This episode looks at the practical assessment of personality. We explore the nuances of psychiatric diagnosis, moving beyond simplistic heuristics with a focus on the DSM-5's Alternative Model for Personality Disorders. Learn about assessing self-functioning (identity, self-direction) and interpersonal functioning, using clinical interviewing, psychosocial history, and even your countertransference as vital tools for a more comprehensive understanding of personality pathology in busy clinical settings.

This episode delves into Good Psychiatric Management (GPM), a practical framework developed by John Gunderson for treating Borderline Personality Disorder (BPD), though its principles offer broad utility across diagnoses. The hosts discuss the importance of integration, managing expectations (both patient and provider), and robust psychoeducation regarding BPD's features, heritability, and treatment course. Key GPM tenets are explored, including focusing on life outside therapy (work/relationships), the adjunctive role of medication, fostering accountability, and the significance of the therapeutic relationship itself as part of the treatment.

Dive deep into the practicalities of psychiatric medication management for PTSD in this clinical discussion. We explore the often limited evidence base and the necessity of off-label prescribing, focusing on strategies for stabilization, safety, and trust… the first stage of trauma treatment. Learn about experience-based approaches using SSRIs like sertraline, sleep aids such as trazodone and gabapentin, the cautious use of antipsychotics, and why benzodiazepines are discouraged. The conversation also touches on managing sleep disturbances and dissociation, situating medication as a supportive tool alongside essential psychotherapy and lifestyle changes, guided by principles like Pierre Janet's three-stage model.

Join us for an in-depth exploration of trauma and Post-Traumatic Stress Disorder (PTSD). This episode moves beyond common language to establish a clinical definition of trauma, detailing the DSM-5 criteria required for a PTSD diagnosis. The hosts break down the core PTSD symptom clusters – intrusion, avoidance, negative alterations in cognitions/mood, and arousal/reactivity – providing clear examples like flashbacks, hypervigilance, and negative self-beliefs. They delve into the concept of dissociation, its role in trauma, and the challenges it presents in assessment. Listeners will gain crucial insights into the diagnostic process, common misdiagnoses (like mistaking PTSD for depression), the vital importance of earning therapeutic trust, and effective interviewing techniques for sensitive topics, ultimately highlighting why accurate identification is key to recovery.

This conversation explores key aspects of forensic psychiatry, including the insanity defense, dissimulating patients, and how clinical practice intersects with legal systems. It highlights the importance of open-ended dialogue, nuanced diagnosis, and maintaining empathy without succumbing to cynicism.

Join us in a conversation about involuntary commitment, and the legal framework behind psychiatric treatment. We discuss real-world scenarios, share insights into how clinicians juggle patient autonomy versus societal protection. Whether you are new to the field or a seasoned professional, this episode offers valuable perspectives on balancing ethical duties, legal obligations, and patient care.

In this episode, we sit down with Dr. Chris Aiken to look at a big question: when do we treat an underlying deficit in psychiatric illness? Focusing on difficult-to-treat depression, our conversation delves into the deficit model and looks at different paradigms, from neuroprotective strategies and lifestyle interventions to the nuanced use of medications like SSRIs, lithium, and thyroid hormones, as well as targeted supplements. Tune in for a thought-provoking discussion that looks at when we approach treating depression by focusing on its underlying causes.

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Schizophrenia treatment is complex, and choosing the right antipsychotic can make all the difference. In this episode, we take a deep dive into schizophrenia medications... breaking down the pros and cons of different antipsychotics, metabolic risks, sedation issues, and the challenges of adherence. We discuss how to tailor treatment to individual patients, avoid unnecessary side effects, and improve long-term outcomes. Whether you're a clinician prescribing antipsychotics or someone looking to understand schizophrenia medications better, this discussion offers practical insights and evidence-based strategies for optimizing treatment.

What is the future of psychiatric treatment? In this episode we explore groundbreaking innovations in neuromodulation, AI driven diagnostics, and the evolving business of mental healthcare. Dr Owen Muir discusses why business and policy are as crucial as clinical advancements in ensuring that cutting edge treatments like accelerated TMS, noninvasive vagus nerve stimulation, and AI assisted tardive dyskinesia detection actually reach patients. From reshaping psychiatric training to rethinking what it means to cure mental illness, this conversation challenges how we view progress in psychiatry. Tune in to discover how technology, policy, and medical practice are converging to transform the field.

Medications and therapy are the foundation of mental health treatment, but what else can you do to improve your well-being? In this episode, we explore the essential lifestyle changes that can make a profound impact on mental health. From exercise and behavioral activation to socialization, sleep, and mindfulness, we break down practical, evidence-based strategies that go beyond prescriptions. We also discuss how avoiding substances and engaging with the right self-help resources can support long-term recovery. Whether you're a clinician, a patient, or just someone looking to optimize mental well-being, this episode offers actionable insights to help build a sustainable, holistic approach to mental health. Tune in for a deep dive into the three pillars of treatment and why lifestyle changes are just as crucial as medications and therapy.