H🔻NMAR

INFJ-T | Jomblo Happy 🇲🇾

[H🔻NMAR @AzhanMar]

A thread

[Psychiatry Excellence @psycheureka]

Autoimmune Encephalitis (AE) is a relatively rare neuroinflammatory disorder.

However, what makes AE so hard for clinicians to spot isn't just its rarity.

Rather, it is that it can look psychiatric early.

To avoid misdiagnosis, here’s a 3-point AE diagnostic criteria clinicians should know:🧵👇

[eClinicalMedicine – The Lancet Discovery Science @eClinicalMed]

Effect of psychotropic medications on suicide-related outcomes: a SRMA of observational studies

There is evidence of varying effects of #psychotropic medication on the risk of suicide-related outcomes across different psychiatric disorders

https://t.co/7LGSmHEip4
@seenafazel

[Robert Y. Chen @therealRYC]

🚨 SSRIs - mechanistically different?

They all inhibit SERT.

But what if they had other actions too?

Researchers looked at how fluoxetine, sertraline, and citalopram affected neurons that can’t make serotonin.

Their effects on gene expression were wildly different 🧵

[Robert Y. Chen @therealRYC]

🚨 Electroconvulsive therapy (ECT) - the most controversial treatment in Psychiatry

A study of >1 million patients with a depressive disorder re-examined the benefits of ECT.

Here's what you need to know about this landmark paper published this week in @BMJMentalHealth

[Psychiatry Excellence @psycheureka]

Lithium: still the most distinctive mood stabiliser we have.

70 years in practice with compelling evidence in mania, acute bipolar depression, and prophylaxis, yet its mechanisms remain multifaceted.

Here’s what makes Lithium so different and it’s mechanisms of action 🧵👇

[Psychiatry Excellence @psycheureka]

Studies suggest that up to 50% of adults with ADHD meet criteria for an anxiety disorder (Fu et al., 2025).

Anxiety is not simply “comorbid”; it is embedded in ADHD’s neurobiology and developmental trajectory.

Let’s explore how anxiety and ADHD intersect, and why recognising this link can improve diagnostic clarity, treatment planning, and patient outcomes. 👇🧵

Note: image is a conceptual illustration (uncertainty ↔ arousal ↔ anxiety), not a validated biomarker/model.

[Keith Sakata, MD @KeithSakata]

Neuroplasticity = the brain’s ability to change.

But plasticity itself isn't “good” or “bad.”

In a bad environment:
• High plasticity → rapid learning of the wrong lessons
• Low plasticity → can't unlearn them

Here's how to unlock your plasticity 🧵

[H🔻NMAR @AzhanMar]

@yousef_ki1 .

[Psychiatry Excellence @psycheureka]

Men are about 1.4 times more likely to develop schizophrenia, and their symptoms appear 3–4 years earlier than in women (Li et al., 2022).

Oestrogen’s neuroprotective role delays onset in women, but symptoms often surge after menopause.

Here are the key hormonal influences shaping schizophrenia outcomes in men and women, and how this knowledge improves patient care. 👇🧵

[Keith Sakata, MD @KeithSakata]

Why do we sleep? And how?
Two ancient questions. Two new answers.

A real theory must explain:
• Switching → how the brain flips into sleep so fast
• Benefits → why it repairs memory, immunity, metabolism
• Drive → why the longer we’re awake, the more we must sleep
• Across species → mammals to fish = same pattern

HOW: Motor Theory
Sleep isn’t a single switch in the brain. It’s a distributed motor + autonomic network (cortex → midbrain → cerebellum) that actively suppresses movement and arousal.

When the “motor brake” engages, non-REM sleep emerges.

WHY: Catecholamine Hypothesis
Sleep works because dopamine, noradrenaline, and adrenaline power down.

That shutdown unlocks:
• Cognition → synapses reset, memories consolidate
• Immunity → microglia go on patrol, inflammation calms down
• Metabolism → hormones like insulin, cortisol, leptin rebalance

Catecholamine neurons (LC, SNc, VTA) are metabolically fragile. Sleep is their scheduled maintenance.

Without it → oxidative stress → worse arousal control → worse sleep. A vicious cycle.

