Thinking In Psychiatry

View the mentioned paper here:

Memantine to Treat Social Impairment in Youths With Autism Spectrum Disorder
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839518

Access the mentioned course here:

Understanding Autism Spectrum Disorder: A Comprehensive Guide to Clinical Assessment & Diagnosis
https://psychscene.co/4zXOHNW 

In this video, Dr Sanil Rege examines a 2025 randomised controlled trial of memantine for social impairment in young people with Autism Spectrum Disorder (ASD).
 
He explores whether memantine can improve social functioning and outlines how glutamatergic dysregulation, NMDA receptor modulation, and elevated anterior cingulate glutamate may help identify a biologically responsive subtype. He also considers how this may move the field beyond viewing autism as a single, uniform condition.
 
This session provides clinicians with a neurobiological framework for understanding autism through biomarkers, circuit dysfunction, and emerging precision psychiatry principles.
  
Chapters:
- Memantine for Social Impairment in Autism
- Why Autism May Not Be One Uniform Condition
- Trial Design and Participant Profile
- pGACC Glutamate as a Biomarker
- Response Rates and Subgroup Findings
- NMDA Receptors and Glutamatergic Mechanisms
- Memantine Versus Ketamine
- From Autism Spectrum to Neurobiological Subtypes
 
#Autism #Memantine #Psychiatry 

Access mentioned course here:

Advanced Psychiatric Formulation and Strategic Management Masterclass

https://psychscene.co/3Rn0Sm3 

Here is the link to the paper mentioned:
Towards a Consensus Roadmap for a New Diagnostic Framework for Mental Disorders
https://www.sciencedirect.com/science/article/pii/S0924977X24007168 

In this episode, Dr Sanil Rege examines a 2025 ECNP consensus roadmap calling for psychiatry to move beyond descriptive diagnosis towards biology-informed, transdiagnostic, and mechanism-based models.

He explores how circuit biomarkers, inflammation, genomic overlap, digital phenotyping, and machine learning may refine patient stratification, treatment selection, and relapse prediction across traditional diagnostic boundaries.

This video provides clinicians with a neurobiological framework for shifting from label-based treatment to mechanism-informed formulation in psychiatric practice.

Chapters:
- A Roadmap for Mechanism-Based Psychiatry

- Why Labels Alone are No Longer Enough

- Shared Vulnerabilities Across Diagnostic Boundaries

- Neurocircuit Profiles and Treatment Response

- Inflammation and Targeted Intervention

- Data-Driven Subtypes and Machine Learning

- Biomarker-Enriched Trials and Future Drug Development

- Clinical Pearls for Mechanism-Informed Formulation 

#Psychiatry #DSM5 #ICD11

Access the mentioned paper here:

Trying to Unravel Why Alzheimer Disease Is More Common in Women

By Rita Rubin, MA

https://jamanetwork.com/journals/jama/article-abstract/2839498# 

Access mentioned courses here:

Women’s Mental Health Course:

https://psychscene.co/41RwJx2

Alzheimer’s Disease Course:

https://psychscene.co/4vNaeqH 

In this episode, Dr Sanil Rege examines why Alzheimer’s disease is more common in women and what this means for clinical assessment, prevention, and treatment.

The discussion reviews a 2025 JAMA medical news feature (https://jamanetwork.com/journals/jama/article-abstract/2839498#) on sex differences in Alzheimer’s disease and outlines a life-course model showing how sex-related vulnerability may shape disease onset, progression, and clinical expression.

This video provides clinicians with a sex-informed clinical framework for assessing Alzheimer’s risk in women through the lens of hormonal transitions, cognitive reserve, and later-life neurodegenerative expression.

Chapters:

00:21 Alzheimer’s Disease in Women

02:59 Beyond Longevity

03:40 Survival Differences After Dementia Diagnosis

04:34 Tau Pathology and Steeper Later Decline

06:00 Menopause and Hormonal Vulnerability

08:11 Modifiable Midlife Risk Factors in Women

13:18 A Sex-Informed Life-Course Formulation1

#Alzheimer's #Psychiatry #Dementia

Here are the links to the papers mentioned:

Parkinson’s disease as a somato-cognitive action network disorder

Ren et. al.

https://psychscene.co/4vQKgmc 

The brain’s action-mode network

Dosenbach et. al.

https://psychscene.co/4ts1pRr 

Access mentioned courses here:

Advanced Psychiatric Formulation and Strategic Management:

https://psychscene.co/4sG214L 

ADHD Masterclass:

https://psychscene.co/4sJ1GOS 

In this video, Dr Sanil Rege examines the Action Mode Network as a unifying clinical framework for understanding how the brain regulates action, arousal, body state, and cognition.

He explores the counterbalance between action mode and default mode, showing how impaired initiation, hyperarousal, poor state shifting, and social withdrawal may be better understood as disturbances of mode regulation rather than isolated symptom categories.

This session provides clinicians with a neurobiological framework for refining psychiatric formulation through the lens of state regulation, brain–body integration, and network-based clinical reasoning.

Chapters:

01:32 – Introducing the Action Mode Network

03:17 – The Brain as an Organ Organised for Action

05:48 – Action Mode vs Default Mode

07:18 – Psychiatric Syndromes as Mode-Switching Disorders

09:48– Overcoming the False Dichotomy of Mind and Body

12:25 – The PACES Model in Clinical Formulation

14:48 – Translating State Regulation into Clinical Practice

#ActionModeNetwork #Psychiatry #Brain

Access the mentioned courses here:

Sleep And Psychiatry:
 
https://psychscene.co/46d0T09

ADHD and Sleep Dysfunction:

https://psychscene.co/4rrE9Cc

In this episode, Dr Sanil Rege explores the "how and why" of sleep by analysing a 2025 Neuron perspective paper (https://pubmed.ncbi.nlm.nih.gov/40961940/) detailing the interplay between sleep, motor circuits, and catecholamine biology.

