The Journal of Clinical Psychiatry Podcast

In this episode of the JCP Podcast, host Dr. Ben Everett speaks with Dr. Steven Berkowitz, Professor of Psychiatry at the University of Colorado School of Medicine and Director of the Stress, Trauma, and Adversity Research and Treatment (START) Center at CU Anschutz. Drawing on a career spanning the Yale Child Study Center, Penn, and CU, Dr. Berkowitz discusses how childhood trauma shapes psychiatric illness across the lifespan and what that means for early intervention, assessment, and treatment.
The conversation covers the neurobiology of early maltreatment, the development and outcomes of the CFTSI early intervention model, the debate over developmental trauma disorder and complex PTSD, and how trauma presents differently in autistic youth. Dr. Berkowitz also addresses treatment sequencing for comorbid substance use and ADHD, the central role of sleep in trauma care, sensory processing deficits in children in the child welfare system, and the scientific and ethical questions that would need to be answered before psychedelic research could be extended to children and adolescents with PTSD.

🎯 KEY EPISODE HIGHLIGHTS:
🌱 WE CAN'T TREAT OUR WAY OUT OF THIS CRISIS [07:00]
“I really believe in prevention, and I think unfortunately, given our current set of circumstances, we're never gonna treat our way out of what is a mental health crisis in this country.”
Dr. Berkowitz frames pediatric trauma work as prevention, noting that most adults in outpatient psychiatric care carry a history of childhood trauma.
😴 TRAUMA PSYCHIATRY IS SLEEP PSYCHIATRY [25:42]
“Trauma psychiatry in many ways is about sleep psychiatry. The goal is to get people sleeping.”
Targeting nightmares and nighttime intrusive symptoms first may make it possible for patients to engage meaningfully in trauma therapy.
🧠 PSYCHOTHERAPY IS ESSENTIAL IN YOUTH PSYCHEDELIC RESEARCH [35:32]
“With kids, feeling is it's not even a question. We should absolutely be doing psychotherapy in these sessions as well as before and after.”
Any future psychedelic trials in children and adolescents will require extensive family preparation and integrated psychotherapy, raising design questions the field has yet to answer.

CHAPTERS:
00:00 – Introducing Dr. Steven Berkowitz
01:30 – Forensic Expert Work and Delayed-Onset PTSD
05:00 – Prevention and the Neurobiology of Childhood Trauma
11:00 – Developing the CFTSI Early Intervention Model
16:00 – Developmental Trauma, Complex PTSD, and the Limits of the DSM
19:30 – How Trauma Presents in Autistic Youth
23:30 – Sequencing Treatment for Substance Use, Comorbidities, and Sleep
26:30 – The START Center, Sensory Processing, and the “Trauma-Informed” Debate
32:00 – PTSD Pharmacotherapy and Psychedelic Research in Youth

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep24-trauma-expert-view-psychedelic-medicine-steven-berkowitz/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. Steven Berkowitz – LinkedIn https://www.linkedin.com/in/stevenberkowitz/
CU Anschutz START Center https://www.cuanschutz.edu/home Dr. Berkowitz's family-centered, lifespan trauma research and treatment center.
Child and Family Traumatic Stress Intervention (CFTSI) https://www.nctsn.org/interventions/child-and-family-traumatic-stress-intervention
Brief early intervention model for children and caregivers discussed in this episode.
#ChildTrauma #PTSD #CFTSI #TraumaPsychiatry #PsychedelicResearch

In this episode of the JCP Podcast, Dr. Ben Everett speaks with Dr. Nina Schooler, a social psychologist whose career in psychiatric research spans more than six decades. Dr. Schooler began her work at the National Institute of Mental Health's Psychopharmacology Service Center in the early 1960s and has since contributed to landmark studies on antipsychotic treatment, maintenance therapy, tardive dyskinesia, long-acting injectables, negative symptoms, and coordinated specialty care for first-episode psychosis.
As the field increasingly looks toward a paradigm of meaningful functional recovery that goes beyond symptom control, this conversation traces how today's clinical standards, from dose-reduction strategies to the RAISE early-intervention model, emerged from decades of trial design, unexpected findings, and hard-won methodological lessons.

