Psychiatry blog
Clinical teaching and practical ideas for your next study session.
Stimulant-Associated Psychotic Agitation: Treat Both Targets
When psychosis and methamphetamine exposure overlap, rapid tranquilization should not become a one-drug reflex. This case shows how to address acute arousal and psychotic symptoms as separate treatment targets while keeping medical evaluation active.
Adolescent Schizophrenia: When Two Trials Point to Clozapine
In an adolescent schizophrenia MCQ, two sequential trials of different antipsychotics at adequate doses for eight weeks each, with persistent symptoms, point to clozapine. Learn how to check trial adequacy, avoid pseudo-resistance, and remember monitoring caveats.
Actigraphy in Bipolar Sleep Assessment: Pattern, Not Diagnosis
Actigraphy can map rest and activity over time and may flag a change worth assessing, but it cannot establish that a bipolar mood episode is beginning or measure circadian phase on its own. Learn how to combine wrist data with a sleep diary, mood history, and the patient’s baseline.
Suicide Risk After Alcohol Intoxication: Reassess, Don’t Use a BAC Cutoff
A suicidal patient’s later denial after intoxication is new data, not an all-clear. Learn how to structure serial assessment, check the timeline against collateral, and make disposition from the whole picture—not a BAC or screening score.
CTO Renewal in Psychiatry: Is Recall Still Necessary?
At a CTO review, past nonadherence is evidence to weigh—not a standalone reason to continue compulsion. Learn to assess whether recall remains necessary, treatment is available, and a less restrictive plan could work.
SSD vs Illness Anxiety Disorder: When Symptoms Dominate
Severe chronic pain, headaches, or nausea shift the differential toward somatic symptom disorder, but do not prove it. Learn the criteria and interview questions that distinguish SSD from illness anxiety disorder.
Why PMDD SSRIs Can Work in Days: The Allopregnanolone Hypothesis
An illustrative patient with a prospectively charted cyclic pattern reports improvement after several days of an SSRI. Learn why rapid benefit is plausible in PMDD, what the allopregnanolone–GABA-A model proposes, and why neither the model nor early response establishes a diagnosis or mechanism.
Why Order TSH in Postpartum Psychosis? Read the Result, Not the Clue
A TSH in a postpartum psychosis question is a targeted check for thyroid dysfunction—not proof of postpartum thyroiditis or an endocrine cause. Learn to interpret results with free T4 while urgent psychiatric care continues.
Before PMDD Surgery: What a GnRH Agonist Trial Can Tell You
For severe, treatment-resistant PMDD, a GnRH agonist trial can inform decisions about irreversible ovarian surgery. Learn what improvement, nonresponse, and add-back effects do—and do not—mean.
IPV Disclosures in the ED: Planning a Safe Exit When a Partner Is Waiting
PTSD symptoms do not answer whether a patient can leave safely. Learn an ED approach to privacy, immediate danger, child safety, monitored communication, and a patient-led disposition.
FND and Workers’ Compensation: Incentive Is Not Intent
A workers’ compensation claim may make an external incentive relevant, but it does not prove intentional symptom production. Learn how to weigh positive FND findings, normal tests, and evidence of intent in board-style diagnosis questions.
Psychiatric Malpractice Review: Separating Evidence From the Legal Standard
In psychiatric negligence review, experts explain relevant professional practice and apply it to the facts known at the time. Guidelines may inform that opinion, but do not automatically define the legal standard.