My Three Shrinks

November 11, 2007: New & Improved! * MacArthur Foundation Grant: Decision-making, substance abuse, and brain abnormalities. Developing guidelines for judges about neuroimaging and brain function. * On our Shrink Rap blog, Clink blogs about What She Learned (Part 1, Part 2, and Part 3) at her AAPL conference. * Delirium. Roy discusses delirium, or encephalopathy, what it is and recent findings about longer term damage. * Shrink-proof containers. Clink brings back a hotel bottle of mouthwash that she could not open. * Q&A: Gerbil brings up recent study on chocolate lovers. * Online CBT for Depression. Study finds it helpful for mild-moderate depression. Eliza. * Telepsychiatry. We just chat about some of the issues. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

October 24, 2007: Dr Anonymous' BlogTalkRadio Show On Thursday night, October 18, the three shrinks called into Dr A's call-in internet radio show (invited) and we talk about general stuff and answer LIVE questions from the listening audience. Most of the questions seemed to be about Halloween (including favorite candy received at Halloween... I feel another Dinah sidebar poll coming on.) You can check out Dr A's talk show every Thursday night from 10-11pm ET at blogtalkradio.com/doctoranonymous. Go to http://mythreeshrinks.com for show notes with links.

October 08, 2007: Just Do It * Crisis in the Treatment of Incompetence to Proceed to Trial. In the recent Online AAPL Journal, an article by Wortzel about problems with assessing defendants who are not competent to stand trial and restoring them to competence. [hmm, wonder whose topic this one is] At any given time, these people occupy about 10% of our nation's state psychiatric hospital beds. A complicated discussion ensues about who pays for forensic mental health care and how the system results in decreasing access to care for uninsured non-forensic patients. * We respond to a question to the NYT Ethicist column, by Randy Cohen, which you can read here (as well as his answer). [Note: we last saw Randy when he stopped by to respond to a discussion about a previous column of his about suicidal people making wills.] The question involves whether it is okay for a physician, who is a psychiatrist, to prescribe a stimulant (Adderall) to his college kid for the purpose of improving test-taking performance. (We discussed the practice of treating family members in a prior post, My Patient, Myself.) A secondary question involves that kid sharing the medication with a friend. We also discuss the issue of using performance-enhancing amphetamines for non-illnesses, in addition to the potential for a performance-reducing effect due to side effects (which is also taken up on Gawker's Unethicist). (We also ask for help from any DEA agent listeners.) * Clink celebrates her 25th Running Anniversary. She's been just doing it for a quarter century. * Price Transparency for Psychotropic Drugs. Dinah discusses her post about the list of prices for antidepressants. Roy unsuccessfully looks for the prices of these drugs on the Maryland Medicaid website. Coming up in Podcast #37... SSRI Poop-out (aka tachyphylaxis) and other good stuff. Oh, and here's a pic from my Vegas conference trip. Yummy!Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