The discussion unpacks the motor theory of sleep, in which sleep control is embedded within somatic and autonomic motor circuits, and the catecholamine hypothesis, which posits that a core biological function of sleep is the inactivation of dopamine, noradrenaline, and adrenaline.

This podcast provides clinicians with a neuroscientific framework for understanding sleep as an active state transition involving a global downshift of somatic and autonomic motor systems.

#Sleep #Neuropsychiatry #Insomnia

Access mentioned course here: https://psychscene.co/46iAaiI

In this episode, Consultant Psychiatrist, Dr Sanil Rege examines the complex relationship between ADHD pharmacotherapy and the emergence of psychotic symptoms.

By analysing synthesis data from The Lancet Psychiatry (https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00248-2/abstract), the podcast distinguishes between drug-induced events and baseline neurobiological vulnerabilities inherent in ADHD populations.

This podcast provides clinicians with a neuroscientific framework for differentiating between protopathic bias and true medication-induced psychotic phenomena, as well as a step-wise screening pathway for risk-guided prescribing using validated at-risk mental state (ARMS) triage tools.

To get access to the complete podcast catalog and material like this plus over 150 hours of interactive CPD education on psychiatry, check out The Academy using the link below:

https://psychscene.co/45M67jh

Access mentioned courses here:

Clinical Audit On Cognitive Aspects of Depression: 

https://psychscene.co/3Z2EdvH

The Aggregation of Marginal Gains as a Philosophy of Clinical Care with Prof Michael Berk: 

https://psychscene.co/4rqS62V

In this episode, Dr Sanil Rege examines the KARMA-Dep 2 trial, a randomised controlled trial comparing adjunctive serial ketamine infusions to midazolam for patients with Treatment-Resistant Depression (TRD) in an inpatient setting.

Based on a JAMA Psychiatry article titled “Serial Ketamine Infusions as Adjunctive Therapy to Inpatient Care for Depression,” the discussion explores why statistically insignificant differences between ketamine and psychoactive comparators necessitate a shift in how clinicians evaluate rapid-acting antidepressants, detailing the "wow effect" of early symptomatic drops and the subsequent plateauing of recovery curves.

This podcast provides clinicians with a clinical framework for differentiating between acute symptomatic response and long-term functional recovery in TRD.

Chapters:

00:22 - The KARMA-Dep 2 Trial Headlines 
03:44 - Primary Outcomes: Ketamine vs. Midazolam Results
04:26 - Analysing the Curves: The "Wow Effect" vs. Sustained Recovery
08:50 - Neurobiology of Response vs. Neurobiology of Recovery
09:21 - Why Improvement Stalls: The Role of Neuroadaptation
10:47 - Clinical Implications for Inpatient Care

To get access to more materials like this plus over 150 hours of interactive CPD education on psychiatry, check out The Academy using the link below:

https://psychscene.co/4rl6pFV

Access the mentioned course ‘Antipsychotic Induced Weight Gain and Metabolic Syndrome (MetS)’ here: 

https://psychscene.co/4a62kQa

In this episode Consultant Psychiatrist, Dr Sanil Rege, explores the complex neurobiology of appetite regulation, diving deep into the nuances of the brain-gut-microbiome system.

Based on a recent New England Journal of Medicine (NEJM) review titled “The Physiology of Hunger,” the discussion examines hunger not as a matter of willpower, but as a sophisticated interaction between the brain, gut, and microbiome.

This podcast provides clinicians with a pathophysiological framework for differentiating between energy balance systems, reward-based drives, and microbial metabolites to better manage obesity, anorexia nervosa, and the cautious implementation of GLP-1 receptor agonists.

To get access to more material like this plus over 150 hours of interactive CPD education on psychiatry, check out The Academy using the link below:

https://psychscene.co/4t8d6gy

#HungerPhysiology #Neuroscience #MetabolicHealth

To access the full episode and over 150+ hours of cutting-edge, interactive courses on Psychiatry subscribe to The Academy: https://psychscene.co/4qfNAny

In this episode, Consultant Psychiatrist, Dr Sanil Rege looks at treatment refractory mood disorders through a psychodynamic lens using a naturalistic study from the Austen Riggs Centre. 

A subset of what most see as Treatment-Resistant Depression (TRD) isn't just pharmacological non-response; it's depression embedded within personality organisation, trauma-related aspects, attachment, and unconscious patterns. 

This podcast provides clinicians with a psychodynamic perspective to understand how clinical refractoriness to standard pharmacotherapy can be sustained by meaning, defences, and relational patterns, not just neurotransmitters.

To access all episodes plus 150+ hours of advanced psychiatric education, join the Academy today. Get access here:

https://www.academy.psychscene.com/

In this episode, we explore a groundbreaking 2025 Neuron paper that reframes how sleep is generated in the brain, and why we sleep at all.

Instead of a single “sleep centre,” sleep emerges from a distributed network embedded within motor and autonomic circuits. The authors also propose a unifying “catecholamine hypothesis” explaining sleep’s restorative functions across brain, immune, and metabolic systems.

We break down what this means for clinicians, how it updates classic models of sleep–wake regulation, and why dysfunction in these systems manifests across psychiatry.

To access all episodes of this podcast plus 150+ hours of advanced psychiatric education, join the Academy today. Get access here:

https://www.academy.psychscene.com/