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Send us Fan Mail Episode 85 Multiple Sclerosis Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Memories in Motion by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Paper for next week: Sophie Waller et al., "The Initial Diagnosis and Management of Parkinson’s Disease," Australian Journal of General Practice 50, no. 11 (November 2021): 793. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 84 Epilepsy Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Urban Starscape by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS International Leage for Epilepsy.  https://www.ilae.org   Paper for next week: Montague, Turlough, James Drummond, Karl Ng, and John Parratt. "Advancements in Multiple Sclerosis." Internal Medicine Journal 55, no. 7 (2025): 895–904. https://doi.org/10.1111/imj.70023. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.  Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 83 Tension Headaches Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Push it to the Extreme by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Paper for next week: Ahmed, Abdullah, Abdul-Habib Rahman, Shimul Williams, Mubeen Toufiq, Eyad Jamileh, Sheema Chaudhry, Khadijah Ahmed, and Munir Ahmed. 2024. “Seizures and Epilepsy: An Overview for UK Medical Students.” Cureus 16 (10): e70654. https://doi.org/10.7759/cureus.70654. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 82 Migraines Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Time for Two by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 81  Schizophrenia Question 1 A 28-year-old man with schizophrenia continues to have difficulty maintaining employment despite adequate control of hallucinations and delusions on antipsychotic medication. Which of the following factors most strongly contributes to his impaired functional outcome? C. Cognitive dysfunction Question 2 A researcher is studying quality of life (QOL) in patients with schizophrenia. Which cognitive domain has been shown to have a stronger relationship with subjective quality of life compared to neurocognition? D. Theory of mind Question 3 A clinician is considering treatment strategies to improve cognitive deficits in a patient with schizophrenia. Based on current evidence, which intervention is most likely to produce sustained improvement in multiple cognitive domains? C. Cognitive remediation therapy (CRT) Paper for next week: Onan, Dara, Samara Youns, Wam David Wesgatiñk, Fatemeh Farham, Saulius Andruškevičius, Ana Abashidze, Ase Jusupova, Yury Romanenko, Oxana Grosu, Meermigul Zamirbekovna Modokulova, Ulkar Mursalova, Sada Sadikhodjaeva, Paolo Martelletti, and Sat Ashina. “Debate: Differences and Similarities between Tension-Type Headache and Migraine.” The Journal of Headache and Pain 24, no. 1 (2023): 92. https://doi.org/10.1186/s10194-023-01614-0.   Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.  Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 81.1  Marijuana and Psychosis Shoot me any comments or questions @Rotations2ptoh  on X Intro/Outro: Night Detective by Amaksi Courtesy of Pixabay under Creative Commons for non-Commercial Educational use only. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Paper referenced: Pourebrahim S, Ahmad T, Rottmann E, Schulze J, Scheller B. Does Cannabis Use Contribute to Schizophrenia? A Causation Analysis Based on Epidemiological Evidence. Biomolecules. 2025 Mar 4;15(3):368. doi: 10.3390/biom15030368. PMID: 40149904; PMCID: PMC11940535. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 81 Schizophrenia Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Big Guy by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 80  Dementia Question 1 A 74-year-old man presents with gradually worsening memory loss over 5 years. Brain autopsy later reveals extracellular amyloid plaques and intracellular neurofibrillary tangles. Further analysis shows that amyloid deposition began years before symptom onset. Which of the following best describes the earliest stage of Alzheimer’s disease pathogenesis? C. Accumulation of amyloid-beta in the neocortex Question 2 An 82-year-old woman presents with progressive memory loss. She has a history of hypertension and diabetes. MRI reveals multiple small infarcts and white matter changes. At autopsy, she is found to have Alzheimer’s disease pathology, TDP-43 inclusions, and vascular infarcts. Which of the following best explains the underlying cause of her dementia? D. Mixed dementia due to multiple coexisting pathologies Question 3 A 79-year-old patient presents with memory impairment. Amyloid PET imaging is negative, but MRI shows hippocampal atrophy. Neuropathologic examination later reveals TDP-43 protein deposition in the amygdala and hippocampus. Which of the following diagnoses is most consistent with these findings? D. Limbic-predominant age-related TDP-43 encephalopathy (LATE) Paper for next week: Aguilar-Shea, Antonio L., and Javier Diaz-de-Teran. “Migraine Review for General Practice.” Atención Primaria 54 (2021): 102208. https://doi.org/10.1016/j.aprim.2021.102208.