Dr. Ira Glick is Professor Emeritus of Psychiatry and Behavioral Sciences at Stanford University Medical Center, where he has served as director of the Schizophrenia Research Clinic. On this episode, he discusses his research journey, which began in the 1960s and followed a shift from psychoanalysis to biological psychiatry. He addresses the broken social safety net for schizophrenia patients, including the controversial topic of treating some patients against their will, as well as the challenges of medication adherence, and the stigma surrounding severe mental illness.
00:00 Introduction
00:49 Evolution of Schizophrenia Treatment
04:34 Science Behind Schizophrenia Medications
07:39 Addressing the Public Health Challenges of Schizophrenia
11:15 Stigma and Misunderstanding of Severe Mental Illness
21:44 Innovative Treatment Approaches and the Future of Schizophrenia Care
31:36 Importance of Public Health Interventions and Political Will
35:45 Closing Remarks and Future Directions
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
Dr. Ira Glick is Professor Emeritus of Psychiatry and Behavioral Sciences at Stanford University Medical Center, where he has served as director of the Schizophrenia Research Clinic. On this episode, he discusses his research journey, which began in the 1960s and followed a shift from psychoanalysis to biological psychiatry. He addresses the broken social safety net for schizophrenia patients, including the controversial topic of treating some patients against their will, as well as the challenges of medication adherence, and the stigma surrounding severe mental illness.
00:00 Introduction
00:49 Evolution of Schizophrenia Treatment
04:34 Science Behind Schizophrenia Medications
07:39 Addressing the Public Health Challenges of Schizophrenia
11:15 Stigma and Misunderstanding of Severe Mental Illness
21:44 Innovative Treatment Approaches and the Future of Schizophrenia Care
31:36 Importance of Public Health Interventions and Political Will
35:45 Closing Remarks and Future Directions
Visit our website for more insights on psychiatry.
Podcast producer: Jon Earle
NOTE: Transcripts of our episodes are made available as soon as possible and may contain errors. Please check the corresponding audio before quoting in print.
DR. THEA GALLAGHER:
Welcome to NYU Langone Insights on Psychiatry, a clinician's guide to the latest psychiatric research. I'm Dr. Thea Gallagher. Each episode, I interview a leading psychiatric researcher about how their work is shaping clinical care. Today, I'm pleased to welcome Dr. Ira Glick to the podcast. Dr. Glick is Professor Emeritus of Psychiatry and Behavioral Sciences at Stanford University Medical Center, where he has served as director of the Schizophrenia Research Clinic. In our conversation, he talks about the evolution of schizophrenia treatment and gets into the nitty-gritty on antipsychotics, medication adherence, and psychosocial interventions. He also shares his vision for improving the social safety net for schizophrenia patients, an especially urgent topic today. All right, Dr. Glick, thank you so much for being on the podcast today.
DR. IRA GLICK:
My pleasure.
DR. THEA GALLAGHER:
You have a long history with research and your focus on schizophrenia, and can you tell us a little bit of that overview of that research journey and kind of what led you to specifically focus on schizophrenia?
DR. IRA GLICK:
Well, during my residency at Hillside Hospital, Hillside back in the 1960s was hospitalizing patients for a year, the city of New York was paying.
And there were two things going on. One was that Hillside, unlike the medical schools in New York, was at the forefront of the revolution that changed from psychoanalysis to biological psychiatry, and the use of medication. My mentor when I was a resident was Don Klein, who was on the NYU faculty at one point, and his wife, Rachel Klein, was on the NYU faculty. And we were treating people with severe mental illness, including schizophrenia, bipolars, anxiety disorders.
And at the time, without knowing for sure, we were trying medication in addition to talking to patients. At the time at Hillside, there were many patients with schizophrenia, and I wrote several articles as a resident about treating schizophrenia, which up to that time, there was no effect to treat. There was just ways to hold patients in check, that is to use electric shock therapy or baths. It was all free medication. So, I got interested in what do you do with medicines, and what we were finding out with some of the new medicines, the first generation of antipsychotics, that they actually changed the mental status of people with schizophrenia, which was an exciting finding at the time.
DR. THEA GALLAGHER:
So, you're talking a little bit about the history of both psychoanalysis to biological medication, but it sounds like also the focus on severe and persistent mental illness became a focus of your career. So, in those articles that you wrote, or from that point to this point, what have you seen? What's changed in the treatment of schizophrenia?
