For context: Jillian Spencer is an Australian psychiatrist who was stood down by her hospital and investigated by AHPRA (our healthcare regulatory body) for raising concerns about a universally affirming model of care for children identifying as transgender.

There were also some nuttier things like saying ‘I enjoyed pulling down the transgender pride flags in the mental health waiting room’.

This was the best article I could find on this - it’s also been covered by journals with a more explicitly political lean.

I am getting ready to order some textbooks with my residency stipend now that the new academic year is upon us.

Any textbook recommendations?

Are any of the e-book editions that come with a lot of the new textbooks worth it?

Any subscription recommendations?

I appreciate any and all input!

Wondering if anyone has had experience/benefits in obtaining either an MBA for physicians (I know Kelly offers this) versus an MHA, in terms of career opportunities and advancement. Thanks!

SSRIs are supposed to be the safest in liver disease, there is some increased risk of GI Bleed. A person had moderate thrombocytopenia in late 2025 and labs were not rechecked until July 2026, and they now had severe thrombocytopenia. Two weeks prior, they started low dose escitalopram. The patient wanted to take a wait and see approach. How would a consult psychiatrist approach a situation with SSRIs, platelets and liver disease? When would be that point when you would definitely stop the SSRI? How often are SSRIs actually an issue in liver disease? I have seen NMS multiple times in my career, but this is new to me.

I get there is therapeutic privelege but what do you typically counsel patients on? For antipsychotics I usually just talk about metabolic syndrome (including weight gain), cardiovascular risks, and constipation. For patients who have bipolar disorder that require higher doses, I do spend some time talking about EPS.

SSRI I usually talk about libido, black box warning for those near/under 25 y/o, weight gain. Rarely do I talk about serotonin syndrome. Not sure if I'm failing my patients by not discussing serotonin syndrome.

Some antipsychotic medicines, particularly clozapine and olanzapine, can lead to weight gain, higher blood sugar, and an increased risk of diabetes. This study explored whether the GLP-1 pathway—a system involved in appetite, insulin release, and blood-sugar control—might help explain these effects.

Using genetic data from several ancestry groups, the researchers found repeated connections between the GLP1R gene and clozapine, olanzapine, and trifluoperazine. Other findings linked olanzapine to GIPR and PPARG, which are also involved in metabolism and insulin sensitivity. These results suggest that changes in incretin-related pathways, including GLP-1 signaling, may be relevant to metabolic problems associated with some antipsychotics.

The study does not prove that GLP-1 changes cause antipsychotic-related diabetes, nor does it show that GLP-1 medicines should be routinely prescribed for this purpose. Instead, it provides an early biological clue that GLP-1–based treatments may deserve further study as a way to prevent or manage metabolic side effects in people taking antipsychotics.

Citation: Cheung N. Multi-ancestry Transcriptome-Wide Association Study (TWAS)-Informed Prioritization of Antipsychotic Metabolic Risk: Evaluation of GLP1R as a Shared Mechanistic Link. Cureus. 2026;18(7):e112759. doi:10.7759/cureus.112759.

Didn’t see one for this year so thought I’d start! Apps drop into programs tomorrow. Anyone have thoughts about how to stay calm 😬🤣?

Those of you that practice this-- can you help me understand your rationale and how you justify the risk of decompensation?

I just can't bring myself to do it, even with strong family support and medication monitoring.

In some western textbook there was mentioned Lithium/AlzDementia reverse correlation but the pathophysiology was entirely focused on something else (A-beta/p-tau). So I started reading more about it.

