South Chesapeake Psychiatry

04/08/2026

Sometimes the best ideas don’t come from the lab. They come from the field.

I’m currently in Boston, where I just finished giving a presentation, and I opened my email to some exciting news: my abstract has been accepted as a poster presentation at the 40th Annual Conference of the American Psychiatric Nurses Association (APNA).

The poster is based on a perspective I have been developing around schizophrenia, cognition, and how we measure treatment success.

For decades, schizophrenia trials have largely been built around symptom scales designed to detect rapid reductions in overt psychosis. Tools like the PANSS have been incredibly valuable for that purpose. But the biology of the illness, and the biology of emerging treatments, may not always reveal itself through those same lenses.

Cognitive impairment remains one of the strongest predictors of whether someone living with schizophrenia can work, maintain relationships, sustain independence, and translate symptom stability into real-world recovery. Yet cognition still sits on the sidelines of many clinical trial endpoints.

The work behind this poster asks a simple question: what happens when our endpoints are optimized for one biological model while the next generation of therapies may operate through different mechanisms?

If cognition truly represents a central axis of schizophrenia, then our clinical trials — and ultimately our treatments, need to reflect that reality.

Much of this perspective was shaped by years working in community psychiatry, ACT teams, crisis centers, jails, and assisted living facilities. In those environments you quickly learn something quickly: symptom suppression does not always equal recovery. The difference between surviving and reclaiming a life often comes down to whether someone can organize thought, process information, and navigate the world again.

I’m grateful to APNA for the opportunity to present this work and contribute to the conversation about where schizophrenia research and treatment may be headed next.

Looking forward to the discussions ahead.

04/03/2026

In the wake of the tragic events at Old Dominion University, many in the Hampton Roads community have been reflecting on the importance of supporting one another during difficult moments.

When students returned to campus following the closure and spring break, the Ellmer School of Nursing invited psychiatric nurse practitioner and alumnus Justin Ray (B.S.N. ’06) to spend time with students who may have needed support while processing the events.

Justin adjusted his clinical schedule to be on campus throughout the day, visiting several nursing classes and making himself available for individual conversations with students who wished to talk privately. His goal was simple: to offer a listening ear, provide reassurance, and remind students that community and connection are essential during challenging times.

He was also joined by Ruth, the therapy dog and “Chief Compassion Officer,” whose presence brought comfort and a few much needed smiles to students and faculty alike.

As a veteran, clinician, and father of an ODU student, Justin understands the weight that moments like this can carry for individuals and communities alike. His message to students was a simple but powerful reminder that even in difficult times, we are stronger when we take care of one another.

The team at South Chesapeake Psychiatry is grateful for the opportunity to support the students, faculty, and staff at Old Dominion University and continues to keep the family of Lt. Col. Brandon Shah and all those affected in their thoughts.

04/01/2026

Happy Birthday, Sarah! 🎂❤️

It's not every day you get to celebrate someone who pours this much heart into everything she does. From leading our incredible team at South Chesapeake Psychiatry to getting out in the community and making a real difference — Sarah shows up every single day with purpose, grace, and a whole lot of energy.

And when it's time to celebrate? Nobody does it better. (The Gatsby party was proof of that. 🥂)

We're so grateful to have you — not just as part of the team, but as family. Wishing you the happiest of birthdays and many, many more beautiful years ahead.

Here's to you, Sarah. 🥳

— The SCP Family

03/28/2026

I joke with my female clients sometimes that they must have upset the man upstairs somehow.

After all, they are the ones who experience menstruation cycles, pregnancy, childbirth, postpartum hormonal shifts, and eventually the endocrine turbulence of perimenopause and menopause. The humor usually lands because there is a shared understanding behind it. And if we are being honest, if men had to experience even one of those physiologic realities, there is a good chance we would be protesting in the streets by lunchtime.