🎯 KEY EPISODE HIGHLIGHTS:
🔍 THE ACCIDENTAL DISCOVERY IN THE FIRST PLACEBO STUDY [12:30]
“the patients who'd been treated with placebo seemed in some ways to be doing better than the patients who had been treated with drug.”
A counterintuitive early finding shows how unblinding and differential attention, not the drug itself, can distort perceived treatment effects in psychiatric trials.
🚧 WHY THE SICKEST PATIENTS ARE MISSING FROM NEGATIVE SYMPTOM TRIALS [1:04:00]
“the patients we most want to include will not be included in the trial because participating in a clinical trial requires effort”
A structural recruitment paradox helps explain why decades of negative symptom trials have struggled to enroll the patients most affected by the condition.
🤝 SCHIZOPHRENIA CARE AS “A TEAM SPORT” [1:19:30]
“My sense of schizophrenia as a treatment target is that it's a team sport, and that it requires a team of people to engage with patients offering a range of treatments for which I see medication as the absolutely essential platform on which other things, can indeed build.”
After six decades in the field, this framing captures why no single intervention, medication or psychosocial, succeeds alone in treating schizophrenia.

CHAPTERS:
0:00 – Introduction: Six Decades of Schizophrenia Research
2:30 – Joining NIMH's Psychopharmacology Service Center in the 1960s
9:00 – Shifting Terminology and the Boundaries of a Schizophrenia Diagnosis
11:30 – A Social Psychologist's Lens on Early Treatment Outcomes
16:00 – Open Questions on Lifelong Treatment and Parallel VA Research
18:30 – The Hogarty-Goldberg Studies and the Two-by-Two Trial Design
27:30 – Expressed Emotion and the Camberwell Family Interview
32:30 – Controlled Trials Versus Real-World Adherence
34:00 – Tardive Dyskinesia and the Push to Lower Antipsychotic Doses
36:30 – Designing the Treatment Strategies in Schizophrenia Study
40:30 – Results: Medication's Value and a Young, Family-Involved Cohort
45:00 – Long-Acting Injectables: Adherence Myths and the PROactive Study
51:30 – Research Diagnostic Criteria for Tardive Dyskinesia and the AIMS Scale
56:30 – Negative Symptoms, Cognition, and the Risperidone Question
1:02:30 – The FDA Workshop and Consent Challenges in the CONSIST Study
1:06:00 – Digital Interventions, EMA, and Smartphone-Based Treatment
1:09:30 – Designing RAISE: A Cluster-Randomized Approach to First-Episode Care
1:15:30 – RAISE Results and the Challenge of Personalized, Team-Based Care
1:21:00 – From RAISE to SAMHSA: Scaling Coordinated Specialty Care
1:25:30 – Has RAISE Changed Community Practice?
1:28:00 – Toward Meaningful Functional Recovery: What Must Change Next

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep23-six-decades-schizophrenia-care-nina-schooler/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. Nina Schooler – LinkedIn
https://www.linkedin.com/in/nina-schooler-11022870/
NIMH – Recovery After an Initial Schizophrenia Episode (RAISE)
https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise
NIMH overview of the RAISE initiative and coordinated specialty care model discussed at length in this episode.
SAMHSA – Early Serious Mental Illness Treatment Locator
https://www.samhsa.gov/find-help/locators/esmi
Locator for coordinated specialty care programs, funded through the SAMHSA block grants described in this episode.
#Schizophrenia #TardiveDyskinesia #LongActingInjectables #FirstEpisodePsychosis #Psychopharmacology

