PsyQ: Journal Club

In this episode, we break down a major longitudinal synthesis of seven North American cohort studies following children with ADHD into adulthood over 10–30 years. The data are striking: while full diagnostic persistence varies, the majority of individuals continue to experience clinically meaningful symptoms and impairment well into adult life. Persistent ADHD is associated with lower educational attainment, unemployment, financial instability, higher rates of mood and substance use disorders, antisocial behavior, driving risk, emergency medical utilization, and even reduced life expectancy. Comorbid disruptive behavior disorders emerge as the strongest predictors of adverse adult outcomes, while internalizing symptoms in females drive elevated suicide risk. Although stimulant treatment remains effective for short-term symptom control, long-term functional normalization is inconsistent, underscoring that medication alone is insufficient. This episode reframes childhood ADHD as a chronic, life-course disorder with major implications for early intervention, comorbidity management, and long-term care planning.

In this episode, we dissect a landmark 2022 randomized controlled trial published in the American Journal of Psychiatrythat challenges the traditional "daily dose" paradigm for treating Alcohol Use Disorder (AUD). We review the efficacy of targeted, event-driven oral naltrexone—taken only in anticipation of heavy drinking or cravings—specifically for sexual and gender minority (SGM) men with mild-to-moderate AUD.

We analyze how this "chemical shield" approach yielded a Number Needed to Treat (NNT) of just 2 to prevent a binge-drinking day , significantly reduced overall consumption volume , and demonstrated sustained therapeutic effects six months post-treatment through likely pharmacological extinction. Join us as we explore how decoupling alcohol from its neurobiological reward can bridge the massive treatment gap for binge drinkers who are resistant to total abstinence.

In this episode, we unpack the psychiatric relevance of the ketogenic diet through the lens of a recent and compelling systematic review and meta-analysis from JAMA Psychiatry. Join us as we explore how ketogenic diets may modulate mood, inflammation, neurotransmission, and energy metabolism—domains increasingly central to the practice of modern psychiatry. We’ll break down what the evidence says (and doesn’t say) about its utility in depression and anxiety, clinical pearls for implementation, safety considerations, and which patients may benefit most. Perfect for psychiatry residents, faculty, and anyone curious about nutritional psychiatry with a rigorous, translational focus.

Antidepressant discontinuation is one of the most contentious topics in psychiatry, fueling both patient fear and clinical uncertainty. But what does the highest quality, placebo-controlled evidence actually say? In this episode, we dive deep into the 2025 JAMA Psychiatry systematic review and meta-analysis by Kalfas et al. that re-examines the incidence and nature of discontinuation symptoms. We break down the study's striking headline finding—that stopping an antidepressant, on average, results in just one additional symptom compared to stopping placebo, a number below the threshold for clinically significant discontinuation syndrome. We discuss which symptoms, like dizziness , are pharmacologically real versus those that are not, and explore the paper's most critical clinical implication: its finding that early mood worsening is not associated with discontinuation, providing a data-driven framework for distinguishing withdrawal from true depressive relapse

In this episode of PsyQ, our psych journal club dives deep into the Bush–Francis Catatonia Rating Scale (BFCRS), guided by the 2022 BFCRS Training Manual and its original 1996 validation study. We walk through each of the 23 items in the scale, clarifying their definitions, how to observe and score them, and the key differentiations between overlapping signs such as mutism, withdrawal, and negativism. From subtle signs like mitgehen and ambitendency to high-risk indicators of malignant catatonia, this conversation aims to strengthen clinical fluency and improve bedside assessment. Whether you’re a trainee learning to recognize catatonia or a seasoned clinician refining your exam technique, this episode provides a practical, evidence-based approach to mastering the BFCRS.

In this week’s episode of PsyQ, we break down the American Journal of Psychiatry review “Ketamine for Depression, but at What Cost?” by Li and colleagues. Here we explore the balance between ketamine’s rapid antidepressant benefits and its potential neurotoxic risks. We’ll discuss what animal and human studies reveal about dose, frequency, and safety, why FDA-regulated esketamine appears cognitively safe while off-label ketamine use raises concern, and how clinicians can responsibly navigate this evolving treatment landscape.

Reference: Li SW, Kumpf KT, Urrutia J, Krystal JH, Sanacora G, Wilkinson ST. Ketamine for Depression, but at What Cost? A Review of Ketamine’s Neurotoxic Effects From Preclinical and Human Studies. Am J Psychiatry. 2025;182:903–912.

In this episode, we take a clinical look at psychedelic-assisted therapy — what it is, how it works, and where it’s headed. We cover MDMA for PTSD and psilocybin for depression, break down the science behind how these drugs work with therapy, and review key trial data, safety concerns, and how psychiatrists may soon integrate these treatments into practice. This episode delivers clear takeaways, clinical pearls, and a balanced view on this rapidly evolving field.

In this episode of PsyQ, we take a critical look at the evolution of major depression treatment over the past two decades. We start with the foundational Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, a study that has shaped clinical practice for years with its widely cited ~70% cumulative remission rate. However, we then dive deep into a startling 2023 re-analysis that challenges this cornerstone of psychopharmacology, revealing a cumulative remission rate closer to 35% when the original study's protocol is strictly followed. This critical re-evaluation serves as a springboard to explore the future, as we discuss a 2024 review on the novel and emerging treatments moving beyond monoamines, including glutamatergic agents like ketamine and the promising field of psychedelic-assisted therapy. Join us as we journey from the bedrock of modern depression treatment to the cutting edge of psychiatric research.

Articles Discussed:

Rush AJ, Fava M, Wisniewski SR, et al. Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004.

Pigott HE, Kim T, Xu C, et al. What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study’s patient-level data with fidelity to the original research protocol. BMJ Open. 2023.

Ghasemi M, Rezaei F, Falahati F, et al. Trends in research on novel antidepressant treatments. Frontiers in Pharmacology. 2024.

In this episode, we break down BrainsWay’s 6-day accelerated Deep TMS for major depression—how its iTBS, 5-sessions-per-day schedule compresses a month of treatment into 6 days with non-inferior outcomes to standard daily TMS—then stack it up against conventional 4–6 week TMS and Stanford’s SAINT (the 5-day, 50-session, MRI-guided protocol boasting rapid, high remission rates). We’ll walk through patient flow (session length, spacing, acute + maintenance phases), efficacy (response/remission and time-to-relief), safety (mostly transient scalp discomfort/headache; no new safety signals), practicalities (staffing and workflow for multi-session days), and the real-world stuff clinicians care about—FDA status (BrainsWay’s accelerated clearance for MDD in 2025; SAINT cleared for TRD), coverage gaps (daily caps vs 5x/day), and how to counsel patients on choosing between speed, access, and cost.

In this episode, we dissect the alarming 75.6% rise in private equity (PE) ownership of US psychiatric hospitals and unpack the central paradox from a landmark 2025 JAMA Psychiatry study: how do these facilities operate with significantly fewer nurses and social workers, yet report better outcomes on official quality metrics like restraint use and readmissions? We deconstruct this quality illusion, revealing how self-reported data, administrative gaming, and the strategic "cream-skimming" of less-ill patients can mask the erosion of care. Drawing stark warnings from the devastating impact of PE in other sectors—where the model is linked to increased patient mortality—we provide a critical guide for clinicians to navigate a healthcare landscape where the pursuit of profit often conflicts with the mission of healing.