Carlat Psychiatry Podcast

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.

Psychiatry, obstetrics and gynaecology, respiratory and primary-care clinicians get a midlife mental-health prescribing update. Perimenopausal depression, bipolar caution, vasomotor symptoms, HRT referral, ADHD symptoms, sleep apnoea screening, atomoxetine, gabapentin, melatonin and adjuncts such as clonidine, L-methylfolate and saffron are kept in view.

Psychiatry, primary-care, obstetrics and sexual-health clinicians get a prescribing update on cyclical symptom worsening, contraception and psychiatric medication. It separates premenstrual syndrome from relapse, highlights PMDD treatment options, and keeps lamotrigine, CYP3A4 inducers, pregnancy, HRT and contraceptive effectiveness in view.

Psychiatry, obstetrics and gynaecology, and endocrinology clinicians get sex-specific prescribing considerations. Valproate’s fetal and endocrine risks, lower zolpidem dose limits, atypical depression, premenstrual symptom changes, pregnancy and breastfeeding are central to the discussion.