Ben welcomes psychiatrist Dr. Mike Halassa back to the podcast to discuss the shifting landscape of inpatient schizophrenia treatment. An early adopter of Cobenfy, Dr. Halassa shares real-world insights from his research published in Nature Mental Health in this conversation that bridges technical neuroscience with the high-stakes reality of managing acute psychiatric crises.The discussion focuses on Cobenfy’s muscarinic mechanism, the first novel approach to psychosis in seventy years. Dr. Halassa details his "dose-sparing" strategy, reducing reliance on traditional D2 blockers and their metabolic burdens, and he shares case studies of treatment-resistant patients who succeeded on this agent after clozapine failed. Finally, Ben and Dr. Halassa explore functional recovery, precision psychiatry, and the empathic connection required to treat society's most vulnerable individuals.Episode Highlights:00:00 - Welcoming Back Dr. Mike Halassa01:46 - ‘Spending a Day in Someone Else’s Brain’04:21 - Empathy, Parenting, and Staying Grounded in Psychiatry06:37 - Why Inpatient Psychiatry Works: Acuity, Speed, and Team-Based Care09:31 - Evaluating Acute Psychosis: Intake, Chronicity, and Treatment Decisions12:46 - Discovering XT as the First Novel Schizophrenia Mechanism in Decades16:19 - A Remarkable XT Case Study23:26 - XT Dosing Tolerability and Early Clinical Results30:15 - From Observation to Evidence: Identifying XT Response Patterns35:12 - Testing Negative Symptoms in Real Time on the Inpatient Unit40:33 - XT vs D2 Blockers for Positive and Negative Symptom Control50:28 - Redefining Success in Schizophrenia Through Functional Recovery54:15 - The Future of Precision Psychiatry and Treating the Whole Person56:42 - Up Next: Dr. Avi BharKey Takeaways:"Inpatient psychiatry demands quick thinking and rapid decisions. It's a critical care type environment.""I find my kids keep me grounded and empathetic. They're my window into empathy.""XT offers a fundamentally different way of engaging the system. It's not just another antipsychotic.""Seeing patients become more socially connected on XT is remarkable. It's a new light in their eyes.""Negative symptoms have been intractable. XT offers hope for functional recovery.""The multidisciplinary team is crucial in schizophrenia care. It requires coordination and dedication.""XT allows for dose sparing of traditional antipsychotics, potentially reducing side effects.""We must aspire to help patients engage with life fully, beyond just managing symptoms."Links:Full transcript and show notes: https://www.psychiatrist.com/jcp/ep8-early-use-xanomeline-trospium-michael-halassa/ Journal of Clinical Psychiatry: psychiatrist.com/jcp/Dr. Halassa’s Substack: michaelhalassa.substack.comThe Halassa Lab: https://halassalab.tufts.edu/Preliminary real-world predictors of response to muscarinic targeting in psychosis:

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