The Journal of Clinical Psychiatry Podcast

Host Ben Everett sits down with Tufts University physician-scientist Dr. Michael Halassa to discuss algorithmic circuit psychiatry. This framework aims to modernize mental health care by mapping subjective experiences onto objective neural computations. By shifting focus to brain circuit mechanics, they explore a new paradigm for treating complex psychotic disorders. This conversation redefines psychiatry as a data-driven, precision-oriented field of medicine.
The episode moves beyond the "chemical imbalance" theory to examine the dynamics of excitation and inhibition. Dr. Halassa explains how large language models and machine learning provide new test beds for analyzing reasoning and belief updating, and that, by using "behavioral clamps" and task-based biomarkers, researchers can now operationalize delusions through the study of counterfactual decision-making. He also notes that causal circuit validation in animal models remains essential for identifying precise drug targets and improving clinical outcomes. The discussion finishes up by touching on emerging muscarinic therapies and the future of psychiatric training.
Episode Highlights:
00:00 – Why Algorithmic Circuit Psychiatry Could Modernize Mental Health Care
02:36 – From Physics to Psychiatry: Building a Scientist-Clinician Lens
05:52 – Decoding Brain Circuits With Computational Models and Modern Tools
10:37 – Returning to Inpatient Psychosis Care and Reframing Clinical Reality
14:47 – Moving Beyond “Chemical Imbalance” Thinking in Schizophrenia Treatment
20:43 – Fixing Computational Psychiatry Limits With Mechanistic, Circuit-Based Models
25:08 – Creating Task-Based Biomarkers to Measure Belief Updating and Reasoning
29:10 – Operationalizing Delusions Through Counterfactual and Decision-Making Tasks
33:59 – Translating Algorithms Into Drug Targets and Better Animal Research
37:54 – Using LLMs and Machine Learning to Test Psychiatric Mechanisms In Silico
44:57 – Redesigning Animal Models to Validate Causal Brain Circuit Algorithms
53:03 – Training the Next Generation for Precision Psychiatry
56:44 – Defining Clinical and Scientific Milestones for the Future of Mental Health Care
Key Takeaways:
"Psychiatry feels different from other fields. We don't have biomarkers to guide decision making."
"The brain functions in packets of information sent between areas. It's more complex than a single synapse."
"In psychiatry, you absolutely need a behavioral clamp. It's not just about resting state measurements."
"Machine learning was inspired by neuroscience. Now, it helps us understand altered thinking in machines."
"The burden is on us to train the next generation to tackle psychiatry's complexity."
"Talking to patients like equals is my default. We're all vulnerable to mental illness."
"Mental health is sidetracked by societal issues. We must agree we're all human beings."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep7-algorithmic-psychiatry-michael-halassa/
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
“Developing algorithmic psychiatry via multi-level spanning computational models”:
https://pubmed.ncbi.nlm.nih.gov/40300598/
Dr. Halassa’s Substack:

Dr. David Feifel, Professor Emeritus of Psychiatry at UC San Diego and founding president of the Kadima Neuropsychiatry Institute, joins the JCP Podcast to kick off the new "Psychedelics in Psychiatry" theme. A pioneer in the field who established the world’s first ketamine infusion program for depression, Dr. Feifel sits down to discuss the paradigm shift currently reshaping mental health care.
In this installment of the Behind the Manuscript series, Dr. Feifel breaks down the findings of his recent JCP paper: “Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Depression”. He explains the significance of the 25mg dose in preventing relapse over 52 weeks and offers a critical look at why traditional SSRIs are no longer enough. Beyond the data, the conversation delves into the nuances of "set and setting," the controversy of microdosing versus "heroic" doses, and the practical challenges clinicians face as the field moves toward interventional psychiatry. Dr. Feifel also challenges the traditional medical view of the placebo effect, arguing that harnessing expectation may be the key to the next generation of healing.
Episode Highlights:
00:00 - Dr. David Feifel and His Breakthrough Career
02:13 - How Early Curiosity Led to Psychiatry Instead of Neurology
07:33 - Balancing Clinical Practice With Research Innovation
11:41 - Psychiatry Entering a Transformational New Era
13:51 - Why SSRIs Fall Short and TRD Demands Better Solutions
17:27 - What Makes Psilocybin the Leading Psychedelic Candidate
20:25 - Why the Psychedelic Renaissance Is Surging Now
25:42 - Microdosing Myths and the Power of Expectancy
33:55 - How Set and Setting Shape Psychedelic Treatment Outcomes
39:51 - Do Psychedelics Really Need Psychotherapy to Work
48:58 - Inside the Phase 2 Study and How TRD Patients Were Enrolled
56:04 - Why 25mg Psilocybin Delivered the Strongest Clinical Results
1:05:39 - What Long-Term Follow Up Reveals About Relapse and Durability
1:11:38 - How Clinicians Can Prepare for Psychedelic Medicine Adoption
1:16:53 - Why the Future of Psychiatry May Rely on Harnessing Placebo Power
Key Takeaways:
"Psychiatry is in the midst of a golden age revolution... I feel like every day I was going to war with Godzilla with a peashooter. Now I feel like we've got some real tools."
"We’re in the midst of what I call the Cambrian explosion of treatments... a massive explosion of life forms after a long time of stagnation."
"The concept of 'one and done' with psychedelics is dead. We aren't going to have patients come in one time and say, 'You're good for life.'"
"Doing ketamine is like doing psychotherapy, but you're both the psychotherapist and the patient at the same time."
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep6-psychedelic-renaissance-david-feifel/
Journal of Clinical Psychiatry: http://psychiatrist.com/jcp/
Dr. David Feifel: https://www.linkedin.com/in/davidfeifel/
Kadima Neuropsychiatry Institute: https://www.kadimanp.com/
“Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Episode of Major Depressive Disorder”:

