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Aug 25 13 tweets 3 min read Read on X
What if your patient’s biggest struggle isn’t the thought, but the tension in their body?

Progressive Muscle Relaxation (PMR) helps interrupt that cycle, reducing arousal and reinforcing regulation.

Here’s how PMR can support patients with chronic anxiety and tension, and how clinicians can integrate it in practice. 👇🧵
When dysregulation hits, the body often reacts before the mind.

Tension builds → signals threat.

Release → signals safety.

PMR retrains patients to notice tension early, release it, and send calming cues through their nervous system.
The science of PMR

Patients activate the parasympathetic nervous system by intentionally tensing and releasing muscles, which is the body’s “rest and digest” mode.

Over time, this builds interoceptive awareness, helping patients recognise stress signals before they become overwhelmed.
Chronic tension keeps the body on alert

For many patients, anxiety and trauma leave the body in a constant state of muscular tension.

This baseline hyperarousal sustains emotional reactivity.

PMR interrupts the loop, reducing somatic symptoms and lowering overall arousal.
Who benefits most from PMR?

Evidence shows PMR is effective across:

● BPD and complex PTSD

● Anxiety disorders

● Trauma survivors

● Chronic pain syndromes

● Sleep disturbances linked to hyperarousal
Evidence in adolescents

A 2024 quasi-experimental study (Köse Kabakcıoğlu & Ayaz-Alkaya) showed PMR significantly reduced stress, anxiety, and depression in adolescents after 8 weeks of practice.

This reinforces PMR as a low-cost, low-risk intervention with broad applicability across patient groups.
Why it works in therapy

The therapeutic gain isn’t just relaxation, it’s contrast awareness.

By noticing the shift between tension and release, patients learn to detect subtle signs of stress early, turning awareness into regulation. Image
Clinical integration

Use PMR:

● Before exposure work (to reduce baseline arousal)

● After interpersonal conflict (to reset the body)

● In a crisis, as a grounding skill

● To improve sleep onset
A clinician’s framing tip

Present PMR as nervous system training, not just relaxation.

Patients are more likely to practise proactively if they see it as rewiring stress responses, rather than a “coping trick.”
Why this matters

For patients who feel constantly “on edge,” PMR offers:

● A sense of bodily safety

● A portable, evidence-based tool

● A foundation for tolerating deeper therapy work
Why “noticing the contrast” works

Recognising the shift from tension to relaxation helps patients identify early signs of physical stress.

That body awareness becomes a powerful self-regulation tool.
From skill to framework

PMR is one example of how body-based strategies strengthen psychiatric care.

In DBT, skills like PMR sit alongside mindfulness, distress tolerance, and emotion regulation, which form an integrated system that clinicians can apply directly in practice.
Want to help patients regulate faster and recover better?

In our CPD-accredited course, “Dialectical Behaviour Therapy (DBT) – A Practical Guide for Clinicians”, you will learn practical, neuroscience-informed DBT strategies, from emotional regulation to distress tolerance, that you can apply straight to your sessions.

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More from @psycheureka

Aug 20
7 key differences in females with ADHD

Females present with a specific neurobehavioural profile that may contribute to an underdiagnosis and subsequent under-treatment.

Here’s what clinicians need to assess and look out for
🧵👇 Image
1/ Under-recognised, different profile.

Girls/women with ADHD often present with internalising symptoms (low mood, anxiety, emotional lability), so they’re mislabelled with mood/personality disorders and referred late.

💡 Psych Scene Tip:

If chronic anxiety/low mood rides alongside lifelong disorganisation, time-blindness, and procrastination across settings (since <12), screen for ADHD before defaulting to mood/BPD labels.
2/ Masking + compensation delay diagnosis.

Compliance, resilience, perfectionism, and high structure (supportive family/school) can temporarily “hide” impairment, until demands rise. 

Expect later recognition at transitions (primary→secondary school, university, new job, parenthood). 
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Aug 19
Which antidepressants work most effectively, and which barely beat placebo?