Dr. Benjamin Brody, an inpatient psychiatrist who built and now directs one of the earliest hospital-based ketamine treatment programs, joins Dr. Ben Everett to unpack the regulatory maze surrounding ketamine and the psychedelics now approaching FDA approval. Dr. Brody traces how he moved generic racemic ketamine from an overlooked anesthetic sitting on the hospital pharmacy shelf to a formally sanctioned inpatient treatment, and explains why esketamine's REMS-regulated pathway looks nothing like the largely unregulated market for take-home ketamine.
As synthetic psilocybin nears a possible FDA decision and the field debates what role psychotherapy should play alongside these treatments, clinicians face fast-moving questions about safety monitoring, staffing, informed consent, and reimbursement. Drawing on his direct experience administering ketamine on the inpatient unit, Dr. Brody discusses self-escalation risk, the paradox reaction his team termed dysphoric dissociation, and what health systems should weigh before building a program of their own.

🎯 KEY EPISODE HIGHLIGHTS:
⚠️ THE NARROW LINE BETWEEN NEUROTROPHIC AND NEUROTOXIC [18:30]
“But at higher doses, it actually becomes neurotoxic and, you know, there's histopathological changes that can be seen.”
At therapeutic doses ketamine is safe and neurotrophic, but Dr. Brody warns that self-escalating doses can quickly cross into neurotoxic and bladder-damaging territory.
🧠 DEFINING DYSPHORIC DISSOCIATION [24:00]
“This is a dysphoric piece or a dysphoric reaction that is layered on top of the dissociative experience for this small minority of patients.”
Dr. Brody explains why his team coined a new clinical term to distinguish ketamine's rare, frightening paradox reaction from a psychedelic “bad trip,” and why naming it matters for informed consent.
🚫 THE CASE AGAINST TAKE-HOME KETAMINE [25:00]
“The unambiguous answer is no, I do not think this is a good idea.”
Citing self-escalation risk, a narrow therapeutic index, and a growing number of ketamine-associated deaths, Dr. Brody explains why he opposes direct-to-consumer telehealth ketamine prescribing.

CHAPTERS:
00:00 – From Creative Writing to the Inpatient Unit
02:30 – A Day in the Life of an Inpatient Psychiatrist
05:30 – How Dr. Brody Came to Believe in Ketamine
12:00 – Ketamine vs. Classical Psychedelics: A Different Mechanism
14:00 – Two Regulatory Worlds: Racemic Ketamine and REMS-Regulated Esketamine
17:30 – Safety Signals: Self-Escalation and Dysphoric Dissociation
24:30 – The Case Against Take-Home Ketamine
29:30 – Psychedelics Enter the Medical Mainstream
33:30 – What to Expect When Psilocybin Gets FDA Approval
39:00 – Staffing and Consent for Hours-Long Sessions
43:00 – Set and Setting: Lessons from Building a Ketamine Program
48:00 – Is This Psychotherapy? Defining the Clinician's Role
54:00 – What Surprised Dr. Brody About Implementation
57:00 – Advice for Health Systems and Reasons for Optimism

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep22-regulatory-maze-ketamine-psychedelics-benjamin-brody/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
How Do We Get Ketamine Safety Right? Three Questions From a Clinical Service
https://www.psychiatrist.com/jcp/how-do-we-get-ketamine-safety-right-3-questions-from-clinical-service/
Dr. Brody's 2025 JCP commentary on self-escalation, paradox reactions, and the regulatory gap between racemic ketamine and esketamine, discussed at length in this episode.
COMPASS Pathways – COMP360 Psilocybin for Treatment-Resistant Depression
https://compasspathways.com/our-work/comp360-psilocybin-treatment-in-trd/
The investigational psilocybin program discussed throughout the episode, including its phase 3 timeline and proposed psychological support model.
Dr. Benjamin Brody – LinkedIn
https://www.linkedin.com/in/benjamin-brody-md-3576bb4/
#Ketamine #Psychedelics #TreatmentResistantDepression #Psychopharmacology #REMS

