Working with families and psychiatric illness

Back from the Abyss: Psychiatry in Stories

Craig Heacock MD

Psychiatry, Bipolar, Suicide, Depression, Ketamine, Psychotherapy, Science, Psychedelics, Health & Fitness, Addiction, Medicine, Psychology, Mental Health

4.8 • 452 Ratings

🗓️ 7 April 2022

⏱️ 62 minutes

🔗️ Recording | iTunes | RSS

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Summary

Dr. H sits down with Dr. Usha Udupa, a Colorado-based child and adolescent psychiatrist, to explore the complexities of working with patients in the context of the family. They discuss topics such as:How and when family members should be included in treatmentWhat if the patient refuses family involvementWhen the identified patient isn't the problemHow and when to break confidentiality, especially with substance abuseWhat are the hidden stories behind what people believe about medsWhy so...

Transcript

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0:00.0	Welcome to Back from the Abyss. I'm Dr. Craig Hecock.
0:17.1	A couple of things before we start today's episode.
0:20.0	First, I'm going to be in the San Francisco Bay Area the first week of June, recording a couple stories.
0:26.4	So if any listeners are interested in perhaps telling their abyss story, just reach out to me via my website, craighecockmd.com.
0:34.9	Second thing.
0:36.4	This morning, I was reading an article from a throwaway journal called Clinical
0:40.8	Psychiatry News.
0:43.0	And very interesting, the cover story was ketamine versus ECT, results of first
0:50.3	head-to-head trial for severe depression.
0:52.9	And this article was summarizing a head-to-head trial for severe depression. And this article was summarizing a head-to-head trial
0:55.8	that was published last year in the International Journal of Neuropharmacology,
1:03.2	neuropsychoparmacology, where they looked at 18-86 patients aged 18 to 85, hospitalized with
1:10.4	severe unipolar depression, and they either
1:12.9	got six treatments of ECT, three times weekly, or they got six treatments of ketamine, 0.5
1:20.8	mic per kig over 40 minutes.
1:23.8	And interestingly, in contrast to the episode I did a few weeks ago, they found ECT to be more effective overall.
1:31.8	It had a 63% remission rate versus 46%.
1:35.2	But that was age bifurcated.
1:39.4	So patients under 50 did better with ketamine, 77% remission versus 50 for ECT, but patients over 50, 61% remitted
1:50.4	with ECT, 30 to 7% with ketamine. So that points out something that Dr. Fisher and I
1:56.0	discussed in the ECT versus ketamine versus TMS episode, that it does appear that older patients don't do as well
2:02.0	with ketamine. Although, I think the study is a huge problem and regular listeners to the
	...

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