The Journal of Clinical Psychiatry Podcast

Dr. Gary W. Small, Director of Behavioral Health Breakthrough Therapies at Hackensack Meridian Health and Professor of Psychiatry and Behavioral Health at the Hackensack Meridian School of Medicine, shares decades of clinical and research insight as he discusses the early detection and treatment of age-related cognitive decline. In this episode, he explores the continuum from normal aging to mild cognitive impairment to dementia, the real-world role of biomarkers, the promise and limits of current pharmacologic options, and the lifestyle interventions—especially aerobic exercise—with the strongest data behind them.

For most patients, cognitive decline unfolds gradually rather than suddenly, and the tools we have to detect it have outpaced the clarity of what to do next. Amyloid and tau assays, PET imaging, and APOE genotyping are increasingly available in primary care, but they raise as many questions as they answer, and disclosure can have real psychological consequences. Emerging evidence points to inflammation as a shared mechanism across many forms of decline, with anti-inflammatory drugs, curcumin, Omega-3s, sleep, and exercise all converging on the same target. Dr. Small frames a pragmatic, patient-centered approach: educate, contextualize tests, rule out reversible causes, treat symptomatically and aggressively when appropriate, and above all, move.

🧠 PROTECT, DON’T REPAIR [05:10]:

“It’s easier to protect a healthy brain rather than try to repair damage once it becomes extensive.”

Dr. Small articulates the case for early detection and prevention that has shaped his entire career.

🔬 TREAT THE PERSON, NOT THE SCAN [23:40]:

“You don’t treat a blood test, you treat a person. The good news with some of these early anti-amyloid drugs—the brain scan looks great. The bad news is, you’re going to forget this conversation.”

Dr. Small urges clinicians to resist reflexive, biomarker-driven treatment and instead anchor decisions in symptoms, goals, and risk–benefit conversations.

🏃 ONE RECOMMENDATION ABOVE ALL [44:50]:

“Physical exercise. There’s no question about it. We have the strongest data on it… Get on the treadmill, or even better, get outside and take a brisk walk or jog.”

Asked for a single, universal recommendation for brain health, Dr. Small is unequivocal.

CHAPTERS:

00:00 - Introducing Dr. Gary W. Small

02:20 - From Math to Metaphysics to Medicine

03:30 - Finding a Path into Psychiatry

04:20 - The Road to Geriatric Psychiatry and the Case for Early Detection

06:10 - Defining the Continuum: Normal Aging, MCI, and Dementia

09:00 - Interpreting Cognitive Complaints and the Weight of Information

12:30 - The Biology of Cognitive Decline and the Role of Inflammation

16:00 - What Is Lost When We Wait, and the Curcumin Story

20:20 - The PCP’s Role in Early Intervention and Lifestyle Counseling

22:10 - Biomarkers and Imaging: From Research Tool to Clinical Reality

25:00 - Biomarker vs. Surrogate Marker

27:20 - Differential Diagnosis and the Brain as a Rheostat

29:30 - Pharmacologic Treatment: Symptomatic vs. Disease-Modifying Drugs

32:40 - Lifestyle Modification and the Evidence for Aerobic Exercise

35:40 - Train, Don’t Strain: Exercising the Mind Socially

37:50 - Knowing When to Refer and Building Specialist Relationships

41:00 - Comorbid Conditions and the Whole-Person Approach

42:40 - Looking Ahead: The Next 5–10 Years

44:20 - The Single Best Recommendation: Physical Exercise

45:30 - Closing Thoughts

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep14-early-detection-cognitive-decline-gary-w-small/

Journal of Clinical Psychiatry: https://www.psychiatrist.com/jcp/

Dr. Gary W. Small: https://www.hmhn.org/find-a-provider

#CognitiveDecline #AlzheimersDisease #GeriatricPsychiatry #BrainHealth

Dr. Roger S. McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto, shares groundbreaking insights as he discusses the profound connection between metabolism and mental well-being. In this episode, he explores how GLP-1s treat psychiatric illness and common metabolic comorbidities.

