Blogs
How to mentor
Judge what you say by what your hearer can appreciate. You’ll be surprised how much people appreciate being taught a little, and how much they resent being taught too much.
Mood Temperaments: A basic explanation
Temperament reflects the biological component of personality; it is about half genetic, and appears to...
Explaining Suicide
Explaining Suicide Complex, but not unpredictable Fill up a small baseball stadium, like Fenway Park in Boston, with...
Antidepressants in bipolar depression: Common practice, poor science
Antidepressants in bipolar depression: Common practice, poor science The context The use of antidepressants in bipolar...
Akathisia: Not exactly what you think
Akathisia: Not exactly what you think Importance of akathisia Akathisia can sometimes be sufficient reason to change...
Addictions: How to understand them
Addictions: How to understand them Two types: primary and secondary Addictions come in two basic types: those...
Going underground
Q: I wanted to ask about integrating the things you teach into my learning and practice as an upcoming resident. Lots...
A 17 year old female refuses olanzapine…
Q: I have a 17 y/o girl that refuses to take olanzapine because at the John Hopkins clinic she was given a list of...
A Reading List for Psychiatry
Here is a reading list that I’ve prepared for advanced psychiatric residents who have done rotations with me. I would...
Harvard Psychiatry Residency Notes – Circa Early 1990s
Some time ago, on a prior blog, I began transcribing some of my residency notes from my years at McLean Hospital and...
The New Canon of Psychiatry: What It Means
Summary of the canon of psychopharmacology So what does the canon of psychopharmacology teach us? An important lesson...
The New Canon of Psychiatry: STEP-BD for Bipolar Depression
The conventional wisdom: STEP-BD for bipolar depression CATIE was the largest (about 1500 patients) and most ambitious...
The New Canon of Psychiatry: STAR*D for Depression
The conventional wisdom: STAR*D for depression The second large canon of psychopharmacology is the STAR*D study, a...
The New Canon of Psychiatry: CATIE
The conventional wisdom: CATIE for schizophrenia Here is the official line on the design and results of this study:...
The New Canon of Psychopharmacology: How We Got CATIE, STARD, and STEPBD
In the mid-1990s, an incredible thing happened. The National Institute of Mental Health (NIMH) decided to fund major...
How to Analyze a Study: Lithium for prevention of suicide, the VA RCT
The recent VA study on lithium provides a good example about why it is important to analyze research studies for...
Does lithium improve suicidality? A new VA study
Suicide-related outcomes in veterans with major depression or bipolar disorder JAMA Psychiatry, Katz et al, 2021 This...
How do you treat melancholic depression?
Q; Never heard of chronic involutional melancholia. I give some activating drugs like venlafaxine or duloxetine for...
What is Bipolar Depression? What is Melancholia?
Q: I'm confused on the melancholia concept. You said that melancholia and mixed depression are more episodic and...
Four antidepressants and still not well
Q. The following patient was referred to me and is unfortunately a very typical case of the standards of current...
What is a disease-modifying drug?
Question: I would like to ask you one question regarding your differentiation between "symptomatic" drugs like...
Keeping Up with the Literature: Read the Journals and the Old Books
What journals should you read? How do you keep up with the scientific literature? The best advice comes from William...
Research and Practice: Twins, Not Opposites
I never have understood clinicians who see clinical research as unrelated or even opposed to what they do. This...
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