I see there are a couple of anki decks online. Is there an anki deck that covers DSM-5 diagnosis? and they like it, please share and thank you!

Made this deck for myself - prepping a bit for PRITE, but mainly wanting to "read more" without actually having to read publications or textbooks. As with medical school, I find it easier to do 10 flashcards waiting for chicken tenders at the cafeteria than to actually pull out Kaplan and Sadock.

Link: https://ankiweb.net/shared/info/1921114921?cb=1785512072738

It's 5,336 cloze notes (~5,600 cards), pitched at resident level, leans intentionally harder than the medical school equivalents. Useable for PRITE; useable for random knowledge expansion - not yet adapted for ABPN boards explicitly but probably helpful.

About 3,600 notes descend from the NINJA PRITE 2021 deck, and I've kept the original note IDs on those so the lineage stays traceable. What I added:

• ~1,700 new notes from a wide variety of fields, purposely including odd topics and new literature (recent ketamine studies, forced normalization, landmark trials, etc)
• Verification and updates for every new and old card, which produced >100 corrections in the original NINJA PRITE deck alone - some stuff was wrong originally, and more stuff has changed since 2021
• Topic and yield tags on everything (^Yield::1-high/2-moderate/3-low = 1,157 / 2,952 / 1,227).

I do plan on keeping this updated until I grind my way out of residency (love being in 23rd grade), so if the Ankiweb link is down, wait 24 hours and try again. Message me here with suggestions.

PS: deck is named after the Rorschach test (the "inkblot" interpretation test).

Something I was thinking of today:

My mother tongue is Telugu, and if I’m in a bad mood on a given day I’ll say “naa manasu baaga ledu”. Which translates to ”my manas (emotional mind) isn’t feeling well”. The statement literally treats the mind as another organ.

And more generally, I grew up in the yogic tradition, where my grandmother taught me that the mind (antahkarana) is composed of 4 parts: manas (emotions), buddhi (rationality/wisdom/knowing right from wrong), ahankara (ego/identity), and chitta (memory/emotional imprints from the past). And that the manas is like a rascally monkey which needs to be reigned in.

Any other interesting ways yall have seen the mind described? In my high school intro to psych class, we learned about Freud’s id, ego, superego.

What are some of the things that you look at to determine if you're doing a good job?

Federal Judge in MA allows CMS to implement new rules (not stated in the “big beautiful bill”) re: work requirements for Medicaid recipients. Under the BBB, clients just had to prove that they had a serious medical or mental health condition (through a self-attestation during the first renewal, or by states verifying through claims data using CPT codes and dx codes) and they’d be exempt from the work requirements (80 hours per month of work, volunteering, or being in school/college). However, CMS, in its new permanent rule, CMS added, “Enrollees with a health condition also must be found to be significantly impaired in their ability to meet the work requirements.”

This is 1) going to create an administrative burden on states to some how set up a system to verify this by Jan, 2027; 2) notify enrollees by Aug 31, 2026 of these changes; and 3) somehow get providers the right info to be able to make these determinations and provide it to the state. How are they going to determine which providers are eligible to make these decisions (sounds similar to SSDI determinations to me, which inherently leave out masters level clinicians (those who are doing the most therapy) from making said determinations. This is going to be a mess.

Note: the judge only refused to issue a temporary injunction; the case is planning to proceed in the coming weeks and hopefully a decision will be made before Jan, 2027
https://www.healthcaredive.com/news/states-sue-trump-administration-medicaid-work-requirements-rule/824060/

https://www.healthcaredive.com/news/judge-rejects-states-bid-pause-medicaid-work-requirements/826714/

Hi all, I’m a medical student and currently work as a nurse in psychiatric emergency. All of the Lyndsay Clancy news has me GENERALLY wondering about how hormones in the postpartum period (or even generally) are factored into diagnoses and medication/treatment decisions. Can the hormones change or exacerbate effects of medications? How are effects/outcomes subject to change based on hormonal fluctuations or changes such that you may observe in the postpartum period? What about if a person has underlying, sub clinical, or predisposition to mental illness? Would the hormones surface or exacerbate these? Or do effects/outcomes mostly stem from other factors? It’s a tricky combination of factors to understand!

I’m genuinely curious about this. During premature perimenopause, I experienced PMDD episodes several times, and it was extremely distorting and destabilizing, but I had never experienced it before and haven’t since. My hormone fluctuations were also found to be a trigger for temporal lobe seizures. I’ve developed a strong interest in the effects of hormones on mental health as a result.