The historical reliance on serotonin, norepinephrine, and dopamine models has proven incomplete, and many individuals with psychiatric illness continue to struggle with inadequate care. New science suggests a deeper connection between metabolism and brain health which challenges long-held beliefs about disease causes. Emerging research highlights how metabolic disruptions contribute to mental health conditions, and that GLP-1 drugs offer a path forward as they could treat mental health conditions and common metabolic problems. In essence, they have the potential to bring about profound improvements in mental health and overall well-being.

⚠️ BEYOND NEUROTRANSMITTERS [07:53]:

"For seven decades, we've really been at this altar of serotonin, norepinephrine and dopamine… That paradigm has been remarkably durable… but it's not been fully explanatory. Most people do not benefit adequately from current treatments."

Explaining why traditional models are incomplete, Dr. McIntyre shows how new science offers hope.

💊 COMBAT MEDICATION SIDE EFFECTS [45:34]:

"Clinicians would be certainly on a reasonable evidentiary base of practice if they were prescribing a GLP-1 to target, for example, clozapine-induced weight gain or clozapine-induced diabetes, that would be reasonable."

Dr. McIntyre offers a proven strategy for mitigating adverse effects of psychiatric medications.

🚀 TRANSFORMING LIFESPANS [01:04:30]:

"GLP-1s… have the potential to transform the health span and the lifespan of people living with mental illnesses by targeting on-label considerations today and potentially targeting the underlying pathophysiology of the brain-based disorder tomorrow. So stay tuned."

Revealing the future of mental health, Dr. McIntyre presents a vision that offers new hope for long-term well-being.

CHAPTERS:

00:00 - Why GLP-1 Drugs Are Transforming Mental Health Research

03:08 - The Career Shift That Linked Metabolism and Mood Disorders

06:45 - Moving Beyond Serotonin to Metabolism

13:18 - How GLP-1 Drugs Influence Brain Function and Neuroplasticity

23:40 - Can GLP-1 Medications Reach the Brain? What the Evidence Shows

32:00 - The Four Key Brain-Protective Effects of GLP-1 Therapies

34:54 - How GLP-1 Reduces Cravings, Addiction, and Food Noise

42:18 - When Clinicians Should Prescribe GLP-1s in Psychiatry Today

53:10 - Safety Risks and Drug Interactions Psychiatrists Must Consider

01:00:57 - The Future of Treatments in Psychiatry

01:04:27 - Summing Up GLP-1s and Mental Health

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep13-emerging-role-glp-1s-psychiatry-roger-s-mcintyre/

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Dr. Roger S. McIntyre: https://www.linkedin.com/in/roger-mcintyre-976bb167/

#GLP1Drugs #AddictionTreatment #DepressionTreatment #MentalIllnessPrevention

Dr. A. John Rush, renowned for leading the famous STAR*D depression study, addresses a critical challenge in modern psychiatry: while physicians often rely on their clinical intuition to treat complex depression, new data proves this approach has a significant blind spot. Experience alone can miss the full extent of a patient's suffering, leaving crucial progress untracked.

Dr. Rush reveals a system to fix this clinical blind spot using the psychology of clinical measurement. He explains how doctors can implement simple assessment tools to gather objective data, leading to more precise treatment adjustments. This straightforward method gives physicians the power to see what is truly working and can significantly boost patient remission rates.

🎯 BIGGEST LESSON [12:17]:

"By bringing measurement to the bedside, we bring precision and science. The evidence is very clear right now. We make better decisions about what to do with patients."

🎯 OTHER KEY TAKEAWAYS:

⚠️ THE HIDDEN GAP IN PSYCHIATRIC CARE [8:10]:

"We don't know anything about in what order, in what combination, and by what methodology we implement that 'what'."

