The Academy by Psych Scene

Why Do Standard Pharmacotherapy Sometimes "Backfire" in Autism Spectrum Disorder (ASD)?

Clinical studies suggest that for some drugs (notably ADHD medications), response may be less robust and adverse effects more common in ASD.

This likely reflects differences in neurodevelopmental wiring and network-level responsivity, rather than a uniform medication response profile.

While stimulants are first-line for ADHD—a condition comorbid in up to 80% of ASD cases—these agents can trigger "iatrogenic agitation" in the ASD population.

Here's a breakdown on why pharmacotherapy can backfire in ASD: 🧵👇

psychscene.co/3Yyv4e0

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2 weeks ago | [YT] | 4

The Academy by Psych Scene

Frequent use of high-potency (high-THC) cannabis is associated with a substantially increased risk of psychotic disorder, particularly in people with underlying vulnerability.

Modern cannabis products often contain higher THC and relatively less CBD, a shift that may increase psychiatric and cognitive harms with early or heavy use: 🧵👇

The brain’s endocannabinoid system primarily involves two receptors:

• CB1 receptors → Abundant in the brain and CNS; involved in memory, reward, emotional processing, and pain modulation.

• CB2 receptors → Predominantly expressed in immune cells and peripheral tissues, with limited but inducible CNS expression, particularly in neuroinflammatory states.

THC is a partial CB1 agonist, disrupting dopamine, GABA, and glutamate signalling, pathways implicated in psychosis and cognitive impairment.

Cannabis & Psychosis

THC can induce acute psychotic-like experiences (e.g. paranoia, perceptual disturbances), even in people without prior psychosis.

Frequent use of high-potency cannabis (“skunk”) is associated with higher risk of schizophrenia-spectrum disorders, especially in those with genetic or clinical vulnerability.

In people who later develop psychosis, cannabis use is associated with an earlier age of onset, typically by several years, though estimates vary across studies.

Gene–environment interactions (e.g. AKT1, COMT) may increase sensitivity to THC, but findings are not yet clinically actionable.

Cognition & memory

THC acutely impairs attention and short-term memory, partly via CB1-rich hippocampal circuits.

Heavy or long-term use is associated with deficits in executive function, processing speed, and decision-making, with partial recovery after abstinence in some users.

Adolescents are particularly vulnerable, as cannabis exposure may interfere with ongoing neurodevelopment.

Cannabis withdrawal commonly includes sleep disturbance, irritability, anxiety, and craving, reflecting neuroadaptation rather than simple “THC accumulation”.

Depression, anxiety & motivation

Many people use cannabis to self-manage anxiety or low mood. However, observational studies link frequent or early use with higher rates of depression and anxiety, though causality is uncertain.

“Amotivational syndrome” remains debated and overlaps with depression, intoxication, and social confounders.

THC vs CBD

• THC: psychoactive; CB1 partial agonist; associated with euphoria, anxiety, transient psychotic symptoms, and memory impairment.

• CBD: non-intoxicating; modulates multiple systems. Shows preliminary antipsychotic signals, but evidence is limited and inconsistent.

The THC:CBD ratio matters.

Higher CBD content may attenuate some THC-related adverse effects, but this is not a reliable way to prevent psychosis and should not be presented as protective or therapeutic.

Sativa vs indica?

These labels have poor scientific validity.

Clinical effects depend on THC dose, THC:CBD ratio, route of administration, terpene profile, and individual vulnerability, not strain names.

Cannabis & Schizophrenia

Cannabis use is common in schizophrenia (often ~25–40%, varying by setting).

While some patients report short-term relief of affective symptoms, cannabis use is consistently associated with symptom exacerbation, higher relapse rates, and poorer long-term outcomes.

Clinical Takeaways for Psychiatrists

Screen for: age of first use, frequency, potency (THC content), route, and personal/family history of psychosis.

Counsel: early and heavy use increases psychosis risk; patients with psychotic disorders should avoid high-THC products. CBD is not an evidence-based treatment for psychosis.

Want to learn more about the link between cannabis and schizophrenia?

Deepen your knowledge of cannabis-induced psychosis and schizophrenia management with our article, The Psychopharmacology of Cannabis & its Impact on Mental Health by Dr Sanil Rege & Prof David Castle.

