For your attention, April 2026

1. Automating thematic review of prevention of future deaths reports: concordance study of a child-suicide analysis using large language models. Very practical use of LLMs from my old registrar, now Professor Dan Joyce.

2. Isolating the Genetic Component of Mania in Bipolar Disorder. Feels like genetics is making genuine progress into the nosology of psychiatric illness. Mania explained 81.5% of the variance in bipolar disorder, with major depressive only explaining 18.5%. ‘Pathway analysis highlighted a significant enrichment in the voltage-gated calcium channel activity pathway’, watch this space.

3. Skin Biopsy Diagnosis of Late-Onset Psychosis as Prodromal Dementia With Lewy Bodies: A Case Series. Keep LBD in mind for patients presenting with psychosis in old age.

4. The prevalence of Lewy body pathology across nine international community-based cohorts. Overall, 27.3% of participants had Lewy Body pathology. Nice work from my colleague Lucy Gibson.

5. GH001 vs Placebo in Patients With Treatment-Resistant Depression A Randomized Clinical Trial. This trial of 5-MeO-DMT had a failure of the placebo arm.

6. The unique efficacy of clozapine is attributable to muscarinic receptor agonism. The effectiveness of Cobenfy has led to a re-evaluation of clozapine’s mechanism of action. Written by not one, not two, not three but four Scottish psychiatrists (3/4 are Glaswegian).

7. Why Is Clozapine Uniquely Effective in Treatment-Resistant Schizophrenia? A Review and Proposal. Another muscarinic-take on clozapine featuring Robin Murray and Sameer Jauhar, alongside various eminent (non-Scottish) coauthors. Quite incredible to see Robin still publishing new ideas into his 80s. He gave me my first break (and still most cited paper) 15 years ago.

8. No Evidence for Cognitive Decline in First-Episode Psychosis: A Meta-Analysis of Long-Term Longitudinal Studies. This study is a strike for the neurodevelopmental hypothesis amid the debate on cognitive trajectories in schizophrenia.

9. Dementia in Severe Schizophrenia. In those with chronic, treatment-resistant schizophrenia, almost half had cognitive impairment which would meet the threshold for severe dementia. The cognitive and genetic profile did not fit with typical dementia syndromes such as Alzheimer’s or LBD. The neurodegenerative hypothesis hits back!

10. Regional Blood Flow Signatures of Opioidergic Modulation of Ketamine in Major Depressive Disorder: A Randomized Crossover Study. Another excellent study from Luke Jelen’s PhD - I’m impressed.

1. Briton was diagnosed with rabies after psychiatrist raised fears, inquest told. Unfortunately this one doesn’t have a happy ending, but well done to Dr Alexander Burns for making the diagnosis. Add rabies to your list of rare causes of psychosis and be vigilant with patients presenting for the first time in middle-age, with recent foreign travel.

2. They said I was crazy and put me on antipsychotics - then police found a man in my loft’. ‘Phrogging’ is apparently the act of secretly living in another person's home without their knowledge or permission.

3. Woman found out she had terminal brain cancer after suitcase fell on her head. Glioblastoma initially diagnosed as ADHD and emotional dysregulation.

4. I’m dyeing … man rushed to A&E after turning blue. A builder sparked alarm at a hospital after he woke up with bright blue skin, until a swab revealed the colour had simply rubbed off from new bedding.

5. When mentally ill teenagers ask to be put to death. These cases disturb me, I have big questions for the psychiatrists involved.

6. Autism study is my life’s work. The spectrum has lost all meaning. Uta Frith no longer believes in the autism spectrum. For a counter-point, see Simon Baron-Cohen’s Triggernometry episode.

7. NHS will offer non-hormonal hot flush treatment to menopausal women. Good news as fezolinetant gains NICE approval. However…I covered this medication three years ago, why does did it take so long?!

8. Ten doctors have prescribed half of all cannabis drugs. Private cannabis clinics getting some negative media attention - there will be more to come. Also featuring an excellent quote by Prof-Sir.

Sir Robin Murray, a professor of psychiatric research at King’s College, London, said: “Usually if a person has a medical condition, they see a doctor who specialises in a particular area of medicine, for example, respiratory or kidney disease. After diagnosis the doctor prescribes from a range of treatments.

“One doesn’t go to a clinic called after the name of a drug. There are no penicillin clinics or steroid clinics. But here we have clinics set up to prescribe what the patients say they want, ie cannabis, irrespective of whether there is any evidence that cannabis can help the complaint.”

1. Michael Halassa: Did John Nash Really Have Schizophrenia? Wonderful post about the genetic dissection of psychosis, featuring research by Cameron Watson. Years ago, Cam kindly mentioned by Substack at an Institute of Psychiatry journal club. Feels like things have now come full circle.

2. Dark Matter Pragmatism: The Route Problem in Psychiatry. Delivering a drug can be as much of a challenge as its effectiveness.