Dr. Rush explains why knowing a treatment can work is only half the battle. This is the crucial gap between research and real-world results that most clinicians overlook.

✨ WHY 'PROVEN' TREATMENTS FAIL YOUR PATIENTS [20:45]:

"Does this apply to everybody with depression, no matter how they show up? Absolutely not. That's where it really gets very, very interesting because now we're going from efficacy research to effectiveness research."

Learn the critical difference between a treatment working in a controlled trial versus in your complex, real-world patient population.

⚡ THE LAW OF DIMINISHING RETURNS IN DEPRESSION [34:57]:

"The more steps you take, the problem is, the less likely you are to get into remission. So remission rates were like 35% in the first step, 28% in the second step, 15% in the third step, 15% in the fourth step."

Dr. Rush reveals the stark data from the STAR*D study. Use this critical insight to set realistic expectations with patients about the challenges of treatment-resistant depression.

CHAPTERS:

00:00 - Introducing Dr. A. John Rush

02:20 - Why Dr. Rush Chose Psychiatry & a Career in Clinical Research

05:45 - How Cognitive Therapy Shaped Evidence-Based Psychiatry

07:10 - Strategies, Tactics, and the Research Gap

10:59 - Using AI & Clinical Data to Guide Treatment Decisions

18:39 - Why Clinical Trial Results Don't Match Real-World Patients

22:54 - Pragmatic Trials That Reflect Everyday Psychiatric Practice

30:48 - The STAR*D Trial: Sequencing Treatments for Depression

36:32 - Dose Optimization & Long-Term Depression Recovery

39:56 - Building a Learning Healthcare System in Psychiatry

43:48 - Dr. Rush’s Advice for Researchers and Clinicians

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep12-bridging-research-reality-mental-health-care-a-john-rush

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Dr. A. John Rush: https://www.linkedin.com/in/a-john-rush-8aa46042/

American Psychiatric Association (APA) Website: https://www.psychiatry.org/psychiatrists/research/registry

#Psychiatry #ClinicalResearch #Depression

Families expect cognitive decline as a normal part of getting older. We watch relatives lose their memories and accept the loss. Past medical trials regarding Alzheimer's disease failed 99 percent of the time, early signs of brain changes were missed, and precious years for early screening and treatment were lost.

But new science changes this reality. Doctors now use blood tests and brain imaging for accurate diagnosis. They prescribe immunotherapy treatments that clear toxic brain plaques and slow cognitive decline by 30 percent. Dr. Marc Agronin shares his exact methods for geriatric psychiatry and dementia care. Learn how early medical intervention stops memory loss as he reveals his new research.

🎯 PRIMARY DISCOVERY[19:51]:

"Someone goes from thinking, ‘I have a terminal disease,’ to ‘I have a manageable disease and I am going to continue to live and do things.’ Their whole mindset changes."

Dr. Agronin reveals the exact medical advancements that give patients their lives back.

🩺 PRACTICE UPGRADE [30:56]:

"We have all sorts of vital signs we check by routine. We need to have a cognitive vital sign that we check, and something like a Mini-Mental, Montreal Cognitive Assessment, something like that is practical to be done in primary care."

Discover how doctors catch memory loss early with simple annual tests.

✨ MEDICAL MILESTONE [46:29]:

"We see over the 18 months of the studies that the rate of decline in terms of both cognition and function is on average about 30 percent slower. And then we know that after 18 months, it is a very slow rate of reaccumulation."

Hear how new monoclonal antibodies melt away brain plaques and stop memory loss.

CHAPTERS:

00:00 - Meet Alzheimer’s Research Leader Dr. Marc Agronin

01:45 - Why a Career in Geriatric Psychiatry and Dementia Care?