October 05, 2007: Guest Mark Komrad, MD Last week, we had our guest, Dr. Mark Komrad, join us and begin to discuss the portrayal of psychiatrists in the movies. Mark used to have a live, two-hour, coast-to-coast, nationally syndicated talk radio show, and is a regular guest on NPR. He is also the Ask-a-Doctor on the NAMI site, and also has a book coming out. Mark was a guest blogger back in July, when he posted on Ethics and Continuing Education for the Psychiatrist.This week Mark continues to discuss how Hollywood likes to portray psychiatrists in film. You can find him at www.komrad.yourmd.com. (Unfortunately, Monkey the parakeet gets sidelined in this podcast.) Topics include: # Leona Helmsley's dog, Testamentary capacity, and Psychological Autopsies. ClinkShrink discusses how one starts to address the question of competency to being able to make the decsion to leave $12 million to one's dog. Bounty and one's natural heirs. # Irv Schneider's 3 Psychiatric Archetypes: Doctors Dippy, Darling & Dangerous. These are the three categories of psychiatrists most frequently played in the movies and television. -DR. DIPPY: Bob Newhart Show; What About Bob? (Richard Dreyfuss); High Anxiety (Mel Brooks); Analyze This (Billy Crystal) -DR. DARLING: Equus (Richard Burton); The Sopranos (Dr. Melfi); Sixth Sense (Bruce Willis); Good Will Hunting (Robin Williams); Prince of Tides (Barbra Streisand); Ordinary People (Judd Hirsch); K-PAX (Jeff Bridges) -DR. DANGEROUS: Silence of the Lambs (Anthony Hopkins); Terminator 2: Judgment Day (Dr. Silberman); Dressed to Kill (Michael Caine); Beauty and the Beast (Belle's father)See My Patient, Myself. How we must "neutralize" the negative images of psychiatrists in the media, "like your podcast." How the movie, Lovesick, affected the idea of psychiatrists falling in love with their patients.# Psychiatric Services: Religion and Psychiatry. We have an interesting talk about the role that a physician's religious background may play in the likelihood of referring a patient with complicated grief to clergy versus a psychiatrist. See Roy's upcoming post on Religion and Psychiatry for more info. Briefly:-Psychiatric physicians were more likely to be Jewish or non-religious than nonpsychiatric physicians.-Protestant physicians were twice as likely as other physicians to refer the example patient to clergy rather than a psychiatrist.# Washington Post: Roy briefly mentions his recent post on the final report on the Virginia Tech tragedy and the potential impacts on privacy of health care information, willingness of college students to get help, and liability. Dinah suggests readers go back to look at our prior posts about college mental health, Suicidal Students and Let's Talk About Suicide. This also led to a discussion about outpatient commitment.# Correction: Dinah corrects her reference in Podcast 34 to Reign Over Me. The movie she was actually discussing was The Departed.# Check out NAMI's Ask-the-Doctor column that Mark writes, also his website at www.komrad.yourmd.com.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

September 26, 2007: Guest Mark Komrad, MD This week we have a special guest, Dr. Mark Komrad, who is an old hat at discussing psychiatric issues on broadcast media. Mark had a live, two-hour, coast-to-coast, nationally syndicated talk radio show for about 5 years. He also had a regular gig on Channel 2 with Rudy Miller, and continues to be a regular guest on NPR. Mark is the Ask-a-Doctor on the NAMI site, and also has a book coming out. Mark was a guest blogger in July, when he posted on Ethics and Continuing Education for the Psychiatrist. (And Monkey the parakeet joins in.) Topics include: # Prison Tattoo Database. Clink informs us about Maryland's tattoo database. Dr. Komrad talks about Match.com's inclusion of tattoos in their matching database. We also talk a bit about the psychology of getting tattoos, in general.# Q&A: I am a second-year medical student in Canada who is considering psychiatry. I have a few questions that hopefully you haven't already addressed elsewhere.Firstly, do you get many negative responses from other medical professionals and the general public for being psychiatrists. If so, how do you deal with it?Secondly, can you discuss some of the differences you know of in practicing psychiatry in Canada versus the US?# Dr. Komrad discusses how he got into Psychiatry, and the images of Psychiatrists in the movies and in Hollywood. (Mentions Irving Goffman here.) Mark points out that only 3% of Americans have even been to a psychiatrist, and so most people learn about what Psychiatry is about from movies. Movies and shows discussed include The Sopranos, Dark Shadows, Beauty and the Beast, Prince of Tides... more on Podcast #35.# Check out NAMI's Ask-the-Doctor column that Mark writes, also his website at www.komrad.yourmd.com.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

