Psychofarm Podcast
PsychoFarm Podcast is a deep dive into the intersection of psychiatry, psychopharmacology, and the evolving understanding of mental health. Hosted by 2 psychiatrists, the podcast explores complex topics such as diagnosing mood and personality disorders, the role of medications in treatment, and the challenges of psychiatric training. Each episode breaks down the clinical insights and philosophical debates surrounding mental health care, providing both practitioners and curious listeners with thoughtful analysis, expert opinions, and practical advice.
Episodes
The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?
We put the Seinfeld cast on the proverbial couch, not to slap diagnoses on fictional characters, but to show why personality formulation can tell us far more than a psychiatric label.Is George a vulnerable narcissist, borderline, or something more complicated? Does Jerry’s obsession with cleanliness and order actually resemble OCD or an obsessive-compulsive personality style? Could Kramer meet cri
Sleep Medications Treatment Tier List: Best Insomnia Medications Ranked
In this episode, the hosts rank the behavioral and medication strategies they use for sleep problems in psychiatric practice, starting with strict wake times, CBT-I, sleep hygiene, exercise, and treating the underlying disorder. They compare doxepin, trazodone, mirtazapine, hydroxyzine, melatonin, gabapentin, benzodiazepines, Z-drugs, antipsychotics, and other options, with attention to sleep onse
Mood Stabilizers for Bipolar Disorder: Lithium, Lamotrigine, Depakote & More
Mood stabilizers for bipolar disorder can be confusing because lithium, lamotrigine, Depakote, carbamazepine, and oxcarbazepine have very different strengths, risks, and clinical roles. In this episode, two psychiatrists break down how they think about maintenance treatment, lithium dosing and monitoring, common side effects, lab levels, toxicity counseling, and medication interactions. They also
Dr. Jim Phelps’ Bipolar Treatment Tier List: Lessons from 30+ Years in Psychiatry
Bipolar disorder treatment is put to the test in this clinically grounded tier list with psychiatrist Jim Phelps. He and Dr. Malzberg rank low-dose lithium, lamotrigine, social rhythm therapy, dark therapy, dawn simulators, antidepressants, carbamazepine, supplements, ketogenic diet, mood tracking, and group psychoeducation. Along the way, they discuss why sleep and circadian rhythm belong in the
Anxiety Medications Tier List: The Best and Worst Treatments for GAD
Anxiety medications tier list: two psychiatrists rank the treatments they actually use for generalized anxiety disorder… and the ones they avoid. The discussion covers first-line SSRIs, why buspirone may be underrated, when benzodiazepines can help or harm, and how to think about mirtazapine, hydroxyzine, propranolol, gabapentin, pregabalin, quetiapine, and bupropion. Just as important, the episod
Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, Interpretation
Psychodynamic therapy interventions are the focus of this episode, organized through a practical levels framework for clinicians. Dr. Fu and Dr. Greg break down empathic mirroring as a way to keep the patient’s narrative moving, clarification as a tool for deepening detail, confrontation as a gentle way to point out patterns or discrepancies, and interpretation as the rare intervention that should
ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen Eller
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 explor
Suicide Risk Assessment: Acute vs Chronic Risk, Formulation, and Suicidal Ideation Types
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 i
Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDD
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, withdraw
Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment Skill
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 s
Psychiatric Technique for Diagnostic Interviewing and Therapy: 6 Mantras Every Clinician Should Know
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 psy
Psychodynamic Technique and Therapeutic Intervention: Containment
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 gla
Tips to Avoid Burnout in Psychiatry (Outpatient, mostly)
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 wi
CPTSD vs BPD: How to Think About the Difference and What to Do About It
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
Detecting Subtle Signs of Psychosis: Assessment of Voices, Delusions, and Psychosis
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,
How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening Questions
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
What Makes a Belief a Delusion? Delusions, Thought Disorder, the TALD Scale
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 framewor
What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the Differential
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 a
Top 10 Things to Know About Clozapine
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 safe
Disability Claims 101 for Psychiatrists: Programs, Pitfalls, and Practical Steps
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
How to Decide When ADHD Is Actually ADHD
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
Why the Therapeutic Alliance Matters in Psychiatry: Recognizing and Repairing Ruptures with Dr. Catherine Eubanks
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 m
ADHD Is Not the Only Diagnosis: Differential and Diagnostic Hierarchy
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, O
Is Psychoanalysis Still Relevant in Modern Psychiatry?
