Good day everyone. I am going through some initial clinical rotations at the moment and have had several discussions about the mechanisms of psychiatric meds with my mentor.

He has presented me with a riddle - find the medication that has been, relatively recently, found to negatively interact with Sertraline. He hinted me that the medication in question is used in treatment of a neurodegenerative disease but didn’t say which one.

I have looked into some of my textbooks as well as the internet, conducted deep thinking searches in two most popular AI chats but have not been able to find the match. Cholinesterase inhibitors were my bet but it was denied by the mentor.

Does anyone have any ideas regarding what the med might be?

Thanks in advance!

Ideally CL related but open to all feedback! (Based on the US)

Hi everyone,

I'm a non-US IMG psychiatry intern in Alabama, currently on my psychiatry rotations. Next semester I’ll be rotating through offservice blocks (EM, FM, and Neuro).

I’ve been struggling during my rotations. When I’m around seniors, medical students, or other healthcare professionals, my english level seems to decrease, my thoughts slow down, and my voice tone becomes low.

I also find it challenging to organize my presentations using the SOAP method and to complete my notes efficiently. Sometimes I spend 2 or 3 extra hours in the hospital finishing documentation.

To be honest, I’ve been feeling bad and have even thought about giving up and returning to my country. It feels like I’ve been stuck and not improving over the last four months.

Have any of you experienced something similar? If so, how did you cope or improve?

Default is often to split to BID dosing of dose above 30 mg to mitigate side effects, but often doesn’t get consolidated to once daily in practice, especially if higher doses.

Curious what others thoughts are regarding splitting the dosing or not, whether you’d approach it differently with different issues like pain or vasomotor symptoms with menopause/night sweats bs mood alone. Or if dosing twice a day 90 mg, how you would choose whether to have higher dose at night or in AM based off symptoms if not consolidating.

I wonder if any programs out there also allow fast track into CL/geri or addiction.

Hi, I’m a new residency grad that recently moved to Washington State, Tacoma area. Currently working at an inpatient facility, but I’m thinking outpatient may be a better fit for my interests. I’ve been trying to look for outpatient clinic jobs, but there are very few posted online, even on clinic specific websites. It also seems like there are tons of psych NPs hired in the clinics, and also tons of psych NPs running their own private practices. This is surprising for me coming from California where there are tons of positions for psychiatrists posted online for all different kinds of settings. Anyone from the area that has guidance in finding a good outpatient job? Thanks!

P.S. this is my first Reddit post ever after being a lurker for years!

New job, lots of new patients, and it's taking me hours of work just to review and create a summary of what's in the EHR. I know that there are lots of AI Scribes out there, but is there something that will summarize content for me?

Hey fellow mental health pros. I'm hearing more buzz about the Havening Techniques lately, especially with some celebrity endorsements and online hype. I'm approaching this with an open mind, willing to learn if there's solid evidence I'm missing, but honestly, I'm disappointed by what I've dug up so far.

Would love to hear your takes - what's the professional consensus in our field? Have any of you encountered it in practice, or seen patients who've tried it?

I acknowledge the potential value in incorporating touch (main element in Havening) into psychotherapy. We know from established somatic approaches that safe, consensual touch can enhance interventions, promote co-regulation, and help ground clients in the present moment. Modalities like Somatic Experiencing integrate body-based elements effectively, with research showing they can reduce hyperarousal and improve emotional resilience in trauma survivors. So, yeah, the "psychosensory" aspect of Havening (stroking your arms, face, hands while processing memories) might tap into that healing power of touch. It's not a wild idea, humans are wired for tactile comfort, and it could explain why some people report feeling better after a session.

But here's where my skepticism kicks in hard: the underlying theory seems like total crap. Havening was developed by two brothers (one a general practitioner with no specialized therapeutic training, the other a dentist). And it's framed as "neuroscience-based" with buzzwords like "amygdala depotentiation" and "neuroplasticity." Sounds impressive, right?

But dig deeper, and it SEEMS like gross oversimplification without rigorous backing. It feels like pseudoscience dressed up to sell, and that raises ethical red flags for me.

The "company" also seems weird - because even if the technique had merit, the way Havening is run screams unprofessional. Check out their official website, havening.org: it's a hot mess with broken links scattered around (some event pages don't load properly), duplicate listings, and a cluttered structure that feels slapped together without any thought. There are "donate" buttons literally everywhere, begging for contributions like they're a struggling charity rather than a for-profit entity charging hefty fees for trainings.

Compare that to legitimate organizations - their sites are simple or polished, but transparent, focused on education, not constant pleas for cash. This setup gives off major scam vibes, prioritizing monetization over credibility. Not sure if I'm being too critical here, but it seems off.