The joke works because it highlights something that is clinically obvious but strangely under-discussed in psychiatry. Hormonal transitions are among the most powerful biological forces affecting mood, sleep, cognition, irritability, energy, and overall functioning. Yet the field has historically treated hormones as though they sit adjacent to psychiatry rather than squarely within it.

That disconnect does not make much sense from a biological standpoint. We routinely discuss neurotransmitters, glutamate signaling, neuroplasticity, and circuit dynamics when we talk about mental health. At the same time, conversations about estrogen, progesterone, and endocrine transitions across the female lifespan often become hesitant or simplified in ways that do not reflect their real neurobiological influence.

That tension pushed me to write the newest issue of The Neuropsychiatry Brief.

In Edition 11, I explore the relationship between hormones, mood, and risk during the menopause transition, along with persistent misconceptions surrounding hormone replacement therapy and cancer risk. The modern literature suggests something far more nuanced than the flattened narratives many clinicians still carry from earlier training. Perimenopausal women show a measurable increase in risk for depressive symptoms, but that vulnerability is not universal and tends to concentrate among those with prior depression, severe vasomotor symptoms, sleep disruption, or significant psychosocial stressors.

The conversation around hormone therapy itself has also evolved. The idea that “hormones cause cancer” does not accurately reflect the complexity of the data. Contemporary guidance emphasizes that risk varies depending on formulation, timing relative to menopause, route of administration, and duration of therapy.

None of this means hormones are a universal antidepressant. But it does mean that if hormonal shifts can meaningfully alter sleep, stress tolerance, cognition, and emotional regulation, then they are not peripheral to psychiatry. They are part of the biology shaping the clinical picture sitting across from us in the exam room.

The full discussion is explored in the newest issue of The Neuropsychiatry Brief.

When we talked previously about postpartum depression, we were really talking about one of psychiatry’s recurring blind spots: we are often comfortable discussing neurotransmitters, circuits, and symptom scales, but far less comfortable discussing hormones with the same seriousness. That is a mist...

03/23/2026

Psychiatry may be quietly shifting away from monoamines and toward something much deeper: neuroplasticity.

For decades psychiatry framed depression primarily through the lens of monoamines. SSRIs, SNRIs, and dopamine modulation dominated the conversation, and for many people those medications still work well. But the past decade has forced the field to reconsider whether we have been focusing on the wrong level of the system.

Increasingly, the evidence suggests that many effective treatments converge on something deeper: neuroplasticity.

Ketamine and esketamine accelerated this conversation by demonstrating that meaningful antidepressant effects could occur within hours rather than weeks. The emerging psychoplastogen literature raised an even more provocative question: if structural and functional plasticity is the true therapeutic driver, do we actually need the psychedelic experience to achieve it?

That question led me to a molecule I have been watching for quite some time: osavampator.

Unlike ketamine, which indirectly increases AMPA signaling through NMDA antagonism, osavampator works directly as a positive allosteric modulator of the AMPA receptor. In other words, it attempts to engage the same plasticity cascade from a different entry point.

What makes this particularly interesting from a clinical standpoint is the potential practicality. Running a Spravato treatment center reinforces every day that while these treatments can be extremely effective, they also require infrastructure. Monitoring, chair time, scheduling, staff, and a controlled clinical environment all become part of the therapeutic equation.

An orally administered AMPA modulator that engages plasticity pathways without dissociation or sedation would represent a very different implementation model if the signal holds.

Early Phase 2 data from the SAVITRI trial have generated attention, with effect sizes approaching 0.7 and remission rates nearing 50 percent by eight weeks in adjunctive treatment resistant depression. Whether those results replicate in Phase 3 remains to be seen, but mechanistically the compound sits directly in the middle of the broader shift psychiatry appears to be undergoing.

We may be moving away from receptor occupancy as our dominant framework and toward something more fundamental: circuit modulation and network plasticity.