06:17 - Why Alzheimer’s Research Is Entering a Breakthrough Era

08:07 - Why Alzheimer’s Disease Is Rising Worldwide

11:04 - How to Explain Alzheimer’s Diagnosis to Patients and Families

16:11 - The Biggest Scientific Breakthroughs in Alzheimer’s Disease

24:30 - How New Biomarker Guidelines Are Changing Alzheimer’s Diagnosis

29:57 - Why Early Screening for Cognitive Decline Matters

36:13 - Brain Health Habits That May Reduce Alzheimer’s Risk

42:50 - Current Alzheimer’s Medications and How They Help Cognition

45:45 - New Anti-Amyloid Treatments That Slow Alzheimer’s Progression

50:01 - Understanding ARIA Side Effects in Alzheimer’s Immunotherapy

54:09 - Emerging Alzheimer’s Treatments and Future Research Directions

01:02:09 - The Role of Empathy and Person-Centered Dementia Care

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep11-what-clinicians-should-know-about-alzheimers-treatment-marc-agronin/

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Dr. Marc Agronin: https://www.marcagronin.com/

Figure referenced at 53:35 comes from Figure 1 in the paper “Alzheimer’s Disease Drug Development Pipeline: 2025.”: https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/trc2.70098

#AlzheimersResearch #BrainHealth #GeriatricPsychiatry

Psychiatric hospitals admit patients for severe mental illness and high suicide risk every day. While mental health professionals treat acute suicidality during these intense crises, standard depression medications can take weeks to work. Traditional clinical psychiatry often leaves vulnerable patients in danger after hospital discharge. Medical teams need rapid suicide prevention treatments to help stabilize psychiatric inpatients quickly.

Learn about potential improvements to inpatient suicide care as Dr. Brett Jones, Medical Head of the Bipolar Disorder Clinic at Toronto’s Center for Addiction and Mental Health, reveals the results of his research review into the best evidence-based medical interventions.

🎯 KEY EPISODE HIGHLIGHTS:

🛑 RESEARCH BLINDSPOT [10:25]:

"I think there are a lot of studies out there. I was reading, I was seeing the evidence, but the consensus as to what would be the most effective treatment and for whom really wasn't there."

Hear Dr. Jones explain the massive missing piece in psychiatric care.

🧠 CLINICAL BREAKTHROUGH [23:45]:

"Some of the chronotherapy was something I actually didn't know about. That certainly is a low cost intervention. So that's quite promising if it turns out to be effective."

See how simple sleep treatments change inpatient psychiatry.

🛠️ STRATEGIC ACTION [34:50]:

"We showed a good effect with a digital version of DBT… So we're going to look at trying to replicate that in a multicenter study."

Get the exact details on digital therapy for hospital units.

CHAPTERS:

00:00 - Honoring Dr. Nolan Williams

03:07 - Career Path into Psychiatry and Suicide Research

07:59 - Why Inpatient Suicide Treatment Needs Better Evidence

12:59 - Key Limitations in Suicide Intervention Research

14:57 - Ketamine and Rapid Acting Treatments for Suicidality

19:48 - Emerging Treatments Beyond Traditional Depression Care

25:47 - Translating Research into Real World Inpatient Practice

30:38 - Major Research Gaps and Need for Better Clinical Trials

33:04 - Hospitalization as a Critical Window to Prevent Suicide

37:41 - Up Next: Dr. Marc Agronin

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep10-inpatient-treatment-suicidality-brett-jones/

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials:

https://pubmed.ncbi.nlm.nih.gov/39832343/

Dr. Brett Jones: https://www.linkedin.com/in/brett-jones-1b308260/?originalSubdomain=ca

Center for Addiction and Mental Health: https://www.camh.ca

University of Toronto Psychiatry: https://psychiatry.utoronto.ca

#AcuteSuicidality #InpatientPsychiatry #ClinicalResearch

Feeling tired despite a full night's sleep? The problem may not be the hours you get, but the quality of your breathing. According to sleep medicine expert and founding physician of SLIIIP, Dr. Avinesh Bhar, many people dismiss fatigue, snoring, or frequent waking, using caffeine and over-the-counter aids to cope.

