In this episode of Psychiatry Boot Camp, Dr. Mark Mullen speaks with Dr. Owen Muir, psychiatrist, entrepreneur, and Chief Medical Officer of Radial Health, about the growing role of transcranial magnetic stimulation (TMS) in psychiatric treatment.The discussion explores how TMS works as a form of noninvasive neuromodulation, using focused magnetic fields to influence neural circuits implicated in depression and other psychiatric conditions. Dr. Muir reviews the evidence supporting TMS for treatment-resistant depression, explains the FDA clearance pathway for neuromodulation devices, and discusses how stimulation parameters, coil positioning, and treatment protocols affect clinical outcomes.The conversation also addresses the broader implications of neuromodulation in psychiatry, including emerging indications, technological innovation, and how clinicians can integrate TMS into modern psychiatric practice. This episode provides a practical and conceptual overview of one of the fastest-growing treatment modalities in mental health care. Takeaways: TMS is a noninvasive neuromodulation technique that uses magnetic fields to induce electrical activity in targeted cortical regions.The primary FDA-cleared indication is treatment-resistant major depressive disorder, though research continues for other conditions including OCD and PTSD.Treatment protocols depend on stimulation parameters, including frequency, location (often the dorsolateral prefrontal cortex), and session scheduling.The FDA device clearance process differs from pharmaceutical approval, relying heavily on device equivalence and clinical safety data.Neuromodulation represents a growing frontier in psychiatry, complementing pharmacotherapy and psychotherapy in the treatment of complex mood disorders. SUPPORT OUR PARTNERS: ⁠⁠⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Cozy Earth: Start the New Year off right and give your home the luxury it deserves, and make home the best part of life. Head to http://www.cozyearth.com and use my code BOOTCAMP for up to 20% off. And if you get a Post-Purchase Survey, be sure to mention you heard about Cozy Earth right here! Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠⁠⁠⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠⁠⁠⁠⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠⁠⁠⁠⁠⁠⁠Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of Psychiatry Boot Camp, Dr. Mark Mullen speaks with psychiatrist and medical ethicist Dr. Mark Komrad about physician-assisted suicide and euthanasia, focusing particularly on their implications for psychiatric practice. The discussion reviews the terminology, legal frameworks, and international trends surrounding assisted death, including developments in Belgium, the Netherlands, Canada, and multiple U.S. states. Dr. Komrad outlines concerns regarding capacity assessments, the expansion from terminal illness to psychiatric suffering, and the ethical tensions between autonomy and the physician’s role as healer.The episode also examines countertransference, projective identification, and the clinical dynamics that arise when treating chronically suicidal patients in jurisdictions where assisted death is permitted. Position statements from the American Medical Association and the American Psychiatric Association are reviewed, along with questions of conscientious objection Takeaways: Terminology matters. Major professional organizations continue to prefer the term “physician-assisted suicide,” reflecting ongoing ethical debate about whether these practices are distinct from suicide prevention work.Capacity assessment standards remain variable. In many jurisdictions, evaluations are left largely to physician (or provider) discretion without standardized psychiatric frameworks.Expansion beyond terminal illness is occurring internationally. Countries that initially limited eligibility to end-of-life conditions have broadened criteria to include chronic disability and, in some regions, primary psychiatric diagnoses. Borderline personality disorder and mood disorders are disproportionately represented in psychiatric assisted death cases in some European jurisdictions.Countertransference and projective identification are clinically relevant. Physicians must remain vigilant about how therapeutic fatigue and induced hopelessness can influence decision-making in chronically suicidal patients.Key professional organizations in the United States maintain opposition to physician assisted suicide. The AMA and APA have articulated clear ethical boundaries regarding the role of physicians and psychiatrists in assisted death.  SUPPORT OUR PARTNERS: ⁠⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Cozy Earth: Start the New Year off right and give your home the luxury it deserves, and make home the best part of life. Head to http://www.cozyearth.com and use my code BOOTCAMP for up to 20% off. And if you get a Post-Purchase Survey, be sure to mention you heard about Cozy Earth right here! Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠⁠⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠⁠⁠⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠⁠⁠⁠⁠⁠Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of Psychiatry Bootcamp, Dr. Mark Mullen is joined by Dr. Mark Ruffalo for an in-depth examination of complex post-traumatic stress disorder (C-PTSD), a construct widely discussed in academic and public discourse, but not currently recognized as a distinct DSM diagnosis.The conversation situates C-PTSD within the historical and theoretical landscape of psychiatry, tracing its origins to Judith Herman’s work and examining its proposed relationship to borderline personality disorder and classical PTSD. Dr. Ruffalo explores core questions of diagnostic validity versus reliability, drawing on foundational psychiatric theory, communication models such as the double bind, and contemporary critiques of the DSM’s proliferation of categories.Listeners will gain a framework for understanding why diagnostic labels matter, how trauma-informed care can coexist with diagnostic rigor, and the potential clinical consequences of adopting constructs without clear discriminant validity. The episode emphasizes careful formulation, treatment matching, and ethical responsibility in an era of expanding diagnostic language.  Takeaways: Complex PTSD lacks consensus diagnostic criteria, raising concerns about discriminant validity when compared with borderline personality disorder and PTSD.Diagnostic reliability is not the same as validity, a central limitation of DSM-based classification systems.Borderline personality disorder encompasses heterogeneous pathways, including, but not limited to, trauma exposure.Mislabeling can lead to mismatched treatment, particularly when trauma-focused approaches obscure underlying personality pathology.Thoughtful diagnosis strengthens, rather than harms, therapeutic alliance when delivered with empathy, dimensional framing, and attention to prognosis.  SUPPORT OUR PARTNERS: ⁠⁠⁠⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Cozy Earth: Start the New Year off right and give your home the luxury it deserves, and make home the best part of life. Head to http://www.cozyearth.com and use my code BOOTCAMP for up to 20% off. And if you get a Post-Purchase Survey, be sure to mention you heard about Cozy Earth right here! Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠⁠⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠⁠⁠⁠⁠Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of Psychiatry Bootcamp, Dr. Mark Mullen speaks with Jesse Bogan, journalist with The Marshall Project, about a profound and often invisible failure at the intersection of psychiatry and the criminal legal system: the prolonged incarceration of individuals found incompetent to stand trial without access to timely psychiatric treatment.Using Missouri as a case study, the conversation traces how defendants with severe mental illness can spend months to years in jail awaiting competency evaluations and restoration, despite legal mandates requiring prompt assessment and care. Jesse shares detailed reporting on systemic delays, limited forensic bed capacity, underfunded community mental health services, and pilot programs that have failed to meet the clinical needs of profoundly ill patients.The episode examines ethical and constitutional implications, including potential violations of the Sixth Amendment right to a speedy trial, and highlights the human cost of untreated psychosis, mania, and depression in carceral settings. This discussion challenges clinicians to confront how structural failures transform jails into default psychiatric holding facilities and asks what role psychiatry must play in reform. Takeaways: Incompetency to stand trial creates legal limbo. Defendants may be jailed for years while their criminal cases are paused, awaiting psychiatric treatment that is legally required but operationally unavailable.Jails are not treatment settings. Severe mental illness often worsens during prolonged incarceration, reducing the likelihood of competency restoration and increasing morbidity and mortality.Systemic underfunding drives criminalization. Gaps in outpatient care, involuntary treatment mechanisms, and forensic infrastructure funnel untreated patients into the justice system.Competency restoration programs have limits. Jail-based and mobile models often fail for patients who are too psychotic or disorganized to engage meaningfully in treatment.This is a national problem. While Missouri is highlighted, similar backlogs and constitutional concerns exist across the United States and internationally. SUPPORT OUR PARTNERS: ⁠⁠⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Cozy Earth: Start the New Year off right and give your home the luxury it deserves, and make home the best part of life. Head to http://www.cozyearth.com and use my code BOOTCAMP for up to 20% off. And if you get a Post-Purchase Survey, be sure to mention you heard about Cozy Earth right here! Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠⁠⁠⁠Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of Psychiatry Bootcamp, Dr. Mark Mullen is joined by Dr. Dinah Miller, psychiatrist, writer, and author of Committed: The Battle Over Involuntary Psychiatric Care, for a rigorous examination of civil commitment and involuntary treatment in modern psychiatry. The conversation explores the legal structures underlying involuntary hospitalization, medication over objection, and outpatient civil commitment, while highlighting the profound ethical tensions between patient autonomy, public safety, and clinical responsibility. Dr. Miller traces the historical evolution of involuntary care, examines why state systems vary so widely, and explains why outcomes data remain limited and difficult to interpret. Listeners will gain a framework for understanding the competing advocacy groups shaping policy, the real-world consequences of emergency department boarding and bed shortages, and the psychological impact involuntary care can have on patients long after discharge. The episode also addresses language, stigma, and how psychiatrists can practice humane, ethically grounded care even when coercion is unavoidable. This is a sober, thoughtful discussion of one of psychiatry’s most challenging responsibilities. Takeaways: Civil commitment is distinct from forensic commitment, yet often conflated in public discourse and policy discussions. Evidence linking involuntary treatment to improved public safety is limited, in part due to ethical and methodological constraints on research. System failures (bed shortages, ED boarding, lack of housing) amplify the harms of coercive care, even when clinically justified. Outpatient commitment models vary widely, with New York’s AOT program offering one of the most studied but resource-intensive approaches. How psychiatrists communicate, document, and set boundaries during involuntary care profoundly affects patient trust and future engagement. SUPPORT OUR PARTNERS: ⁠⁠⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Cozy Earth: Start the New Year off right and give your home the luxury it deserves, and make home the best part of life. Head to http://www.cozyearth.com and use my code BOOTCAMP for up to 20% off. And if you get a Post-Purchase Survey, be sure to mention you heard about Cozy Earth right here! Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠⁠⁠Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Psychiatry stands at the threshold of one of its greatest disruptions,  the rise of artificial intelligence. In this episode, Dr. Mark Mullen speaks with Dr. Allen Frances, Professor Emeritus and former Chair of Psychiatry at Duke University and Chair of the DSM-IV Task Force, about the clinical, ethical, and societal implications of AI’s rapid entry into mental health care. Drawing from his recent paper in the British Journal of Psychiatry (August 2025), Dr. Frances explores how psychotherapy chatbots have already become the world’s most widely used form of therapy, often beneficial for mild distress but profoundly dangerous for severe mental illness. The discussion examines where chatbots outperform human therapists, where they fail catastrophically, and how clinicians can adapt their practices in anticipation of hybrid human-AI models. Dr. Frances also warns of broader threats, privacy loss, manipulation, and the potential use of AI for political or psychological control This conversation challenges clinicians to approach AI with both curiosity and caution, recognizing its utility while defending the irreplaceable humanity of psychiatric care. Takeaways: AI in psychiatry is no longer hypothetical. Over one billion people now engage with chatbots for therapy or companionship, exceeding all human clinicians combined. Clinical utility is bifurcated. AI can enhance care for mild distress but poses major risks for psychosis, suicidality, and eating disorders. Validation over truth. Chatbots are programmed to please users, not challenge delusions,  amplifying psychosis, mania, and self-harm behaviors. Privacy and ethics lag behind innovation. Conversations with chatbots may not be confidential, raising serious HIPAA and legal concerns. Hybrid models are inevitable. Future psychiatrists must integrate AI tools safely, focus on severely ill populations, and preserve the relational aspects machines can’t replicate. References: AI Chatbots: The Good, the Bad, and the Ugly (Frances' column in Psychiatric Times): https://www.psychiatrictimes.com/series/ai-chatbots-the-good-the-bad-and-the-ugly Warning: AI Chatbots will soon dominate psychotherapy (Frances' feature in the British Journal of Psychiatry): https://www.cambridge.org/core/services/aop-cambridge-core/content/view/DBE883D1E089006DFD07D0E09A2D1FB3/S0007125025103802a.pdf/warning_ai_chatbots_will_soon_dominate_psychotherapy.pdf SUPPORT OUR PARTNERS: ⁠⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months) ⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions) Cozy Earth: Start the New Year off right and give your home the luxury it deserves, and make home the best part of life. Head to http://www.cozyearth.com and use my code BOOTCAMP for up to 20% off. And if you get a Post-Purchase Survey, be sure to mention you heard about Cozy Earth right here! Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/ For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠Sales@Human-Content.Com⁠⁠⁠⁠ Connect with HumanContent on Socials: @humancontentpods Produced by: ⁠⁠⁠⁠Human Content⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to Season 4! Join Dr. Mark Mullen and expert guests as we explore AI in psychotherapy, emerging treatments, and the ethical, clinical questions reshaping psychiatric care, and MUCH more. To share topic ideas, ask questions, and get more of the pod, visit psychiatrybootcamp.