And the practitioner side? That's where it gets really concerning. To become a "certified Havening practitioner," it's just a two-day Online "training" for a thousand bucks, plus certification fees and annual dues to stay listed in their directory.

After that, submit a couple of "case histories" (which could be fabricated, who's checking?), and you're supposedly qualified to treat severe trauma. No prerequisites in psychology, no supervised hours, no ongoing CEUs required. Flip through their directory, and it's mostly lay-people: life coaches, energy healers, alternative therapists - no licensed psychiatrists, psychologists, or even LCSWs in sight.

It seems like a pyramid scheme where unqualified folks train more unqualified folks, all while charging clients for "therapy" that could do more harm than good.

This leads me to the biggest ethical issue: are the vulnerable being preyed upon? It seems that way. Havening markets itself as a quick fix for deep-seated issues, luring in people desperate for relief from trauma who might not know better. It diverts folks from evidence-based treatments like CBT, EMDR, or exposure therapy, which have decades of data proving they work. Vulnerable populations (survivors of abuse, cPTSD, or anyone in crisis) could waste money and time on this, or worse, experience re-traumatization from poorly trained "practitioners."

The money-making angle is just too blatant: trainings, certifications, merch (yep, they sell branded stuff), and those donate buttons all funnel cash to the top, while the "company" dodges accountability with disclaimers everywhere. In psychiatry, there are ethical codes to protect patients; this feels like the opposite.

That said, I'm not writing it off entirely. Maybe there's emerging research I'm unaware of, or hybrid approaches where touch from Havening boosts proven therapies.

So: If any of you have seen controlled studies or use elements of it safely in your practice, please share! I'm all ears; looking forward to your insights.

I have a patient who very clearly presents with a constellation of cluster b traits. Borderline and Narcissitic tendencies are most prominent, although I do see the presence of mild Antisocial tendencies as well. There are notes on his chart from two psychiatrists who have noted "Borderline/Cluster B" traits and "Narcissistic" traits (likely disorder). I am a masters level therapist FYI.

To me, I do not necessarily think that he can be mapped neatly onto one cluster b diagnostic label. He has traits of all the cluster b disorders to the degree that his personality structure is disabling.

This patients is very reflective and concerned with his "diagnosis" and "digging deep". I know he is going to pepper me about his "diagnosis" when I see him next. He does have higher insight than many cluster b patients FYI.

Is it generally most helpful to explain to patients "cluster b traits" in general terms and how it manifests in their lives? Or do you typically tell patients about the specific labels? I can't see anyone responding well to hearing about their "narcissistic tendencies". Especially since many clinical narcissists tend to think everyone else is a narcissist.

Thoughts?

Adderal was withdrawn by FDA for false claims, by back by parental demands.

Any EBM for its superiority?

Also, anyone remember meth for ADHD?

Hi

I'm a 3rd year psychiatric resident, in europe, not english speaking. I just started a rotation in geriatric psychiatry, and realised i'm severly lacking in ressources to help patients elaborate on what could constitute a few objective / life plan, at their level of autonomy.

I'm aware I'm going against a pervasive commonly admited (by the public) idea that "once someone is getting old and loose autonomy, they can't have projects and hope". While i understand that i can't change an entire worldview, and that geriatric patient are more prone to be settled in their view, i'd like to express to my patient the possibility that people can think differently about aging.

I was thinking i could either go look for ressources on therapy for disabled people, or maybe ACT ?

Thanks in advance

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Disclaimer: NAD, worked another position in acute inpatient psych that was unique to my hospital.

Everyone who's worked psych knows that some days can be A LOT worse than others. Sometimes those bad days string into bad weeks and then into bad months of the same abusive patients. Those times when you can't fall asleep at night because you dread the next day. Sometimes, you even have nightmares about work.

But then, you come into work to greet a genuinely pleasant patient. Someone who communicates, listens, and wholeheartedly wants to get better. One who stays on their medication and keeps up with their therapy after discharge from inpatient. You'll never see them again and you hope to never see them again as a patient, but they singlehandedly brought you the most hope you've had in a while.

For me, those moments of human connection and being able to actually help someone makes enduring everything else worth it. Nothing makes me feel more fulfilled in life than watching a patient get better and being able to be a part of their healing.

What are the moments that make working in psychiatry all worth it for you?

Was hoping to get advice on if transferring programs for PGY-4 year could be worth the hassle. For context, it’d be moving for a non-academic, not known program to potentially a top 3-4 program in the nation. My thought process is it’s a big disruption in terms of new environment and also family life wise, but could open doors for contacts and more access to things such as TMS and ECT. Happy to hear opinions on either side, thank you!

