Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary Admissions
In this episode, we dive into the complexities of the therapeutic alliance and the real challenges psychiatrists face in everyday practice. From patients insisting on ADHD diagnoses and stimulant prescriptions to those requesting Xanax, disability paperwork, or resisting involuntary admission, we role play common clinical encounters and discuss practical strategies for navigating them. Drawing on concepts like collaboration and alliance, we highlight tools for psychiatrists, therapists, and clinicians to manage difficult conversations without burning out. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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How to Do a Psychiatric Intake | The Art and Science of the First Hour
In this episode we break down how to run a focused, humane, and evidence informed psychiatric intake. We start with setting the frame and role clarity, then show how to use a free narrative to map life course symptoms before moving into targeted history, DSM-5 criteria, and the mental status exam. Along the way we tackle common requests for ADHD or autism evaluations, the risks of checklist thinking, and when to pivot to structured tools. We close with communicating impressions, treatment planning, and next steps. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’
Boundaries aren’t just rules in psychiatry… they’re part of the treatment itself. In this episode, we explore therapeutic ruptures, transference and countertransference, and how clear treatment frames protect patients, clinicians, and the therapeutic process. From handling “doorknob comments” to navigating burnout, we highlight the practical ways psychiatrists and therapists can use boundaries to strengthen care and reduce resentment. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and Liability
In this episode, we examine the complex phenomenon of erotic transference in psychiatric care and the critical role of maintaining ethical boundaries. Using the therapeutic frame as our guide, we unpack how patients may develop romantic or sexual feelings toward their psychiatrist… especially during medication management… and why strong boundaries and reality testing are essential to safeguard the treatment process. Drawing on clinical experience and ethical principles, this episode offers clinicians strategies for addressing counter-transference, reinforcing the therapeutic alliance, and knowing when referral or supervision is necessary to protect both patient welfare and professional integrity. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
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Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication Approach
In this fast‑paced Psychopharm podcast, we break down the OCD medication algorithm for obsessive compulsive disorder. You will hear about pushing SSRI doses, switching to Luvox or clomipramine, adding low‑dose antipsychotics, and glutamate modulators such as N‑acetylcysteine and ondansetron. The conversation also demystifies BrainsWay H7 deep TMS, explains realistic expectations for symptom reduction, and stresses that exposure response prevention remains the centerpiece of care. Helpful for psychiatrists, NPs and trainees who want clinical pearls without the fluff.NAC: https://drive.google.com/file/d/1b7ZBeFDKAAwLhfzUo0Jv58jEL7B70l5r/view This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com
PsychoFarm Podcast is a deep dive into the intersection of psychiatry, psychopharmacology, and the evolving understanding of mental health. Hosted by 2 psychiatrists, the podcast explores complex topics such as diagnosing mood and personality disorders, the role of medications in treatment, and the challenges of psychiatric training. Each episode breaks down the clinical insights and philosophical debates surrounding mental health care, providing both practitioners and curious listeners with thoughtful analysis, expert opinions, and practical advice. psychofarm.substack.com
Ireland