This masks a deeper problem. Undiagnosed sleep-disordered breathing, like sleep apnea, is a silent driver of serious health issues, from heart disease to mental health conditions. Ignoring the root cause makes other medical treatments less effective, creating a cycle of declining health. 90% of people with mental health conditions also struggle with sleep issues. Getting help is easy at SLIIIP.com. No travel required. Insurance accepted.

🎯 KEY EPISODE TAKEAWAYS:

⚠️ THE SURVIVAL MODE TRAP [08:49]:

"If you don't sleep well, your whole day changes in perspective. You are in survival mode, and you can't be your best self. You can't perform."

Are you just surviving instead of thriving? Watch this segment to understand the biological cost of poor sleep and why feeling "just okay" is a major red flag for your health.

✨ THE MENTAL HEALTH BREAKTHROUGH [29:24]:

"If you're a therapist or psychiatrist managing mental health, you should also make sure the sleep is evaluated…otherwise, your improvements in mental health aren't going to reach the level that actually makes the patient feel like they've actually turned the corner.”

Unlock better patient outcomes. See how integrating a sleep evaluation can be the missing piece in treating depression, anxiety, and PTSD effectively.

⚡️ THE 2-QUESTION DIAGNOSTIC [59:40]:

"'Are you sleeping well? Are you waking up refreshed?' If you have a 'no' to either one of those questions, the patient needs an evaluation."

This is the simple, powerful framework you need. Listen to this section to learn the exact questions that tell you if it's time to refer a patient (or yourself) to a sleep specialist and how easy it is via www.sliiip.com. SLIIIP is making advanced sleep care fast & convenient, offering patients same week appointments with board-certified sleep medicine physicians instead of the months‑long wait typical of traditional sleep labs.

CHAPTERS:

00:00 - Introducing Dr. Avi Bhar

03:48 - From ICU to Sleep Medicine and What Clinicians Miss

06:52 - What Sleep Does Biologically and Why Quality Beats Hours

13:23 - Sleep Myths That Keep You Sick and Tired

16:24 - Sleep Hygiene That Works

19:54 - When to Suspect a Real Sleep Disorder Beyond Stress

23:00 - How Sleep Apnea Drives Heart, Metabolic, and Inflammatory Disease

27:51 - Sleep and Psychiatry

30:35 - Solving Access With Home Sleep Tests and Step-Based Care

39:33 - The Ideal Telemedicine Sleep Care Pathway

48:28 - Stop Masking Sleep Problems With OTC Aids and Melatonin

52:33 - When to Retest and How Treatment Lowers Long-Term Healthcare Costs

1:01:03 - Up Next: Dr. Brett Jones

Key Takeaways:

"Sleep is a reparative opportunity. It heals and repairs the trauma of the day. It's essential, not optional."

"Quality and quantity of sleep matter. Sleeping 7-8 hours is good, but waking refreshed is key."

"Sleep disturbances don't just coexist with illnesses; they can drive medical and psychiatric morbidity."

"Evaluate sleep in patients with mental health issues. It's both a driver and symptom of psychiatric illness."

"Speed and efficiency in sleep evaluation are crucial. It reflects the urgency and importance of the issue."

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep9-sleep-issues-psychiatric-practice-avinesh-bhar/

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

SLIIIP: https://sliiip.com/

#SleepApnea #MentalHealth #SleepDisorders

Ben welcomes psychiatrist Dr. Mike Halassa back to the podcast to discuss the shifting landscape of inpatient schizophrenia treatment. An early adopter of Cobenfy, Dr. Halassa shares real-world insights from his research published in Nature Mental Health in this conversation that bridges technical neuroscience with the high-stakes reality of managing acute psychiatric crises.

