PsyDactic

The Therapeutic Alliance Starts With Me

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.

Oppositional Defiant Disorder is a Syndrome, not a Primary Disorder

Dr. O'Leary discusses his critical perspective on Oppositional Defiant Disorder (ODD) and argues that ODD is not a primary diagnosis but rather a risk syndrome, a set of symptoms (defiance, irritability, and vindictiveness) resulting from various underlying conditions like ADHD, anxiety, or trauma. He explains that conceptualizing ODD as a stand-alone disorder often leads to the risky treatment pathway of off-label antipsychotic medication, whereas recognizing it as a syndrome necessitates an etiology-focused approach to treat the true root cause, typically with safer, condition-specific interventions. Dr. O'Leary traces the evolution of ODD criteria through the DSM manuals and urges clinicians to use comprehensive evaluations rather than relying on simple screeners, especially when an ODD diagnosis is present. 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.

Neuroplasticity - What is it?

Neuroplasticity is a real thing that is shrouded in mythology and used by companies to market products, but what do we actually know about neuroplasticity? 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.

Psychoanalysis, Active Inference, Artificial Intelligence, and Human Development with Dr. Grant Brenner

Dr. Grant Brenner joins Dr. O'Leary to explore the fascinating intersection of human psychology, physics, psychotherapy and artificial intelligence. We discuss Active Inference and The Free Energy Principle along side how babies develop a sense of self and so much more. 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.

Dissociated Identities (aka Alters) - How are they formed?

Is it possible to house multiple alternate selves within the same brain? Dr. O'Leary argues that it is not only possible, but under certain conditions it is likely to happen. Dissociative Identity Disorder is discussed not as a "shattering of the self," but instead as a failure to integrate the self during development. Dr. O'Leary explores different biologically and computationally plausible models to explain how the self might fail to integrate during the normal process children go through in order to distinguish the self from others and others from others, as they build a (usually) coherent model of themselves. 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.

Dissociation - What is it really?

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.

Can hooking your head up to a fancy battery (tDCS) cure depression?

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.

• Transcript

Game Theory for Parents and Other Humans with Kevin Zollman

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.

Childhood Deficit Disorder and the Atrophy of American Childhood

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 references and 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.

• Transcript

Clozapine - Beyond the Basics

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.

Therapeutic Ultrasound with Dr. Michael Canney PhD

This episode includes a fascinating interview with a researcher in ultrasound, Dr. Michael Canney who is an acoustics researcher the chief scientific officer at a French company named Carthera (https://carthera.eu/) and they make ultrasound devices that can disrupt the blood-brain barrier in order to let medicines into the brain that otherwise could only get through in very small amounts. We talk more broadly about the explosion of various applications of ultrasound beyond imaging, including things like tissue ablation (or basically cooking highly focussed loci of tissue inside your body), or cavitation (where ultrasound causes tiny bubbles to rapidly expand inside cells or vessels), and I end with a brief discussion of the potential of ultrasound for neuromodulation. 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.

• Transcript

Pediatric Bipolar vs Disruptive Mood Dysregulation Disorder

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.

• Transcript

Gambling Disorder - Rarely Diagnosed, Highly Prevalent

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.

• Transcript

Functional Neurological Disorder, Predictive Processing and Active Inference

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.

• Transcript

Behaviorism Part 1 - Classical Conditioning

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.

• Transcript

Nicotinic Receptors, Anxiety, and PTSD - an A.I. generated discussion

-- 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.

• Transcript

An extraordinary perspective on Suicide Risk Assessments from Dr. Tyler Black via Psychiatry Boot Camp

"People are 14 times more likely to die during a hospital stay than outside of hospital for inpatient psychiatry." 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 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. Mark Mullen interviews Dr. Awais Aftab and Dr. Allen Frances on Psychiatry Boot Camp

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 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.

Meet the Psychiatry Bootcamp Podcast brought to you by Dr. Mark Mullen

Dr. O'Leary is excited to introduce you to Psychiatry Boot Camp (PBC), a podcast created by Dr. Mark Mullen during his psychiatry residency 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 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 a Word - Agonist

--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 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.

• Transcript