Edition 10 of The Neuropsychiatry Brief explores this emerging AMPA story and why it may represent another piece of the larger plasticity puzzle.

If the future of antidepressant treatment is about helping the brain reorganize itself rather than simply nudging neurotransmitters, this is a development worth watching.

If you enjoy these discussions, you can subscribe to The Neuropsychiatry Brief directly on LinkedIn.

If you have followed this newsletter over the past several editions, you have probably noticed that a recurring theme keeps appearing beneath many of the mechanisms we discuss. Whether we are talking about ketamine, psychoplastogens, neuromodulation, or emerging serotonergic compounds, the conversat

03/18/2026

There are usually three people in the room during a psychiatric appointment. The client. The clinician. And the insurance company.

As clinicians we spend a great deal of time staying current with research, new treatments, and evolving models of care so that we can give our clients the best options available. In recent years psychiatry has begun moving beyond a purely neurotransmitter-focused model toward a deeper understanding of neural circuits, plasticity, and how the brain adapts over time. Treatments like ketamine and esketamine are part of that shift and have created new opportunities for individuals with treatment-resistant depression who simply do not respond to traditional antidepressants.

But being a good clinician means more than understanding the science. It also means understanding the system we practice within and learning how to navigate that system on behalf of the people we treat.

This Special Edition of The Neuropsychiatry Brief is about that reality.

Sometime ago, I temporarily took over a client’s Spravato treatment while a colleague was away. The client had been in treatment for roughly a year and was on weekly maintenance dosing. Her PHQ-9 suggested she was not doing well, and after discussing her symptoms we decided to return to twice-weekly dosing. Clinically the reasoning was straightforward. Administratively, it became a battle.

When I went looking for literature supporting a return to twice-weekly dosing during maintenance treatment, I was surprised at how little existed addressing that exact scenario. Ultimately I was able to obtain approval and the client improved significantly once treatment frequency increased.

Because of that experience I wrote up the case.

It was declined for an APNA poster and by a couple of journals. That happens. But rejection by a conference or journal does not mean the observation lacks clinical value. Instead of letting it disappear into a folder, I decided to share it here with colleagues.

The Special Edition of The Neuropsychiatry Brief discusses the clinical reasoning behind the decision and the realities of navigating treatment within an insurance-driven system.

I have also attached the full case study so that other clinicians may be able to use it when advocating for their own clients (link within the brief).

If it helps even one person get better care, it was worth writing.

Modern psychiatry is advancing rapidly, from neurotransmitters to neural circuits and plasticity. Yet in everyday clinical practice there is often an unspoken participant shaping treatment decisions — the insurance company sitting quietly in the room.

02/20/2026

The world feels heavy right now.

ICE raids tearing families apart at school drop-offs. Protests and unrest in Iran. A halftime show that somehow became a political flashpoint. The news cycle is relentless, and it is asking something of all of us, especially those of us who work in mental health, where the weight of the world lands in the room with every client.

And then, in the middle of all of it, Alysa Liu stood on top of an Olympic podium with a gold medal around her neck, her hair down and natural, and waved the other medalists up to share the top step with her.

I needed that. I think a lot of us did.

She walked away from figure skating at 16. Not because she failed. At the height of her career, she stepped away to protect her mental health and figure out who she was outside of the sport that had consumed her childhood.

Then she came back. On her own timeline. Because she missed it. Because it felt joyful again.

She said it herself:
"Quitting was the best decision I ever made. Coming back was the best decision I ever made."

That right there is a clinical story.

As a psychiatric nurse practitioner, I could not let this moment pass without unpacking it properly. So I wrote a Special Edition of The Neuropsychiatry Brief on exactly this — burnout, autonomy, identity, and what genuine recovery actually looks like when it plays out in full.

Because in a week this heavy, this is the kind of story that deserves more than a caption.

The full edition covers:
Why stepping away is not the same as giving up, and why that belief is clinically dangerous

Why autonomy is not a motivational concept. It is neurologically meaningful medicine.