Dr. Elizabeth Ballard, Director of Psychology and Behavioral Research and Director of Pre-Doctoral Training at the National Institute of Mental Health's Experimental Therapeutics and Pathophysiology Branch, joins the JCP Podcast to trace the full arc of suicide risk assessment and treatment. Dr. Ballard helped develop the Ask Suicide Screening Questionnaire (ASQ) and was first co-author on the individual patient data meta-analysis establishing ketamine's rapid antisuicidal effect.
Suicide risk is assessed in some form during nearly every patient encounter, yet the tools clinicians use and the evidence behind current treatments remain works in progress. Dr. Ballard discusses the sensitivity-specificity trade-offs built into screening instruments, what ketamine research reveals about suicidality as distinct from depression, emerging biomarkers such as nocturnal wakefulness and electrophysiological signatures of hopelessness, and the ethical case for including suicidal patients in clinical research rather than excluding the population clinicians most need evidence for.

🎯 KEY EPISODE HIGHLIGHTS:
🩺 SCREENING IS A LIFE-OR-DEATH TRADE-OFF [11:00]
“This is literally a life or death situation, and so you don't want people slipping through the cracks that aren't getting identified.”
Ballard frames the sensitivity-specificity trade-off built into suicide screening tools like the ASQ as a stakes-defining design choice, not just a statistical one.
🎯 SUICIDE RISK IS MULTIFACTORIAL, SO WHERE DO YOU START [39:00]
“There's so many factors that lead somebody in a moment of crisis to think about ending their lives.”
Ballard argues clinicians can't treat every contributing factor at once, which is why her research isolates modifiable targets like hopelessness rather than suicide risk as a whole.
❤️ WHEN IN DOUBT, ASK [52:30]
“When in doubt, ask. There's no harm in asking.”
Ballard's single most actionable takeaway: approach suicide risk assessment with curiosity rather than treating it as a documentation exercise.

CHAPTERS:
00:00 – Introduction: Dr. Elizabeth Ballard's Path to Suicide Research
05:30 – Building and Calibrating the ASQ Screening Tool
12:30 – The 2018 AJP Ketamine Meta-Analysis: Pooling Individual Patient Data
17:30 – Disentangling Ketamine's Effect on Suicidality from Depression
20:30 – Ketamine's Response Trajectory and IV vs. Esketamine Comparison
25:30 – Nocturnal Wakefulness as a Warning Sign for Suicidal Ideation
31:00 – MEG and Electrophysiological Signatures of Suicide Risk
34:00 – Concordance Across Suicide Risk Assessment Scales
38:00 – Hopelessness as a Distinct, Modifiable Treatment Target
41:00 – Neurofeedback and Episodic Future Thinking at Neu Hope
45:00 – Ethically Including Suicidal Patients in Clinical Research
52:00 – Closing Clinical Takeaway: Asking with Curiosity

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep21-rethinking-suicide-risk-screening-treatment-elizabeth-ballard/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Ask Suicide-Screening Questions (ASQ) Toolkit – NIMH
https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials
Free NIMH toolkit for the screening instrument Dr. Ballard helped develop, discussed at length in this episode.
Dr. Elizabeth Ballard – LinkedIn
https://www.linkedin.com/in/elizabeth-ballard-943245350/
#SuicideRiskAssessment #Ketamine #SuicidePrevention #ClinicalResearchEthics #Hopelessness