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 80 Dementia Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Inspired to Begin by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS  Answers for Episode 79  Substance Use Disorder  Question 1 A 32-year-old man presents with agitation, tachycardia, and euphoria after using a recreational drug. Laboratory studies show elevated extracellular dopamine levels in the brain. Which of the following mechanisms best explains the primary neurochemical action of cocaine that produces these effects? C. Inhibition of the dopamine transporter leading to increased extracellular dopamine Question 2  A 45-year-old patient with opioid use disorder is found unresponsive with respiratory depression after injecting fentanyl. Emergency medical services administer naloxone, but repeated doses are required to maintain respiration. Which of the following best explains this phenomenon? C. Naloxone has a shorter half-life than fentanyl and may require repeated dosing Question 3  A research study investigates synaptic changes in the brains of individuals with substance use disorder. Investigators find that repeated exposure to cocaine leads to the formation of “silent synapses” characterized by an altered receptor ratio. Which of the following best describes this synaptic adaptation? B. Decreased AMPA/NMDA receptor ratio at glutamatergic synapses Paper for next week: Takeda, Tomoya, Hidehiro Umehara, Yui Matsumoto, Tomohiro Yoshida, Masahito Nakataki, and Shusuke Numata. “Schizophrenia and Cognitive Dysfunction.” Journal of Medical Investigation 71 (August 2024): 205–209. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 79 Substance Use Disorder Shoot me any comments or questions @Rotation2ptoh  on X  Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Heroic by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 78 ADHD Question 1 A 68-year-old man presents with complaints of lifelong difficulty staying organized, managing finances, and completing tasks. He reports that these issues have been present since childhood but have worsened in impact since retirement. He denies progressive memory loss. Physical exam is unremarkable, and Mini-Mental State Examination (MMSE) score is normal. Which of the following is the most appropriate next step in management? C. Obtain a detailed developmental history focusing on childhood symptoms Question 2 A 72-year-old woman with newly diagnosed ADHD is being considered for pharmacologic treatment. She has a history of hypertension and is currently taking three antihypertensive medications. Which of the following is the most appropriate initial pharmacologic approach? B. Initiate low-dose stimulant therapy with careful titration Question 3 A 66-year-old patient with ADHD reports difficulty adhering to medication regimens for multiple chronic conditions. He frequently forgets doses and misses appointments. His physician decides to incorporate non-pharmacologic strategies. Which of the following interventions is most appropriate? C. Cognitive-behavioral therapy focused on organizational skills Paper for next week: Schneider, Julie A. “Neuropathology of Common Age-Related Dementing Disorders.” Continuum (Minneapolis, Minn.) 28, no. 3 (June 2022): 834–851. https://doi.org/10.1212/CON.0000000000001137. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 78 ADHD Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: When Our Eyes Met by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 77 Insomnia Question 1 A 52-year-old woman presents with a 6-month history of difficulty falling asleep and frequent nighttime awakenings. She reports fatigue and poor concentration during the day. She has no major medical or psychiatric comorbidities. She asks for medication to help her sleep. Which of the following is the most appropriate initial management?  D. Initiate cognitive behavioral therapy for insomnia (CBT I) Question 2 A 60-year-old man presents with chronic insomnia refractory to initial behavioral interventions. He reports snoring and witnessed apneas by his spouse. You are considering further evaluation. Which of the following is the most appropriate next step? C. Order polysomnography Question 3 A 68-year-old woman has chronic insomnia and has failed CBT I. You are considering pharmacologic therapy. Which of the following is most consistent with guideline recommendations? C. Use of prolonged-release melatonin for up to 3 months Paper for next week:  Davis, Sarah, and Jun Zhu. “Substance Abuse and Neurotransmission.” In Reference Module in Biomedical Sciences. Elsevier, 2021. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.  Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.  Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 77 Insomnia Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Code of Reality by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 76 PTSD Question 1 A 32-year-old patient presents to a primary care clinic 4 months after witnessing a fatal motor vehicle collision. The patient reports recurrent intrusive memories, avoidance of the road where the crash occurred, persistent negative mood, exaggerated startle response, and impaired occupational functioning. The patient asks about the most evidence-supported first-line treatment. Which of the following is the most appropriate recommendation? C. Refer for trauma-focused cognitive behavioral therapy or EMDR. Question 2  A 41-year-old patient with a history of prolonged interpersonal trauma reports nightmares, avoidance of reminders, hyperarousal, persistent shame, difficulty regulating emotions, and chronic difficulty maintaining relationships. The clinician suspects complex post-traumatic stress disorder. Which of the following best describes complex PTSD as discussed in the article? C. PTSD symptoms plus affect dysregulation, negative self-concept, and interpersonal disturbances. Question 3  A physician is counseling a patient who is hesitant to begin trauma-focused psychotherapy for PTSD because the patient is worried that discussing the trauma may worsen symptoms. The physician wants to provide realistic anticipatory guidance while encouraging treatment engagement. Which of the following counseling statements is most consistent with the evidence summarized in the article? D. “Some patients experience distress or temporary worsening of symptoms, but trauma-focused therapy remains effective, and support plus a strong therapeutic alliance can help patients continue.” Paper for next week:  Smith, John A., and Jane B. Lee. “The Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Older Adults.” Journal of Clinical Psychiatry 78, no. 4 (2017): 456–465.