Why her hair down on that podium was not a minor detail. It was integration.

Why that podium moment, waving competitors up to share the top step, is one of the clearest behavioral signals that something has genuinely healed.

And what this arc looks like for the clients sitting across from us right now.
This is the mental health story we rarely get to see play out publicly and completely. Not the struggle framed as inspirational suffering, but the full sequence, the stopping, the uncertainty, and the return on different terms.
The world is loud.

This is what quiet healing looks like when it finishes.

By now you may have seen the moment. Alysa Liu, standing at the top of the Olympic podium, gold medal around her neck, hair down and natural, waving the silver and bronze medalists up to share the top step with her.

01/26/2026

A thoughtful surprise on this gloomy Monday. Flowers for Sarah, Lauren, and Amanda as a thank you for the care and support they provide every day. Grateful for a team that makes people feel seen and supported - and for the patients who take the time to share their appreciation.

01/12/2026

We really do want the best for all our patients! Call us today to schedule an appointment! 📲757-908-2124

01/09/2026

We’re honored to share that Global Healthcare Magazine featured our founder, Justin Ray, on the cover in a January 2026 article highlighting his work in community and interventional psychiatry.

The piece reflects the values that guide South Chesapeake Psychiatry every day: depth over volume, accountability over convenience, and care that prioritizes real-world outcomes. From comprehensive evaluations to thoughtful, evidence-based treatment planning, our focus remains on practicing psychiatry with integrity and intention.

We’re grateful to our clients, our team, and our community for the trust you place in us. This recognition is a reminder of why we do the work—and why quality, ethical psychiatric care still matters.

Read the full article here:

For more than a decade, Justin Ray’s professional life unfolded in spaces like these. Long before advanced degrees, leadership roles

12/10/2025

HAPPY BIRTHDAY LAUREN!!! You bring so much joy to all of us here at SCP everyday! Thank you for all the extremely hard work you do for the providers and our clients, your positivity and for making us laugh everyday!! We love you meatball!!!! 🎉🎉🎉🎂🎂🎂🥳🥳🥳

12/05/2025

There are few moments more rewarding in this field than watching a former student grow into a colleague, a leader, and now a teacher in her own right.

When I first met Alysha Cunningham, MSN, PMHNP-BC, she was my student. Even then, it was obvious she had something rare. Not just intelligence or work ethic, plenty of people have that. She had instinct. She had depth. She had the kind of clinical presence you can’t teach, only refine.

I remember thinking, even back then: if I ever get the chance, I’m bringing her into the practice.

And I did.

Today, seeing her published in The Virginian-Pilot, writing about the stress and pressure facing today’s teens, and the real skills they need to cope, was one of those full circle moments that stops you for a second. The student becoming the teacher. The learner becoming the voice others now look to.

Alysha trained at Duke University’s number one ranked PMHNP program and is now pursuing her Doctor of Nursing Practice at Duke while caring for clients across the lifespan at South Chesapeake Psychiatry. Her article is thoughtful, timely, and rooted in exactly the kind of evidence-based compassion our community needs.

Watching someone you once taught step into their own influence is one of the greatest honors in this profession. It’s why we invest in people. It’s why mentorship matters. And it’s why I’m so proud to have her on our team.

Here is her article. It’s worth your time:
https://www.pilotonline.com/2025/12/03/column-give-teenagers-the-tools-they-need-to-manage-stress/?fbclid=IwY2xjawOfpMdleHRuA2FlbQIxMQBzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeG33Ixvt-JtxMT7wxR_cVxoVEmeuV3sVCuXpMuKifBCGFRx0pqfYl1jm30ks_aem_m24qCe5uuYFJOZ-oxP4n7w

Why are we sending teens into daily life unprepared to cope with stress, psychiatric mental health nurse practitioner Alysha Cunningham asks in a guest column.