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 subscri
Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary Admissions
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
How to Do a Psychiatric Intake | The Art and Science of the First Hour
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 thinki
The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’
Boundaries aren’t just rules in psychiatry… they’re part of the treatment itself. In this episode, we explore therapeutic ruptures, transference and countertransference, and how clear treatment frames protect patients, clinicians, and the therapeutic process. From handling “doorknob comments” to navigating burnout, we highlight the practical ways psychiatrists and therapists can use boundaries to
When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and Liability
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 th
Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication Approach
In this fast‑paced Psychopharm podcast, we break down the OCD medication algorithm for obsessive compulsive disorder. You will hear about pushing SSRI doses, switching to Luvox or clomipramine, adding low‑dose antipsychotics, and glutamate modulators such as N‑acetylcysteine and ondansetron. The conversation also demystifies BrainsWay H7 deep TMS, explains realistic expectations for symptom reduct
You Tell Me | Adderall for All?, Surgeons Gone Shrink, Codependency isn't Neurobiological
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
What Is OCD? How to Understand It, Recognize It, and Treat It
Join us in this podcast episode focused on Obsessive Compulsive Disorder, where we explore the DSM‑5 criteria, differentiate OCD vs generalized anxiety, and discuss the neurobiological roots of compulsive behavior. We cover practical guidance on exposure response prevention (ERP), using the Yale‑Brown Obsessive Compulsive Scale as a screener, and outline medication strategies like high‑dose SSRIs
Psychiatrist's Guide to Anxiety Medications: First Line to Last Resort
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 s
Understanding Anxiety, GAD, and Treatments of Anxiety
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
Assessment of Personality: Practical Assessment in a Short Timeframe
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 countertransferen
Treating Borderline Personality Effectively aka How To Be A Good Psychiatrist Through GPM
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 treatme
PTSD Medications: Integrating Pharmacotherapy, Therapy, and the Treatment Frame | Episode 22
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 gaba
Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21
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 examp
Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and Culpability
This conversation explores key aspects of forensic psychiatry, including the insanity defense, dissimulating patients, and how clinical practice intersects with legal systems. It highlights the importance of open-ended dialogue, nuanced diagnosis, and maintaining empathy without succumbing to cynicism. This is a public episode. If you would like to discuss this with other subscribers or get access
Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19
Join us in a conversation about involuntary commitment, and the legal framework behind psychiatric treatment. We discuss real-world scenarios, share insights into how clinicians juggle patient autonomy versus societal protection. Whether you are new to the field or a seasoned professional, this episode offers valuable perspectives on balancing ethical duties, legal obligations, and patient care. T
The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18
In this episode, we sit down with Dr. Chris Aiken to look at a big question: when do we treat an underlying deficit in psychiatric illness? Focusing on difficult-to-treat depression, our conversation delves into the deficit model and looks at different paradigms, from neuroprotective strategies and lifestyle interventions to the nuanced use of medications like SSRIs, lithium, and thyroid hormones,
Choosing Antipsychotics in Schizophrenia: Side-Effects, Maximizing Efficacy, and Finding the Right Medication | Episode 17
Schizophrenia treatment is complex, and choosing the right antipsychotic can make all the difference. In this episode, we take a deep dive into schizophrenia medications... breaking down the pros and cons of different antipsychotics, metabolic risks, sedation issues, and the challenges of adherence. We discuss how to tailor treatment to individual patients, avoid unnecessary side effects, and impr
The Future of Psychiatry: Spravato, Vagus Nerve Stimulation, Trigeminal Nerve Stimulation, PRISM Neurofeedback, TMS and much more with Dr. Owen Muir | Episode 16
What is the future of psychiatric treatment? In this episode we explore groundbreaking innovations in neuromodulation, AI driven diagnostics, and the evolving business of mental healthcare. Dr Owen Muir discusses why business and policy are as crucial as clinical advancements in ensuring that cutting edge treatments like accelerated TMS, noninvasive vagus nerve stimulation, and AI assisted tardive
Beyond Medications: The Best Lifestyle Treatments for Mental Health
Medications and therapy are the foundation of mental health treatment, but what else can you do to improve your well-being? In this episode, we explore the essential lifestyle changes that can make a profound impact on mental health. From exercise and behavioral activation to socialization, sleep, and mindfulness, we break down practical, evidence-based strategies that go beyond prescriptions. We
TMS and The Future of Psychiatry, Part 1 with Dr. Owen Muir
In this engaging episode, Dr. Owen Muir dives into the science and practice of Transcranial Magnetic Stimulation (TMS), exploring its transformative role in modern psychiatry. The conversation begins with a historical look at how TMS emerged from groundbreaking research in the 1980s, evolving into an FDA-approved, noninvasive treatment for mental health disorders such as treatment-resistant depres