Dr. Michael Asbach, Associate Director of Interventional Psychiatry at the DENT Neurological Institute and a nationally recognized educator, joins The JCP Podcast to discuss the critical and expanding role of Advanced Practice Practitioners (APPs) in behavioral health. With a background that spans from sports medicine to leading interventional psychiatric programs, Dr. Asbach offers a unique perspective on how the medical model training of Physician Assistants (PAs) uniquely positions them to address the growing psychiatric workforce shortage.
In a nuanced discussion, Dr. Asbach tackles the headlines and controversies surrounding the profession, including the recent British Medical Journal rapid review and the UK’s "Leng Report." He dismantles the concept of "scope creep," arguing instead for a model of "autonomous collaboration" that respects physician expertise while maximizing patient access. From the history of PAs emerging after the Vietnam War to the modern "Build, Baby, Build" approach to healthcare staffing, this episode provides a roadmap for how interdisciplinary teams can alleviate burnout and improve outcomes in the golden age of biologic psychiatry.
Episode Highlights:
00:00 – JCP Podcast Kickoff and Introduction to Dr. Asbach
01:34 – Expanding PA Engagement and Education in Psychiatry
03:22 – Career Origins and Choosing the PA Path Over Medicine
05:11 – Discovering Psychiatry and the Appeal of Interventional Innovation
08:46 – Mentorship, Research Culture, and Advancing Psychiatric Treatment
12:28 – Understanding PA Training Models and Evolving Clinical Competency
16:44 – Addressing Psychiatry Workforce Shortages Through Advanced Practitioners
20:36 – Evaluating PA Outcomes and Challenges in Measuring Quality of Care
29:24 – Rethinking Workforce Assumptions and Challenging Medical Dogma
32:37 – Regulation, Role Clarity, and Key Takeaways from the Leng Report
41:25 – Navigating Scope Creep Concerns and Physician Training Protection
47:51 – Building Effective Interdisciplinary Psychiatric Care Teams
56:44 – Supervision Ratios, Access Disruption, and Real-World Patient Impact
1:00:04 – Burnout, Non-Clinical Career Paths, and Retaining Expert Clinicians
1:08:09 – Future of Advanced Practice Providers and Closing Reflections
Key Takeaways:
"I think the future of advanced practice providers is going to be one that is collaborative, autonomous, and interdisciplinary."
"We are blessed to be able to play such an important role in people's lives... and have this front row seat to their life longitudinally."
"I’m very much a ‘build, baby, build’ approach to housing... Healthcare is very similar where the more people that we bring in as helpers, the better."
"Psychiatry is... in this golden era of kind of firmly returning back to biologic origin... and the PA medical model means that PAs have taken pathophysiology, gross anatomy, fundamentals of medicine."
"The absence of evidence is not the evidence of absence."
"It’s not about replacing physicians... but rather adjusting regulations to reflect the modern healthcare environment."

