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Clinical Deep Dives

Med School Audio - Medical Knowledge Reimagined & Learning Made Memorable.

Clinical Deep Dives is a Medlock Holmes podcast for clinicians and learners who want understanding, not just information. Using classic medical and surgical texts as a guide and the generative power of AI, each episode explores ideas with curiosity and clarity, designed for learning on the move and knowledge that actually sticks. drmanaankarray.substack.com

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All Episodes

57:08

PSYCH 143: Cardiovascular Disorders

Clinical Deep Dives ·

2026/10/05

Medlock Holmes enters The Engine Room of the Heart, where an enormous mechanical heart is connected to the brain by networks carrying stress, emotion, behaviour, autonomic signals and medication effects.The relationship is strikingly bidirectional. Cardiovascular disease can produce anxiety, depression, cognitive disturbance and trauma-related symptoms, while psychiatric disorders and psychological stress can influence cardiovascular risk, recovery and mortality. Behaviour provides another bridge:

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54:29

PSYCH 142: Consultation-Liaison Psychiatry and...

Clinical Deep Dives ·

2026/10/04

Medlock Holmes enters The Hospital of Two Wings.For generations, one wing has been labelled BODY and the other MIND. Patients are routinely carried from one to the other, as though every symptom must belong exclusively to one side.Holmes immediately notices the flaw.A bridge connects them.Consultation-liaison psychiatry operates on this bridge: the part of psychiatry concerned with psychiatric problems arising within medical settings and with the complex, bidirectional relationships between physical

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45:53

PSYCH 141: Personality Disorders

Clinical Deep Dives ·

2026/10/03

Personality disorder emerges not because someone has a distinctive personality, but when enduring patterns become sufficiently inflexible and maladaptive to repeatedly disrupt the self, relationships and functioning.Medlock Holmes enters The House of Personality, an extraordinary mansion that has been under construction since childhood.Its foundations contain inherited temperament. Its rooms have been shaped by development and experience. Its doors determine how readily someone approaches or avoids

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55:33

PSYCH 140: Adjustment Disorders

Clinical Deep Dives ·

2026/10/02

Medlock Holmes enters The House of Adaptation, where people arrive carrying the weight of events that have changed their lives: relationship breakdown, financial hardship, illness, unemployment, conflict, relocation, bereavement and unexpected transitions.But Holmes immediately encounters psychiatry’s central difficulty with adjustment disorder:“When does distress become disorder?”Adjustment disorder is defined by the development of significant emotional or behavioural symptoms in response to an

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43:09

PSYCH 139: Kleptomania

Clinical Deep Dives ·

2026/10/01

Medlock Holmes enters a vast Neo-Victorian department store where an unusual investigation is underway.An object has been stolen.But the person who took it did not need it. The object had little personal importance. They could easily have afforded it. They may not even use it afterwards - sometimes the stolen objects are hidden, hoarded, given away or even secretly returned.So Holmes asks the question that defines the investigation:“If they did not need the object, why did they steal it?”Kleptomania

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44:41

PSYCH 138: Pyromania

Clinical Deep Dives ·

2026/09/30

and subsequent pleasure or relief.Medlock Holmes enters a vast Neo-Victorian fire investigation chamber where one question dominates the room:WHY WAS THE FIRE SET?Pyromania is not simply fire setting, and most people who deliberately start fires do not have pyromania. The diagnosis requires repeated, deliberate and purposeful fire setting accompanied by increasing tension or emotional arousal beforehand and pleasure, gratification or relief during the act or while witnessing its aftermath

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40:44

PSYCH 137: Intermittent Explosive Disorder

Clinical Deep Dives ·

2026/09/29

Medlock Holmes enters an immense Neo-Victorian institution known as The Hall of Impulsive Aggression.At first, the building seems calm.Then a small bell rings.Someone makes a dismissive remark.A door slams.A criticism is heard.A minor disagreement begins.Within seconds, an enormous brass pressure chamber erupts.The explosion is dramatic, but brief.Then silence.The whole event has lasted less than half an hour.Holmes looks around at the damage and immediately notices something important:this was not

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52:25

PSYCH 136: Sleep Disorders

Clinical Deep Dives ·

2026/09/28

Sleep disorders arise when the mechanisms controlling sleep quantity, timing, breathing, movement, arousal or dream-state boundaries become disrupted - and the consequences can range from chronic distress to accidents, cardiovascular disease and major functional impairment.Medlock Holmes enters an immense Neo-Victorian institution called The Grand Observatory of Sleep and Wakefulness.At first glance, the building appears quiet.But Holmes quickly realises that nothing is truly inactive.Behind the

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56:32

PSYCH 135: Feeding and Eating Disorders

Clinical Deep Dives ·

2026/09/27

health become entangled - sometimes producing profound malnutrition, dangerous compensatory behaviours, loss of control over eating, nutritional deficiency, medical instability and substantial psychosocial impairment.Medlock Holmes enters an immense Neo-Victorian institution called The House of Eating, Weight and Regulation.At first, the building appears deceptively ordinary.At its centre is a vast dining hall.Food arrives.People eat.Bodies regulate energy.Meals connect families.Hunger rises and

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44:05

PSYCH 134: Sexual Addiction

Clinical Deep Dives ·

2026/09/26

The central clinical question is not “How much sex is too much?” but “Has sexual behaviour become the person's primary way of regulating distress, reward and self-experience?”Medlock Holmes enters an immense Neo-Victorian institution called The House of Driven Behaviour.At first, nothing in the building looks inherently pathological.There are rooms devoted to:sexual fantasymasturbationromantic attachmentpornographypartnered sexsexual explorationAll of these can occur within ordinary human

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56:56

PSYCH 133: Gender Identity, Gender Diversity, and...