Probably The Most Important Topic in Psychiatry: Therapeutic Alliance and Frame
Explore the fundamentals of the Therapeutic Alliance and Frame in this podcast episode, where we highlight how trust, clear communication, and structured boundaries form the bedrock of effective psychiatric practice. Learn practical strategies for aligning treatment goals, clarifying diagnostic expectations, and navigating challenges like medication hesitancy or “trauma dumping.” Perfect for psych
The Best Bipolar Medication Review From The Best Bipolar Expert
Humbly…. we explore a practical overview of bipolar disorder, from refining your diagnostic approach to navigating effective treatments. In this episode, we highlight how sleep patterns play a pivotal role, how substances and antidepressants can complicate clinical presentations, and the fundamentals of evidence-based medication choices, spanning mood stabilizers and second-generation antipsychoti
Treating Depression: Practical Tips & Pearls for Anti-Depressant Medications
This episode delves into the pearls of treating depression with medications, offering practical strategies for clinicians and patients alike. From identifying the root causes of depressive symptoms to exploring evidence-based medication and lifestyle interventions, this discussion provides actionable insights for improving mental health outcomes. Learn about personalized treatment options, managin
Understanding Borderline Personality Disorder with Dr. Mark L. Ruffalo
Join renowned therapist Dr. Mark Ruffalo as he unpacks the complexities of Borderline Personality Disorder (BPD). This discussion delves into the relational patterns, effective communication of diagnoses, core anxieties, and the need-fear dilemma. Whether you're a mental health professional or someone seeking understanding, Dr. Ruffalo provides invaluable insights. This is a public episode. If you
Insomnia and Sleep Medications in Psychiatry
In this episode, we dive into the use of sleep medications in psychiatry. Is insomnia a standalone condition or a symptom of deeper issues? We discuss our clinical approach to treating sleep disturbances in psychiatric patients, focusing on medications to the nuanced use of trazodone, gabapentin, and antihistamines. Along the way, we explore the intersections of sleep and psychiatric illnesses, an
Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPD
In part two of our conversation with Dr. Nancy McWilliams, we explore a diverse range of personality dynamics, from the socially expressive yet vulnerable histrionic style to the introspective and reserved schizoid personality. Dr. McWilliams offers unique insights into how cultural and social contexts shape personality types, especially the often misunderstood histrionic style, which she discusse
Psychosis: History, Delusions, Diagnosis, Theories, and Modern Care
We explore the evolution of psychosis diagnoses from the early DSM days to modern psychiatry, unpack the role of language in shaping delusions, and discuss how treatment has (and hasn’t) progressed. From Lacanian theories to real-world clinical challenges, this episode bridges the gap between theory and practice while tackling stigma head-on. Perfect for clinicians, patients, and anyone curious ab
Nancy McWilliams on Psychoanalytic Diagnoses, Part 1: Personality, Defenses, Themes, Paranoid Personality
In this episode, Dr. Nancy McWilliams explores the foundations of personality, tracing how our unique defenses and core life themes shape who we are and how we relate to others. She discusses the concept of personality as a tapestry woven from central themes rather than fixed traits, revealing how these themes serve as guiding narratives that influence our behaviors and relationships. The conversa
Healthy Personality Traits, Trauma vs. Personality, and Why Trauma Doesn’t Explain It All
This episode is a continuation of our previous conversation on personality. We dive deep into the complex world of personality disorders and healthy personality traits. From the misconceptions that plague psychiatric diagnoses to the often-overlooked truths about how we develop emotionally… We discuss the difference between normal development and personality disorders, discuss the stigma surroundi
What Psychiatrists Get Wrong About Personality Disorders
In this episode, we take a peak into the often-misunderstood world of personality disorders. We explore common misconceptions that psychiatrists and clinicians make when diagnosing and treating personality disorders, shedding light on why these errors happen and how to approach personality pathology in a more integrative, effective way. The conversation challenges the traditional views and advocat
ADHD Again, But Juicier: Unpacking Misdiagnosis, Medication Overuse, and Cultural Trends
In this episode, Dr. Fu rejoins us as we take a deep dive into the world of ADHD—beyond the usual headlines and social media buzz. We’ll talk about how ADHD is often misunderstood, misdiagnosed, and even overhyped. Join us as we explore why so many people are getting diagnosed, the real role of medication, and why it's dangerous to use 1 thing to explain behavior. We’ll also dig into how cultural
ADHD... Diagnosis, What is ADHD? Is ADHD real? Do I have ADHD? Is ADHD biological?
Unfortunately my co-host Dr. Fu is missing from today. But in this episode, we dive deep into the topic of ADHD, exploring its diagnosis, challenges with the DSM criteria, and the complexities of executive functioning deficits that define the disorder. We tackle the common question, “Is ADHD real?” and discuss how the history of ADHD has shaped the way it is understood today. We also explore the n
Bipolar Misunderstandings, Integrating Biology & Personality, & Broader Conceptualizations
In this episode, we dive into the challenges of diagnosing bipolar disorder, especially when it overlaps with personality disorders. We discuss how psychiatric training often focuses on severe cases, which can make it harder to recognize milder forms. You'll hear about the importance of gathering detailed patient history and why short-term observations can be misleading. We also touch on the limit
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