The discussion focuses on Cobenfy’s muscarinic mechanism, the first novel approach to psychosis in seventy years. Dr. Halassa details his "dose-sparing" strategy, reducing reliance on traditional D2 blockers and their metabolic burdens, and he shares case studies of treatment-resistant patients who succeeded on this agent after clozapine failed. Finally, Ben and Dr. Halassa explore functional recovery, precision psychiatry, and the empathic connection required to treat society's most vulnerable individuals.

Episode Highlights:

00:00 - Welcoming Back Dr. Mike Halassa

01:46 - ‘Spending a Day in Someone Else’s Brain’

04:21 - Empathy, Parenting, and Staying Grounded in Psychiatry

06:37 - Why Inpatient Psychiatry Works: Acuity, Speed, and Team-Based Care

09:31 - Evaluating Acute Psychosis: Intake, Chronicity, and Treatment Decisions

12:46 - Discovering XT as the First Novel Schizophrenia Mechanism in Decades

16:19 - A Remarkable XT Case Study

23:26 - XT Dosing Tolerability and Early Clinical Results

30:15 - From Observation to Evidence: Identifying XT Response Patterns

35:12 - Testing Negative Symptoms in Real Time on the Inpatient Unit

40:33 - XT vs D2 Blockers for Positive and Negative Symptom Control

50:28 - Redefining Success in Schizophrenia Through Functional Recovery

54:15 - The Future of Precision Psychiatry and Treating the Whole Person

56:42 - Up Next: Dr. Avi Bhar

Key Takeaways:

"Inpatient psychiatry demands quick thinking and rapid decisions. It's a critical care type environment."

"I find my kids keep me grounded and empathetic. They're my window into empathy."

"XT offers a fundamentally different way of engaging the system. It's not just another antipsychotic."

"Seeing patients become more socially connected on XT is remarkable. It's a new light in their eyes."

"Negative symptoms have been intractable. XT offers hope for functional recovery."

"The multidisciplinary team is crucial in schizophrenia care. It requires coordination and dedication."

"XT allows for dose sparing of traditional antipsychotics, potentially reducing side effects."

"We must aspire to help patients engage with life fully, beyond just managing symptoms."

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep8-early-use-xanomeline-trospium-michael-halassa/

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Dr. Halassa’s Substack: michaelhalassa.substack.com

The Halassa Lab: https://halassalab.tufts.edu/

Preliminary real-world predictors of response to muscarinic targeting in psychosis: https://www.nature.com/articles/s44220-025-00529-w

Real-World Implementation of Xanomeline-Trospium in Schizophrenia: A Consensus Panel Report: https://pubmed.ncbi.nlm.nih.gov/41201439/

Host Ben Everett sits down with Tufts University physician-scientist Dr. Michael Halassa to discuss algorithmic circuit psychiatry. This framework aims to modernize mental health care by mapping subjective experiences onto objective neural computations. By shifting focus to brain circuit mechanics, they explore a new paradigm for treating complex psychotic disorders. This conversation redefines psychiatry as a data-driven, precision-oriented field of medicine.

The episode moves beyond the "chemical imbalance" theory to examine the dynamics of excitation and inhibition. Dr. Halassa explains how large language models and machine learning provide new test beds for analyzing reasoning and belief updating, and that, by using "behavioral clamps" and task-based biomarkers, researchers can now operationalize delusions through the study of counterfactual decision-making. He also notes that causal circuit validation in animal models remains essential for identifying precise drug targets and improving clinical outcomes. The discussion finishes up by touching on emerging muscarinic therapies and the future of psychiatric training.

