Thinking In Psychiatry

Access the mentioned courses here:Sleep And Psychiatry: https://psychscene.co/46d0T09ADHD and Sleep Dysfunction:https://psychscene.co/4rrE9CcIn this episode, Dr Sanil Rege explores the "how and why" of sleep by analysing a 2025 Neuron perspective paper (https://pubmed.ncbi.nlm.nih.gov/40961940/) detailing the interplay between sleep, motor circuits, and catecholamine biology.The discussion unpacks the motor theory of sleep, in which sleep control is embedded within somatic and autonomic motor circuits, and the catecholamine hypothesis, which posits that a core biological function of sleep is the inactivation of dopamine, noradrenaline, and adrenaline.This podcast provides clinicians with a neuroscientific framework for understanding sleep as an active state transition involving a global downshift of somatic and autonomic motor systems.#Sleep #Neuropsychiatry #Insomnia

Access mentioned courses here:Clinical Audit On Cognitive Aspects of Depression: https://psychscene.co/3Z2EdvHThe Aggregation of Marginal Gains as a Philosophy of Clinical Care with Prof Michael Berk: https://psychscene.co/4rqS62VIn this episode, Dr Sanil Rege examines the KARMA-Dep 2 trial, a randomised controlled trial comparing adjunctive serial ketamine infusions to midazolam for patients with Treatment-Resistant Depression (TRD) in an inpatient setting.Based on a JAMA Psychiatry article titled “Serial Ketamine Infusions as Adjunctive Therapy to Inpatient Care for Depression,” the discussion explores why statistically insignificant differences between ketamine and psychoactive comparators necessitate a shift in how clinicians evaluate rapid-acting antidepressants, detailing the "wow effect" of early symptomatic drops and the subsequent plateauing of recovery curves.This podcast provides clinicians with a clinical framework for differentiating between acute symptomatic response and long-term functional recovery in TRD.Chapters:00:22 - The KARMA-Dep 2 Trial Headlines 03:44 - Primary Outcomes: Ketamine vs. Midazolam Results04:26 - Analysing the Curves: The "Wow Effect" vs. Sustained Recovery08:50 - Neurobiology of Response vs. Neurobiology of Recovery09:21 - Why Improvement Stalls: The Role of Neuroadaptation10:47 - Clinical Implications for Inpatient CareTo get access to more materials like this plus over 150 hours of interactive CPD education on psychiatry, check out The Academy using the link below:https://psychscene.co/4rl6pFV

To access the full episode and over 150+ hours of cutting-edge, interactive courses on Psychiatry subscribe to The Academy: https://psychscene.co/4qfNAnyIn this episode, Consultant Psychiatrist, Dr Sanil Rege looks at treatment refractory mood disorders through a psychodynamic lens using a naturalistic study from the Austen Riggs Centre. A subset of what most see as Treatment-Resistant Depression (TRD) isn't just pharmacological non-response; it's depression embedded within personality organisation, trauma-related aspects, attachment, and unconscious patterns. This podcast provides clinicians with a psychodynamic perspective to understand how clinical refractoriness to standard pharmacotherapy can be sustained by meaning, defences, and relational patterns, not just neurotransmitters.

To access all episodes plus 150+ hours of advanced psychiatric education join the Academy today. Get access here: https://www.academy.psychscene.com/Why is Alzheimer’s disease more common in women?In this episode, we break down what current research reveals about sex differences in Alzheimer’s biology — including hormonal changes, tau progression, genetics, and how women often compensate on early cognitive testing, delaying diagnosis.We also discuss how these differences shape clinical assessment, treatment responses to emerging anti-amyloid therapies, and why midlife risk modification is especially important.Key PointsWomen show faster tau accumulation once amyloid appears.Cognitive compensation can lead to later diagnosis in women.Estrogen decline at menopause influences inflammation, synaptic resilience, and neuroprotection.APOE-ε4 confers greater Alzheimer’s risk in women.Sex-specific risk factors require tailored prevention and assessment.To access all episodes plus 150+ hours of advanced psychiatric education join the Academy today. Get access here: https://www.academy.psychscene.com/