PsyDactic - Residency

Dr. O'Leary explores the neuroscience of dissociation, defining it as a degenerate concept that refers to a wide range of functional disconnections within the brain rather than a single clinical entity. The discussion moves from the standard medical definitions—such as depersonalization, derealization, and amnesia—toward a broader view of dissociation as a neurobiological defense mechanism that uses sensory attenuation to manage background noise and overwhelming trauma. By examining how specific regions like the temporal parietal junction and the default mode network integrate our sense of self and environment, Dr. O'Leary compares how disruptions in these areas lead to the fragmented reality experienced in various psychiatric conditions. This discussion aims to shift the listener's perspective of dissociation from a vague symptom to a complex breakdown of mental integration that can be induced by drugs, trauma, or even intentional meditative practices. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

In December 2025, the FDA authorized  the Flow F100, an innovative at-home wearable headset that utilizes transcranial direct current stimulation (tDCS) to treat major depressive disorder. Unlike traditional pharmaceuticals that act systemically, this device targets the dorsolateral prefrontal cortex with localized electricity to modulate neuronal excitability and address the asymmetry hypothesis of depression. While the Empower study that evaluated this technology demonstrated statistically significant improvements in response and remission rates, the FDA approved it with a moderate level of uncertainty regarding its true efficacy due to a clinically insignificant 2.3-point difference on the average improvement using the Hamilton scale and potential unblinding bias in the trial. By contrasting frequentist and Bayesian statistical frameworks, Dr. O'Leary encourages a skeptical but curious evaluation of whether this technology represents a genuine clinical breakthrough or a temporary trend in the long history of electrotherapy. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

PsyDactic welcomes The Game Theorist's Guide to Parenting co-author, Kevin Zollman who discusses game theory as the science of strategic thinking. We explore how mathematical models like the Prisoner’s Dilemma and mechanism design can be used to manage family dynamics by creating win-win solutions rather than competitive, zero-sum outcomes. The conversation highlights practical techniques such as "I cut, you pick" for fairness, the importance of making credible threats that parents are actually willing to execute, and ways to make honesty more profitable than lying through strategic questioning. While children may be impulsive and at times difficult to predict, applying game theory helps parents influence behavior by understanding their children's incentives and fostering a predictable environment built on reciprocity and trust. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary proposes Childhood Deficit Disorder as a way to conceptualize the rise in mental health issues among modern youth, exploring how systemic changes in culture and environment contribute. He contrasts the "free-range" parenting style prior to the 1980s, which fostered autonomy and resilience, with the modern trend of intensive, managerial parenting driven by economic anxiety and a "culture of fear" fueled by media. Dr. O'Leary explores how children's independent mobility has plummeted due to these shifts and in response to a built environment hostile to pedestrians, leading to a loss of key socialization spaces.  Digital media, including social media, both actively displaced healthy social spaces and filled the void created by anxious, fearful parenting, and poor urban design. Childhood Deficit Disorder (CDD) is a framework—not a clinical diagnosis—to describe the developmental consequences of chronic deprivation of autonomous play, independent movement, and connection to the physical world, often exacerbated by the "digital colonization of childhood." For a more in depth discussion: https://sciencebasedpsych.blogspot.com/2025/12/childhood-deficit-disorder-and-atrophy.html Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary explores the history of clozapine, highlighting its initial revolutionary impact as the first atypical antipsychotic, followed by a ban on its use, followed by its re-emergences as a strictly monitored medication, and then culminating in new recommendations that greatly encourage its use. The discussion details the severe side effects that led to its initial discontinuation,  and then emphasizes other critical but often overlooked adverse effects, such as metabolic syndrome, sialorrhea, and especially severe gastrointestinal hypomotility, which can be life-threatening.  Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