Clinical Deep Dives ·

2026/09/25

Medlock Holmes enters an immense Neo-Victorian institution called The Grand Observatory of Gender.At its centre stands a transparent human figure surrounded by several rotating brass rings.One is labelled:SEX CHARACTERISTICSAnother:GENDER IDENTITYAnother:GENDER EXPRESSIONAnother:SEXUAL ORIENTATIONAnother:SOCIAL ROLEThe rings frequently align.Sometimes they do not.Holmes immediately discovers the chapter’s first essential distinction:Gender identity and sexual orientation are not the same thing.A

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52:50

PSYCH 132: Paraphilic Disorders

Clinical Deep Dives ·

2026/09/24

Medlock Holmes enters an immense Neo-Victorian institution called The Tribunal of Sexual Interest, Consent and Harm.At its centre stands a large brass balance.On one side:UNUSUAL SEXUAL INTERESTOn the other:DISTRESS • IMPAIRMENT • HARM • NONCONSENTHolmes quickly discovers the central distinction in modern psychiatric classification:A PARAPHILIA IS NOT AUTOMATICALLY A PARAPHILIC DISORDER.DSM-5 defines a paraphilia as an intense and persistent sexual interest outside genital stimulation or preparatory

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39:54

PSYCH 131: Homosexuality, Gay and Lesbian Identities,...

Clinical Deep Dives ·

2026/09/23

Medlock Holmes enters an immense Neo-Victorian institution called The Hall of Sexual Identity and Social Meaning.At its centre is a large brass compass with three separate needles:DESIRE • BEHAVIOUR • IDENTITYHolmes notices immediately that the needles do not always point in the same direction.A person may experience same-sex attraction without acting on it. Another may have same-sex relationships without identifying as gay or bisexual. Another may identify strongly with an LGB community. Still

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57:59

PSYCH 130: Normal Human Sexuality and Sexual...

Clinical Deep Dives ·

2026/09/22

Medlock Holmes enters an immense Neo-Victorian institution called The Grand Observatory of Human Sexuality.It is part anatomy theatre, part neuroscience laboratory, part relationship clinic and part cultural museum.At its centre stands an enormous brass instrument labelled:SEXUAL FUNCTIONSeven interlocking systems surround it:BODY • BRAIN • HORMONES • DESIRE • RELATIONSHIP • LEARNING • CULTUREHolmes immediately sees the central lesson:sexual function cannot be understood by examining any one of

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48:30

PSYCH 129: Dissociative Disorders

Clinical Deep Dives ·

2026/09/21

Medlock Holmes enters an extraordinary Neo-Victorian building called The House of Disconnected Rooms.From outside, it appears to be one house. Inside, however, corridors terminate unexpectedly, doors open into rooms that seem unaware of one another, clocks show different times, mirrors reflect unfamiliar faces, and sections of the archive are inaccessible from the main library.Nothing has disappeared completely.The connections have been disrupted.This becomes Holmes’s central metaphor for

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45:19

PSYCH 128: Factitious Disorder

Clinical Deep Dives ·

2026/09/20

At first, the cases look extraordinary.A patient presents with recurrent sepsis caused by unusual organisms. Another has persistent wounds that never heal. Another reports repeated seizures that vanish under observation. One produces dramatic laboratory abnormalities. Another travels from hospital to hospital under changing identities. In a paediatric ward, a child appears inexplicably ill whenever one caregiver is present.Holmes immediately recognises the central diagnostic requirement:There must

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56:22

PSYCH 127: Somatic Symptom and Related Disorders

Clinical Deep Dives ·

2026/09/19

Medlock Holmes enters an immense Neo-Victorian medical complex called The House of Bodily Signals.Every corridor is crowded.One patient reports abdominal pain. Another dizziness. Another weakness. Another chest discomfort. Another is convinced that a subtle bodily sensation means serious disease. One patient has undergone scan after scan without reassurance. Another has genuine physical illness but has become consumed by fear and monitoring. In a neighbouring neurological ward, someone presents with

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49:38

PSYCH 126: Post-Traumatic Stress Disorder

Clinical Deep Dives ·

2026/09/18

Medlock Holmes enters an immense Neo-Victorian institution called The Citadel of the Unfinished Alarm.At the centre is a vast clock frozen at the moment of trauma.Outside the citadel, the danger has passed.Inside, however, bells continue to ring.A veteran ducks at the sound of a car backfiring. A survivor avoids a street that resembles the place of an assault. Another wakes from the same nightmare night after night. A fourth scans every room for exits.Holmes immediately recognises the defining

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50:10

PSYCH 125: Gambling Disorder

Clinical Deep Dives ·

2026/09/17

Medlock Holmes enters an immense Neo-Victorian casino called The House of the Endless Chase.At first, the place appears glamorous.Roulette wheels turn beneath chandeliers. Cards slide across green felt. Slot machines sing. Sports odds flicker across brass boards. Online betting screens glow in distant alcoves.But Holmes notices something that ordinary gamblers do not.Almost every corridor leads back to the tables.A sign above the entrance reads:“The first wager is about winning. The disorder is

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51:51

PSYCH 124: Obsessive-Compulsive and Related Disorders

Clinical Deep Dives ·

2026/09/16

Medlock Holmes leaves the Grand Dispensary of Anxiety and enters an entirely different institution: The Grand House of Repetition.At first, everything appears orderly. Doors are locked. Hands are washed. Objects are aligned. Possessions are carefully preserved.Then Holmes notices something unsettling.The same actions are happening again.And again.And again.A man checks a locked door for the twentieth time. A woman washes already-clean hands. Another person stands before a mirror searching endlessly

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