Episode Highlights:

00:00 – Why Algorithmic Circuit Psychiatry Could Modernize Mental Health Care

02:36 – From Physics to Psychiatry: Building a Scientist-Clinician Lens

05:52 – Decoding Brain Circuits With Computational Models and Modern Tools

10:37 – Returning to Inpatient Psychosis Care and Reframing Clinical Reality

14:47 – Moving Beyond “Chemical Imbalance” Thinking in Schizophrenia Treatment

20:43 – Fixing Computational Psychiatry Limits With Mechanistic, Circuit-Based Models

25:08 – Creating Task-Based Biomarkers to Measure Belief Updating and Reasoning

29:10 – Operationalizing Delusions Through Counterfactual and Decision-Making Tasks

33:59 – Translating Algorithms Into Drug Targets and Better Animal Research

37:54 – Using LLMs and Machine Learning to Test Psychiatric Mechanisms In Silico

44:57 – Redesigning Animal Models to Validate Causal Brain Circuit Algorithms

53:03 – Training the Next Generation for Precision Psychiatry

56:44 – Defining Clinical and Scientific Milestones for the Future of Mental Health Care

Key Takeaways:

"Psychiatry feels different from other fields. We don't have biomarkers to guide decision making."

"The brain functions in packets of information sent between areas. It's more complex than a single synapse."

"In psychiatry, you absolutely need a behavioral clamp. It's not just about resting state measurements."

"Machine learning was inspired by neuroscience. Now, it helps us understand altered thinking in machines."

"The burden is on us to train the next generation to tackle psychiatry's complexity."

"Talking to patients like equals is my default. We're all vulnerable to mental illness."

"Mental health is sidetracked by societal issues. We must agree we're all human beings."

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep7-algorithmic-psychiatry-michael-halassa/

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

“Developing algorithmic psychiatry via multi-level spanning computational models”:

https://pubmed.ncbi.nlm.nih.gov/40300598/

Dr. Halassa’s Substack: michaelhalassa.substack.com

The Halassa Lab: https://halassalab.tufts.edu/

Dr. David Feifel, Professor Emeritus of Psychiatry at UC San Diego and founding president of the Kadima Neuropsychiatry Institute, joins the JCP Podcast to kick off the new "Psychedelics in Psychiatry" theme. A pioneer in the field who established the world’s first ketamine infusion program for depression, Dr. Feifel sits down to discuss the paradigm shift currently reshaping mental health care.

In this installment of the Behind the Manuscript series, Dr. Feifel breaks down the findings of his recent JCP paper: “Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Depression”. He explains the significance of the 25mg dose in preventing relapse over 52 weeks and offers a critical look at why traditional SSRIs are no longer enough. Beyond the data, the conversation delves into the nuances of "set and setting," the controversy of microdosing versus "heroic" doses, and the practical challenges clinicians face as the field moves toward interventional psychiatry. Dr. Feifel also challenges the traditional medical view of the placebo effect, arguing that harnessing expectation may be the key to the next generation of healing.

Episode Highlights:

00:00 - Dr. David Feifel and His Breakthrough Career

02:13 - How Early Curiosity Led to Psychiatry Instead of Neurology

07:33 - Balancing Clinical Practice With Research Innovation

11:41 - Psychiatry Entering a Transformational New Era

13:51 - Why SSRIs Fall Short and TRD Demands Better Solutions

17:27 - What Makes Psilocybin the Leading Psychedelic Candidate

20:25 - Why the Psychedelic Renaissance Is Surging Now

25:42 - Microdosing Myths and the Power of Expectancy

33:55 - How Set and Setting Shape Psychedelic Treatment Outcomes

39:51 - Do Psychedelics Really Need Psychotherapy to Work

48:58 - Inside the Phase 2 Study and How TRD Patients Were Enrolled

56:04 - Why 25mg Psilocybin Delivered the Strongest Clinical Results

1:05:39 - What Long-Term Follow Up Reveals About Relapse and Durability

1:11:38 - How Clinicians Can Prepare for Psychedelic Medicine Adoption

1:16:53 - Why the Future of Psychiatry May Rely on Harnessing Placebo Power

Key Takeaways:

"Psychiatry is in the midst of a golden age revolution... I feel like every day I was going to war with Godzilla with a peashooter. Now I feel like we've got some real tools."

"We’re in the midst of what I call the Cambrian explosion of treatments... a massive explosion of life forms after a long time of stagnation."

