Psychofarm Podcast

In this episode, we examine the complex phenomenon of erotic transference in psychiatric care and the critical role of maintaining ethical boundaries. Using the therapeutic frame as our guide, we unpack how patients may develop romantic or sexual feelings toward their psychiatrist… especially during medication management… and why strong boundaries and reality testing are essential to safeguard the treatment process. Drawing on clinical experience and ethical principles, this episode offers clinicians strategies for addressing counter-transference, reinforcing the therapeutic alliance, and knowing when referral or supervision is necessary to protect both patient welfare and professional integrity. 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

Discover the intricacies of treating OCD with a focus on medication strategies like SSRIs, clomipramine, and the promising role of N-acetylcysteine. Learn about the significance of exposure response prevention and how alternative approaches like TMS can aid in symptom management. The discussion delves into the complexities of OCD diagnosis and the potential pitfalls of treatment, emphasizing personalized care. Unpack the fascinating role of the Sigma-1 receptor in medication effectiveness and explore new therapeutic methods to enhance patient outcomes.

In the pilot episode of You Tell Me, the hosts dive into the controversial question: “What’s the harm in more widespread stimulant use?” They explore Silicon Valley’s productivity culture, stimulant risks, and the ethical dilemma of turning psychiatry into a tool for optimization. From there, the conversation shifts into a lighter segment on the stereotypes of medical specialties. The episode ends with a candid discussion on trauma, codependency, and why inpatient psychiatry often misses the mark.This off-the-cuff episode blends unfiltered opinions with occasional psychiatric insights… approachable for clinicians, medical students, or anyone curious about the culture of modern psychiatry. 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

Dive into the complex world of Obsessive Compulsive Disorder as the hosts unpack its DSM-5 criteria and the challenges in diagnosing it. They explore the neurobiological roots behind compulsive behaviors, drawing parallels with addiction. The importance of Exposure and Response Prevention (ERP) is emphasized, alongside effective medication strategies. Personal anecdotes add depth, shedding light on the nuances of OCD while providing practical guidance for clinicians and individuals alike.

We unpack the anxiety medication algorithm, moving from first-line SSRI picks like Sertraline and Escitalopram to augmentation with buspirone, gabapentin and lavender. CBT, mindfulness and evidence-based psychopharmacology weave throughout the podcast, so clinicians prescribe appropriately and with the right psychoeducation. 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

In this episode, we explore anxiety not as a disease in itself, but as a critical signal from your mind and body. We discuss how this signal can point to deeper issues like hidden emotions or relational trauma, and why common diagnoses like GAD (Generalized Anxiety Disorder) often miss the true source of the problem. We also cover the fundamental brain science of fear, the key differences between anxiety, panic, and worry, and introduce five different treatment models designed to help you find and resolve the root cause. 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

This episode looks at the practical assessment of personality. We explore the nuances of psychiatric diagnosis, moving beyond simplistic heuristics with a focus on the DSM-5's Alternative Model for Personality Disorders. Learn about assessing self-functioning (identity, self-direction) and interpersonal functioning, using clinical interviewing, psychosocial history, and even your countertransference as vital tools for a more comprehensive understanding of personality pathology in busy clinical settings. 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

This episode delves into Good Psychiatric Management (GPM), a practical framework developed by John Gunderson for treating Borderline Personality Disorder (BPD), though its principles offer broad utility across diagnoses. The hosts discuss the importance of integration, managing expectations (both patient and provider), and robust psychoeducation regarding BPD's features, heritability, and treatment course. Key GPM tenets are explored, including focusing on life outside therapy (work/relationships), the adjunctive role of medication, fostering accountability, and the significance of the therapeutic relationship itself as part of the 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

Dive deep into the practicalities of psychiatric medication management for PTSD in this clinical discussion. We explore the often limited evidence base and the necessity of off-label prescribing, focusing on strategies for stabilization, safety, and trust… the first stage of trauma treatment. Learn about experience-based approaches using SSRIs like sertraline, sleep aids such as trazodone and gabapentin, the cautious use of antipsychotics, and why benzodiazepines are discouraged. The conversation also touches on managing sleep disturbances and dissociation, situating medication as a supportive tool alongside essential psychotherapy and lifestyle changes, guided by principles like Pierre Janet's three-stage model. 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

Join us for an in-depth exploration of trauma and Post-Traumatic Stress Disorder (PTSD). This episode moves beyond common language to establish a clinical definition of trauma, detailing the DSM-5 criteria required for a PTSD diagnosis. The hosts break down the core PTSD symptom clusters – intrusion, avoidance, negative alterations in cognitions/mood, and arousal/reactivity – providing clear examples like flashbacks, hypervigilance, and negative self-beliefs. They delve into the concept of dissociation, its role in trauma, and the challenges it presents in assessment. Listeners will gain crucial insights into the diagnostic process, common misdiagnoses (like mistaking PTSD for depression), the vital importance of earning therapeutic trust, and effective interviewing techniques for sensitive topics, ultimately highlighting why accurate identification is key to recovery. 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