
Hosted by Mark Mullen, MD · EN

Eating disorders are among the most lethal conditions in psychiatry and some of the most misunderstood. In this episode, I’m joined by Dr. Patricia Westmoreland and Dr. Anne O’Melia, two internationally recognized experts with eight combined board certifications spanning psychiatry, internal medicine, pediatrics, and consultation-liaison psychiatry. Together, we take a deep dive into the medical, psychiatric, ethical, and forensic complexities of eating disorders, especially as they appear in the general medical hospital. We talk through how to recognize eating disorders in patients who may not even identify as ill, when to intervene, and what the thresholds for medical stabilization really look like. We also explore the psychological underpinnings, how control, trauma, and insight all intersect, and the delicate balance between autonomy and safety when capacity is limited. Takeaways: Eating disorders are both psychiatric and medical emergencies. Anorexia nervosa has one of the highest mortality rates of any psychiatric illness, surpassed only by opioid use disorder.Early recognition saves lives. Common signs include unexplained bradycardia, electrolyte disturbances, fatigue, hypoglycemia, or rapid weight loss, even in patients who deny an eating disorder.Patients often lack insight. Many individuals with severe anorexia are highly intelligent but unable to apply their knowledge to themselves, leading to deceptive presentations of “capacity.”Treatment is multidisciplinary and stepwise. Levels of care range from outpatient and intensive outpatient programs to residential, psychiatric inpatient, and medical stabilization units, depending on weight, vitals, and lab findings.Recovery is possible and expected. Full restoration of nutrition and function can reverse nearly every medical complication of starvation, and with the right care, patients can go on to live full, independent lives. Key References: 1. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders (Crone 2023) 2. Ethical Challenges in the Treatment of Patients With Severe Anorexia Nervosa (Westmoreland 2024) 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) 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, I sit down with Dr. Mira Zein, clinical associate professor at Stanford and co-author of the APA Resource Document on Decisional Capacity Determinations, to break down one of the most frequent and misunderstood consults in psychiatry.We go deep into the Appelbaum–Grisso criteria and discuss how they apply to real-world cases where the answer isn’t always clear. Dr. Zein walks us through difficult scenarios, from life-saving refusals to medically complex delirium cases, highlighting how to think, document, and communicate clearly when capacity is in question. This episode will help you shine on rounds, guide your primary team through their own assessments, and remind you that capacity isn’t about saying “yes” or “no”, it’s about respecting autonomy while protecting patients at their most vulnerable. Takeaways: Capacity is decision-specific and time-specific. It’s not a global judgment, and it can fluctuate with illness, treatment, or environment.The Appelbaum–Grisso framework defines the process. Every evaluation should include communication, understanding, appreciation, and reasoning.Primary teams can and should do their own assessments. Psychiatrists are consultants, not gatekeepers; the best work happens through collaboration.Delirium, dementia, and psychosis are common culprits. Each affects different aspects of capacity, requiring tailored interventions and re-evaluation.Documentation is key. Define the specific decision, describe your assessment of each criterion, and explain your reasoning clearly for the record. Key resources: 1) APA Resource Document on Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist (2019) 2) Seminal Article on Appelbaum-Grisso Criteria (Appelbaum 1988) 3) Evaluating Capacity: Appelbaum’s Framework Interpreted Diagrammatically (Bari 2023) 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) 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

Organ transplantation isn’t just a medical miracle, it’s a psychological marathon. In this episode, I talk with Dr. Paula Zimbrean, Yale psychiatrist and pioneer in Transplant Psychiatry, about what really happens when mind and medicine intersect at the edge of life and death. We walk through the evolution of psychiatry’s role on transplant teams, from risk gatekeeping to long-term integration, and explore what pre-transplant evaluations truly aim to uncover. Dr. Zimbrean shares how to assess risk, capacity, and motivation in patients preparing for transplant, and what it means to treat not just the organ recipient, but their family and support system as well. We also discuss the unseen emotional toll of the transplant journey, from steroid-induced mood changes to post-traumatic stress symptoms, and why empathy is as vital as immunosuppression. Takeaways: Transplant psychiatry has evolved. It began with managing post-op delirium and psychosis, but now focuses on enhancing long-term outcomes through integrated psychiatric care.Pre-transplant evaluations go beyond “yes” or “no.” They assess diagnosis, prognosis, capacity, adherence potential, and the patient’s understanding of lifelong treatment demands.Psychiatrists aren’t gatekeepers, they’re collaborators. The goal is to identify modifiable risks, optimize mental health, and align medical decisions with patient values.The journey is psychologically intense. From waiting list uncertainty to post-op PTSD and steroid-induced mood shifts, every stage requires active psychiatric support.The future is integration. As patients live longer post-transplant, psychiatry’s role will increasingly involve ongoing care, research, and improving quality of life beyond survival. Selected references: Transplant Psychiatry: A Case-Based Approach to Clinical Challenges Transplant Psychiatry: An Introduction 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) 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

A season on consultation-liaison psychiatry would not be complete without an episode on suicide risk assessment! Dr. Black: "I say without exaggeration that this podcast, in which Dr. Mullen and I discuss suicide risk assessment, is one of the professional things in life that I am most proud of." WOW! That's quite the claim from one of the world's foremost psychiatrists about a podcast episode. Take a listen and see what you think! Dr. Tyler Black, a suicidologist and child psychiatrist at British Columbia Children's Hospital, walks through common suicide myths, structuring the suicide risk assessment interview, common motivations for suicide, clinical decision making, best practices for documentation, and what works in preventing suicide. Selected references: Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment (O'Connor 2004) 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) 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