"The concept of 'one and done' with psychedelics is dead. We aren't going to have patients come in one time and say, 'You're good for life.'"

"Doing ketamine is like doing psychotherapy, but you're both the psychotherapist and the patient at the same time."

Links:

Full transcript and show notes: https://www.psychiatrist.com/jcp/ep6-psychedelic-renaissance-david-feifel/

Journal of Clinical Psychiatry: http://psychiatrist.com/jcp/

Dr. David Feifel: https://www.linkedin.com/in/davidfeifel/

Kadima Neuropsychiatry Institute: https://www.kadimanp.com/

“Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Episode of Major Depressive Disorder”:

https://www.psychiatrist.com/jcp/long-term-follow-up-study-single-dose-psilocybin-treatment-resistant-episode-major-depressive-disorder/

Dr. Michael Asbach, Associate Director of Interventional Psychiatry at the DENT Neurological Institute and a nationally recognized educator, joins The JCP Podcast to discuss the critical and expanding role of Advanced Practice Practitioners (APPs) in behavioral health. With a background that spans from sports medicine to leading interventional psychiatric programs, Dr. Asbach offers a unique perspective on how the medical model training of Physician Assistants (PAs) uniquely positions them to address the growing psychiatric workforce shortage.

In a nuanced discussion, Dr. Asbach tackles the headlines and controversies surrounding the profession, including the recent British Medical Journal rapid review and the UK’s "Leng Report." He dismantles the concept of "scope creep," arguing instead for a model of "autonomous collaboration" that respects physician expertise while maximizing patient access. From the history of PAs emerging after the Vietnam War to the modern "Build, Baby, Build" approach to healthcare staffing, this episode provides a roadmap for how interdisciplinary teams can alleviate burnout and improve outcomes in the golden age of biologic psychiatry.

Episode Highlights:

00:00 – JCP Podcast Kickoff and Introduction to Dr. Asbach

01:34 – Expanding PA Engagement and Education in Psychiatry

03:22 – Career Origins and Choosing the PA Path Over Medicine

05:11 – Discovering Psychiatry and the Appeal of Interventional Innovation

08:46 – Mentorship, Research Culture, and Advancing Psychiatric Treatment

12:28 – Understanding PA Training Models and Evolving Clinical Competency

16:44 – Addressing Psychiatry Workforce Shortages Through Advanced Practitioners

20:36 – Evaluating PA Outcomes and Challenges in Measuring Quality of Care

29:24 – Rethinking Workforce Assumptions and Challenging Medical Dogma

32:37 – Regulation, Role Clarity, and Key Takeaways from the Leng Report

41:25 – Navigating Scope Creep Concerns and Physician Training Protection

47:51 – Building Effective Interdisciplinary Psychiatric Care Teams

56:44 – Supervision Ratios, Access Disruption, and Real-World Patient Impact

1:00:04 – Burnout, Non-Clinical Career Paths, and Retaining Expert Clinicians

1:08:09 – Future of Advanced Practice Providers and Closing Reflections

Key Takeaways:

"I think the future of advanced practice providers is going to be one that is collaborative, autonomous, and interdisciplinary."

"We are blessed to be able to play such an important role in people's lives... and have this front row seat to their life longitudinally."

"I’m very much a ‘build, baby, build’ approach to housing... Healthcare is very similar where the more people that we bring in as helpers, the better."

"Psychiatry is... in this golden era of kind of firmly returning back to biologic origin... and the PA medical model means that PAs have taken pathophysiology, gross anatomy, fundamentals of medicine."

"The absence of evidence is not the evidence of absence."

"It’s not about replacing physicians... but rather adjusting regulations to reflect the modern healthcare environment."

Links:

Journal of Clinical Psychiatry: psychiatrist.com/jcp/

Michael Asbach: https://www.dentinstitute.com/michael-asbach/

White Coats of the Round Table: https://healthpodcastnetwork.com/show/white-coats-of-the-round-table/