DR. IRA GLICK:
What has happened as the field of psychiatry has changed from a talking field, it has changed to a field which includes not only psychotherapy and talking fields, but the treatment of choice for severe mental illness has become antipsychotics. We now know that antipsychotics are an effective treatment for most everybody who has schizophrenia. It's a tremendous change in the field, and I'm one of the people that has been advocating not only the use of medication but combining it with psychosocial treatments.
So, again, what I'm trying to say is that this is a huge, huge change for people like you and me, who are treating patients with schizophrenia. We actually have something now that works. The big question at this point in terms of history is what is it that's changing in the brain that allows these medications to work? We know for sure that patients with schizophrenia, this disease is a genetic disease. Two-thirds of the etiology is genetic and one-third is psychologic. And now, we're trying to figure out what is it in the brain these medications do, how do they change the mind.
DR. THEA GALLAGHER:
And do you think that there are functional changes being made? Or what do we know about the mechanisms that are changing by the medication?
DR. IRA GLICK:
What's happening up there is that we're changing the neurotransmitters, the dopamine, serotonin, et cetera, et cetera, in different parts of the brain. The one that's most relevant to your question is the frontal lobe, which coordinates thinking.
And we know that somehow the brains of patients with schizophrenia is like a broken computer, they don't work together easily. And what you're doing, somehow some of these neurotransmitters are changing, particularly the one that everybody's been focusing on is D2 receptors to improve the life of people with schizophrenia. So, no, we don't know for sure. We do know the medicines work, but we don't know how. And that's as of this week, as of today.
DR. THEA GALLAGHER:
And so, is that where you're hoping the research goes in kind of understanding how they work? And we talk a lot on this podcast even about precision psychiatry, being able to treat people more precisely.
DR. IRA GLICK:
Again, what common misconception is that you're going to find something, a neurotransmitter or a gene that's effective, and then things are going to get better in terms of treatment.
Actually, what I've written with Don Klein is that most of the advances have come serendipitously. That is we've tried different medications without knowing how they work, and we found some of them work and some of them don't. But now, the treatment is just as good as most chronic diseases in medicine. So, my answer to your question is that what I'm hoping for is we continue to do randomized controlled trials of new medications, with new mechanisms of action to improve the treatment outcome of our seriously mentally ill people.
DR. THEA GALLAGHER:
It sounds like what you're saying is that we might not need to know exactly how it works in order for it to be effective, but what has been shown is that there are a lot of effective treatments out there.
DR. IRA GLICK:
Correct.
DR. THEA GALLAGHER:
And with talking about schizophrenia, it's a source of personal suffering for both the individual and their families, loved ones. It's also a major public health problem and one that we know can coincide with homelessness and other challenges in the public health sphere. Can you say a little bit more about the disease burden?
DR. IRA GLICK:
Yeah. Well, you've summarized it nicely. The disease is not only a disease that affects an individual. For example, if you break your leg, it mostly affects you, it may have a little bit of effect with your significant others. But this disease has a huge effect not only on the individual, but on the significant others around the individual and the society in which they live.
One of the examples are homelessness, where so many... There's two kinds of homelessness. One is the economically homeless, people who don't have the money, but their brain is okay. The other is the mentally ill homeless, which, that group of people has brain trouble, and economic troubles, and they are a tremendous burden on the communities, states, societies, tribes, families that they live with. I'm working with the mayor's office here to try to do something with the homeless mentally ill. It's a problem that can't be solved simply by medication or housing. It has to be a very complicated plan, which I can go into.
The other thing that I've done recently in terms of the burden on society, I've done, with a New York psychiatrist named Nina Cerfolio, we have done the first scientific study of mass murderers. It's never been studied. When there's a mass murder, you read The New York Times and they ask the family, "What's the kid like?" But there's never been a scientific study. We did our first scientific study studying those... We had a database of 135 mass murderers, 100 of whom were killed, 35 lived, and they were in jail. We got the court records, we've interviewed them, we've interviewed their psychologists and psychiatrists, and we find they all had a brain illness, and half of them were schizophrenia. And guess how many had been diagnosed and treated before they made the murders?
DR. THEA GALLAGHER:
How many?
DR. IRA GLICK:
Zero. None had been diagnosed and none had been adequately treated. It's a tremendous finding. We published an article in the Journal of Clinical Psychopharmacology, and I've been on the radio and TV, but the media still has not picked this up.