September 16, 2007: Inane Banter Topics include: * Q&A from Jennifer: "In your relationships with the greater world, do you find that you are more compassionate and understanding when it comes to putting up with the foibles of people since you have a greater understanding of the brain? When you see people in traffic driving like they own the road, do you still simmer and think dark thoughts like the rest of us, or do you think, 'well there goes a person who clearly has issues of narcissism (or whatever), and I just hope he doesn't smash into anyone'? Do you find the inane banter of teenage girls less headache inducing because you know the stage is only one of a thousand they will go through on their way to the grave and Oblivion? If a really religious neighbor keeps bugging you about your lack of faith and tries to nag you into going to church with her, would you just smile and thank your stars that you are free of 'invisible friend' delusions? If any of these scenarios are true, I think I may need to go into psychiatry." We do a decent job of answering these questions. * American Visionary Arts Museum (AVAM). Clink discusses her observations about this Baltimore museum and some critical comments noted about the squelching of creativity by Psychiatry. * Involuntarily medicating an "incompetent" defendant. Clink discusses a Baltimore Sun story (couldn't find link) about changes in Maryland created by "the Kelly case". It has now become harder to medicate defendants who are not competent to stand trial. * Q&A from Emily: "Have you read the book called 'Crazy: A Father's Search Through America's Mental Health Madness' by Pete Earley? It is about the criminalization of the mentally ill. When I read it, my mind was opened to the phenomenon of mentally ill people who commit crimes while under the 'influence' of their symptoms, and are punished by being imprisoned rather than getting adequate mental health care assistance. A few questions for you: -Do you feel that prisoners who require mental health care are able to be receive adequate assistance while locked up? -How do you feel about mentally ill prisoners? For example, a paranoid schizophrenic who committed acts such as breaking & entering, destruction of private property, etc while hearing voices instructing him to do so, and winds up in prison rather than a psychiatric hospital. Do you treat people in similar circumstances? -Something else that the book talks about is mentally ill people who are arrested and put in jail, then deemed incompetent to stand trial and sent to psychiatric hospitals until they can be stabilized, then sent back to the jail where they rapidly decline again for a number of reasons before they can stand trial. And the cycle goes on and on. -So I was wondering how much of this you witness in your daily work. How often do you see people that you think should be in a psychiatric facility instead of a prison? How big of an issue do you think it is, or what do you think should be done differently?" Clink addresses these questions, and also her contact with Pete Earley, and about another book of his, Hothouse, about Leavenworth Prison.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

September 2, 2007: Doctor Anonymous on Depression Overdiagnosis Topics include: * DrA on Skype (not a soundboard). Dinah relished the memory of Podcast #24. Check out DrA's blog, doctoranonymous.blogspot.com. * Is Depression Overdiagnosed? We discuss two point-counterpoint pieces in the August 18 2007 issue of BMJ (British Medical Journal). The YES piece is written by Gordon Parker, who believes there is a trend to turn "sadness" into a medical condition: "The ease of assigning a diagnosis of clinical depression, even of major depression, has rebounded on psychiatry, blunting clarification of causes and treatment specificity." The NO piece is written by Ian Hickie, who argues that despite the benefits of increased rates of diagnosis, many people with depression continue to go unrecognized, untreated, and impaired: "The increased rate of diagnosis has had other benefits, including reduced stigma, removal of structural impediments to employment and health benefits, increased access to life insurance, improved physical health outcomes, reduced secondary alcohol and drug misuse, and wider public understanding of the risks and benefits of coming forward for care." Find online comments on these articles at BMJ's website here. * Further discussion about the symptoms of major depression, subsyndromal depression, dysthymia, substance abuse, the influence of the pharmaceutical industry, depression screening, access-to-care problems, inpatient bed capacity problems, per capita psychiatrists and psychologists, stigma about mental illness, primary care management of depression, emergency evaluations. * We digress into hot McDonald's coffee, Twinkies, and chocolate. Also, check out DrA's new talk show at doctoranonymous.com. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

August 20, 2007: Biteproof Gloves * Q&A: from Midwife with a Knife: Short version: How would you manage an agitated, aggressive patient in your OB/GYN office? [Okay, here's the long version: Let's say I have this patient who's clearly distressed and obviously psychotic (if I can tell, it's pretty obvious) who's caretaker reports that they're seriously considering hurting themselves or others, clearly the patient needs to be sent to the psych ed/crisis center/whatever hospital equivalent for evaluation by an actual mental health provider... So, after the caretaker says to us, "I'm worried about taking her back to the group home, I'm think she's planning to hurt someone there.", and I talk with the patient who says something to the effect of, "I know that woman's planning to take my baby, and I'm going to hurt her before she gets the chance." I make the decision that she needs to be emergently evaluated. I try to talk her into going voluntarily (mostly by saying things like, "You seem pretty upset, I think it might help if you went and talked with the doctors downstairs", she refuses, and security is called to escort her down to the psych ED. Eventually, (I think triggered by the stress of that situation and the chaos of a busy clinic and the security officer's arrival), and in an attempt to leave the room (I happened to be sitting between her and the door), she kind of half tackled/half grabbed/half pushed me (Maybe to push me out of the way? I think she was just trying to leave. I don't think she was really trying to hurt me), the security officer grabbed her, she bit him (although he was wearing biteproof gloves) and she eventually was taken to psych. My question for you guys is, How do you psychiatrists recommend those sorts of situations be handled? So, we answer the question in the podcast. We also speculate about "bite-proof gloves."Oh, and if you want to see a funny but very strange rendition of Zappa's Peaches and Regalia -- with a man using his ungloved but cupped hands as a musical instrument -- then do check out this YOUTUBE VIDEO (turn down your volume first). I could not stop laughing. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