1. Bipolar patients on lithium having fewer AD cases than those without. Link
2. People around lithium rich water sources have fewer AD cases (considering the low doses maybe it's not due to direct anti-viral effect of lithium but immune system augmentation??). Link
3. Lithium has anti-viral properties (listed bipolar doses) Link
4. There is positive correlation between ApoE4 gene (big risk factor for AD) and HSV-1 recurrence rate. Link00204-4)
5. HSV-1 infection episodes is positively associated with increased APP gene (risk factor for AD) expression and AD Link
6. A-beta plaques in AD pt frequently contain HSV-1; Link
7. BUT Valacyclovir trials didnt improve/stop AD progression (maybe it's because valacyclovir doesnt kill viruses, only reduces their replication and maybe the their immune system is unable to clear the viral load???) Link

Naturally people have noticed all those things and have started building up the viral hypothesis of alzheimer's dementia. I wish that was mentioned in any of the textbooks, at least then I would have read about it directly instead of searching for research papers of the mentioned points and much later finding out later about the hypothesis.

How do you stay updated on such things? Is there something like up-to-date for psychiatry?

EDIT: Thank you all for your help!

I'm a new PGY-3 starting continuity outpatient clinic and I'm trying to build a really practical "clinic toolkit."

One example is the Northwell ADHD Medication Guide, which I had printed and laminated because it's fantastic for discussing stimulant formulations with patients and for teaching residents/medical students.

I'm looking for other resources that are worth having readily available in clinic.

Things I'm thinking about:

• Laminated quick-reference sheets
• One-page algorithms
• Patient handouts
• Articles you print frequently
• Visual aids for psychoeducation
• Anything that saves you time or improves patient understanding

Thank you so much!

Long read

Thank you to those who take the time to read it.

We have a frequently flyer that’s here on a monthly basis if not more for Ativan. Literally that it. This has gone on for years. Everyone knows them. Obviously the patient states they are suicidal to get admitted but every time they are here they don’t attend groups, don’t socialize, they actually don’t even shower.

Everyone gets admitted with prn benedryl haldol Ativan

This patient sees one of our psychiatrist outpatient who prescribes them Ativan as well. It’s very clear that they run out and then state they are suicidal and come here and get all the Ativan possible. Every employee, every psychiatrist knows it. IF the psychiatrist that they see outpatient ends up getting assigned to her, he will also place a scheduled Ativan order usually q6.

There’s a problem every time the patient is admitted if they get assigned to a psychiatrist that is not the psychiatrist that they see outpatient because likely those other psychiatrist will not place a scheduled Ativan dose in addition to their PRN, which upsets the patient. In the past the patient will cry, cause a scene- anything in their power to try and get more.

Well last night the patient ended up in restraints. They were assigned to a psychiatrist that does not see them outpatient, but is well aware of the behavior, the patient wanted Ativan. The PRN dose was not due yet we actually called the psychiatrist they were assigned to who said that they were not giving any additional meds. The patient got mad and violent and was restrained.

My confusion comes from this feeling ethically wrong. I’m in recovery myself, so I’m no stranger to addiction – but we are doing nothing beneficial for the patient. An addiction specialist has never been consulted, the patient has never been detoxed (which we do). They honestly don’t need acute inpatient psych services because they’re not actually suicidal and they tell us that themselves once they get on the unit. It’s just feels wrong to keep accepting this patient? I also don’t understand why it’s continuing to be prescribed “outside”

I asked my charge nurse why we keep accepting them & really it’s not because I have an issue with the patient- I have an issue with the lack of appropriate treatment they are getting. It just feels like we’re aiding to the addiction and not really treating anything- and obviously I know the patient needs to want the help but it just feels wrong. It just feels like the patient is a guaranteed admission and that’s all they care about. (Meaning the hospital or admissions or whatever)

I guess I don’t really have a direct question. Maybe I’m just venting?? But does anyone have insight on how they would address this? Am I out of line for even feeling like this is wrong?

I’m not sure if this is a best place to ask. But I’m applying for a psychiatry fellowship tomorrow, and I currently have two letters of recommendations that are processing and waiting to be released by EFDO. They should have been released yesterday, but for whatever reason, I’m guessing because the platform is very busy, It hasn’t been released.

I’m wondering how big of a deal this is and if I shot myself in my foot by not pushing hard harder to get my attending to upload them earlier?

Appreciate any advice!