Links:
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Michael Asbach: https://www.dentinstitute.com/michael-asbach/
White Coats of the Round Table:

Fluctuating ADHD Across the Lifespan with Margaret Sibley, PhD
Dr. Margaret Sibley, Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital, joins The JCP Podcast to discuss the evolving understanding of the trajectory of ADHD across the lifespan. The recipient of the 2024 Paul Wender Best Paper Award, Dr. Sibley shares her journey from political science to clinical psychology and offers a behind-the-scenes look at the landmark Multimodal Treatment of ADHD (MTA) study.
Challenging the traditional binary view of ADHD persistence versus remission, Dr. Sibley details the findings of her award-winning paper, revealing that for the majority of patients, ADHD follows a fluctuating course into adulthood rather than a static one. The conversation explores the critical role of "environmental fit," the complex interplay between anxiety and symptom management, and the distinct clinical profiles of those with persistent versus fluctuating ADHD. Today’s thoroughly enlightening episode offers vital nuances on how patient environments and comorbidities shape long-term outcomes beyond childhood diagnosis.
Episode Highlights:
00:00 – Introducing Dr. Margaret Sibley and the Paul Wender Best Paper Award
02:41 – From Political Science to Psychology: A path to public health
04:55 – The importance of engaging with patient advocacy groups like CHADD
08:06 – A historical look at the Multimodal Treatment of ADHD (MTA) study
11:59 – Why childhood treatment doesn't always predict adult outcomes
20:17 – Challenging the myth of permanent remission vs. persistence
24:53 – Defining the "Fluctuator": The most common ADHD profile
28:15 – The "Gas and Brakes" analogy: The role of comorbid anxiety
29:48 – Understanding comorbidities in severe, persistent ADHD
31:45 – Clinical Pearls: Environmental fit and rising to the occasion
34:09 – What’s next for the MTA study
Key Takeaways:
"The fluctuators are really kind of like your bread and butter people with ADHD."
"We should be thinking about environmental fit as a potential way to help people manage their ADHD better.”
"Make sure that you read the Reddit threads about what people are saying that have a condition that you're working with."
"Most people were looking at persistence as a finality, a single outcome... But it seems very dynamic."
"The persistent ADHD group have many more comorbidities... and are much more impaired in their daily lives. And so this is sort of our severe ADHD profile.”
"People do better in behavior therapy for ADHD if they have comorbid anxiety."
"Parental psychopathology was a strong predictor of being in that 10% stable ADHD group."
"When environmental demands were higher, people were more likely to be experiencing remission."
“Make sure that you go out there and try to be non-judgmental about the lenses people see aspects of mental health through, even if it's different than what you were trained in or even what the science says.”
Links:
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Dr. Margaret Sibley: https://www.margaretsibley.com/
Dr. Sibley’s Award-Winning Paper:

Dr. Stephen Brannan brings decades of experience from both academic psychiatry and leadership roles at top pharmaceutical companies to the JCP Podcast today. He details his transition from university research to industry, offering a candid look at the forces that drive innovation in mental health care.
Dr. Brannan unpacks the complex process of bringing a new drug to market, using his work on treatments like Cobenfy (xanomeline-trospium) as a case study. The discussion covers the critical decisions in clinical trial design, from selecting the right patient populations to establishing meaningful endpoints that satisfy both regulatory bodies and clinical needs. He also addresses some of the most persistent hurdles in psychiatric research including the high placebo response rates that can obscure a drug's true efficacy and the operational complexities of running large, multinational studies. For clinicians seeking to better understand the evidence behind new medications, Dr. Brannan’s insights provide a unique level of enlightenment in the pragmatism, science, and collaboration required to advance patient care.
Episode Highlights:
00:00 - Introducing Dr. Stephen Brannan
01:56 - From Pre-Med Doubts to a Career in Psychiatry
06:51 - The "Push and Pull" from Academia to Industry
08:50 - Advice for Young Psychiatrists Considering Industry
10:56 - Pitfalls and Misconceptions of Pharmaceutical Work
14:37 - Balancing Real-World Applicability and Regulatory Realities
20:40 - The Science and Strategy Behind Cobenfy
22:10 - Understanding and Mitigating the Placebo Effect
28:57 - The Role of Expert Steering Committees
32:38 - Designing Trials
42:37 - The Nuances of Safety Surveillance in Clinical Trials
53:27 - Reflections on the Future of Psychiatric Treatment
Key Takeaways:
"I will not sacrifice quality for the sake of speed."
"I've learned how to talk with people rather than just sort of barking an order."
"We're a hell of a lot more alike than we're different."
"The better we understand that and we're able to pick treatments based on biomarkers...that's going to make a huge impact."
"That's extremely useful in psychiatry because it's rare when you first see somebody...you absolutely know what's going on. It usually takes time and patience and a tolerance for ambiguity."
"You also want to be able to talk to people who will tell you what's wrong with your thinking."
"You want your beachhead. And your beachhead is...what's the best segment of patients?"
Links:
Full transcript and show notes: https://www.psychiatrist.com/jcp/ep3-academia-to-pharma-stephen-brannan
Journal of Clinical Psychiatry: psychiatrist.com/jcp/
Dr. Stephen Brannan: https://www.linkedin.com/in/steve-brannan-b7376019/