Deepen your knowledge of cannabis-induced psychosis and schizophrenia management with our article, The Psychopharmacology of Cannabis & its Impact on Mental Health by Dr Sanil Rege & Prof David Castle. Click the link below.

psychscene.co/3YWXqyG

2 weeks ago (edited) | [YT] | 6

The Academy by Psych Scene

How Do Brain Functions Differ in Patients With ASD?

Autism Spectrum Disorder involves complex neurobiological shifts across distinct functional domains.

While once viewed as a simple behavioural “deficit,” studies revealed a pattern of atypical connectivity and structural organisation that alters how the brain processes social and sensory data.

Meaning, the ASD brain follows a unique computational logic rather than a "broken" one.

Here’s a breakdown of the neurobiological substrate of ASD.

To understand the full scope of ASD neurobiology and its distinct clinical phenotypes, check out the full course on The Academy using the link below:

psychscene.co/4q0wnOJ

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3 weeks ago | [YT] | 6

The Academy by Psych Scene

Are "Feelings" and "Emotions" the Same Thing?

Linguistically, we use these terms interchangeably, assuming the difference is merely semantics.

However, studies revealed that they are distinct physiological events occurring in two different "theatres" (Damasio, 2003).

• Emotion = Theatre of the Body (unconscious physiological arousal)

• Feeling = Theatre of the Mind (conscious interpretation)

Here’s the neurobiological breakdown of the distinction between the two and why it matters clinically.

To further bridge the gap between the physiology of “emotion” and the psychology of “feeling,” hit the link below and check out our deep dive on Psych Scene Hub, “The Neuroscience of Emotions”:

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3 weeks ago | [YT] | 5

The Academy by Psych Scene

There are no ‘silver bullets’ in psychiatry…

Knowing that a treatment exists is not the same as knowing when to use it, how to explain it, or where it fits in a patient’s journey.

Here are 10 clinical insights from The Academy to take into 2026 🧵👇

(Prof Michael Berk) (Prof David Barton)

1. Formulation is not reflective writing, it is the architecture of care.

Formulation must directly guide what you do next and why. If a formulation cannot be operationalised into a management plan, monitoring strategy, and review points, it has failed its primary clinical function.

2. Clinical expertise is the art of what you choose to weigh.

The clinical skill is not information gathering, but relevance filtering, identifying which detail meaningfully shifts diagnostic probability and treatment direction.

3. Recovery in psychiatry is usually additive, not dramatic.

Meaningful improvement often comes from stacking small, targeted interventions. Sleep, physical health, adherence, psychosocial support, and pharmacology. Rather than chasing a single transformative treatment.

4. When pain is reduced to tissue damage alone, patients are misunderstood and outcomes worsen.

Pain is not equivalent to nociception. It is shaped by emotional, cognitive, developmental, and cultural factors, all of which fall squarely within psychiatric expertise.

5. Good prescribing is structured follow-up, not a one-off decision.

For example, In peri/menopause-related presentations (mood, sleep, cognition, irritability), the job is not to “start HRT”—it’s to select, monitor, and revise while holding psychiatric differentials in mind (and avoiding diagnostic overshadowing in either direction).

6. Speed without translation produces transient gains.

For example, Esketamine creates a window of reduced symptom burden, but functional recovery depends on how that window is used—therapy re-engagement, behavioural activation, and relapse prevention planning.

7. Advanced treatments fail not because they are weak, but because they are mispositioned. Timing is a therapeutic variable.

For example, TMS requires algorithmic placement—not desperation referral. Its value depends on patient phenotype, illness chronicity, prior treatment exposure, and how success is defined (symptom reduction vs. functional recovery).

8. Lithium is avoided less because of evidence and more because it demands long-term stewardship.

Lithium remains foundational for patients with a history of mania because it provides true mood stabilisation, not just suppression of acute symptoms.

Antipsychotic monotherapy may reduce manic behaviour but does not confer the same long-term protection against relapse or suicide.

9. The ethical quality of care improves when values are made visible.

Many “clinical” conflicts are value conflicts in disguise: autonomy vs. safety, immediate risk reduction vs. long-term agency, individual rights vs. systemic fear. Naming values explicitly improves team alignment and reduces coercive drift.

10. The most important diagnostic skill is recognising when your frame is too narrow.

Re-run first principles: pain, physical illness, trauma, environment, communication mismatch, medication effects, sleep, mood, and psychosis—and make reasonable adjustments to your assessment style.