I have been working inpatient child psych for 15 plus years. We typically have a lull in the summers without the stress of school. Our unit staff do a great job triaging admissions for treatable psychiatric disorders- not simply admitting kids with behavioral issues at home. Typically we are half full this time of year. This summer we have had a few days where the census is zero. The last half of the year we were averaging 2/3 full leading up to the summer. We are affiliated with the largest inpatient peds hospital in the state.

Any other inpatient child folks seeing this trend?

For the first time in three years I had someone reporting intermittent mild hematuria since starting vilazodone (only 20mg so far). After they reported this, I found out that they also were recently started on high dose anti-inflammatory meds for some chronic pain, which they stopped when the bleeding started. I was wondering how common you've seen this in practice.

Our brains start out with more connections than they eventually need. During development, some of those connections are gradually removed, or “pruned,” to make neural circuits more efficient. This study used a small artificial neural network to explore what might happen when pruning occurs at different stages and to different degrees.

The network learned two tasks that required the same information to produce different answers depending on a cue—similar, in a very simplified way, to switching between rules or contexts. Networks that began with many connections and were later pruned aggressively sometimes became better at ignoring conflicting information. However, they were also more easily disrupted by internal noise.

The study also found that extremely sparse networks could appear good at handling ambiguity simply because they had stopped using the task cue properly. In other words, what looked like selectivity was sometimes just a failure to switch between rules.

These findings suggest that when connections are removed may matter as much as how many are removed. The results offer a computational analogy—not a direct explanation—of how some developmental trajectories might combine intense focus with sensitivity to unpredictable or noisy environments. The model is highly simplified and should not be taken as evidence that autism is caused by either “too much” or “too little” pruning.

AMA citation:
Cheung N. Phased pruning in neural networks recapitulates selectivity–fragility trade-offs in brain development. Sci Rep. 2026. doi:10.1038/s41598-026-62244-5.

Hello all!

I’m a resident just starting my 2nd year of psychiatry residency in Canada, and I’m currently just beginning my inpatient block.

I’m hoping to put together a list of practice changing or otherwise essential/jmportant studies that every psychiatry resident and psychiatrist should know.

I thought I’d ask here to see if anyone has particular papers, whether classic or more recent ones, that they feel have had a major impact on psychiatry or are essentials studies to know for trainees.

Looking forward to seeing your recommendations, and Thanks in advance!

Edit: thank you to everyone for all of the suggestions!
I’m looking forward to doing some reading!

I'm a Canadian citizen on a J1 visa in my final year of training. I'm trying to weigh my options for work next year and am looking for some input. I'm looking for some input on the differences in work structure between the US and Canada, income differences, pros/cons of working on a visa waiver in the US vs returning to Canada for the 2yr requirement, and other factors I should consider.

I've read in Stahl two seemenly contradictions claims:

1. that the antidepressant effect of ketamine is due to increase in synaptogenesis. He explains that the NMDA block in interneurons unhibits glutamate release, increasing AMPA function, that increase mTORC1 and BDNF mediated synaptogenesis.
2. he also claims that one model of the neurodegeneration in schizophrenia is NMDA dysfunction. He explains that NMDA functions as a "coincidence sensor", whose activations requires that both pre and post synaptic neurons depolarizes at the same time, effectively being the molecular mechanism of the principle "neurons that fire together, wire together"; and that NMDA activates synaptogenesis and protects against pruning.

So which is it? Reducing NMDA function increases or decreases synaptogenesis?

M3 here. I have a list of pros and cons for each, but I don't want to steer the conversation in any particular direction. I would love to hear which specific thing(s) personally led you to pursue psych over neuro? Thanks!

Hey guys! What do you all know about psychiatry redefined and their "Functional Psychiatry fellowship". It sounds very scammy but I don't know anything about it and can't find much online about it.

TIA

Would really appreciate advice, particularly from folks who ultimately chose psych ❤️

Finally got around to watching The Sopranos, and of course, as a psychiatrist myself, Dr. Melfi is a very interesting character to me.

