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13/ The Brain’s response to allostatic load be it trauma, grief, infection , injury isn’t to look at the DSM or ICD. From melancholic depression to trauma-linked presentations, from mixed affective states to hormonal transitions…. Effective treatment starts with recognition

3/ So what are we actually seeing when we assess depression? We must begin with phenomenology- not labels. That’s where the domains PACES™ help : 1. Perception 2. Activity 3. Cognition 4. Emotion 5. Sleep Each domain helps identify the dominant clinical disturbance.

1/ Depression is frequently reduced to sadness or low mood. But these symptoms, while common, are not central to every presentation. Instead, depression involves dysfunction across three core domains: Activity, Cognition, and Emotional Hedonics (ACE)

🧵Difficult-to-Treat Depression: What’s Resistant- and What’s Misunderstood?🚨1/14 In psychiatry, we often label complex cases as treatment-resistant. But that term suggests the illness is the problem. What if the issue lies in how we think-not just what we treat? Let’s

Interesting.

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Key clinical takeaways ● Amisulpride is unique in its dual-dose mechanism – antidepressant at low doses and antipsychotic at high doses. ● Selective D2/D3 binding reduces EPS compared to typical antipsychotics. ● Favourable metabolic profile, but prolactin elevation

Dosing Considerations And Safety ● Negative symptoms/depression → 50–300 mg/day ● Acute schizophrenia → 400–800 mg/day ● Resistant cases → Up to 1200 mg/day Key Safety Concerns: ● Hyperprolactinemia (higher than risperidone/olanzapine) ● QTc prolongation

Clinical Applications  1. Schizophrenia (both positive & negative symptoms). 2. Treatment-resistant depression (low doses < 100 mg/day). 3. Cognitive improvement in schizophrenia (Mortimer et al., 2007). 4. Clozapine-induced hypersalivation (low-dose adjunctive use).

Pharmacokinetics Of Amisulpride ● Absorption → Rapid, ~50% bioavailability. ● Peak concentration (Cmax) → Reached in 1–4 hours. ● Steady-state levels → Attained within 3 days. ● Half-life (T½) → ~12 hours, requiring twice-daily dosing. ● Elimination → Primarily

Why Is Amisulpride Considered "Atypical"? Unlike other atypical antipsychotics, amisulpride: 1️⃣ Selectively binds D2/D3 receptors (no affinity for D1, D4, or 5-HT2A receptors). 2️⃣ Has a low extrapyramidal symptom (EPS) burden due to limbic selectivity (Perrault et al., 1997).

Amisulpride’s Mechanism of Action  1. Low doses (<400 mg/day) → Blocks presynaptic D2/D3 autoreceptors → Increases dopamine release → Improves negative symptoms and depression. 2. High doses (400–1200 mg/day) → Blocks postsynaptic D2/D3 receptors → Reduces positive

Is there an antipsychotic that acts like an antidepressant at one dose and an antipsychotic at another? Amisulpride is unusual in psychiatry for this dose-dependent dual action. At low doses, it can relieve depression and negative symptoms; at higher doses, it treats psychosis

Why Psychotherapy is Not Always First Line in PTSD Management 🚨 1. PTSD is heterogeneous. Phenotypes differ 👉Dissociative vs hyperarousal - each with unique neurobiology (amygdala hyperactivity, impaired prefrontal regulation). Trauma-focused therapy doesn’t fit all. 2.

This is the only reasonable and non-authorative sounding and aware of realities thread I've seen about "prescribing" exercise. https://t.co/HURMPO0Q1P

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Psych Scene Tip Think developmental trajectory, not snapshot. Adolescents with early-onset depression or anxiety are more likely to progress to recurrent MDD, bipolar spectrum, or treatment-resistant states. Early recognition + tailored intervention = prevention of lifelong

Intervention priorities Effective early care means going beyond symptom checklists. ● Screen proactively in girls and gender-diverse teens ● Manage sleep, anxiety, and distress together ● Ask about social media and online stressors ● Involve families early; teens rarely

In adolescents, depression rarely presents as “classic sadness.” Watch for: ● Irritability, agitation ● Sleep and circadian disruption ● Somatic complaints (fatigue, headaches) ● Academic decline or social withdrawal ● Heightened risk in girls and gender-diverse youth

National context ABS data: 40% of 16–24-year-olds reported mental disorder symptoms in the past year (up from 26% in 2007). Implication → adolescent-onset disorders are not only more prevalent but also more chronic, fuelling adult psychiatric burden.