The Journal of Clinical Psychiatry Podcast

Psychiatric hospitals admit patients for severe mental illness and high suicide risk every day. While mental health professionals treat acute suicidality during these intense crises, standard depression medications can take weeks to work. Traditional clinical psychiatry often leaves vulnerable patients in danger after hospital discharge. Medical teams need rapid suicide prevention treatments to help stabilize psychiatric inpatients quickly.
Learn about potential improvements to inpatient suicide care as Dr. Brett Jones, Medical Head of the Bipolar Disorder Clinic at Toronto’s Center for Addiction and Mental Health, reveals the results of his research review into the best evidence-based medical interventions.
🎯 KEY EPISODE HIGHLIGHTS:
🛑 RESEARCH BLINDSPOT [10:25]:
"I think there are a lot of studies out there. I was reading, I was seeing the evidence, but the consensus as to what would be the most effective treatment and for whom really wasn't there."
Hear Dr. Jones explain the massive missing piece in psychiatric care.
🧠 CLINICAL BREAKTHROUGH [23:45]:
"Some of the chronotherapy was something I actually didn't know about. That certainly is a low cost intervention. So that's quite promising if it turns out to be effective."
See how simple sleep treatments change inpatient psychiatry.
🛠️ STRATEGIC ACTION [34:50]:
"We showed a good effect with a digital version of DBT… So we're going to look at trying to replicate that in a multicenter study."
Get the exact details on digital therapy for hospital units.
CHAPTERS:
00:00 - Honoring Dr. Nolan Williams
03:07 - Career Path into Psychiatry and Suicide Research
07:59 - Why Inpatient Suicide Treatment Needs Better Evidence
12:59 - Key Limitations in Suicide Intervention Research
14:57 - Ketamine and Rapid Acting Treatments for Suicidality
19:48 - Emerging Treatments Beyond Traditional Depression Care
25:47 - Translating Research into Real World Inpatient Practice
30:38 - Major Research Gaps and Need for Better Clinical Trials
33:04 - Hospitalization as a Critical Window to Prevent Suicide
37:41 - Up Next: Dr. Marc Agronin
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep10-inpatient-treatment-suicidality-brett-jones/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Inpatient Treatment of Suicidality: A Systematic Review of Clinical Trials:
https://pubmed.ncbi.nlm.nih.gov/39832343/
Dr. Brett Jones: https://www.linkedin.com/in/brett-jones-1b308260/?originalSubdomain=ca
Center for Addiction and Mental Health: https://www.camh.ca
University of Toronto Psychiatry: https://psychiatry.utoronto.ca
#AcuteSuicidality #InpatientPsychiatry #ClinicalResearch

Feeling tired despite a full night's sleep? The problem may not be the hours you get, but the quality of your breathing. According to sleep medicine expert and founding physician of SLIIIP, Dr. Avinesh Bhar, many people dismiss fatigue, snoring, or frequent waking, using caffeine and over-the-counter aids to cope.
This masks a deeper problem. Undiagnosed sleep-disordered breathing, like sleep apnea, is a silent driver of serious health issues, from heart disease to mental health conditions. Ignoring the root cause makes other medical treatments less effective, creating a cycle of declining health. 90% of people with mental health conditions also struggle with sleep issues. Getting help is easy at SLIIIP.com. No travel required. Insurance accepted.
🎯 KEY EPISODE TAKEAWAYS:
⚠️ THE SURVIVAL MODE TRAP [08:49]:
"If you don't sleep well, your whole day changes in perspective. You are in survival mode, and you can't be your best self. You can't perform."
Are you just surviving instead of thriving? Watch this segment to understand the biological cost of poor sleep and why feeling "just okay" is a major red flag for your health.
✨ THE MENTAL HEALTH BREAKTHROUGH [29:24]:
"If you're a therapist or psychiatrist managing mental health, you should also make sure the sleep is evaluated…otherwise, your improvements in mental health aren't going to reach the level that actually makes the patient feel like they've actually turned the corner.”
Unlock better patient outcomes. See how integrating a sleep evaluation can be the missing piece in treating depression, anxiety, and PTSD effectively.
⚡️ THE 2-QUESTION DIAGNOSTIC [59:40]:
"'Are you sleeping well? Are you waking up refreshed?' If you have a 'no' to either one of those questions, the patient needs an evaluation."
This is the simple, powerful framework you need. Listen to this section to learn the exact questions that tell you if it's time to refer a patient (or yourself) to a sleep specialist and how easy it is via www.sliiip.com. SLIIIP is making advanced sleep care fast & convenient, offering patients same week appointments with board-certified sleep medicine physicians instead of the months‑long wait typical of traditional sleep labs.
CHAPTERS:
00:00 - Introducing Dr. Avi Bhar
03:48 - From ICU to Sleep Medicine and What Clinicians Miss
06:52 - What Sleep Does Biologically and Why Quality Beats Hours
13:23 - Sleep Myths That Keep You Sick and Tired
16:24 - Sleep Hygiene That Works
19:54 - When to Suspect a Real Sleep Disorder Beyond Stress
23:00 - How Sleep Apnea Drives Heart, Metabolic, and Inflammatory Disease
27:51 - Sleep and Psychiatry
30:35 - Solving Access With Home Sleep Tests and Step-Based Care
39:33 - The Ideal Telemedicine Sleep Care Pathway
48:28 - Stop Masking Sleep Problems With OTC Aids and Melatonin
52:33 - When to Retest and How Treatment Lowers Long-Term Healthcare Costs
1:01:03 - Up Next: Dr. Brett Jones
Key Takeaways:
"Sleep is a reparative opportunity. It heals and repairs the trauma of the day. It's essential, not optional."
"Quality and quantity of sleep matter. Sleeping 7-8 hours is good, but waking refreshed is key."
"Sleep disturbances don't just coexist with illnesses; they can drive medical and psychiatric morbidity."
"Evaluate sleep in patients with mental health issues. It's both a driver and symptom of psychiatric illness."
"Speed and efficiency in sleep evaluation are crucial. It reflects the urgency and importance of the issue."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep9-sleep-issues-psychiatric-practice-avinesh-bhar/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
SLIIIP: https://sliiip.com/
#SleepApnea #MentalHealth #SleepDisorders