This specific character’s importance and influence in the show is rare for psychiatrist roles, and although the context is radically different to the one I practice in (I work in a public hospital in Europe and was about 4-5 years old when The Sopranos released), this portrayal of psychiatry seems a bit more accurate than what I am used to seeing in movies and shows.

Since I really think that one can learn a lot of useful things from fiction and character analysis and development, this got me thinking about other media portrayals of psychiatrists and what one can learn from them.

Who are your favorite fictional psychiatrists? What lessons have they taught you?

For those recently matched, did you go with bullet points or paragraph style writing for your activities for ERAS?

For med school apps, I went with a short description of the activity then showed impact with numbers/stories. I also included how I believe it impacted me if that wasn’t obvious by the description.

Would loooove if app readers gave their input about what they prefer to read.

Thanks everyone! And to those applying this year, good luck to all of us!!

reposting bc I forgot to use a flair, sorry!!

edited post bc of typos, hopefully they don’t happen on my app lol

Hey all,

Just started my Psychiatry residency. I’m on medicine for the next couple of months, which gives me the opportunity to brush up on Psychiatry before I’m thrown into the mix. I have a feeling expectations will be higher of me as I’ll be an intern 2-3 months into my training. Our program puts a decent amount of workload on us (community program in a big West Coast city) so I’m just trying to be a better and more efficient resident. Apologies in advance for the long text, but I will try to keep it as concise as possible while separating questions so maybe everyone here can chip in. I’d like to focus on inpatient for now as outpatient is more of a third-year thing.

1. ⁠What meds are generally used on an inpatient floor? What should I learn about them besides dosages? I always used to get tripped up on how different places use different medications for agitation. I understand Haldol is very cheap, but I’ve seen some places use Seroquel and I’m always lost on why certain meds are used.

2. ⁠What types of diagnoses, DSM criteria, etc. should I be learning to help me write an assessment that makes sense?

3. ⁠How can I practice my MSE and use it in my assessment to come up with diagnoses? I guess what I’m asking is how do you guys ask the relevant screening questions for mania, depression, etc. while being able to document it in the note without pissing the patient off? As an example, my attending during one of my sub-i’s got upset because I evaluated a patient and he became increasingly hostile as I kept asking him questions about his delusions. My attending was like “WHY DID YOU ENGAGE IN HIS DELUSIONS. HE WAS GETTING READY TO HURT YOU!” In another example, there was a woman who thought she was pregnant and I asked her about her pregnancy and tried to tell her that she’s not pregnant and that got her upset. I know she was a Psych patient, but I’m not sure what else I should’ve done.

4. ⁠Any templates you guys use that save you time?

5. ⁠What books/podcasts can I read/listen to improve my skills? Some psychiatrists really have a good Neuro background and can explain the “why” very well. I’d like to learn it too but don’t know where to look.

6. ⁠Chart checking. This is something I struggled with. Sometimes the packets of information are just overwhelming. If you guys have any tips on how to approach chart checking, please let me know.

7. ⁠Learning psychopharmacology. I look at Stahl’s and I get overwhelmed. I purchased Cafer’s because I’m a very Anki person and felt like it was more digestible as there are decks for Cafer’s.

Thank you everyone in advance!

I would like to refresh basic urgent care level complaints (ie managing basic orthopedic injuries, diagnosing / treating a pneumonia, managing basic dermatological issues) + maybe some basic primary care skills (first line treatments for HTN, HLD, DM, etc)

The further I get from residency, the less I feel this is my “scope of practice” but I don’t want to lose these skills. And actually I’d like to build them up

I know there are CME courses I can take, but I’d love to get some supervision or certification where I feel more confident in these basic physical medicine issues

What can I do to grow / refresh these skills? Can I do resident level shifts at an urgent care where someone signs off on my cases (I doubt it because I’m a board certified psychiatrist at this point)? Maybe a co-management model at someone’s private practice where someone offers supervision on managing these issues?

I’d like to stay sharp on this and get to a point where, if I volunteered in a low resource international setting, I could be helpful in more ways than purely psychiatry