Psychofarm Podcast

ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen Eller 17.06.2026 54min

Unfortunately no Dr. Fu today, but Dr. Malzberg speaks with the wonderful psychiatrist Dr. Mary Ellen Eller, who walks through what modern electroconvulsive therapy actually looks like and when clinicians should consider it. The episode covers ECT history, stigma, seizure monitoring, memory concerns, side effects, and the real-world logistics patients face during a treatment course. It also explores where ECT fits in the algorithm for severe depression, depression with psychosis, catatonia, bipolar mania. The result is a grounded, clinician-friendly guide to a misunderstood treatment. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Suicide Risk Assessment: Acute vs Chronic Risk, Formulation, and Suicidal Ideation Types 02.06.2026 1h 3min

Suicide risk assessment is often taught like a checklist, but this episode argues that the real work is formulation. We talk about why history is only the starting point, how acute and chronic risk differ, and why suicidal ideation can mean very different things depending on context. We cover stress-related suicidality, intoxication, baseline recurrent thoughts, mood and psychotic disorders, OCD intrusive thoughts, hospitalization decisions, red flags, countertransference, and documentation. The result is a practical psychiatry conversation for clinicians and trainees who want to think more clearly about suicide risk without pretending they can predict the future. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDD 19.05.2026 1h 14min

Psychiatrists rank antidepressants for major depressive disorder, including SSRIs like sertraline, escitalopram, fluoxetine, and paroxetine; SNRIs like venlafaxine and duloxetine; and atypical options like bupropion and mirtazapine. They also cover lithium, low-dose aripiprazole, trazodone, esketamine, stimulants, benzodiazepines, TCAs, and MAOIs, with emphasis on diagnosis, side effects, withdrawal, weight gain, sexual dysfunction, anxiety, insomnia, and why “which antidepressant is best” depends on the patient. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment Skill 05.05.2026 52min

Mindfulness in psychiatry is the focus of this episode, with Doctors Malzberg and Fu treating it as a practical clinical skill rather than vague wellness advice. They define mindfulness as deliberate attention to the present moment without judgment, then connect it to DBT, MBCT, ACT, anxiety, depression, PTSD, substance use, and trauma-informed care. The conversation also covers when mindfulness should be modified, why it is not always a standalone treatment, and how clinicians can teach it through short, scheduled practice, DBT “what skills,” grounding techniques, and careful follow-up. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Psychiatric Technique for Diagnostic Interviewing and Therapy: 6 Mantras Every Clinician Should Know 21.04.2026 46min

Psychotherapeutic techniques are the subject of this episode, as the conversation lays out six memorable therapy mantras for better diagnosis, formulation, and treatment. Rather than focusing on abstract theory, the discussion shows how clinicians can stay close to patient material, clarify vague symptom language, notice countertransference, rewind key moments, and make links that improve both psychotherapy and medication management. It’s a practical lesson in interviewing: ask simpler questions, tolerate not knowing too quickly, observe contradictions, and avoid getting lost in content when the process is where the diagnostic data actually lives. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Psychodynamic Technique and Therapeutic Intervention: Containment 08.04.2026 58min

Psychodynamic technique is the throughline of this episode, which argues that the core skills of therapy belong at the center of psychiatry, not at the margins. The conversation maps five levels of intervention, from level zero through interpretation, while stressing that the most important work usually happens earlier: frame, alliance, follow the affect, and technical containment. Rather than glamorizing clever interpretations, the episode shows why reflective listening, emotionally accurate language, and careful therapeutic interventions help patients think, regulate, and elaborate on their experience. It’s a practical discussion for clinicians who want to improve interviewing, formulation, and treatment across everyday psychiatric practice.Lots of material from this lecture is from here: https://www.appi.org/Products/Psychotherapy/Clinician-Technique-in-Personalized-Psychotherapy This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Tips to Avoid Burnout in Psychiatry (Outpatient, mostly) 24.03.2026 55min

