How do you actually evaluate a “delusion” in the room, especially when the belief could be plausible, culturally reinforced, or tied to mood or substances? In this episode, we break down a practical approach to psychosis language, why “fixed false belief” is often insufficient, and the interview questions that help clarify origin, certainty, flexibility, and function. We also use the TALD framework to expand beyond the usual linear vs circumstantial vs tangential model of thought disorder, then apply everything to a case vignette where a single supplement becomes the explanation for an entire life collapse. Educational and clinically focused.

TALD: https://ars.els-cdn.com/content/image/1-s2.0-S0920996414005933-mmc1.docx

Understanding Delusions Paper: https://journals.lww.com/inpj/fulltext/2009/18010/understanding_delusions.2.aspx

What does “psychosis” actually mean, and how do clinicians recognize it in practice? In this episode, we define psychosis as a syndrome (not a single diagnosis) and walk through the core symptom domains: delusions, hallucinations, disorganized thinking/speech, disorganized behavior, and negative symptoms. We focus on the differential diagnosis, including how to distinguish schizophrenia-spectrum and schizoaffective disorders from mood disorders with psychotic features, trauma-related phenomena, borderline personality disorder, neurodevelopmental presentations (including autism spectrum traits), and substance-induced psychosis. We share red flags that can be easy to miss, like new-onset suspiciousness, functional decline, social withdrawal, and subtle thought disorganization, and we emphasize the value of collateral history and longitudinal follow-up. We close with treatment implications: when antipsychotics are helpful, why risks and benefits need to be individualized, and when psychotherapy and supportive interventions are the better first move. Educational disclaimer: This episode is for educational purposes only and is not medical advice.

In this episode, we outline the top 10 things clinicians need to know before prescribing clozapine. Aimed at psychiatrists and trainees, we cover when to use Clozaril. for treatment-resistant schizophrenia and highlight unique benefits like reducing suicidal behavior and aggression. We also discuss why this gold-standard treatment remains underused and review the monitoring protocols. Crucial safety considerations are addressed, including how to watch for neutropenia and constipation. Tune in for practical tips on clozapine titration, side effect management, and best practices to ensure safe and effective use of this life-changing medication.

Today we tackle a nerve-wracking topic for many clinicians: psychiatric disability assessments and paperwork. We break down everything from FMLA leave and short-term disability to Social Security benefits, explaining how to evaluate mental health impairments and fill out disability forms ethically. They discuss how to handle patient requests for time off work, balance treatment with recovery, and even touch on ADA accommodations like emotional support animals. Without the jargon, they share tips to avoid pitfalls and personal biases, helping you feel more confident in this tricky area. It’s a practical guide to navigating the gray areas of disability claims in mental health care.

Many adults who struggle with concentration, disorganization, or procrastination wonder if they have ADHD. But when is it ADHD, and how can you suss this out? In this episode, two psychiatrists explore a nuanced case of possible ADHD to demonstrate why diagnosis isn’t always straightforward. They discuss how personal history, childhood environment, mood swings, and even personality traits can all cloud the clinical picture. Listeners will learn how a comprehensive evaluation is done, what other conditions can mimic ADHD, and which practical strategies (like structured routines or therapy) can help improve focus. We emphasize careful assessment and a holistic approach to treating attention difficulties.

Dr. Catherine Eubanks, PhD joins us to unpack the therapeutic alliance in everyday practice: how to spot withdrawal and confrontation ruptures, why Bordin’s goals–tasks–bond still predicts outcomes, and how metacommunication jump starts repair. We translate research into concrete moves you can use in brief psychiatric visits, psychotherapy, and supervision. We discuss telehealth, boundaries, and measuring ruptures with the 3RS system. Clinicians, trainees, and curious listeners will leave with a clearer lens and usable language for repair that strengthens trust and improves care across settings.

Upcoming Workshop

Alliance Rupture Repair with Dr. J. Christopher Muran & Dr. Catherine EubanksWhen: Thursday, November 13 (1:00–4:00 PM EST)Where: Virtual via ZoomCost: $60 CE | $50 General | Students 50% off (code: STU)CEs: APA for psychologists; NYSED for LCAT, LCSW, and clinical psychologists

Description:A 3-hour transtheoretical workshop on recognizing and repairing alliance ruptures. Includes didactics, video analysis, and skills training to improve repair strategies and strengthen therapeutic effectiveness.

Register: https://www.eventbrite.com/e/alliance-rupture-repair-3-ces-tickets-1797546502979?aff=oddtdtcreator

Recommended Books & Videos

Therapist Performance Under Pressure: Negotiating Emotion, Difference, and Ruptureby Catherine Eubanks & J. Christopher Muranhttps://www.apa.org/pubs/books/therapist-performance-under-pressure

Rupture and Repair in Psychotherapy: A Critical Process for Changeedited by J. Christopher Muran, Catherine Eubanks, & Lisa Wallner Samstaghttps://www.apa.org/pubs/books/rupture-repair-psychotherapy

Video: Rupture and Repair in Psychotherapyhttps://www.apa.org/pubs/videos/rupture-repair-psychotherapy

Alliance-Focused Training: An Evidence-Based Guide to Negotiating Ruptures in Therapyby J. Christopher Muran, Catherine Eubanks, Lisa Wallner Samstag, & James Macdonaldhttps://www.apa.org/pubs/books/alliance-focused-traininga

Video: Using Alliance-Focused Traininghttps://www.apa.org/pubs/videos/using-alliance-focused-training

Why does it feel like everyone thinks they have ADHD lately? In this episode, two psychiatrists discuss the differential of ADHD. They explore how social media trends (like viral TikTok videos) are fueling ADHD self-diagnosis, and they emphasize the importance of careful evaluation. You’ll learn how to think through whether it’s ADHD vs. look-alike conditions such as depression, anxiety, trauma, OCD, sleep deprivation, or even just chronic stress and burnout. The doctors also talk about the burnout mental health providers are facing with so many people seeking ADHD meds, and they share their balanced approach to diagnosing and treating attention issues in an evidence-based way.

Is psychoanalysis still relevant in modern psychiatry and medication management? We unpack psychodynamic therapy, DSM-5 personality disorders, object relations, ego psychology, splitting, projective identification, attachment theory, and how solid psychiatric formulation improves outcomes in even medication management.

In this episode, we dive into the complexities of the therapeutic alliance and the real challenges psychiatrists face in everyday practice. From patients insisting on ADHD diagnoses and stimulant prescriptions to those requesting Xanax, disability paperwork, or resisting involuntary admission, we role play common clinical encounters and discuss practical strategies for navigating them. Drawing on concepts like collaboration and alliance, we highlight tools for psychiatrists, therapists, and clinicians to manage difficult conversations without burning out.

In this episode we break down how to run a focused, humane, and evidence informed psychiatric intake. We start with setting the frame and role clarity, then show how to use a free narrative to map life course symptoms before moving into targeted history, DSM-5 criteria, and the mental status exam. Along the way we tackle common requests for ADHD or autism evaluations, the risks of checklist thinking, and when to pivot to structured tools. We close with communicating impressions, treatment planning, and next steps.