research (2020)
• Sleep, Cognitive impairment, and Alzheimer’s disease: A Systematic Review and Meta-Analysis (2016)

Visit our website for more information:
https://physicianfocus.nyulangone.org/nyu-langone-insights-on-psychiatry-podcast/

Visit our website for more insights on psychiatry.

Podcast producer: Jon Earle

Naomi Simon, MD, talks about her research into mindfulness-based stress reduction (MBSR) and yoga as treatments for anxiety disorders. Dr. Simon is a Professor in the Department of Psychiatry at the NYU Grossman School of Medicine, and Director of the Anxiety, Stress, and Prolonged Grief Program.

Topics:

• Generalized Anxiety Disorder (GAD)
• Mindfulness-Based Stress Reduction (MBSR)
• Kundalini yoga
• Selective serotonin reuptake inhibitors (SSRIs)
• Access to MBSR & Yoga (including smartphone apps)
• Cognitive behavioral therapy (CBT)
• Exercise
• Mechanism(s) of action

Cited: Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders (Nov. 2022)

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Podcast producer: Jon Earle

Mohammed Milad, PhD, discusses recent research into fear conditioning, regulation, and extinction. Dr. Milad is a Professor in the Department of Psychiatry at the NYU Grossman School of Medicine and Director of the Behavioral Neuroscience Program.

Topics covered:

• Transcranial magnetic stimulation (TMS)
• Estrogen and PTSD
• Post-traumatic stress disorder (PTSD)
• Meditation
• Deep brain stimulation

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Podcast producer: Jon Earle

Ayana Jordan, MD, PhD, is the Barbara Wilson Associate Professor of Psychiatry at the NYU Grossman School of Medicine, an Associate Professor in the Department of Population Health, and the Pillar Lead for the Institute for Excellence in Health Equity.

Topics covered:

• Lack of improvement in health equity nationwide
• Advice for clinicians on providing equitable care
• Structural competence vs. cultural competence
• Thoughts on integrating alternative therapies (ex. acupuncture, spirituality)
• Using data to improve health equity

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Podcast producer: Jon Earle

Lenard A. Adler, MD, is a Professor of Psychiatry and Child and Adolescent Psychiatry at the NYU Grossman School of Medicine and Director of the Adult ADHD Program at NYU Langone Health. 

Topics covered:

• Symptomology (incl. sluggish cognitive tempo)
• Screening and diagnostic tools
• Pharmacological treatments (and recent developments)
• Cognitive behavioral therapy (CBT)
• Medication shortage
• Approaches to treatment-refractory patients

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Podcast producer: Jon Earle

Dan Iosifescu, MD, is an Associate Professor of Psychiatry at the NYU Grossman School of Medicine and director of clinical research at the Nathan Kline Institute for Psychiatric Research. His research has led to the validation of novel treatments for patients with severe mood and anxiety disorders, including pharmacological treatments such as ketamine and other glutamatergic drugs, and devices such as novel forms of magnetic stimulation.

Topics covered:

• Ketamine and Esketamine
• Why certain people respond better to certain medications
• SSRI mechanism of action
• Transcranial magnetic stimulation

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Podcast producer: Jon Earle

Charles R. Marmar, MD, is the Peter H. Schub Professor of Psychiatry and Chair of the Department of Psychiatry at NYU Langone Health. He also serves as Director of the Center for Precision Medicine in Alcohol Use Disorders and Post-Traumatic Stress Disorder (PTSD) and as Executive Director of the Steven A. Cohen Military Family Center.

Topics covered:

• The shortcomings of existing "gold-standard" treatments for PTSD
• Creating subtypes of PTSD
• Study of gabapentin enacarbil and heavy drinkers
• Study of gender differences in efficacy of SSRIs and other antidepressants
• The need for objectivity in psychiatric diagnosis and treatment

Internationally renowned for his expertise in PTSD for over 25 years, Dr. Marmar's focus ranges from combat-related conditions in military veterans to PTSD in refugees and earthquake victims. He has served on multiple committees and scientific advisory groups at the national level for both the Department of Veterans Affairs and the National Institute of Mental Health (NIMH) and as counsel to the VA Medical Centers, fire departments, disaster response teams and police departments, including the NYPD.

Visit our website for more insights on psychiatry.

Podcast producer: Jon Earle