So, again, I'm speaking to your question about the burden on society. It's not only family, friends, significant others, it's people out there living on the street or in schools, et cetera, et cetera.
DR. THEA GALLAGHER:
I think the thing that worries me with even those data that you were sharing is there is a lot of stigma and misunderstanding about severe and persistent mental illness, and if we can just solve this problem or keep guns out of the hands of maybe of people who have a thought disorder, we could change all of this. Can you talk a little bit about the stigma of schizophrenia and severe and persistent mental illness?
DR. IRA GLICK:
A lot of people were very upset with my findings, feeling that this is going to further stigmatize patients with schizophrenia. So, we've talked about brain illness because there were seven other diagnoses of these mass murderers.
But the important point for this podcast is half of them did have schizophrenia, did have paranoia, angry feelings, and their families didn't pay attention to it, didn't get these people to doctors to treat them. And there is no specific system set up to treat these patients, especially schizophrenia.
The New York Times, as you know, last week had three pages of these patients with schizophrenia who are violent, and the word brain and the word medicine was never mentioned in the three entire pages of The Times. So, it's still not been picked up by the general public. So, it's a tremendous problem because we can treat and help the patients if we get them diagnosed and treated before they act on their violent impulses.
DR. THEA GALLAGHER:
Right. And that's really the way to break the stigma. It's not just to diagnose and stigmatize, it's to diagnose and treat, and make the world and those individuals and their loved ones safer.
DR. IRA GLICK:
Very, very well said. And I should emphasize, whenever I lecture on this or talk today, I should emphasize that patients with schizophrenia have a lower incidence of violence than the general population, including you and me. So, this information is only going to help treatment for schizophrenia, not make it worse.
DR. THEA GALLAGHER:
So, a lower incidence of violence, but a higher rate of mass murder if untreated?
DR. IRA GLICK:
Yeah.
DR. THEA GALLAGHER:
Okay.
DR. IRA GLICK:
The point is, to some of those people with the lower incidence of violence, when they get certain symptoms, act on it.
DR. THEA GALLAGHER:
Right. Okay. So, it's only when they're experiencing certain symptoms.
And I think another angle of the public health discussion that we're having, and I know that they've rolled this out in some cities, is having crisis intervention workers alongside of police.
Because you've spent a lot of your career and life around people with severe and persistent mental illness. I'm a psychologist and have spent some time, but not a lot. But when you spend time around people struggling with severe persistent mental illness like schizophrenia, you realize they're struggling in a different way than your patient with general anxiety. It does seem like it's a very misunderstood group of individuals, very misunderstood condition. So, not only, it sounds like, do we have to have effective treatments, and I would love to hear the plan that you were talking about rolling out in a public health way, but also, is part of this plan to have more people who accompany police, who also understand the condition and can better intervene in these settings?
DR. IRA GLICK:
So, what has to happen now, it's just a federal, not a state, not a city problem. You've got all these people with untreated schizophrenia who are potentially dangerous. Hospitalizing them overnight as we used to do in New York when they do something wrong or they threaten doesn't help. We are going to need to set up a special unit that cares for patients with schizophrenia over their lifetime and are focused on not only getting them better, but is focused on preventing future violence. There are crisis units that pick them up and take them somewhere, but there is no unit that is focused on lifetime management of this group of people. You're going to have to build into every community, whether it's New York City, or Seattle, Washington.
DR. THEA GALLAGHER:
And what would this look like? Because I remember I heard a lecture on someone to essentially bring back the asylum and bring back spaces that do care for these individuals in ethical, compassionate ways. That wasn't the way that it was done in the past, but... So, what does this look like?
DR. IRA GLICK:
So what this looks like, this unit is charged... When they get the patients from the crisis units that you mentioned, first thing you have to do is diagnose them. And depending on what their illness is, treat them.
There are two primary outcomes. Number one, there are some of these people who you can treat. They get better and they could live independently. The other group, you diagnose them, they've got the schizophrenia, since that's what we're talking about today. And you treat them, they don't get better, and they can't live independently. Have nobody that cares for them. They can't take care of themselves. They're wandering the streets, as in The New York Times article last week.
What has to happen to them is they have to go back to a humane locked facility, against the wishes of the advocates who want them to have the freedom to stay on the streets, to be raped, robbed, killed, or kill others, or kill themselves. And that's the hard part.