In this episode, Dr. Fu and Dr. Malzberg share practical systems for time protection: start on time, end on time, finish documentation inside the visit, and use tools like AI scribes and quiet typing gear. They also lay out clear messaging rules so emails, texts, and forms do not become off-the-clock clinical care, plus the value of emergency slots. The deeper work is emotional: process the job with mentors or supervision, know your limits, and build a real life outside medicine so you can stay effective for the long game. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

CPTSD vs BPD: How to Think About the Difference and What to Do About It 10.03.2026 56min

In this episode, Dr. Malzberg and Dr. Fu tackle one of psychiatry’s hottest diagnostic debates: complex PTSD versus borderline personality disorder. They walk through the DSM-5 and ICD-11 definitional differences, the historical roots of the C-PTSD concept in Judith Herman’s work, and the real clinical distinctions clinicians can use to differentiate the two. More than a theoretical argument, the conversation zeroes in on how to communicate these diagnoses to patients, why BPD stigma drives some of the debate, and what therapies fit each presentation… from DBT and mentalization-based therapy to EMDR and trauma-focused approaches. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Detecting Subtle Signs of Psychosis: Assessment of Voices, Delusions, and Psychosis 24.02.2026 35min

Subtle psychosis can be missed when you rely on checklists or slip into an interrogator stance. We break down a clinician-friendly approach to detecting psychosis early: use countertransference as a signal, mirror emotion without agreeing with delusions, and clarify the patient’s narrative without derailing it. You’ll also get an OLDCARTS-style framework for taking a voice-hearing history (onset, location, duration, character, and more), plus practical alliance moves for paranoia. We close with how to bridge the treatment gap once you’re seeing the pattern clearly. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening Questions 10.02.2026 54min

Bipolar diagnosis is tricky without labs, so this episode lays out a practical, semi-structured interview you can use in real clinics. We start with what many clinicians skip: a medication and substance timeline, plus medical causes, before jumping into mood symptoms. Then we map major depressive episodes, screen for hypomania with narrative follow-ups, and compare behavior to baseline instead of trusting yes/no answers. Along the way we cover classic pitfalls and mimics, including PTSD insomnia, borderline traits, psychosis-related agitation, and ADHD mislabeling. Finally, we talk about when tools like the MDQ or Rapid Mood Screener help, and why collateral history can change the case. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

What Makes a Belief a Delusion? Delusions, Thought Disorder, the TALD Scale 27.01.2026 45min

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.docxUnderstanding Delusions Paper: https://journals.lww.com/inpj/fulltext/2009/18010/understanding_delusions.2.aspx This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the Differential 13.01.2026 1h

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Top 10 Things to Know About Clozapine 29.12.2025 45min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Disability Claims 101 for Psychiatrists: Programs, Pitfalls, and Practical Steps 09.12.2025 1h 8min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

How to Decide When ADHD Is Actually ADHD 25.11.2025 56min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Why the Therapeutic Alliance Matters in Psychiatry: Recognizing and Repairing Ruptures with Dr. Catherine Eubanks 11.11.2025 55min

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 WorkshopAlliance 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 psychologistsDescription: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=oddtdtcreatorRecommended Books & VideosTherapist Performance Under Pressure: Negotiating Emotion, Difference, and Ruptureby Catherine Eubanks & J. Christopher Muranhttps://www.apa.org/pubs/books/therapist-performance-under-pressureRupture 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-psychotherapyVideo: Rupture and Repair in Psychotherapyhttps://www.apa.org/pubs/videos/rupture-repair-psychotherapyAlliance-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-trainingaVideo: Using Alliance-Focused Traininghttps://www.apa.org/pubs/videos/using-alliance-focused-training This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

ADHD Is Not the Only Diagnosis: Differential and Diagnostic Hierarchy 04.11.2025 1h 5min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Is Psychoanalysis Still Relevant in Modern Psychiatry? 21.10.2025 50min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary Admissions 07.10.2025 1h 7min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

How to Do a Psychiatric Intake | The Art and Science of the First Hour 17.09.2025 58min

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com