The Academy by Psych Scene

PTSD can involve both heightened and reduced pain sensitivity.

Anxiety may amplify pain, while dissociation can blunt it.

Here’s how to tell these patterns apart, and why it matters when assessing pain in PTSD.

To learn more about PTSD neurobiology and how these mechanisms can inform assessment, formulation and treatment planning in practice, click the link in the comments below and check out the full course inside The Academy.

Skip the Carousel

1 2 3 4 5 6 7 8 9 10

10 hours ago | [YT] | 8

The Academy by Psych Scene

“The course was highly relevant to everyday psychiatric practice. It reinforced the importance of seeing the patient as a whole person and recognising the therapeutic relationship as an essential part of psychiatric care.”

Medication decisions are not made in a relational vacuum.

A prescription can carry meaning, fear, hope or mistrust.

When that is missed, adherence and response can falter.

Thus, clinicians need to formulate the relationship around the medication, not just the medication itself.

Inside The Academy, our Psychodynamic Psychotherapy and Psychopharmacology course helps clinicians bring psychodynamic formulation into everyday psychiatric care.

It shows how alliance, meaning, adherence and resistance can shape assessment, prescribing and treatment planning in complex presentations.

In this course, you’ll learn how to:

- Apply core psychodynamic principles to assessment and formulation

- Link attachment, trauma, implicit memory, and relational patterns to symptom formation

- Use transference, countertransference, resistance, and defence mechanisms clinically

- Identify factors that shape prescribing, adherence, nocebo effects, and treatment resistance

- Integrate psychotherapy and pharmacotherapy in complex care

Accreditation:

✅ 3.5 CPD hours (EA 2.25, RP 0.75, MO 0.5)
✅ Self-accreditable with RANZCP
✅ Self-accreditable with RACGP
✅ Certificate of Completion

Start learning today. Link in the comments below.

2 days ago | [YT] | 4

The Academy by Psych Scene

Psych Scene is heading to Stockholm for WCP 2026!

Come find us at Booth 6.

We’ll be running a clinical quiz throughout the congress, with a daily scoreboard so you can see how your results compare with your peers.

You can also pick up free Psych Scene article handouts to take away.

You’ll find us on the left-hand side of the exhibition hall, near the Networking Lounge.

📅Exhibit Hours:
23 September: 14:00–16:00
24–25 September: 09:45–16:45
26 September: 09:45–13:45

📍 Stockholmsmässan, Stockholm
🔎 Hall B, Booth 6

We’ll see you there! 👋

Skip the Carousel

1 2

6 days ago | [YT] | 3

The Academy by Psych Scene

To learn more about methylphenidate formulations and how ADHD treatment coverage shapes clinical decision-making, click the link in the comments below and check out the full course inside The Academy.

Skip the Carousel

1 2 3 4 5 6 7 8

1 week ago | [YT] | 11

The Academy by Psych Scene

The Lindsay Clancy case has reiterated something psychiatry needs to confront:
We are not taught enough about severe mood disorders - particularly melancholic and psychotic affective presentations. 🚨

The skill is to recognise the phenotype, severity and underlying biology early enough to treat it appropriately.

Melancholic depression: what gets missed?

1️⃣ Psychomotor disturbance matters

Melancholia is not simply “more severe depression”.

Psychomotor retardation or agitation, anhedonia, impaired reactivity, cognitive slowing, early-morning worsening and biological disturbance should immediately change how we conceptualise the illness.

Agitation in particular can be mistaken for “anxiety”.

2️⃣ An SSRI-first model is often too narrow without evaluating arousal systems.

Treatment should match the phenotype- not simply move sequentially through antidepressants.

3️⃣ Always look for bipolarity and mixed features

Melancholia itself does not equal bipolar disorder BUT patient may have arousal present at levels that can worsen with an antidepressant only approach.

A careful longitudinal history is crucial -mixed symptoms
-activation
-episodic pattern
-family history
-previous hypomanic phenomena that significantly alter treatment decisions.

The diagnosis is in the trajectory, not merely today's cross-sectional symptom checklist.

4️⃣ And then there is psychotic depression 🚨

Psychotic depression is usually melancholic dep with psychotic features.
Lies along a Bipolar spectrum - doesnt have to reach threshold of BP I or II

The critical issue is recognising it.
👉 We miss psychosis in depression because we look for the wrong things.

Clinicians often ask:
“Are you hearing voices?”
“Do you think people are following you?”

But depressive psychosis is frequently much more congruent with the person's emotional state:

“I have destroyed my family.
There is no possibility of recovery.
My body has stopped functioning.
Everyone would be better off without me.”

The thought may initially sound understandable.

What changes is its salience, certainty and resistance to contrary evidence.