This PsyDactic podcast episode, hosted by Dr. O'Leary, delves into the complex and often controversial topic of diagnosing Pediatric Bipolar Disorder and its differentiation from other conditions, particularly Disruptive Mood Dysregulation Disorder (DMDD). Dr. O'Leary, a Child and Adolescent Psychiatry Fellow, explores the DSM-5-TR diagnostic framework, the history of Pediatric Bipolar diagnosis, the debate surrounding irritability as a diagnostic criterion, and the challenges of distinguishing it from ADHD, Autism Spectrum Disorder, and trauma-related disorders. Using case vignettes and drawing on both personal knowledge and AI-assisted research, the episode aims to provide a comprehensive and nuanced understanding of this challenging area of child psychiatry. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Gambling disorder may be the most under-diagnosed disorder in the DSM.  This is an exhaustive treatment of the neurobiological, psychological, and societal aspects of gambling addiction, featuring discussions on the brain's reward system, cognitive distortions, and the impact of advertising and the design of gambling products. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Functional Neurological Disorder was previously called Conversion Disorder or psychogenic neurological symptoms and is a condition in which a patient develops any number of neurological symptoms (such as loss of ability to move or seizure like episodes or inability to feel parts of their body or phantom pain) that cannot be explained by a clear lesion in the nervous system.  It was called conversion disorder because it was previously thought that repressed emotions or desires had been converted into neurological symptoms as a defense against those emotions or desires.  Therefore, the symptoms were "psychogenic" instead of neurological or biological.  Even though emotional states contribute to neurological function, we now know that this model is incorrect.  The most compelling new models of functional neurological symptoms come from the theories of the Bayesian brain, predictive processing, and active inference. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Dr. O'Leary introduces PsyDactic - Child and Adolescent Board Study edition by sharing the first of two episodes on behaviorism, that field of psychology that took the radical stance of completely ignoring the fact that we have a mind. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

-- Dr. O'Leary explores how an artificial intelligence tool summarizes recent data on the use of nicotinic receptor modulators for the treatment of anxiety and PTSD.  Please send any comments to feedback@psydactic.com. Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

--Send us a message-- In the last episode, I shared an episode of Psychiatry Boot Camp, which is a podcast created by Dr. Mark Mullen to help medical students and junior residents hone their psychiatric skills.  Mark interviews some of the most competent and amazing psychiatrists our country has to offer.  I am excited that Mark let me share his interview with Dr. Tyler Black, who talks about evaluating suicidal patients.  I have never heard any advice about suicide assessments as insightful and compassionate as what Tyler Black has to offer. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

--Send us a message-- In the last episode, Dr. O'Leary interviewed the creator and host of the Psychiatry Bootcamp Podcast, Dr. Mark Mullen, who is currently a psychiatry clerkship director at St. Louis University School of Medicine.  He created this podcast after discovering a dearth of resources available for medical students and junior psychiatry residents to prepare them for their transition to practice.  He graciously allowed PsyDactic to include a couple of his episodes in this feed as a way to spread the good news about Psychiatry Boot Camp.  This is his introductory episode where he sets the tone of PBC by interviewing Dr. Awais Aftab, Clinical Professor of Psychiatry at Case Western University,  and Dr. Allen Frances, Chair of the DSM-4 Task Force and Chair Emeritus at Duke. Check out Psychiatry Boot Camp! https://linktr.ee/psychbootcamp https://pubmed.ncbi.nlm.nih.gov/38724723/ https://podcasts.apple.com/us/podcast/psychiatry-boot-camp/id1671902940 https://open.spotify.com/show/4Vjlz4CO0G5D6nGo74O0jE https://www.audible.com/podcast/Psychiatry-Boot-Camp/B0BVK4HYLW https://x.com/markrmullen Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

