Psychiatric nurse practitioner Jonathan Murphy, PMHNP-BC, returns to the Lindsay Clancy case for a deeper clinical perspective. In this episode of Actually ADHD, we move past the media circus and into the clinical reality — what psychosis actually looks like, why personality disorders are the more logical differential diagnosis, and why the mob's narrative keeps stretching further from the facts. After twenty years in psychiatry starting from one-to-ones with psychotic patients on a 27-bed acute unit to prescribing medication in private practice, this case is not about the system failing a patient. The question is straightforward — did she knowingly kill her children or was she out of her mind? The benzodiazepine prescriptions, the timing around her return to work, the fact that she said she wanted to start therapy but never did — these are the details the media skips past while framing her as a victim. Narcissistic personality disorder and narcissistic injury are discussed as the most clinically logical explanation for what happened. Narcissistic injury can and does kill. The concept of mentalization — the ability to understand that other people have their own thoughts and emotions — is central to understanding the pathology underneath. Not everyone operates with the same concept of self and others. If you are a golden rule person, not everybody is. A parent kills a child every three days. Brown University FBI arrest data, 32-year longitudinal study. The rate has been stable for decades.This episode also raises the question of whether the mob's influence on this case could affect the legal outcome, and what it means when media narrative overrides the rule of law. Next episode: Reddit — more tea to spill. Actually ADHD is sponsored by the Focus Path YouTube channel — practical ADHD strategies from a nurse practitioner with 20,000+ hours of clinical experience. Subscribe at @FocusPathSystems The Process: An Adult's Guide to ADHD Medication — available now on Amazon

Psychiatric nurse practitioner and Duxbury native Jonathan Murphy, PMHNP-BC, breaks down the Lindsay Clancy trial from a clinical and local perspective. In this episode of Actually ADHD, we discuss how misinformation spreads through echo chambers, the difference between postpartum depression and personality disorders, why the mob mentality around this case is dangerous, and what it's actually like to live in Duxbury, Massachusetts — the Pine Barrens, not the South Shore. Includes discussion of group psychology, media literacy, and how to filter information during high-profile criminal cases. This is not a true crime breakdown. This is a mental health professional's perspective on a case that hits close to home. A mother kills a child every 3 days in the US. The rate has been stable for 32 years. (Brown University, FBI arrest data)Postpartum psychosis affects 1-2 in every 1,000 women. (MGH Center for Women's Mental Health)Actually ADHD is sponsored by the Focus Path YouTube channel — practical ADHD strategies from a nurse practitioner with 20,000+ hours of clinical experience. Subscribe at @FocusPathSystems The Process: An Adult's Guide to ADHD Medication — available now on Amazon

How to actually navigate the current ADHD medication shortage and the generic manufacturing variability underneath it. Jonathan Murphy, PMHNP-BC, walks through what the Reddit narrative gets wrong, why Adderall XR generics have the least reliable quality control, and how to work the pharmacy system to find your medication. This episode covers:The August 2026 ADHD medication shortage compared to the 2020-2021 shortage and why this one is harder to work aroundWhy the "I can't function" Reddit echo chamber distorts the actual choices patients haveWhy medication optimization matters more than any specific generic manufacturer and what optimization would do to shortages overallThe Adderall XR generic manufacturing problem: many manufacturers, low quality control, high variabilityWhy patients should never lock into "I have to have brand X" thinking when generic manufacturers shift constantlyThe medications with better quality control: brand-only, Dexedrine Spansules, Vyvanse, Mydayis, Focalin, and the various methylphenidate extended-release optionsWhy Concerta's spherical versus oblong tablet distinction matters for absorptionThe pharmacy hierarchy: pharmacy-first stores versus grocery-store pharmacies (Safeway, Fred Meyer, Hannaford) versus big-box (Costco, Sam's Club) versus mail order (Express Scripts)The polite pharmacy-transfer script that gets a prescription moved without provider interventionWhy one pharmacist saying "we'll never have it" is not a reliable signal about the wider supplyThe middleman supplier reality: one pharmacy on a block is out while the one across the street has stockWhen to switch medications entirely: Mydayis, Vyvanse, Dexedrine, or the methylphenidate family as alternatives to Adderall XRWhy the controlled substance barriers happen before pickup and picking up your medication is not a suspect actWhy consistency matters more than the "best" medication, and how daily consistency compounds into new habits and new neural pathwaysThis is the fifteenth episode of Actually ADHD. Previous episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, ADHD and identity, the ADHD Matrix, the peer clinician perspective, the DRT origin story, the Focus Path YouTube channel reflection, the Friction and Flow talk, the guanfacine controversy, the Vyvanse deep dive, and the Ride Out or Bail side effects framework.The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.

The Ride Out or Bail framework for the first month on an extended-release ADHD stimulant. Jonathan Murphy, PMHNP-BC, reads from The Process and walks through the eight most common side effects, week by week, so patients and prescribers know when to hold the course and when to switch. This episode covers: Why the first four weeks are the assessment window and how to think about tolerable side effects inside "all good, no bad" Dry mouth: ride out weeks one and two, bail at week four, and why prolonged dry mouth signals overstimulation Why caffeine, cannabis, and nicotine muddy the read on any side effect and have to be pulled out to assess the medication alone Low appetite versus appetite suppression, and why the ADHD-food-dopamine relationship changes on medication Protein and calorie strategies for the first weeks and when persistent low appetite becomes a real problem Mild insomnia and the first-place-to-look rule: take the medication as soon as you wake up, consistently When mild insomnia after four weeks signals the wrong extended-release capsule or the wrong dose Jitteriness as a mild overstimulation signal, and the caffeine-elimination step before considering a medication change Euphoria in week one as honeymoon period versus euphoria at week four as a mania signal Hypersexuality as a possible mood-irregularity signal versus a baseline personality feature Headache: hydrate first, and why headaches are usually not caused by the medication itself Irritability as a new-skill side effect versus true agitation The automatic bailouts: persistent agitation, anxiety, and complete zombification, most commonly on methylphenidate This is the fourteenth episode of Actually ADHD.  The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T Focus Path | PMHNP-BC for the Ride Out or Bail video and the full clinical education catalog. https://www.youtube.com/@focuspathsystems For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

Why Vyvanse became the internet's favorite ADHD medication and what patients and prescribers should actually understand about it.  Jonathan Murphy, PMHNP-BC, walks through the pharmacology, the Reddit hype cycle, and how Vyvanse fits into the real optimization pathway. This episode covers: Why extended-release stimulants became first-line and how insurance approval finally caught up to clinical reality The two stimulant chemicals: amphetamine and methylphenidate, and why roughly half of adults respond best to one over the other What "zombification" on methylphenidate signals and what "tweaking out" on amphetamine signals Why Adderall XR gets prescribed first most of the time and what that pathway leads to The Vyvanse pharmacology: lisdexamfetamine as a prodrug that converts in the bloodstream to dextroamphetamine The dextro versus levo amphetamine distinction: dextro for the brain, levo for the peripheral nervous system Why Vyvanse feels like a smoother ride for patients who don't tolerate the levoamphetamine in Adderall XR The Reddit dynamic that keeps positioning Vyvanse as the best ADHD medication and why that framing distorts optimization The Dexedrine Spansule as the older, cheaper alternative that does essentially the same thing pharmacologically Why "all good, no bad" is the standard, not "good enough" The big four extended-release stimulants: Adderall XR, Vyvanse, extended-release methylphenidate (Ritalin LA or Concerta), and Focalin Why there is no best ADHD medication, only the right medication for your brain This is the thirteenth episode of Actually ADHD.  The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.