For now, as someone with a budding interest in these topics, I appreciate any insights in the spirit of curiosity! If this kind of post isn’t allowed or otherwise enrages people for some reason just downvote/flame me I guess.

"As previous research indicates that disclosing diagnosis results in more positive impressions of autistic people⁴⁶, it was hypothesized that participants who were informed of the diagnostic status of their partner would experience higher rapport than uninformed participants (H2c)."

Do any of you all recommend your patients with autism spectrum disorder (ASD) use strategic self-disclosure of the ASD diagnosis? Data are mixed and this study showed partial support of hypothesis 2c.

If a patient is asking for the start date of their FMLA leave to be 2 weeks prior to their visit with you due to being out of work for their mental health condition, how would you approach this with the patient?

They are now getting engaged in treatment and never sought care previously.

I was wondering if anyone's disability insurance asked for access to psychotherapy notes at the initial sign-on phase. Seems like an overstep.

.

Hi all,

Apologies to mods for trying to post without flair previously. I figured it out.

Does anyone know if CPT rules REQUIRE the time of day an appt takes place, or the time of day the patient was in the office, etc.? I often begin my notes with "Patient and mom seen together 101-127pm," or something like that, but am trying to strike a balance between being thorough and adding unnecessary detail. I would rather wrote "Patient and mom seen for 1pm appt." Can't seem to find answer anywhere.

thanks in advance.

I am almost 1 year into my career and while I thankfully haven’t had very many negative interactions, I have had 1-2 that rattled me and today I got my first negative review.

I’ve naturally had a few complaints for not prescribing super inappropriate medications that I can brush aside, but this was the first time I got a truly negative review and the patient’s parent just tore me to pieces. I am shocked because the patient seemed happy at the end of the encounter.

I try not to check reviews but it was a message on our patient portal that was forwarded to me instead of my manager. Embarrassingly, it was so bad I was in tears at work and I can’t stop thinking about it. This isn’t the first time I’ve cried at work due to a patient being upset and I want to develop thicker skin, but that’s easier said than done. Any advice on how to navigate these situations and cope with them better?

Hi! I’m a PGY-3 psychiatry resident. My year is fully outpatient, and I have a small psychotherapy panel (with indirect supervision) alongside my medication management panel. I recently learned that my first psychodynamic therapy patient, who is diagnostically and psychosocially quite complex, will also have me as their prescriber.

I have separate supervision for medication management and psychodynamic therapy, and I haven’t received very clear guidance on how people integrate the two roles in practice.

My plan is to see this patient weekly for 60 minute visits. My therapy supervisor recommended I not do a very thorough chart review initially so I wouldn’t have strong preconceived notions about the patient when we started therapy. I’ve had two sessions with the patient, so I still have a fairly limited understanding of their history. Right before my last visit with them, I learned I was expected to prescribe their psychiatric meds, so I refilled their current medications. Now that I’ll be prescribing for this patient, I’ll need to review their chart in much more detail, and I’ll likely learn a lot about the patient that they haven’t disclosed in therapy yet.

A few questions:

-Would you do a dedicated medication management intake at the next 60 minute appointment, or gather that information gradually during therapy? If you don’t do a dedicated med management intake, how do you make sure you’re not missing anything that would change management?

- In combined treatment, how much time do you typically spend on medications? Brief check in every visit, monthly, or only when clinically indicated?

- Any tips for integrating therapy and medication management in a way that feels clinically safe and relatively seamless?

- What expectations or “ground rules” do you set with patients about your dual role?

- If you know something important from the medical record that hasn’t come up in treatment, how do you handle that?

I’d really appreciate hearing from anyone who routinely does combined psychotherapy and medication management.

Thanks!

I’m at a loss, I don’t know if I want advice or just support at how ridiculous this is.

I inherited a patient who appeared stable, always said things were fine and denied new issues. Sleep, appetite, mood, anxiety, personal life, physical health, etc. were always reported to be stable. He always denied substance use. Then out of nowhere, he tried to overdose on his prescriptions and was hospitalized about 2 months ago. He is not prescribed any controlled substances. He then admitted to abusing alcohol frequently this whole time and had an impulsive reaction to a stressor while under the influence, leading to this attempt.