So, in this system, what it looks like, is have doctors, social workers, psychologists and lawyers in the system to deal with this problem to save the lives of the patients and of the communities.
DR. THEA GALLAGHER:
And it makes me wonder, if you know this, what percentage of individuals with a schizophrenia diagnosis will benefit from the antipsychotic medications that you are talking about?
DR. IRA GLICK:
Most everybody. What I teach the residents at Stanford is almost every patient with schizophrenia can beat it. There is almost no such thing as treatment-resistant schizophrenia, the same way there's almost no such thing as treatment-resistant diabetes. These are genetic illnesses. It depends how bad the genes are, how damaged they are. Is that clear what I'm saying, damaged?
DR. THEA GALLAGHER:
Yeah.
DR. IRA GLICK:
And most patients will benefit. And there are, like with any chronic disease, a few that will barely benefit. But most everybody benefits, 90%.
DR. THEA GALLAGHER:
But not everybody is going to benefit to the level of independence?
DR. IRA GLICK:
Right. I would say, of the really bad population, which I think is behind your question, it's 50/50. That's what has to happen. You have to have hospitals like Rikers Island, which I was there last year. There's a hospital right by the Triborough Bridge. It's got 2,000 beds and there's 23 people hospitalized now. 23 people there out of the hundreds of beds that are there. Those people can't live independently. They're going to have to live in that environment and be taken care of.
DR. THEA GALLAGHER:
Yeah, I think when you're following that thread of schizophrenia and homelessness, and like you said, there needs to be an option that is aware of this correlation, and then also is doing something about it.
DR. IRA GLICK:
Correct. Out here, it's Napa State Hospital. As soon as the courts send... They get in trouble. They're declared incompetent. They're sent to Napa. They're treated with injectable medicines. And then, Napa discharges them. And the whole cycle starts all over again.
DR. THEA GALLAGHER:
And speaking of medication, and you were just saying injectable medicine, how much of a medication adherence problem do we see in this population? Because you're saying the medication is so effective, it works for so many people so well, is it a larger issue of treatment adherence? How often are we running into that and what are some thoughts about what we can do about that?
DR. IRA GLICK:
It's always a problem with schizophrenia because patients with schizophrenia have aglossia. They're not aware that they're sick. Unlike somebody, you break your bone in your leg, you're screaming in pain and you're saying, "Doctor, help me, fix my problem." With schizophrenia, their brain is effective. And very commonly, the patients don't know they're sick, they don't know they need the effective medicines, and they don't adhere to treatment.
So, the major part of my teaching about schizophrenia is not only what to do but it's how to do it to increase adherence. And what I always say is, "We have to work as a team. I'm not good enough to treat you," the patient. "I need help from you and your family to work as a team. The three of us, you, your family and us, have to work together to help, so that you know to take your medicine most likely for your lifetime, like other people with chronic genetic diseases."
DR. THEA GALLAGHER:
And I want to know how you do that, because I've experienced family members of patients I've worked with over the years who are devastated by the fact that they know their loved one benefits from the medication, but they can't get them to adhere to the treatment protocol. So, how do you get that done?
DR. IRA GLICK:
Well, number one, you start with psychoeducation. Psychoeducation is teaching everybody, the patient, the family, significant others, case workers about what this disease is all about, the etiology, treatment, prognosis. Number two is medication will help. Thinking and realizing you're sick will help adherence.
Number three is getting the teammates to work together, including the advocates, to increase adherence, so that regular appointments, medication, working as a team, psychoeducation of everybody is the way to do it.
DR. THEA GALLAGHER:
When it fails or if it doesn't work, what are your thoughts on mandated medication?
DR. IRA GLICK:
What I always teach, you medicate with long-acting injectables, which is one of the newest findings. The two newest things we're doing with schizophrenia treatment is treating you early, including your early adolescence or even pre-adolescence, when somebody starts saying they hear voices, gets auditory hallucinations, or paranoia. And to use injectables regardless of whether the patient wants them or not. And what the residents always say is, "Well, don't they sue you for treating against their will?" And I've said, "In 50 years of treatment, I've done this numerous times, I've never gotten sued and I've gotten 50 letters saying, 'Thank you. You saved my life.'"