August 17, 2007: Parity Feels Like a Bird Topics include: * MENTAL HEALTH INSURANCE PARITY LEGISLATION. 20-minute discussion about some of the current legislation (mind you this was recorded before the revisions made in early August to SB 558). Go to this link to see recent parity-related posts. This leads into a brief discussion of... * MIND-BODY DUALISM. Why are there different rules for brain stuff than for body stuff? Isn't the brain part of the body? Will we still be having this debate in yet another 2400 years? * PINK FLOYD'S SYD BARRETT. Brief mention of my post last month, [Shine On, You Crazy Diamond], which, in turn, points to the "Images in Psychiatry" section of the July, 2007, issue of AJP, a tribute written by Paolo Fusar-Poli. "Nobody knows where you are, How near or how far." * THREE ARTICLES ON SUICIDE in the July 2007 AJP. The first, by Simon & Savarino, is a well-done study looking at the relationship between the initiation of depression treatment (medication or psychotherapy) and suicide attempts by looking at outpatient insurance claims of a half-million members. They found that suicide attempt rates were highest in the month before treatment initiation, and that the patterns were similar for medications and psychotherapy. See below image. Most of the people (some 90% or so) were being treated by their primary care physicians. Those with the highest risk appeared to have been referred on to therapists or psychiatrists. Regardless (and not surprisingly), the patterns were the same. As stated by David Brent in his editorial, "it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior." * 2ND SUICIDE ARTICLE by Posner et al about Classifying Suicidal Events. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) is explained, in an attempt to standardize the disparate definitions currently in use across treatment trials. Click here to see examples of difficulties in defining injurious behaviors as adverse events. Click here to see the Table of C-CASA definitions and training examples. * 3RD SUICIDE ARTICLE by Gibbons et al about the Relationship Between Antidepressant Initiation and Suicide Attempts in a Large Veteran Population. This group found that SSRI antidepressants had a protective effect. "Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not..."The last few seconds is from Astronomy Domine, from Pink Floyd's album, Pipers at the Gate of Dawn, can be purchased at iTunes.The next podcast, or podette, will be a brief one (for us) which I will post this weekend (yes, two podcasts in as many days... we have to make up for lost time somehow) prior to our next regular podcast, which we will record on Aug 19, probably between 3-5 pm ET. If any other psychiatrist listeners can join in at that time via Skype or Talkshoe, let us know and we might include you as a guest on the show. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

