Carlat Psychiatry Podcast

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.

Psychiatry, general practice and emergency clinicians get a balanced harm-reduction frame for psilocybin. It separates possible effects in depression or terminal illness anxiety from treatment-resistant uncertainty, contraindications, serotonergic medicine review, supervised dosing, integration therapy and persistent perceptual disturbance.

Trauma presentations with flashbacks, nightmares, persistent anxiety or low self-esteem may need more than symptom labelling. The EMDR guide is useful for understanding stabilisation, readiness for reprocessing, bilateral stimulation and the eight-phase model before considering accredited training.

Autistic young people may carry suicide risk even when supervision, routine or communication differences make distress harder to read. The emphasis is concrete language, processing time, collateral history and safety planning that includes sensory triggers, access to lethal means and family roles.

Gender-affirming care needs respectful assessment rather than pathologising identity. Document diagnosis, capacity, informed consent, comorbidity and social support, while separating reversible, partially reversible and irreversible interventions and making suicide-risk assessment visible.

Gender-affirming care is approached through critical appraisal of a flawed historical follow-up study. The teaching is to separate evidence quality from assumptions about social conformity, and to prioritise patient-reported distress, functioning and safety when services are discussed.

This psychiatry and critical appraisal item is specialist, but worth choosing when adolescent gender dysphoria outcomes or consent records are under review. It separates appearance satisfaction from broader mental health outcomes, then treats dextromethorphan augmentation in clozapine-resistant schizophrenia as an early, cautious signal.

Complex gender-related distress needs more than satisfaction data. The psychiatry appraisal stresses evidence limits, multidisciplinary assessment before irreversible treatment, external pressures around detransition, and ADHD reviews that focus on functional organisation rather than early stimulant energy.