Dr. David T. Liebers, MD, MPhil, MPP, a research assistant professor of psychiatry at the NYU Grossman School of Medicine and a research psychiatrist at the Nathan Kline Institute, joins Dr. Ben Everett to explore metabolic psychiatry: the growing evidence linking mitochondrial function, bioenergetics, and whole-body metabolism to psychiatric illness. Building on a previous conversation about GLP-1 receptor agonists, this episode broadens the lens to ketogenic diet interventions, SGLT2 inhibitors, and metformin, tracing how each may support brain energetics in depression, schizophrenia, and bipolar disorder.
This conversation arrives as clinicians increasingly confront the metabolic burden of antipsychotic treatment alongside a widening evidence base for interventions originally developed for diabetes and heart failure. Dr. Liebers discusses recent trial data on ketogenic diets in serious mental illness, the mechanistic case for SGLT2 inhibitors as a psychiatric tool, expanding guidelines for metformin co-prescription, and why brain energetics may represent a legitimate and increasingly tractable therapeutic target, not a replacement for existing models of psychiatric illness, but an additional clinical perspective.

🎯 KEY EPISODE HIGHLIGHTS:
🏛️ THE “ERA OF FOOD AS MEDICINE” ISN’T NEW [12:30]
“We have now entered the era of food as medicine.”
Dr. Liebers traces today's food-as-medicine rhetoric back through nearly two centuries of psychiatric interest in diet's role in mental illness.
🧬 MITOCHONDRIAL DYSFUNCTION AS A TREATMENT TARGET [23:30]
“The big challenge, I think, is identifying those interventions that can reliably improve, metabolic function in a way that can be measured and is suitable for randomized trial designs that let us talk about causation.”
Dr. Liebers frames abnormal brain bioenergetics as a specific, measurable target for a subset of patients underserved by monoamine-based treatments.
⚖️ METFORMIN IS DRAMATICALLY UNDERUSED [55:30]
“I think ten to fifteen percent of the people that should be or would qualify under the new guidelines to get metformin are actually on it.”
Despite expanded 2025 consensus guidelines, Dr. Liebers' EHR data suggest most eligible patients are still not receiving metformin for antipsychotic-associated weight gain.

CHAPTERS:
00:00 – Introduction: Building on the GLP-1 Conversation
02:30 – An Unconventional Path to Metabolic Psychiatry
10:30 – Diet in the Asylum Era: A History of Food as Medicine
18:00 – Why Metabolism Returned to Scientific View
23:30 – Imaging Brain Energetics: Bridging Peripheral and Central Metabolism
28:30 – The Stanford Pilot Trial and the Abrams Follow-On RCT
36:00 – Adherence, Meal Delivery, and the Path to GLP-1s
39:30 – GLP-1 Receptor Agonists in Psychiatric Practice
41:30 – Discovering SGLT2 Inhibitors: A Resident's Chance Encounter
45:00 – The Ketogenic Mechanism Behind SGLT2 Inhibition
49:30 – Trial Emulation and the Empagliflozin Pilot Study
52:00 – Metformin's Expanding Role in Antipsychotic-Associated Weight Gain
56:30 – SGLT2 Inhibitors as a Complement to Ketogenic Therapy
61:30 – Toward a Whole-Person Model: Diet, Drugs, and Exercise
66:00 – Confronting the Treatment Gap: Underused Medications
68:00 – The Future of Metabolic Psychiatry: Integration, Not Revolution
71:30 – Closing Thoughts and Sign-Off

LINKS:
Full transcript and show notes:
https://www.psychiatrist.com/jcp/ep20-feeding-mind-metabolism-psychiatry-david-t-liebers/
Journal of Clinical Psychiatry
https://www.psychiatrist.com/jcp/
Publisher of peer-reviewed research discussed in this episode.
Dr. David T. Liebers – LinkedIn
https://www.linkedin.com/in/david-liebers-7b9706169/
Metabolic Mind
https://www.metabolicmind.org/
Patient and clinician resource on ketogenic and metabolic therapies for mental illness, recommended by Dr. Liebers in this episode.

The Emerging Role of GLP-1s in Psychiatry with Roger S. McIntyre, MD, FRCPC
Listen to a previous episode from April 21, 2026 covering GLP-1s in Psychiatry

#MetabolicPsychiatry #KetogenicDiet #SGLT2Inhibitors #Metformin #Mitochondria