DeepSummary
The transcript is a discussion among Dr. David Puder, Dr. Adam Brecky, and Joni Burns about a holistic, five-factor approach to psychiatric care. The five factors are therapy, sleep, activity (exercise), nutrition, and medication. They emphasize the importance of considering these multiple domains and tailoring the treatment plan to each individual patient's needs and circumstances.
The participants discuss the benefits and nuances of each factor. For therapy, they highlight the importance of a good therapeutic alliance, reflective function of the therapist, and committing to long-term therapy when needed. They also discuss the positive impacts of adequate sleep, exercise (including strength training), and proper nutrition on brain health and overall well-being.
Regarding medication, they stress the importance of underutilized medications like lithium, clozapine, and long-acting injectables for certain conditions. They also emphasize the goal of using the lowest effective dose and potentially tapering off medications when appropriate, especially with the support of the other four domains.
Key Episodes Takeaways
- A holistic, five-factor approach to psychiatric care that considers therapy, sleep, activity, nutrition, and medication is recommended for optimal outcomes.
- Treatment plans should be tailored to each individual patient's unique needs and circumstances.
- Therapy should involve a strong therapeutic alliance, and patients may require long-term commitment for lasting change.
- Adequate sleep, exercise (including strength training), and proper nutrition have significant positive impacts on brain health and overall well-being.
- Underutilized medications like lithium, clozapine, and long-acting injectables should be considered for certain conditions when appropriate.
- The goal should be using the lowest effective dose of medication and potentially tapering off when appropriate, especially with the support of the other four domains.
- A team-based, collaborative approach between providers and patients is essential for successful implementation of this holistic model.
- A mindset of curiosity, continuous learning, and tailoring recommendations to each unique patient is crucial for providers.
Top Episodes Quotes
- “Between stimulus and response, there is a space, and that space is our power to choose our response. In our response lies our growth and our freedom.“ by Joni Burns
- “Lithium is, I think, probably one of the most underprescribed medications. And the reason I say that is because I think objectively, it might be one of the most effective medications that weve ever come across in psychiatry.“ by Adam Brecky
- “Even though clozapine is considered one of the most effective medications and is listed in the who model list of essential medications, there's frequently a delay in clozapine initiation leading to poor mental health and functional outcomes, preceded by attempts of polypharmacy treatment without evidence for effectiveness.“ by David Puder
- “I think my favorite, one of my favorite things is, like, helping patients get off of medications. And again, this is such a nuanced conversation.“ by Adam Brecky
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Episode Information
Psychiatry & Psychotherapy Podcast
David Puder, M.D.
3/8/24
In this Episode, Dr. David Puder, Dr. Adam Borecky, and Joanie Burns discuss the 5-factor approach to holistic, patient-centered psychiatric care. This approach takes into account that each individual who seeks care is unique in their physiological and psychological make-up and that multiple factors influence both physical and mental health (for better or worse).
The 5-factor approach to treatment is based on the importance of sensorium and its pivotal role in regulating thoughts, feelings, and overall mental health. Sensorium is a lens to understand how we focus on various things. Sensorium is total brain function, which fluctuates throughout the day and depends on a number of factors, including sleep, stress levels, and more.