Ben welcomes psychiatrist Dr. Mike Halassa back to the podcast to discuss the shifting landscape of inpatient schizophrenia treatment. An early adopter of Cobenfy, Dr. Halassa shares real-world insights from his research published in Nature Mental Health in this conversation that bridges technical neuroscience with the high-stakes reality of managing acute psychiatric crises.
The discussion focuses on Cobenfy’s muscarinic mechanism, the first novel approach to psychosis in seventy years. Dr. Halassa details his "dose-sparing" strategy, reducing reliance on traditional D2 blockers and their metabolic burdens, and he shares case studies of treatment-resistant patients who succeeded on this agent after clozapine failed. Finally, Ben and Dr. Halassa explore functional recovery, precision psychiatry, and the empathic connection required to treat society's most vulnerable individuals.
Episode Highlights:
00:00 - Welcoming Back Dr. Mike Halassa
01:46 - ‘Spending a Day in Someone Else’s Brain’
04:21 - Empathy, Parenting, and Staying Grounded in Psychiatry
06:37 - Why Inpatient Psychiatry Works: Acuity, Speed, and Team-Based Care
09:31 - Evaluating Acute Psychosis: Intake, Chronicity, and Treatment Decisions
12:46 - Discovering XT as the First Novel Schizophrenia Mechanism in Decades
16:19 - A Remarkable XT Case Study
23:26 - XT Dosing Tolerability and Early Clinical Results
30:15 - From Observation to Evidence: Identifying XT Response Patterns
35:12 - Testing Negative Symptoms in Real Time on the Inpatient Unit
40:33 - XT vs D2 Blockers for Positive and Negative Symptom Control
50:28 - Redefining Success in Schizophrenia Through Functional Recovery
54:15 - The Future of Precision Psychiatry and Treating the Whole Person
56:42 - Up Next: Dr. Avi Bhar
Key Takeaways:
"Inpatient psychiatry demands quick thinking and rapid decisions. It's a critical care type environment."
"I find my kids keep me grounded and empathetic. They're my window into empathy."
"XT offers a fundamentally different way of engaging the system. It's not just another antipsychotic."
"Seeing patients become more socially connected on XT is remarkable. It's a new light in their eyes."
"Negative symptoms have been intractable. XT offers hope for functional recovery."
"The multidisciplinary team is crucial in schizophrenia care. It requires coordination and dedication."
"XT allows for dose sparing of traditional antipsychotics, potentially reducing side effects."
"We must aspire to help patients engage with life fully, beyond just managing symptoms."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep8-early-use-xanomeline-trospium-michael-halassa/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Dr. Halassa’s Substack: michaelhalassa.substack.com
The Halassa Lab: https://halassalab.tufts.edu/
Preliminary real-world predictors of response to muscarinic targeting in psychosis: https://www.nature.com/articles/s44220-025-00529-w
Real-World Implementation of Xanomeline-Trospium in Schizophrenia: A Consensus Panel Report: https://pubmed.ncbi.nlm.nih.gov/41201439/

