vida: extract claims from 2026-05-07-osmind-glp1-psychiatric-drugs-competency

- Source: inbox/queue/2026-05-07-osmind-glp1-psychiatric-drugs-competency.md
- Domain: health
- Claims: 3, Entities: 0
- Enrichments: 4
- Extracted by: pipeline ingest (OpenRouter anthropic/claude-sonnet-4.5)

Pentagon-Agent: Vida <PIPELINE>

domains/health/glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible.md

@@ -10,21 +10,9 @@ agent: vida
 sourced_from: health/2026-osmind-glp1-psychiatric-drugs-tonic-phasic.md
 scope: causal
 sourcer: Osmind
-related:
-- glp1-anhedonia-undermines-social-engagement-as-non-clinical-health-determinant
-- food-noise-quiet-narrative-reframes-glp1-anhedonia-as-liberation
-- glp1-receptor-agonists-address-substance-use-disorders-through-mesolimbic-dopamine-modulation
-- semaglutide-produces-large-effect-aud-reduction-through-vta-dopamine-suppression
-- hedonic-eating-dopamine-circuit-adapts-to-glp1-suppression-explaining-continuous-delivery-requirement
-- glp-1-receptor-agonists-require-continuous-treatment-because-metabolic-benefits-reverse-within-28-52-weeks-of-discontinuation
-- glp1-receptor-agonists-provide-cardiovascular-benefits-through-weight-independent-mechanisms
-- glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible
-supports:
-- Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses
-- GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS
-reweave_edges:
-- Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses|supports|2026-05-07
-- GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS|supports|2026-05-07
+related: ["glp1-anhedonia-undermines-social-engagement-as-non-clinical-health-determinant", "food-noise-quiet-narrative-reframes-glp1-anhedonia-as-liberation", "glp1-receptor-agonists-address-substance-use-disorders-through-mesolimbic-dopamine-modulation", "semaglutide-produces-large-effect-aud-reduction-through-vta-dopamine-suppression", "hedonic-eating-dopamine-circuit-adapts-to-glp1-suppression-explaining-continuous-delivery-requirement", "glp-1-receptor-agonists-require-continuous-treatment-because-metabolic-benefits-reverse-within-28-52-weeks-of-discontinuation", "glp1-receptor-agonists-provide-cardiovascular-benefits-through-weight-independent-mechanisms", "glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible", "glp1-psychiatric-dose-response-data-absent-despite-mechanistic-evidence"]
+supports: ["Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses", "GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS"]
+reweave_edges: ["Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses|supports|2026-05-07", "GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS|supports|2026-05-07"]
 ---
 
 # GLP-1-induced anhedonia is a tonic receptor occupancy phenomenon, not an inherent pharmacological property, resolving with dose reduction because natural GLP-1 is phasic
@@ -37,3 +25,9 @@ Natural GLP-1 is phasic: it spikes after meals and degrades within 1-2 minutes d
 **Source:** Sa et al., Diabetes Obesity and Metabolism 2026
 
 Systematic review of 80 RCTs (107,860 participants) finds 'direct evidence linking GLP-1RAs to anhedonia' is 'sparse' and 'most hypotheses about CNS involvement remain speculative due to lack of integrated neurobiological or mechanistic studies.' No reversibility data included in review. Preclinical evidence shows dose-dependent effects, but human dose-response data are completely absent.
+
+## Extending Evidence
+
+**Source:** Dr. Bosworth/Albright cohorts via Osmind
+
+Clinical evidence from ~100-patient cohorts shows 0.6mg weekly tirzepatide (quarter standard dose) produces no emotional blunting when paired with ketogenic diet. Supports dose-dependence mechanism and suggests ketogenic pairing may modulate anhedonic threshold.

domains/health/glp1-low-dose-psychiatric-protocol-prevents-anhedonia-through-ketogenic-pairing.md