DR. THEA GALLAGHER:
I think you're highlighting something with both that and this homelessness challenge, in that how can we... We know in some ways what will make their life better, and knowing that as the physician, how can you kind of push that forward and keep people from more suffering. And like you said, the suffering that they might experience without these medications and interventions could be far worse.
DR. IRA GLICK:
Correct. I guess, the other crucial part is to make sure that the doctors and other mental health professionals know which medicines are best and which are not. There are three medicines that are better than all the others. I always tell the residents, "You have to know these three medicines like your middle name. And they are clozapine, risperidone, and olanzapine." The others, we don't know how effective they are. We know they work, but we don't know how well they work compared to those three.
DR. THEA GALLAGHER:
Well, it sounds like, again, very effective treatments. And you said that the two findings that have been exciting, more recent findings are you said long-acting medication, and what was the other one?
DR. IRA GLICK:
Long-acting medications is what I said. Injectables, you can give them every month, every two months. And now, we even have them, you can put them under the skin and take it every six months. Patients don't have to worry about swallowing a pill every day, don't even have to think about it.
DR. THEA GALLAGHER:
Yeah, that seems like an incredible public health intervention, because like you're saying, one of the symptoms that you're up against is forgetting or not realizing that you are sick, that would be a huge challenge in taking the medication, "What am I taking it for?" And so, having something that is long-acting, more sustainable, durable over time, it seems extremely profound in a finding and in an intervention.
DR. IRA GLICK:
Right. And again, part of your question is getting adherence, you do the psychoeducation, you educate everybody that most likely they are going to have to take these medicines over a lifetime. And doing it every month, that's against every day, or two months, or six months is a much easier way to do it.
DR. THEA GALLAGHER:
And do you think the combination of medication with psychosocial interventions is best? Or do you feel like if they're medically managed, everything else falls into place?
DR. IRA GLICK:
No, I strongly believe you have to talk to patients. So, I always do psychotherapeutic intervention of some sort, doesn't make any difference which psychotherapy you use, whether it's cognitive-behavioral. I happen to be do like psychodynamic psychotherapy, but you combine medication with psychosocial intervention to improve outcome.
DR. THEA GALLAGHER:
And what are the main targets of your psychosocial interventions?
DR. IRA GLICK:
Function, symptoms, how are you doing on your symptoms, how are you doing on your function, socialization, work, exercise, etc. Those are the targets that I do in every session.
DR. THEA GALLAGHER:
Yeah, those sound very behavioral and along the line of also establishing healthy habits and routines and patterns and things that will help in the long run. But it sounds like having some accountability for those healthy habits is important.
DR. IRA GLICK:
Correct.
DR. THEA GALLAGHER:
And seeing what's getting in the way, and building an awareness about the importance of them. But it seems like none of that work can be done unless one is medicated.
DR. IRA GLICK:
Correct.
DR. THEA GALLAGHER:
Are there any more innovative or lesser known treatments that you believe hold promise for the future, whether that's... We've talked a lot on this podcast about psychedelics, ketamine, TMS, ECT. Is there anything that you're excited about? It sounds like, again, these long acting drugs are really exciting. Anything else that you're excited about?
DR. IRA GLICK:
Well, I'm very wary of psychedelics. I'm wary of ketamine. I'm very pro-ECT, where you have to use it where everything else fails. I'm not above using ECT. There may be other electrostimulant methods that come along, but right now they're not in common use. So, you're asking the right question. And there's a real slowdown on doing controlled clinical trials of new medicines with new mechanisms of action to develop new medicines to answer the question that you're asking, which is how can we better help our patients.
DR. THEA GALLAGHER:
And what are you hoping to see? What would be your dream to see the science move forward in treating these individuals? It sounds like you're saying you're putting a lot of your energy, effort, and focus into public health interventions that bolster what we already know is effective.
DR. IRA GLICK:
Since I was a resident in New York, I've always done drug trials. New drugs, new mechanisms. My middle name is long-term treatment outcome efficacy. So, that's what I'm trying to do. I'm not a basic scientist. It's very complicated. I work with my students who are in basic science, but I was trained by Klein, who said, "Keep trying new medicines to get even better than clozapine, risperidone, and olanzapine."
DR. THEA GALLAGHER:
And are you specifically concerned about psychedelics and other kind of interventions specifically for this population? Because I'm thinking about some of the data that's come out about cannabis and young people developing symptoms of psychosis. And so, is there something specifically about the nature of schizophrenia that makes it, to you, more problematic when maybe trying some of these other types of brain-altering medications?