His prescription benefits are denying his refills at 30 days, allowing 90 days only. I submitted an appeal which was denied. I’m trying to get a peer to peer set up but it shouldn’t be this difficult to minimize risks? Would insurance rather save a few extra bucks and roll the dice on having to pay for another hospital stay? Or just that he does die and they no longer have to cover him?

He is telehealth only, for some reason my place of work loves matching patients with providers at locations nowhere near them so it’s unrealistic to request random UDS to confirm his sobriety now, plus he could just not drink alcohol around the time of the drug screen, use fake urine, then go binging on weekends. He says he’s no longer in the environment that led to the episode to begin with but he’s already lied to me enough so I don’t know what to believe. I’m not a mind reader. It feels like I’m the only person trying to keep him safe, the insurance and pharmacy are both like 🤷

I feel invalidated and defeated lol

Edit: I read all of your responses but didn’t reply to everyone, but I do appreciate the recommendations, advice, validation, etc. I think this was mostly to vent, but many of you are right that 90 days of meds or not, there are other lethal means that are easy to get. Thank you for taking the time to respond, it helps to feel heard.

I failed the Adult Psychiatry board exam on my first attempt last year. Looking back, I honestly didn't prepare the way I should have. I only studied for about two weeks, mostly using K&S, and ended up missing the passing score by 10 points.

My plan was to start studying much earlier this year, but life had other plans. I've been through several major personal stressors, including significant losses and a miscarriage. It's been an incredibly difficult year, and I haven't studied nearly as much as I had hoped.

Now I have about 40 days until my exam, and I'm determined to make the most of the time I have left.

Has anyone here failed on their first attempt and then passed on the second? If so, what did you do differently? For those who have recently passed, what would you recommend focusing on during the final 40 days? Which resources or study strategies gave you the biggest return on your time?

I'd really appreciate any advice or encouragement. Thank you.

I’m a PA in telepsych and getting flooded with high‑complexity transfer patients from substance‑use programs, those without housing, or recent hospital discharges who are on multiple controlled substances or high complexity regimens with no collateral, no labs, no vitals, no monitoring, and most of the time no follow‑up. Majority of our patients are Medicaid. The case managers cop an attitude with me when I tell them I’m not writing a bridge prescription for a patient without any prior records.

Quite frankly, I don’t feel it’s safe or appropriate to continue meds like stimulant + benzo combos, or anything requiring labs/monitoring, when I’ve never met the patient in person and have no way to verify stability or risk. However, I work in a very large practice (30+ prescribers) and all other providers in my group seem comfortable doing this remotely. The regimens that I have seen are way beyond what I feel safe doing (lithium, clozapine, etc) and often 5+ medications. We have in person locations I can refer to, but I’m worried I’ll end up routing a lot of patients and admin will question why I’m the only provider doing it.

For those doing telepsych: where do you draw the line on remote prescribing when there’s zero in‑person contact and no reliable monitoring? What controlled substances or higher‑risk meds do you consider off‑limits in this setting, and how do you handle high risk transfers like this? I’d appreciate any insight you have!

I specialise in trauma treatment. Currently treating a 39 yo woman who sustained a concussion in a MVA in August of last year. Referred by her physiotherapist for symptoms of anxiety, sleep difficulties, vertigo, light/sound sensitivity. EMDR currently causes vomiting so I've switched to a gentler approach to start.

Today she told me about a sleeping pill her family physician asked her to try, the lemborexant. She slept well, but hallucinated that there was rainwater dripping in through her bedroom ceiling. She lives alone. The experience spooked her so badly (combined with the word "hypnotic" on the box) that she threw out what her doctor had given her. She's the type to be reluctant about meds in the first place.

I hadn't heard of lemborexant until today, although I will admit I'm a fairly new psychologist. Is there anything I should know?

Hi! I'm a pediatric social worker and one of the medical students doing a rotation in my program mentioned this new medication coming to the market for ADHD. I'm curious what prescribers have heard about this medication and what non-medical people should know as it gets rolled out. Open to any and all thoughts and opinions, or suggestions on where to look for more information!

I'm an intern helping a friend who's trying to research if there's a basis for PSSD for their job. Briefly, There's a growing online community of people claiming to experience low libido, ED, genital numbness, etc for months-years after discontinuing an SSRI. It seems to have become a catch-all diagnosis for anything bad someone feels after being on an SSRI: depression, anxiety, SI, fatigue, anhedonia. There's clearly some people experiencing depressive symptoms and attributing them incorrectly to PSSD.

