The Psychiatric Record

After First Psychotic Mania, Revisit the Maintenance Plan

An observational study prompts a clearer account of why a regimen is continuing after the acute episode.

Long-Acting Injections in Bipolar Disorder: Relapse Polarity Matters

A drop in manic admissions is a meaningful finding. Depression prevention still needs its own evidence.

Treating ADHD Alongside Stimulant-Use Disorder

A treatment ranking still needs a clinical target, a suitable patient, and a workable follow-up plan.

Whose Voice Is a Psychiatric Speech Model Learning?

Separating patient speech from a full diagnostic interview changed model performance. What a model hears defines the scope of its evidence.

Restlessness After an Antipsychotic Change Is Not Automatically Anxiety

Assess the experience and treatment timeline before interpreting the symptom.

Physical Dependence Is Not a Benzodiazepine Use Disorder

A diagnostic label and a prescribing decision each need their own explanation.

An Intrusive Thought Is Not an Intention

Understand the experience while separately assessing actual intent, behavior, and safety.

A Quiet Patient Is Not a Delirium-Free Patient

An acute change in attention matters even without agitation.

A Normal BMI Is Not Medical Stability

Eating-disorder assessment needs the trajectory and current medical findings.

An ADHD Rating Scale Is Not a Diagnosis

What an ADHD questionnaire can and cannot settle

A Suicide Risk Score Is Not a Discharge Plan

Screening can identify a concern. Assessment must explain the next step.

A Gaming Prevention Trial Is Not a Screen-Time Prescription

A school-based trial found a benefit in high-risk adolescents. What does that result mean for clinical assessment?

A Reassuring Mindfulness Study Is Not a Safety Clearance

A Short-Term Sleep Prescription Is Not a Short-Term Treatment Plan

The first Z-drug prescription needs a treatment target, a review date, and a next step.

Psychotherapy Dropout Is Not Treatment Refusal

What one to three visits can tell a psychiatric clinician, and what they cannot

State Regulation Is Not an Efficacy Verdict

What Oregon's new psilocybin data can and cannot tell psychiatric clinicians

Reduced Stimulant Use Is Not Treatment Failure

A nonabstinent outcome can be clinically meaningful without becoming a verdict on safety or causation

Stopping the SSRI Is Not Removing the Risk

Pregnancy changes the counseling question. It does not turn untreated illness, a medication change, or fragmented follow-up into a zero-exposure option.

“The Gene Test Chose This Medication” Is Not a Prescribing Decision

A pharmacogenomic report may identify a meaningful gene-drug relationship. It does not diagnose the patient, rank every reasonable treatment, or replace a prescribing decision.

“The Patient Has a Psychiatrist” Is Not a Treatment Plan

A name in the chart establishes contact. It does not establish care.

“Neurology Cleared the Patient” Is Not a Psychiatric Diagnosis

A negative neurologic evaluation may narrow the differential. It does not establish anxiety, depression, somatic symptom disorder, or functional neurological disorder.

The Psychiatry Note Is Not a Transcript

Four things to verify before you attest

“I Charge $400 an Hour” Is Not My Hourly Rate

The arithmetic is right. The conclusion is not.

“The REMS Is Gone” Is Not “The Monitoring Is Gone”

A federal program ended. A label recommendation didn't. What disappeared between those two sentences was the system that noticed when the blood draws stopped.

Lamotrigine Is Not a Diagnosis

An Editor's Note on Mood Reactivity, ADHD Explanations, and Why I Keep Reaching for an Off-Label Drug