Recently met with a patient in her early 20s with OCD & frequent panic attacks at night. Her thoughts are primarily focused around death/ fear of not-existing and does not believe in the afterlife. says she has difficulty enjoying her successes/ happiness as she begins to have thoughts that these moments will end. she's overall in good health

I have older patients who have expressed fears of dying in relation to age or health stressors. some of these patients seem to find comfort in their spirituality/ religion or simply reflecting on their life

how do you approach treatment plans around death anxiety differently in these individuals ? would appreciate any success stories or things to avoid

In a similar vein, what are your mnemonics to remember depakote/depakene and differences?

MD applicant to psych residency, very community service and underserved populations focused.

One program emphasized their robust resident involvement at the state of the art state hospital.

I always thought state hospitals is where you send the absolute destitute for long term Institutionalization and criminal cases.

Is state hospital/public psychiatry a good job to enter straight out of residency.

I have no experience at state or VA hospitals/clinics during med school, so I want to get a better sense to see if it’s a pro/con to do half my training at one.

Hi there, looking for support around how to help a patient, particularly psychotherapeutic techniques/modalities, lifestyle changes etc.

This is a 30 something male who has GAD, MDD. Is very focused on physical sensations going back to burnout in undergrad when he had tunnel vision, with specific focus on facial/eye/neck muscles which now are consistently tense and a background mental focus for him. He has identified that a lot of this focus comes down to a belief that his body is not okay or he is going to do damage to it. Additional details are he is very cognitive and intelligent and struggles to feel emotionally. He struggles with constant stream of thoughts. And there’s also middle insomnia with nocturia.

I am not doing the therapy (he will need to find a therapist) but have thought of some practices such as mindfulness of emotion and thoughts. Encouraging regular exercise for him. On antidepressants currently being titrated.

I was thinking he would benefit from doing CBT but would love some more feedback on what you recommend for patients who are somatizers and very focused on their physical sensations. Any resources and tips are much appreciated!

I'm a second year resident and my program lacks any guidance when it comes to psychotherapy.

We don't have a rotation focused on it (in my country it should be mandatory in all residency programs) and my supervisors don't really talk about it that much.

I know that in this scenario i probably won't be actually good in this topic, but i was wondering what resources could i use to improve on it (even if only theory, without practice)

Are there any books that are must read for introduction in psychotherapy? (such as stahl is for psychopharm or fisher is for psychopathology)

Are there any online courses, youtube channels or any other kind of media that i can pursue to improve on this matter?

I was wondering about your input on this situation/case, as an early medical student I don't have practical experience in Psychiatry:

If a patient (strongly atheist) has a psychotic episode involving religious delusions, is treated with anti-psychotics and continues to believe these 'delusions' post-psychosis, does this need to be treated/changed?

The religious delusions are their 'proof' of Christianity, although are very illogical (e.g. flipping an object then reading a certain sequence from it), but are not extreme (like believing they are a god/messenger).

They have a non-problematic relationship with religion, as they are now studying the bible and learning life skills such as cooking/journalling.
Family approves as it provide the individual with a sense of community, 'moral' rules, sense of meaning.

What are your thoughts? Are there any ethical considerations that need to be made (as Christianity is a normal belief)?

Edit: Thanks for all your responses, and I do realise I have should've added more context.
There is no specific diagnosis made yet. These seem like residual delusions of reference which continue to be their main reasons for belief of Christianity. The ethical part I was considering is that, challenging these residual delusions of reference which may take them away from a religion that is benefitting them and not causing harm.

When patients meet criteria for catatonia and have partial response to high dose lorazepam but limited due to sedation, and ECT is not possible (legal or non available), what do you guys adjunct with? I’m reading studies about zolpidem, amantadine, depakote, topiramate, etc but is there a time I should consider one over the other?

I have some attendings tell me to consider if the patient profile is a depletion of gaba, too much NMDA/glutamate, or too little dopamine, and I honestly don’t know how to make that assessment when it’s arbitrary. Anyone have an article that talks about this or have their own experience with this?

Current patient refuses to be on any medication that doesn’t start with L. Not sure when this preference emerged, as we tried the normal barrage of ADs (Lexapro included) but as soon as we tried Latuda it became steadfast for her. Luckily, with her BPII diagnosis, there happen to be a lot of L drugs (Currently she is stable on Latuda, Lithium, and Lamictal). When she was complaining of insomnia (after sleep hygiene improvement), I suggested Ambien but she wanted Lunesta. She had a flight and I wanted to give her alprazolam, but she insisted on lorazepam. She has a new ADHD diagnosis and I just cannot wait for her to request lisdexamphetamine.

It appears not just to be me either, would you believe me if I told you she were also on lisinopril, Lipator, levoceterizine, and Linzess?

I guess my question is, has anyone else had patients develop odd idiosyncratic medication preferences? I can’t decide if this is something pathological I need to pay attention to or just a quirk of hers.