These insights represent the distilled collective wisdom from The Academy over the past year, the specific 'relevance filters' that differentiate clinical information from clinical expertise.

As psychiatric treatment interventions grow more complex, our ability to deconstruct, understand, and strategise becomes the only safeguard against clinical stagnation.

Access these insights in an interactive format, plus 150+ hours of material with The Academy from $1.64/day. Find out more:


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3 weeks ago | [YT] | 5

The Academy by Psych Scene

Why Do Clinicians Often Miss Dissociative PTSD?

Most associate PTSD with autonomic hyperactivity: elevated startle response and amygdala-driven panic.

However, research indicates that for 30% of patients (Wolf et al., 2012), trauma manifests as silence, detachment, and numbness.

This refers to the Dissociative Subtype (PTSD-DS), a pathology of regulatory rigidity, where the brain severs connectivity to survive.

Here’s the neurobiological breakdown of this PTSD mechanism clinicians often miss.

To further understand the nuances of the Dissociative Subtype of PTSD and how to tailor interventions for complex trauma presentations, hit the link below and check out our article on Psych Scene Hub, “Advances in Understanding PTSD”:

psychscene.co/490dVzX

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3 weeks ago | [YT] | 5

The Academy by Psych Scene

Happy New Year! We want to say a sincere thank you to our Academy community. 💚

This year was a big one for The Academy by Psych Scene, and it simply wouldn’t be possible without the people behind it — our members, educators, and wider YouTube community.

Here’s what we achieved together in 2025:

📚 27,595 course enrolments
✅ 4,860 completions
⏳ 22,023 hours of learning
🏆 18,108.5 CPD credits awarded
🌍 Reached learners in 48 countries

Our viewers make this community what it is.

Our educators bring depth, clarity, and real-world experience to every course.

And together, you allow us to keep investing back into education — including growing this YouTube channel so more people can access thoughtful, high-quality learning.

Whether you’re a clinician, an educator, or someone here simply to learn and think more deeply — thank you for being part of the Academy.

Here’s to an even bigger 2026, built on people, ideas, and shared learning.

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3 weeks ago | [YT] | 0

The Academy by Psych Scene

Why is BPD Systematically Misdiagnosed in Men?

Traditionally, Borderline Personality Disorder (BPD) is perceived through a female-centric lens of "internalised" distress that leads to a gendered-diagnostic blindspot.

Research suggests that BPD is equally prevalent in men.

However, because the male phenotype manifests as "externalising" aggression, symptoms are misattributed to externalising disorders.

Here’s the neurobiological breakdown of why male BPD diagnosis is often missed.

To learn more about the neurobiological drivers and phenotypic variations of BPD, click the link below and check out our article on Psych Scene Hub, “Borderline Personality Disorder – Deconstructing the Diagnosis from a Neurobiological and Psychodynamic Lens”:

psychscene.co/3YJbYlo

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4 weeks ago | [YT] | 6

The Academy by Psych Scene

We’re proud to share a major milestone for The Academy.

Three years after launching, we’re excited to welcome our first large European medical university to The Academy.

To put this into perspective:

This institution alone represents 30 clinicians engaging in structured, evidence-based learning.

This matters because it reflects what the Academy was built for:

practical, clinically relevant education that translates directly into real-world practice grounded in evidence, not theory alone.

If you or your organisation are looking for education that bridges research and day-to-day clinical decision-making, we’d love to talk.

Get in touch using the link below:

psychscene.co/4auUkcj

4 weeks ago | [YT] | 8

The Academy by Psych Scene

Are women more vulnerable to anxiety and depression than men?

Statistics show women are 2x as likely to develop anxiety and depression than men.

Some attribute this disparity to gendered societal strain.

However, neuroscience reveals the female brain is simply biologically wired that way: primed for vigilance, having denser stress receptors that consolidate threat data more intensely than the male equivalent.

Here’s a breakdown of the neurobiological differences 👇🧵

To understand the full scope of female-specific psychiatric nuances and their clinical implications, visit the link below and check out our article on Psych Scene Hub, “Navigating Female-Specific Complexities in Psychiatry”:


psychscene.co/3N1MgG6

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1 month ago | [YT] | 6