Docs Tracey and Paul Discuss It All!

EPISODE #5: Anosognosia and the LEAP approach with Dr. Xavier Amador

Wed, 07 Oct 2026 08:55:00 -0400

In this episode, Dr. Xavier Amador, founder of the LEAP Institute and originator of the LEAP® method, joins Docs Tracey and Paul to discuss anosognosia as a bona fide neurological symptom rather than a moral failing or simple denial. They describe the term's origin in early neurology and how contemporary research in schizophrenia and bipolar disorder shows consistent findings: executive dysfunction, frontal lobe impairment, and structural differences in the prefrontal cortex. When a person with a severe and persistent mental illness persistently asserts they are not ill for months, that assertion typically reflects a brain-based deficit in self-appraisal.

We also address the ethical and practical dilemmas of involuntary treatment. We acknowledge deep respect for individual rights while defending court-ordered outpatient treatment and carefully considered inpatient holds when judgment is impaired by brain disorder. We draw on lived experience and clinical cases where timely involuntary intervention prevented harm and later elicited gratitude. Training clinicians, law enforcement, judges, and families in LEAP principles is presented as a concrete means to reduce coercion and improve outcomes while preserving dignity.

Learn more about the LEAP Institute at leapinstitute.org.

*DISCLAIMER:* This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances.

If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline.

Episode #4: Schizophrenia – Truth, Myths, and Hope

Wed, 30 Sep 2026 07:30:00 -0400

In this episode, Docs Tracey and Paul present schizophrenia as a serious mental illness that is defined primarily by psychosis, including hallucinations and delusions. Having treated thousands of patients with schizophrenia, Tracey notes that onset is often in the late teens or early twenties and that both genetic and environmental factors contribute to risk.

When it comes to treating schizophrenia, antipsychotic medications can reduce positive symptoms, but have side effects – and there are limited pharmacologic options for negative and cognitive symptoms, so psychosocial supports and community care are essential. Tracey and Paul describe catatonia and command hallucinations and stress the importance of early intervention to protect brain function.

So-called "wraparound" services are essential, including case management, vocational and peer support, and family education. Tracey and Paul urge compassion and continued research and affirm that with timely, comprehensive care many people can improve significantly.

**DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only, and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances.

If you are in crisis, reach out to a local mental health provider or call the National Suicide Prevention Lifeline at 988.

EPISODE #3: Is It Bipolar, or Just a Mood Swing?

Wed, 23 Sep 2026 07:30:00 -0400

In this episode, Docs Tracey and Paul speak as clinicians and internationally regarded experts in treating bipolar disorder. They define the clinical poles of mania and depression and emphasize that many patients experience mixed states that combine elements of both. They review key diagnostic signs that help distinguish bipolar from unipolar depression: early onset in childhood, psychotic features in depression, postpartum psychosis, abrupt "light switch" changes in mood, poor or paradoxical response to antidepressants, and family history.

Tracey and Paul stress that "mania" is diagnosed by duration and change from baseline and that "hypomania" is subtler, but clinically important. They recommend a careful, structured history and collateral information from family or friends. Tracey explains the DIG-FAST mnemonic for mania to guide clinicians and families. They underscore the importance of sleep and circadian stability as triggers for mood shifts. The central message is that accurate diagnosis matters because the treatments and risks differ substantially between bipolar I, bipolar II, and unipolar depression.

If you are in crisis, reach out to a local mental health provider or call the National Suicide Prevention Lifeline at 988.

EPISODE #2: DEPRESSION — Am I Depressed or Just Having a Bad Week?

Wed, 16 Sep 2026 07:30:00 -0400

In the second episode of Docs Tracey and Paul Discuss it All, we define major depressive disorder with clinical precision. We distinguish transient sadness from pathological depression by highlighting loss of interest, functional decline, disrupted sleep and appetite, reduced energy, impaired concentration, and the presence of suicidal ideation.

We emphasize that many patients report emotional numbness rather than recognizable sadness, and discuss vegetative signs tied to the limbic system, noting that suicidal thinking can range from passive thoughts to concrete plans.

We underscore the need for objective tracking with rating scales and for clinicians to ask directly and calmly about suicide. We assert that the treatment aim is full remission, not mere reduction of symptoms, and that shared decision making and long term maintenance of effective therapies are essential.

If you are in crisis, reach out to a local mental health provider or call the National Suicide Prevention Lifeline at 988.

EPISODE #1: Two Minds, Better Than One – Docs Tracey and Paul Discuss it All!

Wed, 09 Sep 2026 07:00:00 -0400

When it comes to mental health, Docs Tracey and Paul Discuss it All! This episode centers on the intricate and multifaceted nature of mental illness, as discussed by esteemed psychiatrists, Dr. Tracey Skale and Dr. Paul Keck. In this inaugural installment of a series dedicated to mental health, we endeavor to elucidate the definition of mental illness and explore its prevalence and impact on individuals and society at large.

Our collective experience of over 70 years in the psychiatric field equips us with unique experience and insights, which we hope to share with both the general public and our professional peers. Throughout the series, we will examine various mental health conditions, including depression, bipolar disorder, schizophrenia, and anxiety disorders –while fostering a deeper understanding of these critical issues. Through our new podcast – Docs Tracey and Paul Discuss it All – we aspire to provide a platform for open dialogue, reducing stigma and enhancing awareness regarding the complexities of mental health.

If you are in crisis, reach out to a local mental health provider or call the National Suicide Prevention Lifeline at 988.

Two Minds, Better Than One – Docs Tracey & Paul Discuss It All

Mon, 24 Aug 2026 13:10:00 -0400

Welcome to Tracey & Paul Discuss It All!

Psychiatric illness is unequivocally the foremost public health challenge confronting our society today. In this discourse, Docs Tracey and Paul (Dr. Paul E. Keck Jr., MD and Dr. Tracey Goodman Skale, MD) endeavor to illuminate the pervasive nature of mental health issues, and create public awareness and understanding of the signs and symptoms associated with various psychiatric disorders.

The goal of our podcast is to empower every day people – and mental health professionals – to recognize potential mental health struggles in themselves and those around them, and helping to facilitate timely access to appropriate care. In each episode, we'll explore the complexities of mental illness and dispel prevalent myths that cloud public perception.

With nearly 70 years of combined expertise in psychiatry, Docs Tracey and Paul are dedicated to fostering a compassionate dialogue surrounding mental health, ultimately advocating for the dignity and respect of those affected by mental illness.

If you are in crisis, reach out to a local mental health provider or call the National Suicide Prevention Lifeline at 988.