Psychofarm Podcast

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...

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 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...

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 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...

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 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...

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...

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...

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,...

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...

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 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...

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...

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...

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...

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...

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 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 subscrib...

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...

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...

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...

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...

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...

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 end...