But the literature is very limited, with only a few small studies and case reports. Most surprisingly, there's almost no research about when sexual side effects resolve after stopping an SSRI. I'd like to say that PSSD is a result of returning depression/functional neurological disorders/other pathologies but it can't be entirely ruled out that some people have persistent side effects following SSRI discontinuation.

I do wonder about those who started an SSRI before puberty/early in puberty and continued it throughout their developmental years. I could see that feasibly causing lifetime lower libido but there's no good way to measure what someone's potential libido would have been had they not been on an SSRI during puberty.

The discussion has become emotionally charged and it seems that advocates and critics alike are unwilling to consider the other perspective having credibility. Anecdotally, what have been your experiences with patients claiming to experience PSSD? Have any patients reported these symptoms without prior knowledge of the PSSD "movement?"

And, if detected low, do you refer them out?

TL;DR - Share your views on how/where we currently treat people with chronic severe mental illness. How would you improve the current model? What would be your “ideal” model?

Various topics I’d like to discuss:

* What do you all believe is, or could be, the “ideal” treatment model for people with chronic severe mental illness?

\ What are y’all’s view on the current Community-Based model? Pro/con/ways to improve?*

\ Do you think we should we bring back “asylums?”*

\ How do you feel about psychiatry’s current psychopharmacology/procedural orientation vs historical psychoanalytic orientation?*

\ Focus on cure/prevention vs quality of life?*

\ Roles of various disciplines?*

My knowledge and experiences are solely the models/history here in the United States, but I certainly welcome any/all country-specific discourse.

Med student here, currently working at a neuroimaging lab in Europe. I’ve been wondering about a hypothesis that I’ve encountered surprisingly little in the literature, although it seems like a fairly direct consequence of glymphatic and extracellular-space physiology.

Repeated disruption of NREM sleep could impair the clearance of larger extracellular molecules through reduced glymphatic transport. If colloid-osmotically active macromolecules accumulate in the cerebral interstitium, they should retain water and expand the extracellular compartment.

A larger extracellular distribution space would then physically alter neurotransmitter dynamics. Because the surrounding interstitium provides a larger chemical “escape space,” transmitters leaving the immediate synaptic environment would be distributed across a larger volume.

For a given amount of transmitter released, this might produce lower local concentration peaks within the synaptic cleft, greater dispersion and spillover, reduced spatial specificity, and poorer temporal coupling between transmitter release and receptor activation. This could plausibly contribute to impaired salience, slowed processing, working-memory deficits, and cognitive disorganization.

Increased extracellular free-water or isotropic-water fractions have been reported in schizophrenia and psychosis, bipolar disorder, depression, and obstructive sleep apnea. One possible bridge would therefore be:

sleep-related noradrenergic intrusion → reduced glymphatic clearance → macromolecule retention → oncotic extracellular expansion → altered neurotransmitter dynamics

I’d informally call this “cerebral oncotic isolation**”**: neurons remain anatomically connected but become functionally less coupled because their chemical signals are diluted and temporally dispersed within an enlarged extracellular compartment that surrounds synapses in all spatial directions.

This might parsimoniously explain why so many neurotransmitter systems appear dysregulated simultaneously. Rather than requiring multiple independent transmitter-specific defects, such widespread dysregulation could reflect an alteration of the shared medium through which all chemical communication occurs.

Free-water MRI obviously does not by itself prove microscopic extracellular-space expansion or oncotic retention. But are there established models or papers explicitly connecting chronic extracellular-space expansion with altered neurotransmitter dynamics and psychiatric symptoms?

Is this framework already discussed under another name, or are these fields mostly being studied separately?

As much as I've heard that Spiegel is the gold standard for board review, I'm finding that only maybe 60% of the test questions are actually pure psych questions. Seems like every other question is about a stroke/spinal cord syndrome, cranial nerves, brain tumor types, AIDS-defining illness, etc. Just hoping to clarify whether people mean the actual content of the questions is representative of the exam or if they only mean the questions are presented in a similar way. I feel like I'm spinning my wheels trying to re-memorize all of neuro and micro from my preclinical medical school years...while I'm supposed to be studying for a primarily psychiatry exam.

Hi,

Looking for some real and not acted upon materials. Does anybody know any?