Sleep drive:
Stay awake long enough and these neurons fatigue. Immune + adenosine signals pile on. The very chemistry that makes you alert by day builds the pressure to sleep at night. (FYI this is what caffeine hijacks)

So What?
This explains real-world patterns:
• High evening adrenaline blocks sleep despite “good hygiene”
• Insomnia improves when adrenergic tone is lowered
• Wearables that track motor/autonomic braking may predict sleep better than EEG

Your toolkit tonight
• Motor brake → dark, cool, quiet, predictable sleep place
• Catecholamine off-ramp → no late caffeine/nicotine, dim screens, calming evenings
• Anchor timing → same sleep/wake to train the system

TL;DR
Motor Theory = the sleep switch
Catecholamine Hypothesis = the benefits + the drive
The brain figured it out a billion years before we did

[Dr Sanil Rege FRANZCP | MRCPsych @sanilrege]

🧵Antidepressants: Starting, Stopping, and the Ethics of Long-Term Trials

Antidepressants are often prescribed for years, yet most clinical trials last only weeks-median duration: 8 weeks.

What does this mean for long-term use, discontinuation, and trial ethics? Let’s unpack. 1/10

[Psychiatry Excellence @psycheureka]

Why do some patients respond poorly to antipsychotics despite adherence and diagnosis?

Emerging research points to muscarinic receptor dysfunction. M1 and M4 receptors are densely localised in memory circuits, especially the hippocampus, amygdala, and neocortex, where they modulate synaptic plasticity and cognitive processes.

Could a missing cholinergic signal explain what dopamine alone cannot?

1/13 🧵

[H🔻NMAR @AzhanMar]

Ni statement untuk escape diri. 300 orang tu yang supposedly datang. Paham ke tidak ni? Mana paham sebab tukang buat statement duk dalam office je. But 150 still a lot for 3 mos and 3 pakar. 3 pakar tu pon bukan semua dekat klinik. Kena round ward, kena buat OT. Bodoh!

[KKMalaysia🇲🇾🩺❤️ @KKMPutrajaya]

Salam Sejahtera, Tuan. Terima kasih atas keprihatinan terhadap isu yang dibangkitkan.

Merujuk kepada situasi pada 30 Jun 2025 di Klinik Pakar Ortopedik, Hospital Sungai Buloh, pihak kami telah mendapatkan maklumat lanjut daripada pihak hospital. Berdasarkan semakan:

1. Seramai 158 pesakit hadir pada hari tersebut.

2. Klinik dikendalikan oleh 3 Pakar dan 3 Pegawai Perubatan, mengikut jadual dan kapasiti sedia ada.

Anggaran kehadiran lebih 300 orang seperti yang tular turut merangkumi ahli keluarga atau penjaga yang menemani pesakit. Ini adalah amalan biasa di fasiliti kesihatan awam, khususnya bagi warga emas dan kanak-kanak.

Kami memahami kesulitan yang dihadapi pesakit dan keluarga, terutama berkaitan masa menunggu. KKM sedar beban kes di hospital rujukan seperti HSgB adalah tinggi dan usaha penambahbaikan sedang dijalankan secara berterusan untuk memperbaiki aliran pesakit.

[Nicholas Fabiano, MD @NTFabiano]

This is the Atlas of Cognitive Disorders

[H🔻NMAR @AzhanMar]

@aishanefertari @3ricO2l7 @adzizi The answer is because you just dont like it not because it is historically correct. Bagi la segunung fakta pon.

Dunia ni berputar dan awak bukan lah paksinya. People dont care how you like it or not. Accept the differences and move on.

[H🔻NMAR @AzhanMar]

@gundikkakitroll @joesamuel0101 @mnasrullah00 Kepala kau. Kau ingat faraid je ke disebut dalam Al-Quran. Dalam al-Quran ada sebut pasal berbuat baik dengan orang tua, sebut “Ah” pon kau dilarang, cuba tadabbur sikit Surah Al-Isra’ ayat 23-24. Tak kira anak lelaki, anak perempuan wajib berbuat baik dengan orang tua.

[Psychiatry Excellence @psycheureka]

What is the scientific foundation of psychiatric diagnosis and clinical reasoning?

🧵👇

[H🔻NMAR @AzhanMar]

@aishanefertari @adzizi Malaya tu istilah dulu merujuk Tanah Melayu. Lain kali jangan ponteng kelas sejarah.

[H🔻NMAR @AzhanMar]

@meinmokhtar Ni baru betul parents “derhaka” dengan anak. Buat anak as investment plan diorang.

[H🔻NMAR @AzhanMar]

@meinmokhtar Suka hati kau la. Malaih aku