Clinical decision support that reasons like a psychiatrist: screen for bipolarity before an antidepressant, choose and escalate depression treatment, start the antipsychotic in first-episode psychosis, and run a structured suicide risk assessment — with the decision rule and exactly what would change it. Built for verified physicians.
Two real psychiatry questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Depression with a past episode of a decreased need for sleep, racing thoughts and overspending — before I start an SSRI?
Screen for bipolarity before prescribing any antidepressant. A past episode of decreased need for sleep, racing thoughts, grandiosity and impulsive spending points to hypomania or mania, which reframes this as bipolar depression. An unopposed antidepressant can precipitate a manic switch or rapid cycling, so treat bipolar depression with a mood stabilizer or an approved agent — quetiapine, lurasidone, cariprazine or lamotrigine — rather than antidepressant monotherapy. Confirm the history with a collateral and a tool such as the MDQ.
Decision ruleDepression + any past hypomania or mania → bipolar; screen before an antidepressant (MDQ + collateral); treat bipolar depression with a mood stabilizer or approved agent (quetiapine/lurasidone/cariprazine/lamotrigine), not antidepressant monotherapy.
Not established from this alone — the manic history, the collateral and the course change the diagnosis and the drug.
Passive death wishes after a recent loss, with access to firearms at home — the assessment?
Do a structured suicide risk assessment: ask directly and specifically about ideation, plan, intent, access to means and prior attempts, and weigh protective factors — asking does not plant the idea. Build a collaborative safety plan, and make means restriction concrete, above all the firearms. Decide the level of care from the risk: hospitalize when there is intent or a plan with available means and the person cannot stay safe, and arrange close follow-up otherwise.
Decision ruleStructured assessment (ideation, plan, intent, means, prior attempts, protective factors — e.g. C-SSRS); asking does not increase risk; collaborative safety plan + means restriction (firearms); hospitalize for intent/plan/means with inability to stay safe.
Not established from this alone — the intent, the plan, the means and the protective factors change the level of care.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Confirm the diagnosis and severity, screen for bipolarity and suicide risk, then start an SSRI or SNRI as first-line, paired with psychotherapy, and reassess in two to four weeks. If there is no response at an adequate dose and duration, optimize the dose, then switch agent or augment — with an atypical antipsychotic, lithium or bupropion. For treatment-resistant depression, consider esketamine or ECT, which remains the most effective option for severe or psychotic depression.APA
Decision ruleConfirm + screen bipolar/suicide → SSRI/SNRI + psychotherapy; reassess 2–4 weeks; no response → optimize dose, then switch or augment (atypical/lithium/bupropion); treatment-resistant → esketamine or ECT.
Missing data: the severity, the bipolar screen and prior trials change the choice.
Diagnose from a history of a manic or hypomanic episode, not depression alone, and always screen a depressed patient for past highs before treating. For acute mania, use lithium, valproate or an antipsychotic, alone or combined; for bipolar depression, use quetiapine, lurasidone, cariprazine or lamotrigine and avoid antidepressant monotherapy. Lithium anchors long-term maintenance and reduces suicide risk. Monitor levels, thyroid and renal function.APA · bipolar
Decision ruleDiagnose on manic/hypomanic history; acute mania → lithium/valproate/antipsychotic; bipolar depression → quetiapine/lurasidone/cariprazine/lamotrigine, not antidepressant alone; lithium for maintenance + suicide reduction; monitor levels/thyroid/renal.
Missing data: the episode type, the history and the comorbidity change the medication.
Work up a first psychotic episode to exclude substance-induced and medical causes, then start a single antipsychotic at the lowest effective dose, choosing by the side-effect profile rather than presumed superiority — except clozapine, reserved for treatment resistance. Combine medication with coordinated specialty care, family involvement and psychosocial support, which improve outcomes in early psychosis. Monitor metabolic parameters and movement disorders from the start.APA · schizophrenia
Decision ruleExclude substance/medical causes → one antipsychotic at lowest effective dose (choose by side-effects); coordinated specialty care + psychosocial support; clozapine for treatment resistance; monitor metabolic + extrapyramidal effects.
Missing data: the cause, the side-effect profile and the response change the agent.
Assess risk structurally — ideation, plan, intent, access to means, prior attempts and acute stressors, balanced against protective factors — using a tool such as the Columbia scale, and ask directly, because asking does not increase risk. Manage with collaborative safety planning and concrete means restriction, especially of firearms and lethal medication. Match the level of care to the risk, hospitalizing when intent, a plan and available means combine with an inability to stay safe.APA · suicide
Decision ruleStructured assessment (ideation/plan/intent/means/prior attempts/stressors vs protective factors; C-SSRS); ask directly; safety plan + means restriction; hospitalize for intent + plan + means + inability to stay safe.
Missing data: the intent, the plan, the means access and the supports change the disposition.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist psychiatry colleague across mood disorders, anxiety and trauma, psychosis, suicide risk, substance use and medication emergencies — cited, non-directive, always with the decision rule.
Deep specialist agents for mood and anxiety disorders, psychotic disorders, addiction psychiatry and child and adolescent psychiatry — each its own soul and knowledge base — plus your own uploaded materials.
From the bipolar screen to the suicide risk call the margin is thin. Only one of these reasons like a psychiatry colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the psychiatry build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment psychiatry opens — with your Founding Psychiatrist offer.
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It reasons in the frameworks you use — the bipolar screen, the depression treatment ladder, the antipsychotic choice and structured suicide risk assessment — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and on consults. Access is gated to verified physicians.
Mood and anxiety disorders, psychotic disorders, addiction psychiatry and child and adolescent psychiatry each have their own deep specialist agent on the Pro plan, on top of the full psychiatry scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited psychiatry knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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