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 76 PTSD Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Keep it Moving by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use.  Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 75 Bipolar Disorder  Question 1 A 22-year-old college student presents to a primary care clinic with a 3-month history of depressed mood, hypersomnia, low energy, impaired concentration, and anhedonia. He reports two prior depressive episodes beginning in adolescence. His mother has a history of bipolar disorder. When previously treated with an antidepressant, he became unusually energetic, slept only 3 hours per night, talked rapidly, and engaged in impulsive spending for several days. He was not hospitalized and did not have psychotic symptoms. Which of the following is the most appropriate next step in management? C. Evaluate for bipolar disorder and avoid antidepressant monotherapy Question 2 A 31-year-old man is brought to the emergency department by his partner because he has not slept for 5 days, has been speaking rapidly, claims he has “special financial powers,” and has spent $18,000 on risky investments. He is euphoric, distractible, and agitated. Urine toxicology is negative. He has no known chronic medical conditions. Which of the following is a first-line monotherapy option for this patient’s acute condition? B. Lithium Question 3 A 29-year-old woman with bipolar I disorder is 30 weeks pregnant and presents for prenatal counseling. She previously had severe manic episodes requiring hospitalization. She stopped her mood stabilizer early in pregnancy because she was worried about fetal effects. She asks about the risk of relapse after delivery. Which of the following counseling statements is most accurate? C. The postpartum period is high risk for relapse, and relapse rates are higher without medication use. Paper for next week: Riemann, Dieter, Colin A. Espie, Ellemarije Altena, Erna Sif Arnardottir, Chiara Baglioni, Claudio L. A. Bassetti, Celyne Bastien, et al. “The European Insomnia Guideline: An Update on the Diagnosis and Treatment of Insomnia 2023.” Journal of Sleep Research 32, no. 6 (2023): e14035. https://doi.org/10.1111/jsr.14035. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 75 Bipolar Disorder Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Endless Highway by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 74 Generalized Anxiety Disorder Question 1 A 32-year-old woman presents to a primary care clinic because she has been “worrying all the time” for the past 8 months. She worries about her job performance, her parents’ health, household finances, and minor daily responsibilities. She reports difficulty sleeping, muscle tension, irritability, fatigue, and trouble concentrating. She says she knows her worry is excessive but cannot control it. Her symptoms are causing problems at work and in her relationships. Which of the following is the most likely diagnosis? C. Generalized anxiety disorder Question 2 A 41-year-old man is diagnosed with generalized anxiety disorder. His physician explains that several neurotransmitter systems may contribute to his symptoms. The physician states that one inhibitory neurotransmitter is particularly important because dysregulation may increase amygdala activity and make it harder for the body to relax after stress. Which of the following neurotransmitters is being described? D. Gamma-aminobutyric acid Question 3 A 27-year-old woman with generalized anxiety disorder asks about treatment options. She prefers a nonpharmacologic treatment because she is concerned about medication adverse effects. Her physician recommends a therapy that focuses on identifying and changing maladaptive thought patterns and behaviors. According to the article, which of the following is considered the “gold standard” psychological treatment for generalized anxiety disorder? D. Cognitive behavioral therapy Paper for Next Week: Billings, Jo, and Helen Nicholls. “PTSD and Complex PTSD, Current Treatments and Debates: A Review of Reviews.” British Medical Bulletin 156 (2025): 1–13. https://doi.org/10.1093/bmb/ldaf015. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 74 Generalized Anxiety Disorder Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Blues Rock by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use.  Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS  Answers for Episode 73 Depression Question 1  A 34‑year‑old woman with major depressive disorder has persistent depressed mood, anhedonia, poor sleep, and impaired concentration. She completed two antidepressant trials (an SSRI followed by an SNRI), each at adequate dose and duration, with good adherence, but reports minimal improvement. She asks what this means and what options exist beyond “just trying another similar medication.”Which of the following is the best next step and most accurate characterization? C. Identify treatment‑resistant depression (TRD) and discuss/referral for non‑monoaminergic options such as rTMS, ECT, or ketamine/esketamine. Question 2   A neuroscience team uses a chronic unpredictable mild stress (CUMS) rodent model to study antidepressant mechanisms of repetitive transcranial magnetic stimulation (rTMS). They compare 5 Hz stimulation with 1 Hz stimulation and measure hippocampal endocannabinoid signaling. Which finding most strongly supports that rTMS’s antidepressant‑like effects are mediated through enhanced endocannabinoid signaling via CB1? C. 5 Hz (high‑frequency) rTMS improves depressive‑like behavior, normalizes synaptic DAGLα and CB1 expression, increases hippocampal 2‑AG, and these effects are blocked by CB1 antagonists or by DAGLα/CB1 knockdown.  