Carlat Psychiatry Podcast

ADHD treatment access can be undermined by the organisational difficulties of ADHD itself, while telehealth prescribing rules, financial incentives and evidence comparing treatment onset, efficacy and tolerability all require careful distinction rather than simple claims of improved access.

Treatment should match the substance: methadone or buprenorphine form the foundation for opioid use disorder, contingency management leads for stimulant use disorder, while alcohol and tobacco use disorders allow greater choice between medication and behavioural treatment.

Sleep hygiene and relaxation alone rarely treat chronic insomnia. Structured cognitive behavioural therapy for insomnia uses regular wake times, morning daylight, stimulus control, reduced sleep effort and work on catastrophic beliefs, with supported hypnotic reduction when appropriate.

Chronic insomnia can persist through extended time in bed, napping and conditioned arousal even after the original stressor improves. A subjective sleep diary guides time-in-bed restriction and stimulus control, including when psychiatric or physical illness coexists.

Lifelong attention symptoms require a developmental timeline rather than a checklist alone. Bipolar disorder, sleep problems, substance exposure, brain injury, vascular or inflammatory disease and cognition-impairing medicines can mimic or compound adult attention-deficit/hyperactivity disorder.

Adult attention problems require separation of lifelong neurodevelopmental symptoms from new cognitive impairment caused by substances, medical illness or other psychiatric conditions. Cannabis may impair attention, working memory, executive function and verbal learning despite perceived benefit, making symptom timing, abstinence and objective testing clinically useful.

Psychiatry and critical-appraisal clinicians get a careful approach to attention problems first reported in adulthood. Developmental history and collateral information help identify overlooked childhood ADHD, while sleep disorders, substance use, mood disorders, obsessive symptoms and psychosis remain important alternative explanations.

Psychiatry and primary-care clinicians get a diagnostic framework for adult inattention that starts with childhood-onset symptoms and current functional impairment. Sleep apnoea, sleep deprivation, substance use, concussion, menopause, social-media overuse and increased occupational demands remain important alternatives, while collateral history can strengthen uncertain retrospective accounts.

Psychiatry, mental-health and medical-education clinicians get a practical introduction to dialectical behaviour therapy for borderline personality disorder. The acceptance-change dialectic, biosocial formulation, diary cards, behavioural chain analysis, target hierarchy and skills training are linked to the management of self-harm, suicidal behaviour and pervasive emotion dysregulation.

Psychiatry and primary-care clinicians get a sex-aware prescribing review covering urinary symptoms, sexual dysfunction, prolactin elevation, bone health, sedation and substance-related harm. It also highlights sleep-apnoea screening when poor concentration or ADHD-like symptoms coexist with snoring, daytime sleepiness or witnessed apnoeas.