Thinking In Psychiatry

Have We Been Thinking About Sleep Wrong? (Motor Theory Explained)

Access the mentioned courses here: Sleep And Psychiatry:   https://psychscene.co/46d0T09 ADHD and Sleep Dysfunction: https://psychscene.co/4rrE9Cc In 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

Do ADHD Stimulants ‘Cause’ Psychosis?

Access mentioned course here: https://psychscene.co/46iAaiI In this episode, Consultant Psychiatrist, Dr Sanil Rege examines the complex relationship between ADHD pharmacotherapy and the emergence of psychotic symptoms. By analysing synthesis data from The Lancet Psychiatry (https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00248-2/abstract), the podcast distinguishes between drug-induced events and baseline neurobiological vulnerabilities inherent in ADHD populations. This podcast provides clinicians with a neuroscientific framework for differentiating between protopathic bias and true medication-induced psychotic phenomena, as well as a step-wise screening pathway for risk-guided prescribing using validated at-risk mental state (ARMS) triage tools. To get access to the complete podcast catalog and material like this plus over 150 hours of interactive CPD education on psychiatry, check out The Academy using the link below: https://psychscene.co/45M67jh

Did Ketamine 'Fail' or Are We Asking The Wrong Questions? *Full Study Review*

Access mentioned courses here: Clinical Audit On Cognitive Aspects of Depression:  https://psychscene.co/3Z2EdvH The Aggregation of Marginal Gains as a Philosophy of Clinical Care with Prof Michael Berk:  https://psychscene.co/4rqS62V In 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 Results 04:26 - Analysing the Curves: The "Wow Effect" vs. Sustained Recovery 08:50 - Neurobiology of Response vs. Neurobiology of Recovery 09:21 - Why Improvement Stalls: The Role of Neuroadaptation 10:47 - Clinical Implications for Inpatient Care To 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

The 3 Types of Hunger Clinicians Need to Know For Medication Side Effects

Access the mentioned course ‘Antipsychotic Induced Weight Gain and Metabolic Syndrome (MetS)’ here:  https://psychscene.co/4a62kQa In this episode Consultant Psychiatrist, Dr Sanil Rege, explores the complex neurobiology of appetite regulation, diving deep into the nuances of the brain-gut-microbiome system. Based on a recent New England Journal of Medicine (NEJM) review titled “The Physiology of Hunger,” the discussion examines hunger not as a matter of willpower, but as a sophisticated interaction between the brain, gut, and microbiome. This podcast provides clinicians with a pathophysiological framework for differentiating between energy balance systems, reward-based drives, and microbial metabolites to better manage obesity, anorexia nervosa, and the cautious implementation of GLP-1 receptor agonists. To get access to more material like this plus over 150 hours of interactive CPD education on psychiatry, check out The Academy using the link below: https://psychscene.co/4t8d6gy #HungerPhysiology #Neuroscience #MetabolicHealth

Why Pharmacotherapy Alone May 'Fail' in Complex TRD (Treatment-Resistant Depression)

To access the full episode and over 150+ hours of cutting-edge, interactive courses on Psychiatry subscribe to The Academy: https://psychscene.co/4qfNAny In 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.