DR. IRA GLICK:
That's a very thoughtful question. And so, yes, we are very concerned, given the genetic damage of patients, the teenagers who have developing schizophrenia, and complicated, then they get treated with psychedelics and it blows their brain apart. Or cannabis, cannabis kicks off a schizophrenia that wouldn't have been developed if they didn't have the cannabis.
DR. THEA GALLAGHER:
Yeah. So, it sounds like your goal is, "Let's stick to what we know that's effective and only make it better, more accessible, and potentially create more communities that are really taking on the responsibility of somebody struggling with schizophrenia."
DR. IRA GLICK:
Yeah. And I'm not above new medicines, but they have to be done in controlled random assignment studies rather than anecdotal reports.
DR. THEA GALLAGHER:
And it sounds like you're very firm about following the long-term outcomes and really making sure that they're effective, they're working well, and they're helping the patient. And so, in thinking about this, what would it take for us as a society, do you think, to ensure that everybody suffering from schizophrenia has access to quality care? And do you think that goal is within reach?
DR. IRA GLICK:
What it's going to take is a federal, political effort to set up these units to provide the funding for these units that I described earlier. That's what it's going to take. This can't be done by any city. Eric Adams in New York is under fire for what he's tried. He's tried heroically with a very difficult prop.
DR. THEA GALLAGHER:
It needs to be more of a-
DR. IRA GLICK:
Coordinated political effort, the feds leading the way, the NIMH doing the controlled trials to bring together all the treatments we now have.
As you know, I was the science advisor at the National Institute of Mental Health a while back, and this is what we tried to do with our public academic liaison program, bring together the public and academics to work together to make this better, to answer your question.
DR. THEA GALLAGHER:
And I think it's such a heavy topic, and it's one that I think we're getting a lot more information about, even like you're saying, "Okay, there might be a correlation with mass shootings. There's a correlation with homelessness. There's a correlation with some of these problems." But it sounds like, a lot of times I feel like that's where it ends. There's not a lot of talk like you're talking about, which is, "What are we doing about the problem? This is a public health issue that we as a community need to address."
DR. IRA GLICK:
Correct.
DR. THEA GALLAGHER:
And just in my last question, it sounds like you said you're talking to the mayor, you're talking to people, you're trying to bring an awareness, what are some ongoing projects or advising you're doing to maybe push these efforts forward?
DR. IRA GLICK:
Well, we're trying to work with city governments and trying to work with academics. And I'm trying to get the word out, that this is what we need to do. So, I'm constantly writing in academic journals and legal journals. I'm waiting for an article on legal aspects of treating patients with serious mental illness against their will. Working with multiple constituencies to bring together the people, to set up the units to help the patients that we serve.
DR. THEA GALLAGHER:
Wonderful. Well, it's interesting because I think that you brought a topic that I think has been labeled as complex and complicated and, "We can't do anything about it," and you're making it, I feel like refreshingly treatable, manageable. And the plan actually seems very streamlined. It just needs, it sounds like, the funding, the support, the infrastructure to make it happen.
DR. IRA GLICK:
Correct. And the will to do something about this rather than shaking our heads. It's slowly changing. This family, they just convicted the mother, they're going to convict the father of helping the kid with schizophrenia who shot other kids. It's a huge problem, and it's got to be addressed politically, as well as scientifically and legally.
DR. THEA GALLAGHER:
Right. And what's exciting is that there are evidence-based treatments that can help.
DR. IRA GLICK:
Correct. What we need is an evidence-based unit to pull the whole thing together. So, someday I hope to see Bellevue having a special unit just to deal with these problems.
DR. THEA GALLAGHER:
Wonderful. Well, thank you for such a refreshing conversation. Again, making something that feels overwhelming, everyone's throwing up their hands, making it feel like it's something that we could actually see progress in in this lifetime.
DR. IRA GLICK:
It's been a pleasure. I've learned something.
DR. THEA GALLAGHER:
Thanks so much for that conversation, Dr. Glick. If you enjoyed this episode, be sure to rate and subscribe to NYU Langone Insights on Psychiatry on your podcast app. For the Department of Psychiatry at NYU Langone, I'm Dr. Thea Gallagher. See you next time.