July 22, 2007: Suicidal Breast Implants Topics include: * Brief discussion about iTUNES. We hit #6 in the MEDICINE SECTION in iTunes last week, thanks in part to KevinMD blogging about our last podcast. We are now getting about 8-9000 podcast downloads per month, which we all find rather amazing. Of course, after the U.S., the country we get the most hits from is China, so we figure there must be Chinese people somewhere trying to learn English from us (big mistake). For the handful of psychiatrists out there (Chinese or otherwise), perhaps we'll release one of those Dummies books about how to make podcasts. * CURBING NOCTURNAL BINGES IN SLEEP-RELATED EATING DISORDER. Clink talks about this article from Current Psychiatry, about eating in your sleep, particularly after taking AMBIEN, or zolpidem. Clink read us a related poem: My Grandma had a habit Of chewing in her sleep. She chewed on Grandpa's whiskers, And called it Shredded Wheat. The article lists weird things people eat in their sleep, including coffee grounds, cat food, and buttered cigarettes (yum!). [I don't think it mentioned eating your own placenta.] * YOU'RE SUPPOSED TO GET BETTER. Dinah's post about how to know when you are making progress in therapy, and when to move on. (On the blog, this led to a series of emotional posts and comments about therapy, the power inequity between therapist and patient, and the differences between docs blogging about pts and vice versa. Go here, here, and there to read more.) * ARCHETYPEWRITING.COM. Dinah provides an unsolicited (and unpaid) advertisement for this website ("The Fiction Writer's Guide to Psychology") about injecting believable shrinkiness into your fiction, while Clink shows off her new nerdy book (2000 Most Challenging and Obscure Words, by Norman W. Schur) by declaring the word of the day to be HIRCINE. * COSMETIC BREAST AUGMENTATION AND SUICIDE. Dinah reviews this article from the July issue of AJP, from David B. Sarwer, et al., which finds "Across the six studies, the suicide rate of women who received cosmetic breast implants is approximately twice the expected rate based on estimates of the general population." I guess we need a black box warning on silicone breast implants now. (We had a post a year ago about the Good Breast; this one is obviously the Bad Breast.) * Q&A: "Is chronic antidepressant use harmful in the long term?" We don't really do this topic justice, but Dinah refers to a prior post here. * Coming up on the NEXT PODCAST: 3 AJP articles on suicide and depression treatment; federal parity laws; managing agitated patients in your office.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

July 9, 2007: Can You Hear Me Now? Topics include: * Panetti v. Quarterman. Clink talks about a hot-off-the-press, landmark Supreme Court case about COMPETENCY TO BE EXECUTED and death penalty cases for people with mental illness. She also refers to the Ford v. Wainwright case. "It's a hint that, down the road, we will probably not have a death penalty for mentally ill people, just like we no longer have a death penalty for juveniles or mentally retarded people." * Dinah goes back to Podcast #27 and refers to Dr. Kay Redfield Jamison's book, An Unquiet Mind, talking about therapists' DISCLOSURE to patients about their own mental health issues (which was blogged about here). * ON BEING A FEMALE INTERN. Clink rants against DrCrippen's (NHS Blog Doctor) rant about part-time doctors (mostly mothers): DrC: "You need to grow up a little. You can't expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? ... If you won't do the hours, you can't have job... Just because you are a girlie, you can't expect medical training to be turned on its head." * PHYSICIAN STRESS & BURNOUT. This discussion transitions into talk of a 2004 article (IC McManus, et al.) on physician stress and burnout, finding that the consequences of physician training stress has more to do with how one handles stress in general. * iPHONE aPATHY. Roy mentions his iPhone post. Who cares? * iTUNES REVIEWS. Clink asks our listeners to do more reviews of our podcast, and we offer to mention the next 3 reviewers (good or bad) on our next podcast (whoopee!). * SEX CHANGE OPERATIONS IN PRISON?. Clink talks about a recent case of many thousands of dollars being spent litigating a case of a prisoner requesting a sex change operation. * PRISTIQ. Desvenlafaxine (a metabolite of Effexor or venlafaxine) is up for final approval at the FDA (I misspoke in the podcast... Pristiq is not an extended release of Effexor, but rather a metabolite of it).Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