--Send us a message-- Dr. O'Leary is excited to introduce you to  Psychiatry Boot Camp (PBC), a podcast created by Dr. Mark Mullen to help prepare medical students for psychiatry residency. It covers fundamental topics in psychiatry and inspires young psychiatrists to think critically about their approach to the field. The curriculum is based on published literature on psychiatry crash courses and boot camps, and features interviews with experts in the field.   Some specific PBC episodes that are discussed include those introducing students to psychiatry as a discipline with unique challenges, including interviews with Dr. Awais Aftab, Clinical Professor of Psychiatry at Case Western University,  and Dr. Allen Frances, Chair of the DSM-4 Task Force and Chair Emeritus at Duke.  We also discuss Dr. Mullen's eye-opening interview with Dr. Tyler Black, a suicidologist and child psychiatrist at British Columbia Children's Hospital who provides the best foundational discussion of the suicide assessment that Dr. O'Leary has ever encountered. Enjoy this interview and afterward, please check out Psychiatry Boot Camp. https://pubmed.ncbi.nlm.nih.gov/38724723/ https://podcasts.apple.com/us/podcast/psychiatry-boot-camp/id1671902940 https://open.spotify.com/show/4Vjlz4CO0G5D6nGo74O0jE https://www.audible.com/podcast/Psychiatry-Boot-Camp/B0BVK4HYLW https://x.com/markrmullen Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a text --In today's episode, Dr. O'Leary explores agonists, inverse agonists, partial agonists, and antagonists. These terms describe how molecules bind to receptors and either increase, decrease, or prevent changes in receptor signaling. Agonists increase receptor activity, with full agonists like dopamine and serotonin raising activity to its maximum. Partial agonists can increase activity in the absence of full agonists but decrease it in their presence. Inverse agonists reduce the baseline activity of receptors. Antagonists block receptor activity without changing the baseline rate. We also discussed the complex interactions between these molecules and how their effects can vary depending on the presence of other molecules and the specific receptors involved. Below are a couple of helpful references: https://pmc.ncbi.nlm.nih.gov/articles/PMC2804881/ https://link.springer.com/article/10.2165/00023210-199605050-00007  Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a Text Message. Dr. O'Leary discusses the term Transference, and if you listen until the end, he relates it to some computational neuroscience.   Transference is a historically loaded term.  Transference is supposed to be an unconscious process, so it can not really be observed, only inferred, so this means that both the definition of transference and any instance of it in psychotherapy is dependent upon the therapist’s model and their particular way of interpreting that model.  But what exactly is this elusive but data rich unconscious process? Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a Text Message.   -- More recently I have faced the diagnostic conundrum of catatonia in autism, and that is what I want to explore in more excruciating detail today.  There is surprisingly little literature on the subject, and that is concerning because being able to identify and treat catatonia can be life-saving, not to mention life-altering for patients and their caretakers.  Misidentifying catatonia as mere aggression or highly limited interests in autism can result in exactly the wrong medication being given or no medication being given and a worsening of the condition. -- Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a Text Message.   --  Dr. O’Leary interviews forensic psychiatrist and author Dr. Michael Schirripa about his career as a forensic psychiatrist, the release of his first thriller, Mindhunt, and his podcast Mindhunting.  Dr. Shirripa explores how his love of literature influenced his decision to pursue forensic psychiatry and ultimately resulted in his creation of an international thriller with an ambitious forensic psychiatrist as the main character.  We explore topics like medical ethics, medical education, popular culture, mental health stigma, Australian football, and how people react when we tell them we are psychiatrists.  Learn more about Michael at https://michaelschirripa.com/. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a Text Message. - - In the world of psychotropic medication, the question is not just whether it works or not, but whether it works better than a placebo and whether the effect size is clinically significant and the benefits outweigh the risks.  In the case of MDMA (aka molly or ecstasy), the effect size for improving post-traumatic stress disorder symptoms reported by researchers has been very large.  Often it is found to be two to three times higher than is often found for serotonin reuptake inhibitors, which are currently the first line therapy for PTSD.  On the surface this is super exciting.  A deeper look will reveal why excitement may need to be tempered, and why an independent panel recommended that the FDA not approve this medication. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a Text Message. In the short, the Narrative Fallacy describes our tendency to find meaning, connections, and causal relationships where they do not necessarily exist.  In this episode, Dr. O'Leary had the pleasure of interviewing Dr. Alexey Tolchinsky. He recently published a paper called “Narrative fallacy and other limitations of psychodynamic case formulation.”  Dr. Tolchenski did not invent the idea of the Narrative Fallacy, but he is working to apply this idea to his own clinical practice. We could all benefit from recognizing the ways that Narrative Fallacy plays out in our lives.  The great thing about these ideas is that they are so generalizable.  The Narrative fallacy is not limited to medicine or science, but can be applied, for example in how we explain to ourselves why our neighbor seems to hate us. Tolchinsky, A. (2023). Narrative fallacy and other limitations of psychodynamic case formulation. Practice Innovations. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Send us a Text Message. Dr. O'Leary discusses a variety of concerns that all clinicians should have in mind when using psychometrics.  In the end, he hopes you come away  with some level of agreement with the statement: “Our primary concern should not be with the quantity of data, but with the quality of the data.”  Statistics are conceptual machines that will produce results no matter what you feed them.  These results can be truly helpful and informative.  But statistics are also poop in poop out machines, and adding more malarky does not magically convert the results into something other than BS. Please leave feedback at https://www.psydactic.com. References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.