5️⃣Think dimensionally:
thought → preoccupation → overvalued idea → delusional conviction

The content does not need to be bizarre for the morbidity and suicide risk to be significant.

👉 Treatment needs to match the severity.

For psychotic depression, antidepressant–antipsychotic combination treatment has evidence, and ECT remains one of our most effective treatments.

But pharmacology should still be individualised.

More dopamine blockade is not automatically better - particularly in someone already experiencing severe anhedonia and psychomotor impairment.

👉 ECT works; but treatment does not finish when ECT finishes.
Relapse after successful ECT remains high.

The period following response therefore requires active continuation treatment, close monitoring and a therapeutic “buffer” around the patient.

6️⃣Suicide risk is dynamic.

Do not assume improvement in observable activity means that the dangerous cognitions have resolved.

Repeatedly assess guilt, hopelessness, nihilistic thinking, psychotic conviction, intent and the person's changing capacity to act.

We get lost in labels
-bipolar or unipolar
-psychotic depression, postnatal depression, postpartum psychosis….

when these are often describing different dimensions:
-phenomenology
-timing
-severity
-spectrum.

The underlying biology does not organise itself according to DSM categories; frontostriatal, limbic and salience circuits cut across them.

The brain does not say, “I’ll present my distress according to the DSM.”

1 week ago | [YT] | 0

The Academy by Psych Scene

“Excellent course. Eating disorder presentations have increased in my practice, making this course particularly relevant and timely.”

Team-based care is central to eating disorder management.

But in practice, it only works when roles, risks, and treatment planning are clearly coordinated.

Otherwise, clinical input can easily become fragmented.

Medical monitoring may not align with psychiatric formulation, treatment planning may become reactive, and the wider team may lose a shared pathway.

Led by Dr Lilian Zou and Dr Karen Spielman, our Eating Disorder Management: Clinical Care Pathways course explores the assessment and management of eating disorders in practice, what not to miss in medical management, and how team-based care should function.

This course is designed to help clinicians move toward safer, more coordinated, team-based eating disorder care.

In this course, you’ll learn how to:

- Demystify eating disorder presentations across psychiatric and primary care settings

- Identify medical risk, red flags, monitoring needs, and escalation thresholds

- Use patient-centred questions to strengthen assessment and engagement

- Clarify GP, psychiatrist, and team roles in coordinated care

- Apply practical principles to Eating Disorder Plan reviews and treatment pathways

Accreditation:
✅ 2 CPD hours
✅ Self-accreditable with RANZCP
✅ Self-accreditable with RACGP
✅ Certificate of Completion

Start learning today. Link in the comments below.

1 week ago | [YT] | 2

The Academy by Psych Scene

Female and male brains do not mature in the same way.

Differences emerge across cerebral maturation, cortical development, hormonal signalling and neurophysiology.

Using ADHD as an example, here are 5 sex-linked neurodevelopmental differences and what they mean in clinical practice.

To learn more about gender differences in ADHD and the role of developmental factors in ADHD assessment and management, click the link in the comments below and check out the full course inside The Academy.

Skip the Carousel

1 2 3 4 5 6 7 8 9 10

1 week ago | [YT] | 11

The Academy by Psych Scene

OCD isn’t simply the presence of obsessions or compulsions

21–38% of people endorse one or both, yet only a small minority meet criteria for OCD. [Bralten et al, 2020]

Here’s how to tell when obsessive-compulsive symptoms warrant an OCD diagnosis.

For more evidence-based psychiatry insights like this, join the Psych Scene newsletter.

We share clinical frameworks, research updates, diagnostic explainers, and practical resources designed to support mental health professionals in practice.

Link in the comments below.

Skip the Carousel

1 2 3 4 5 6 7 8 9 10

1 week ago | [YT] | 9

The Academy by Psych Scene

To learn more about lithium, future dementia risk, and safe renal monitoring in bipolar disorder, click the link in the comments below and check out the full course inside The Academy.

Skip the Carousel

1 2 3 4 5 6 7 8 9 10

2 weeks ago | [YT] | 6

The Academy by Psych Scene

ADHD treatment can improve symptoms and still ‘fail’ to achieve functional recovery.

Symptom reduction becomes more clinically meaningful when it improves the functional problem the patient wants treated.

Here’s a 6-step framework clinicians can use to make ADHD treatment more functionally targeted and clinically meaningful.

Once the desired functional change is clear, the next step is deciding what treatment should be targeted to achieve it.

Join Dr Sanil Rege for Emerging Treatment Targets in Psychiatry: Translating New Mechanisms into Clinical Practice and explore how treatment targets can be mapped across molecules, circuits and clinical domains, then linked to meaningful patient outcomes.

Book your spot now. Limited spots available.

Link in the comments below.

Skip the Carousel

1 2 3 4 5 6 7 8 9 10

2 weeks ago | [YT] | 7