Host Ben Everett sits down with Tufts University physician-scientist Dr. Michael Halassa to discuss algorithmic circuit psychiatry. This framework aims to modernize mental health care by mapping subjective experiences onto objective neural computations. By shifting focus to brain circuit mechanics, they explore a new paradigm for treating complex psychotic disorders. This conversation redefines psychiatry as a data-driven, precision-oriented field of medicine.
The episode moves beyond the "chemical imbalance" theory to examine the dynamics of excitation and inhibition. Dr. Halassa explains how large language models and machine learning provide new test beds for analyzing reasoning and belief updating, and that, by using "behavioral clamps" and task-based biomarkers, researchers can now operationalize delusions through the study of counterfactual decision-making. He also notes that causal circuit validation in animal models remains essential for identifying precise drug targets and improving clinical outcomes. The discussion finishes up by touching on emerging muscarinic therapies and the future of psychiatric training.
Episode Highlights:
00:00 – Why Algorithmic Circuit Psychiatry Could Modernize Mental Health Care
02:36 – From Physics to Psychiatry: Building a Scientist-Clinician Lens
05:52 – Decoding Brain Circuits With Computational Models and Modern Tools
10:37 – Returning to Inpatient Psychosis Care and Reframing Clinical Reality
14:47 – Moving Beyond “Chemical Imbalance” Thinking in Schizophrenia Treatment
20:43 – Fixing Computational Psychiatry Limits With Mechanistic, Circuit-Based Models
25:08 – Creating Task-Based Biomarkers to Measure Belief Updating and Reasoning
29:10 – Operationalizing Delusions Through Counterfactual and Decision-Making Tasks
33:59 – Translating Algorithms Into Drug Targets and Better Animal Research
37:54 – Using LLMs and Machine Learning to Test Psychiatric Mechanisms In Silico
44:57 – Redesigning Animal Models to Validate Causal Brain Circuit Algorithms
53:03 – Training the Next Generation for Precision Psychiatry
56:44 – Defining Clinical and Scientific Milestones for the Future of Mental Health Care
Key Takeaways:
"Psychiatry feels different from other fields. We don't have biomarkers to guide decision making."
"The brain functions in packets of information sent between areas. It's more complex than a single synapse."
"In psychiatry, you absolutely need a behavioral clamp. It's not just about resting state measurements."
"Machine learning was inspired by neuroscience. Now, it helps us understand altered thinking in machines."
"The burden is on us to train the next generation to tackle psychiatry's complexity."
"Talking to patients like equals is my default. We're all vulnerable to mental illness."
"Mental health is sidetracked by societal issues. We must agree we're all human beings."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep7-algorithmic-psychiatry-michael-halassa/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
“Developing algorithmic psychiatry via multi-level spanning computational models”:
https://pubmed.ncbi.nlm.nih.gov/40300598/
Dr. Halassa’s Substack: michaelhalassa.substack.com
The Halassa Lab: https://halassalab.tufts.edu/

Dr. David Feifel, Professor Emeritus of Psychiatry at UC San Diego and founding president of the Kadima Neuropsychiatry Institute, joins the JCP Podcast to kick off the new "Psychedelics in Psychiatry" theme. A pioneer in the field who established the world’s first ketamine infusion program for depression, Dr. Feifel sits down to discuss the paradigm shift currently reshaping mental health care.
In this installment of the Behind the Manuscript series, Dr. Feifel breaks down the findings of his recent JCP paper: “Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Depression”. He explains the significance of the 25mg dose in preventing relapse over 52 weeks and offers a critical look at why traditional SSRIs are no longer enough. Beyond the data, the conversation delves into the nuances of "set and setting," the controversy of microdosing versus "heroic" doses, and the practical challenges clinicians face as the field moves toward interventional psychiatry. Dr. Feifel also challenges the traditional medical view of the placebo effect, arguing that harnessing expectation may be the key to the next generation of healing.
Episode Highlights:
00:00 - Dr. David Feifel and His Breakthrough Career
02:13 - How Early Curiosity Led to Psychiatry Instead of Neurology
07:33 - Balancing Clinical Practice With Research Innovation
11:41 - Psychiatry Entering a Transformational New Era
13:51 - Why SSRIs Fall Short and TRD Demands Better Solutions
17:27 - What Makes Psilocybin the Leading Psychedelic Candidate
20:25 - Why the Psychedelic Renaissance Is Surging Now
25:42 - Microdosing Myths and the Power of Expectancy
33:55 - How Set and Setting Shape Psychedelic Treatment Outcomes
39:51 - Do Psychedelics Really Need Psychotherapy to Work
48:58 - Inside the Phase 2 Study and How TRD Patients Were Enrolled
56:04 - Why 25mg Psilocybin Delivered the Strongest Clinical Results
1:05:39 - What Long-Term Follow Up Reveals About Relapse and Durability
1:11:38 - How Clinicians Can Prepare for Psychedelic Medicine Adoption
1:16:53 - Why the Future of Psychiatry May Rely on Harnessing Placebo Power
Key Takeaways:
"Psychiatry is in the midst of a golden age revolution... I feel like every day I was going to war with Godzilla with a peashooter. Now I feel like we've got some real tools."
"We’re in the midst of what I call the Cambrian explosion of treatments... a massive explosion of life forms after a long time of stagnation."
"The concept of 'one and done' with psychedelics is dead. We aren't going to have patients come in one time and say, 'You're good for life.'"
"Doing ketamine is like doing psychotherapy, but you're both the psychotherapist and the patient at the same time."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep6-psychedelic-renaissance-david-feifel/
Journal of Clinical Psychiatry: http://psychiatrist.com/jcp/
Dr. David Feifel: https://www.linkedin.com/in/davidfeifel/
Kadima Neuropsychiatry Institute: https://www.kadimanp.com/
“Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Episode of Major Depressive Disorder”:
https://www.psychiatrist.com/jcp/long-term-follow-up-study-single-dose-psilocybin-treatment-resistant-episode-major-depressive-disorder/