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Nicholas Kontos, Director of the Consultation-Liaison Psychiatry Fellowship at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School, joins us for a reflective conversation on factitious disorder, malingering, and clinical deception. We begin by unpacking the concept of “thinking dirty”—a term used in consultation-liaison psychiatry to describe the delicate and often uncomfortable task of considering deception in clinical care. Dr. Kontos walks us through why patients may deceive providers, including both conscious and unconscious motivations, and shares strategies for approaching these situations with clinical humility, curiosity, and compassion. We explore practical interviewing techniques to elicit more accurate histories and review key distinctions between factitious disorder and malingering, including diagnostic criteria, prevalence, and typical management strategies. Dr. Kontos discusses the concept of the “therapeutic discharge,” a framework for ending unproductive hospitalizations while still maintaining a therapeutic posture. Throughout the episode, we emphasize the central role of dignity and professionalism in managing deceptive behavior in medical settings, highlighting a model of psychiatry that avoids antagonism and centers patient care, even in the most complex situations. Teaching Psychiatric Trainees to “Think Dirty”: Addressing Hidden Motivations in the Consultation Setting (Beach, 2017)The Therapeutic Discharge I: An Approach to the Management of Deceptive Suicidality (Kontos, 2017)The Therapeutic Discharge II: An Approach to Documentation in the Setting of Feigned Suicidal Ideation (Kontos, 2018)

Dr. Caitlin Adams, psychiatrist at Massachusetts General Hospital, provides an overview of functional neurological disorder (FND). This episode covers how to recognize, explain, and treat FND using a modern, evidence-based, and patient-centered approach. We begin by defining FND and discussing nomenclature from hysteria through conversion disorder and into our current construct of FND. Dr. Adams directly addresses one of the most critical misconceptions in clinical practice: whether symptoms like functional weakness or psychogenic non-epileptic seizures (PNES) are under voluntary control. We explore what current neuroscience tells us about the pathophysiology of FND and how this can support compassionate and effective care. The episode outlines how to positively diagnose FND—including key physical exam findings such as Hoover’s sign, tremor variability, and features that distinguish PNES from epileptic seizures. We also review how to communicate the diagnosis to patients, reduce stigma, and improve treatment engagement. Dr. Adams describes the biopsychosocial model of FND, including common predisposing, precipitating, and perpetuating factors. We discuss the central role of cognitive behavioral therapy (CBT), the benefits of specialized physical therapy for functional movement symptoms, and additional psychotherapeutic approaches such as mindfulness and psychodynamic therapy. Finally, we address how to manage chronic or treatment-resistant FND, and when to re-evaluate the diagnosis. Key References:  ​Incidence and prevalence of functional neurological disorder: a systematic review (Finkelstein 2025)  ​Neurosymptoms.org  ​Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial- (Goldstein 2020) ​FND Hope  ​Overcoming Functional Neurological Symptoms Workbook (Williams) 

Dr. Christina Wichman, Professor of Psychiatry and Obstetrics & Gynecology, Medical Director of The Periscope Project and Director of Women’s Mental Health at the Medical College of Wisconsin, joins us for an in-depth introduction to reproductive psychiatry. This episode is co-hosted by Erica Browne, an M4 at Saint Louis University School of Medicine.We explore the unique clinical and ethical challenges of treating psychiatric illness during pregnancy and the postpartum period, including how to navigate the needs of both mother and child. Dr. Wichman walks us through distinctions between common perinatal mental health presentations—such as baby blues, perinatal depression, and major depressive disorder—and discusses how to differentiate normal postpartum stress from psychiatric conditions that require treatment.The episode covers validated screening tools, pharmacologic treatment during pregnancy and lactation, and non-pharmacologic options for patients with limited access to care. Dr. Wichman shares her clinical approach to balancing risk and benefit when initiating or continuing psychotropic medications, and offers guidance on red flags for perinatal psychosis.We also highlight The Periscope Project, a model for expanding access to reproductive psychiatry expertise, and discuss training pathways and future directions in women’s mental health.Key References & Clinical ResourcesThe Periscope Project – A perinatal psychiatry consultation and resource program based in Wisconsin.National Access Programs – Lifeline for Moms – A directory of statewide perinatal mental health access programs.National Curriculum in Reproductive Psychiatry (NCRP) – Free, evidence-based training for clinicians in reproductive psychiatry.MGH Center for Women’s Mental Health – Clinical and research resource for perinatal and reproductive psychiatry.MotherToBaby – Trusted information on medication and other exposures during pregnancy and breastfeeding.Pharmacologic Treatments for Mania (Kishi 2021) – Meta-analysis regarding antimanic effects of selective estrogen receptor modulators.