Question 3  A 56‑year‑old man with TRD begins electroconvulsive therapy (ECT) and reports significant mood improvement but develops new memory impairment. He asks if there is any known strategy to reduce cognitive side effects without eliminating benefit. You recall a preclinical depression model discussed in a review where a mechanistic intervention mitigated ECT‑associated memory problems while preserving antidepressant‑like effects. Which of the following best matches the findings summarized in the review? C. Pharmacologically block CB1 receptors to reduce ECT‑induced memory deficits while maintaining antidepressant‑like efficacy. Paper for Next Week: Singh, Balwinder, Holly A. Swartz, Alfredo B. Cuellar-Barboza, Ayal Schaffer, Tadafumi Kato, Annemieke Dols, Sarah H. Sperry, Andrea B. Vassilev, Katherine E. Burdick, and Mark A. Frye. “Bipolar Disorder.” The Lancet 406, no. 10506 (August 30, 2025): 963–978. https://doi.org/10.1016/S0140-6736(25)01140-7. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 73 Depression Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Path to Bright by Alex Grohl  Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS  Answers for Episode 72 Rosacea  QUESTION 1  A 44-year-old woman presents to an outpatient clinic for recurrent facial “flare-ups” for the past 18 months. She reports episodes triggered by exercise and hot beverages with a burning sensation across the cheeks. On examination, there are scattered inflammatory papules and pustules over the central face with visible telangiectasia. There is no persistent baseline erythema at today’s visit. She denies vision changes. Which additional finding, if present, would be considered independently diagnostic of rosacea in the updated phenotype-basedclassification system? C. Phymatous changes QUESTION 2  A 39-year-old man is diagnosed with rosacea. He has moderate-to-severe disease (IGA 3) with both persistent facial erythema and numerous inflammatory papules/pustules. He requests a regimen that targets both redness and inflammatory lesions. His medical history is unremarkable. Based on evidence summarized in the article, which regimen best aligns with a randomized, double-blind, vehicle-controlled trial evaluating a combination approach for patients who have both erythema and inflammatory lesions?  B. Brimonidine 0.33% AM + ivermectin 1% PM QUESTION 3 A 58-year-old patient presents with severe papulopustular rosacea (IGA 4) with extensive inflammatory lesions and frequent flushing. He has been adherent to topical therapy. He is started on topical ivermectin 1% cream, but he wants an evidence-based approach that improves the probability of clearing lesions more completely. Which additional therapy is best supported by the phase IIIb/IV trial summarized in the article for improving outcomes in severe rosaceacompared with topical ivermectin alone? D. Doxycycline 40 mg modified release Paper for Next week: Mishra, Aneesh K., and Anuj R. Varma. "A Comprehensive Review of the Generalized Anxiety Disorder." Cureus 15, no. 9 (September 28, 2023): e46115.  Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.  Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan Mail Episode 72 Rosacea Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025 Outro Music: Heartwide by Alex Grohl Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS  Edited by: Todd Fredricks DO MSS Answers for Episode 71 Squamous Cell Carcinoma  Question 1  A 68‑year‑old patient presents to a family medicine clinic with a scaly, tender, hyperkeratotic plaque on the helix of the ear that has enlarged over 2 months. Shave biopsy confirms cutaneous squamous cell carcinoma (cSCC). The pathology report additionally notes tumor cells tracking along a nerve. The patient is otherwise healthy. Which is the most appropriate next step in management? C. Arrange urgent dermatology (and/or head & neck) referral for high‑risk cSCC management planning Question 2  A researcher examines the tumor microenvironment of cSCC and finds abundant regulatory T cells (Tregs)associated with high extracellular adenosine, which suppresses local anti‑tumor immunity. The researcher asks how these Tregs generate adenosine in the extracellular space. Which mechanism best explains the increased extracellular adenosine production? C. Tregs express ectoenzymes CD39 and CD73 that metabolize extracellular ATP → adenosine Question 3  A 79‑year‑old patient has locally advanced cSCC that is not amenable to curative surgery or radiation therapy. The oncology consultant recommends first‑line systemic therapy with a PD‑1 immune checkpoint inhibitor per evidence summarized in the review. Which regimen matches a PD‑1–targeted treatment dosing schedule described in the article? B. Cemiplimab 350 mg IV every 3 weeks Rosa, Ilenia, Lorenzo Pio Padula, Francesco Semeraro, Carlotta Marrangone, Antonio Inserra, Luisa De Risio, and Marta Boffa, et al. “Endocannabinoids, Depression, and Treatment Resistance: Perspectives on Effective Therapeutic Interventions.” Psychiatry Research 352 (2025): 116697. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.