PsyQ: Journal Club

In this episode of PsyQ , we critically examine the etiology of cognitive decline in severe, extremely treatment-resistant schizophrenia (SETRS) through the lens of a 2026 JAMA Psychiatry cohort study. By analyzing clinical and genetic data from 155 chronically institutionalized patients, the research demonstrates that the cognitive deficit profile in SETRS intensifies the patterns seen in communi...

In this episode of PsyQ, we critically evaluate the recent randomized clinical trial by Gao et al. published in JAMA Psychiatry investigating the ketogenic diet (KD) as an adjunctive treatment for treatment-resistant depression (TRD). The study randomized 88 adults with TRD to either a 6-week, highly supported KD or an active phytochemical control diet, specifically isolating the dietary variable...

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit upathak.substack.com

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit upathak.substack.com

In this episode of PsyQ , we confront the "zone of danger" in acute suicidality—the critical lag period where standard antidepressants often fail to address immediate "psychache". Anchored by the seminal Yovell et al. (2016) randomized controlled trial, we explore the neurobiological overlap between physical and social pain , testing the hypothesis that ultra-low-dose buprenorphine (starting at 0....

In this episode of PsyQ, we review a large national inpatient study examining the association between cannabis use disorder (CUD) and suicide attempts/self-harm among hospitalized adolescents in the United States. Using data from more than 800,000 adolescent hospitalizations, the study demonstrates that CUD is independently associated with approximately 40% increased odds of suicide attempts and s...

In this episode of PsyQ , we review the landmark STEP-BD randomized controlled trial evaluating the effectiveness of adjunctive antidepressant treatment for bipolar depression. We analyze the study's methodology, specifically the use of equipoise-stratified randomization to mirror routine clinical care and the selection of "durable recovery"—defined as eight consecutive weeks of euthymia—as the pr...

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In this episode of PsyQ , we perform a forensic analysis of the landmark OPTIMUM trial, a study that fundamentally reshapes the treatment algorithm for resistant depression in older adults. We dissect the head-to-head battle between switching antidepressants versus augmentation, revealing why aripiprazole claims the crown for efficacy while exposing a counterintuitive and critical safety signal re...

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In this episode, we break down a major longitudinal synthesis of seven North American cohort studies following children with ADHD into adulthood over 10–30 years. The data are striking: while full diagnostic persistence varies, the majority of individuals continue to experience clinically meaningful symptoms and impairment well into adult life. Persistent ADHD is associated with lower educational...

In this episode, we dissect a landmark 2022 randomized controlled trial published in the American Journal of Psychiatry that challenges the traditional "daily dose" paradigm for treating Alcohol Use Disorder (AUD). We review the efficacy of targeted, event-driven oral naltrexone —taken only in anticipation of heavy drinking or cravings—specifically for sexual and gender minority (SGM) men with mil...

In this episode, we unpack the psychiatric relevance of the ketogenic diet through the lens of a recent and compelling systematic review and meta-analysis from JAMA Psychiatry . Join us as we explore how ketogenic diets may modulate mood, inflammation, neurotransmission, and energy metabolism—domains increasingly central to the practice of modern psychiatry. We’ll break down what the evidence says...

Antidepressant discontinuation is one of the most contentious topics in psychiatry, fueling both patient fear and clinical uncertainty. But what does the highest quality, placebo-controlled evidence actually say? In this episode, we dive deep into the 2025 JAMA Psychiatry systematic review and meta-analysis by Kalfas et al. that re-examines the incidence and nature of discontinuation symptoms. We...

In this episode of PsyQ, our psych journal club dives deep into the Bush–Francis Catatonia Rating Scale (BFCRS), guided by the 2022 BFCRS Training Manual and its original 1996 validation study. We walk through each of the 23 items in the scale, clarifying their definitions, how to observe and score them, and the key differentiations between overlapping signs such as mutism, withdrawal, and negativ...

In this week’s episode of PsyQ , we break down the American Journal of Psychiatry review “Ketamine for Depression, but at What Cost?” by Li and colleagues. Here we explore the balance between ketamine’s rapid antidepressant benefits and its potential neurotoxic risks. We’ll discuss what animal and human studies reveal about dose, frequency, and safety, why FDA-regulated esketamine appears cognitiv...

In this episode, we take a clinical look at psychedelic-assisted therapy — what it is, how it works, and where it’s headed. We cover MDMA for PTSD and psilocybin for depression, break down the science behind how these drugs work with therapy, and review key trial data, safety concerns, and how psychiatrists may soon integrate these treatments into practice. This episode delivers clear takeaways, c...

In this episode of PsyQ, we take a critical look at the evolution of major depression treatment over the past two decades. We start with the foundational Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, a study that has shaped clinical practice for years with its widely cited ~70% cumulative remission rate. However, we then dive deep into a startling 2023 re-analysis that cha...

In this episode, we break down BrainsWay’s 6-day accelerated Deep TMS for major depression—how its iTBS, 5-sessions-per-day schedule compresses a month of treatment into 6 days with non-inferior outcomes to standard daily TMS—then stack it up against conventional 4–6 week TMS and Stanford’s SAINT (the 5-day, 50-session, MRI-guided protocol boasting rapid, high remission rates). We’ll walk through...

In this episode, we dissect the alarming 75.6% rise in private equity (PE) ownership of US psychiatric hospitals and unpack the central paradox from a landmark 2025 JAMA Psychiatry study: how do these facilities operate with significantly fewer nurses and social workers, yet report better outcomes on official quality metrics like restraint use and readmissions? We deconstruct this quality illusion...

In this week’s episode of PsyQ, we explore psychiatry’s role in decreasing violence in America. While mental illness is often blamed for violent acts, research shows it accounts for only a small fraction of overall violence. Instead, substance use, social stressors, and access to firearms are far more influential. We discuss how psychiatrists can assess and mitigate risk, the limits of violence pr...

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In this episode we’ll orient listeners to catatonia’s core features and standard pathways (lorazepam → ECT), then pivot to emerging third-line options when Ativan is ineffective and ECT isn’t feasible. Using a recent systematic review and a bipolar-catatonia case report as anchors, we’ll cover why NMDA antagonism makes mechanistic sense, dosing patterns (most reports used 0.5 mg/kg IV over ~40 min...

How should psychiatrists respond when patients use racist language or refuse care based on a clinician’s identity? In this episode, we translate the NEJM five-factor framework into psychiatry’s day-to-day reality—balancing EMTALA obligations and patient autonomy with Title VII protections and clinician well-being—and turn it into practical playbooks for the ED, inpatient units, and clinic. We cove...

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit upathak.substack.com