3. Thinking Psychiatry: Losing faith in the SAINT protocol. I’ve seen a lot of hype about the SAINT protocol - here is a more skeptical take.

4. Asimov Press: AI Won’t Automatically Accelerate Clinical Trials. Completely agree that AI will struggle to get round the bottle-neck of clinical trials to develop new medications.

5. Cognitive Wonderland: Why We're Right-Handed But Not Right-Brained. Lateralisation is surprisingly interesting. See also my post about why people with schizophrenia have higher rates of left-handedness.

1. The university you go to matters (in the UK at least). Not seen for medicine because five years post graduation, everyone will still be in NHS training programmes.

   

   Tom Calver@TomHCalver

   This week's column: choose your university wisely Post-1992 providers have been rapidly expanding business, law and computing courses. Yet the returns for students 5 years after graduating from these courses have, to date, been woeful 1/4

   

   12:31 PM · Mar 8, 2026 · 448K Views

   66 Replies · 121 Reposts · 862 Likes

2. Manual systematic reviews look to be an early casualty of AI.

Samuel Hume@DrSamuelBHume

Today we're launching the world's first AI-native systematic review platform. We made it for researchers in academia, medicine, and pharma. Search, screening, data extraction, risk of bias, and analysis – in hours, not months. Try it now at scholara.ai

7:39 PM · Mar 16, 2026 · 27K Views

8 Replies · 17 Reposts · 148 Likes

3. I cry.

   

   Leah Pierson@leah_pierson

   omg this title, this paper

   

   2:34 AM · Mar 4, 2026 · 621K Views

   45 Replies · 1.31K Reposts · 19.4K Likes

4. Studies are still being eviscerated in tweets, science-twitter is not dead yet!

John Mandrola, MD@drjohnm

I am not a psychiatrist but these effect sizes are very large. Placebo was corn oil. I would have liked a test for blinding. I'm skeptical that fish pills have this large of an effect in 20 year-olds

Max Lugavere @maxlugavere

A new randomized, double-blind trial found that taking omega-3s daily for 3 months significantly improved stress, anxiety, depression, sleep quality, and everyday memory in adults with severe psychological distress. A simple daily intervention (500mg EPA and 250mg DHA) improved

6:39 PM · Mar 9, 2026 · 56.3K Views

34 Replies · 14 Reposts · 184 Likes

Igor Eckert@igoreckert

@drjohnm This trial is riddled with internal inconsistencies and improbable data patterns. - A placebo group that doesn't improve symptoms at all over 12 weeks is something that never happens in trials like this - Study had full retention rates (no dropout at all), which is odd

6:59 PM · Mar 9, 2026 · 56.7K Views

14 Replies · 16 Reposts · 238 Likes

5. How to deliver bad news.

Ross Prager@ross_prager

Delivering bad news as an ICU doctor is one of the harder parts of the job. Here are some lessons I've learned along the way👇 1. Always sit down 2. Don't just jump into it. Spend the first couple of minutes with introductions to yourself, your team (if present), but more

11:02 AM · Mar 9, 2026 · 57.6K Views

28 Replies · 66 Reposts · 365 Likes

6. Most side-effects on labels aren’t real.

Crémieux@cremieuxrecueil

Here's an example: Most (94%!) of the things on statin warning labels are *not* actually caused by statins. And the things that are there are all minor and manageable! We really need reforms to warning labels.

Crémieux @cremieuxrecueil

Reminder: Warnings on drugs do not mean drugs cause those things. The typical side effect warning is generated from anecdotal evidence and doesn't have a basis in reality so much as some random person's delusional misattribution.

10:05 PM · Mar 10, 2026 · 13.9K Views

8 Replies · 8 Reposts · 98 Likes

7. RCPsych elections delivering drama. Oh to be a fly on the wall of UCL faculty meetings.

Robert Howard@ProfRobHoward

Nobody who follows me here should be in doubt that I will always promote evidence-based practice and would want the RCPsych to do so. I hadn’t expected support from the Critical Psychiatry Network, but fascinating that my UCL colleague should advise them all by email how to vote.

10:16 AM · Mar 12, 2026 · 27.5K Views

43 Replies · 17 Reposts · 74 Likes

1. Science Fictions: Electroconvulsive therapy. Most psychiatrists have seen ECT work clinically, sometimes in dramatic ways, but the RCT evidence base is actually pretty thin (correct me if I’m wrong).

2. The Thinking Mind Podcast: The Nazi & The Psychiatrist. Fascinating insight into the complex character of Dr Douglas Kelley.

3. Radical with Amol Rajan: Over-Diagnosis: Are Too Many People Being Given Medical Labels? (Dr Suzanne O’Sullivan). This neurologist has been taking a lot of heat for suggesting that long-covid is psychosomatic. She also covers the expanding spectrum of neurodiversity, with some challenges from Amol who is a top class interviewer.

4. Dr Nassir Ghaemi Podcast: Emil Kraepelin: The most misunderstood psychiatrist in history - and the most relevant. All roads lead back to Kraepelin.