July 1, 2007: Shrinks on the Take Topics include: * Doctor Anonymous has new Podcast, where he talks about chatty doctors, nursing home patients, and discovers BlogTalk Radio (similar to TalkShoe). * Vermont Shrinks Rolling in Pharma Dough. The New York Times reported on doctors who get money from drug companies, finding that in Vermont the #1 specialty to cash in is Psychiatry. Vermont has a law requiring the reporting of such income, and the story misleading suggests that the average Vermont psychiatrist gets $45,000 from drug companies. Closer reading shows that there were 11 psychiatrists who received an average of $45,000. Still. What are they getting paid for? Here's some insight from a #2 specialty: Endocrinologists. A US Senator has suggested that all such income get reported, just like they have to do (makes sense to me). * Zyprexa Class Action Lawsuit for Fraudulent Marketing Zips Ahead. CL Psych informs us that a judge is allowing this suit to go forwards, based on allegations that Lilly engaged in fraudulent marketing of Zyprexa for unapproved uses. See also the March FDA Drugs for an FDA warning against Provigil. We launch into a wider discussion about off-label prescribing and combination medications. Listen to find out the #1 prescribed drug which is FDA-approved for bipolar depression (hint: it's not an SSRI). * Doctors Who Talk Too Much. The Archives of Internal Medicine has an article by McDaniel et al., which has been in the news. They sent fake patients into participating physician offices over the course of a year and recorded the interactions, categorizing the utterances in various ways. One-third of the visits contained physician "self-disclosures" (talking about themselves), with 85% of these not being useful. It doesn't seem that they asked the pretend patients how useful these discussions were. I view the study's conclusions with suspicion. I would like to see compliance rates and outcome measures compared between a group of patients whose physicians self-disclose and one whose physicians do not (ideally, assignment would be randomized, and a physician would have patients in both groups). * Q&A: Can you have a mental disorder and still become a mental health professional? Listen in as we address this question from a listener.Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 24, 2007: Black Box Reloaded Topics include: * Side Effects of Psychotherapy. Sharon Begley from Newsweek wrote an article entitled, "Get Shrunk at Your Own Risk." We discuss this particularly in reference to grief and bereavement, PTSD, and CISD. * Discussion at Cheryl Fuller's Jung at Heart about therapy as a treatment for an illness vs. as a tool to improve one's life. And here's an afterthought. * The Impact of the FDA's SSRI Black Box on the Decline in Depression Treatment in Kids. We discuss the June 2007 AJP article by Libby et al. showing that there was a 58% drop in expected number of antidepressant prescriptions for this population after the black boxes went up, and that the proportion of depressed children who remained untreated with antidepressants increased some three-fold. Other data has showed an increase in the suicide rate if this population afterwards. In the graph below, the black line represents the percentage of kids with major depression who were prescribed no antidepressant. * Q&A: "In my neck of the woods there is pretty much NO 'talk' therapy in short term inpatient settings. I know of many depressed individuals who have decompensated in these settings, and have had their depression actually increase on their departure. Any thoughts?"Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 17, 2007: Sibling Reveille Topics include: * Clink wonders if iPOD USERS have more musical auditory hallucinations. But, can deaf people get auditory hallucinations, or do they hallucinate people signing at them? "Yes, We Have No Bananas" seems to be a popular musical hallucination with older folks. Wonder if "Reveille" is heard by folks who were in the military? This is clearly a wake-up call for all you iPod users. * KevinMD placed us on his "Power 8" list of medical blogs with an "exceptional week" of blogging, particularly noting Clink's post on forensic psychiatry issues raised by the latest PARIS HILTON SAGA, which also leads to a discussion of the Goldwater Rule, of high profile cases (like Cho... see Face to Face and Unspeakable), and of freedom of speech. * Dinah talks a bit about Dr Melfi's firing of TONY SOPRANO. * We talk at length about a June 2007 AJP article by Waldinger, Vaillant, and Orav, entitled "CHILDHOOD SIBLING RELATIONSHIPS AS A PREDICTOR OF MAJOR DEPRESSION IN ADULTHOOD: A 30-Year Prospective Study." This is an amazing study in that they followed a group of some 229 men from age 20 to age 50, doing lots of interviews and tests along the way. In this analysis, they looked at the quality of their sibling and parental relationships, as well as family history of mood disorder, and made a surprising finding. Send us your general questions at mythreeshrinksATgmailDOTcom.Go to http://mythreeshrinks.com for show notes with links.

June 15, 2007: Dr Phil gag w/KLF Mashup * Dr. Phil visits My Three Shrinks. THIS IS A MUST-LISTEN SEGMENT! Clink and I play a trick on Dinah by "calling" Dr. Phil on Skype and he "interviews" us. This is a riot!! Dinah is such a good sport. [link to DrPhil Soundboard] (this is the prank from podcast #24... without all the other stuff...if you've already heard it, there is nothing new here so just delete it... or post it all over the internet, as Dinah would be oh-so-appreciative).Go to http://mythreeshrinks.com for show notes with links.