The largest meta-analysis (Cipriani et al., 2018) compared 21 antidepressants in 116,477 patients, revealing striking differences in efficacy and tolerability.

Here’s how this data can transform your prescribing practice 🧵👇Image
Most ‘Effective’ Antidepressants (Head-to-Head)

In the largest network meta-analysis to date, the following antidepressants consistently outperformed others in head-to-head comparisons for efficacy (odds ratio range: 1.19–1.96):

● Agomelatine
● Amitriptyline
● Escitalopram
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These consistently outperformed others.

Note: Just because a drug ranks high in efficacy doesn’t mean it’s the best choice for every patient.Image
The Numbers Behind Antidepressant’s Efficacy

Odds ratios (OR) provide a clearer picture.

● Amitriptyline: OR = 2.13 (113% higher odds vs. placebo)
● Reboxetine: OR = 1.37 (37% higher odds)

All drugs beat the placebo, but not equally.

Higher OR = greater efficacy. Image
Read 10 tweets
Aug 16
Why is the MEQ (Modified Essay Question) one of the hardest exams in psychiatry?

Because it doesn’t just test what you know, it tests how you think.

And here’s the problem: most psychiatric training doesn’t actually teach us to think. 🧵

1/12 Image
We’re taught to memorise.

To conform.

To defer to authority and quote the guidelines.

But real-world psychiatry? That’s messy. Uncertain. Full of grey zones.

The MEQ throws you right into that world.

2/12🧵
Take this:

Textbook:

“How to manage akathisia”

Sounds simple.

But now look at a real-world MEQ slice:

“A 52-year-old male with schizophrenia on aripiprazole 10mg nocte for 1 year reports leg restlessness. It’s keeping him awake. Outline your approach.”

See the difference?

3/12🧵
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Aug 13
Molly, age 14, was found wandering in Cork city, confused, agitated, and rifling through bins.

She has no psychiatric history and was sectioned under suspicion of acute psychosis. But a butterfly-shaped rash redirected her diagnosis.

Let’s walk through this case and explore what it teaches clinicians about diagnosing neuropsychiatric disease.

1/14🧵Image
Initial Presentation

Molly presented in 1994.

Symptoms: 

● Disorientation

● Behavioural disinhibition

● Public agitation

Initial impression: primary psychotic disorder.

She had no prior mental health history.

2/14🧵
Autoimmune Features Identified

On assessment, clinicians noted:

🔍 Malar (butterfly) rash

🔍 Patchy alopecia

🔍 Positive anti-dsDNA antibodies

🔍 Low complement (C3)

Renal function remained normal.

These findings shifted diagnostic suspicion toward systemic autoimmunity.

But what could be the real diagnosis?

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Aug 12
Pregabalin and gabapentin are widely prescribed for neuropathic pain and seizures

Yet, their rising misuse potential and risks of dependency are raising alarms among clinicians

Are we underestimating the dangers?

Here’s an evidence-based guide to their mechanisms, clinical uses, and how to balance the benefits and risks 👇🧵
Mechanism of Action

Gabapentinoids bind the α2δ subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release (glutamate, noradrenaline, substance P).

Pregabalin is 6x more potent in binding than gabapentin.
Despite being GABA analogues, they do not act on GABA receptors. 

Instead, they influence synaptogenesis by inhibiting thrombospondin binding to α2δ-1—critical for excitatory synapse formation.
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Aug 9
76% of ADHD patients achieved >50% symptom reduction when neurofeedback protocols were tailored to individual EEG profiles, 

Using QEEG, researchers matched each patient to a protocol based on their brainwave patterns — producing significant improvements in inattention and hyperactivity.

Here’s what you need to know about EEG subtypes in ADHD, and how they can guide treatment when standard approaches fail.

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QEEG can reveal brain-activity heterogeneity in ADHD that checklists miss.

Important: major guidelines don’t recommend QEEG to diagnose ADHD. Think of it as a potential stratification aid when progress stalls.

2/15 🧵
What QEEG does: records theta/alpha/beta rhythms and compares them to normative databases.

Deviations create a profile that may help plan treatment.

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Read 15 tweets

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