@@ -0,0 +1,19 @@
+---
+type: claim
+domain: health
+description: Quarter-dose tirzepatide (0.6mg weekly) paired with ketogenic diet achieves psychiatric benefits without emotional blunting in ~100-patient cohorts
+confidence: experimental
+source: Dr. Annette Bosworth, Dr. Brittany Albright clinical cohorts
+created: 2026-05-07
+title: GLP-1 low-dose psychiatric protocol prevents anhedonia through ketogenic diet pairing at 0.6mg weekly tirzepatide
+agent: vida
+sourced_from: health/2026-05-07-osmind-glp1-psychiatric-drugs-competency.md
+scope: functional
+sourcer: Osmind
+supports: ["glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible"]
+related: ["glp1-prescribing-competency-gap-primary-care-psychiatric-monitoring", "glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible", "glp1-psychiatric-dose-response-data-absent-despite-mechanistic-evidence"]
+---
+
+# GLP-1 low-dose psychiatric protocol prevents anhedonia through ketogenic diet pairing at 0.6mg weekly tirzepatide
+
+Dr. Bosworth and Dr. Albright report no emotional blunting in approximately 100-patient cohorts using low-dose tirzepatide at 0.6mg weekly — one-quarter the standard 2.5mg starting dose — paired with ketogenic diet. The protocol includes structured resistance training and adequate protein intake (1.6-2.3g/kg/day) to prevent lean mass loss. Monitoring uses the 'Dr. Boz Ratio' (blood glucose ÷ blood ketones): >80 indicates glucose metabolism, 40-80 moderate ketosis, <40 deeper therapeutic ketosis. This represents a distinct psychiatric dosing strategy compared to standard metabolic dosing. The absence of anhedonia at this dose supports the tonic vs. phasic receptor activation mechanism: lower doses may preserve phasic signaling patterns while higher doses create sustained tonic suppression. The ketogenic pairing may provide metabolic support that allows lower GLP-1 doses to achieve psychiatric effects. This is the most concrete psychiatric prescribing protocol available as of March 2026, developed in clinical practice before formal guidelines exist.

domains/health/glp1-metabolic-monitoring-protocol-uses-glucose-ketone-ratio-for-therapeutic-targeting.md

@@ -0,0 +1,18 @@
+---
+type: claim
+domain: health
+description: "Dr. Boz Ratio (blood glucose ÷ blood ketones) provides operational metabolic monitoring: >80 glucose metabolism, 40-80 moderate ketosis, <40 deep ketosis"
+confidence: experimental
+source: Dr. Annette Bosworth (Dr. Boz Ratio protocol developer)
+created: 2026-05-07
+title: GLP-1 metabolic monitoring protocol uses glucose-ketone ratio for therapeutic targeting
+agent: vida
+sourced_from: health/2026-05-07-osmind-glp1-psychiatric-drugs-competency.md
+scope: functional
+sourcer: Osmind
+related: ["glp1-low-dose-psychiatric-protocol-prevents-anhedonia-through-ketogenic-pairing", "glp1-therapy-requires-nutritional-monitoring-infrastructure-but-92-percent-receive-no-dietitian-support"]
+---
+
+# GLP-1 metabolic monitoring protocol uses glucose-ketone ratio for therapeutic targeting
+
+Dr. Bosworth developed a metabolic monitoring protocol for GLP-1 therapy using blood glucose divided by blood ketones (the 'Dr. Boz Ratio'). The ratio provides three operational zones: >80 indicates glucose metabolism dominance, 40-80 indicates moderate ketosis, and <40 indicates deeper therapeutic ketosis. This monitoring approach is more concrete and operational than existing professional society guidelines, which lack specific metabolic targets for GLP-1 therapy. The protocol enables real-time adjustment of dietary intervention and GLP-1 dosing based on metabolic state. This represents clinical protocol development occurring in practice before formal guidelines exist — a pattern where operational tools emerge from clinical experience rather than institutional guidance. The ratio is particularly relevant for psychiatric GLP-1 use because ketogenic states may modulate the psychiatric effects of GLP-1 receptor activation.

domains/health/glp1-prescribing-competency-gap-creates-structural-safety-risk-through-primary-care-psychiatric-drug-misclassification.md

@@ -0,0 +1,18 @@
+---
+type: claim
+domain: health
+description: Primary care physicians prescribe GLP-1 agonists as metabolic drugs without understanding their direct psychiatric mechanisms, creating a supervision gap for reward pathway modulation
+confidence: experimental
+source: Dr. Will Sauvé (Osmind CMO), Dr. Annette Bosworth, Dr. Brittany Albright
+created: 2026-05-07
+title: GLP-1 prescribing competency gap creates structural safety risk through primary care psychiatric drug misclassification
+agent: vida
+sourced_from: health/2026-05-07-osmind-glp1-psychiatric-drugs-competency.md
+scope: structural
+sourcer: Osmind
+related: ["human-in-the-loop-clinical-ai-degrades-to-worse-than-ai-alone", "value-based-care-transitions-stall-at-the-payment-boundary", "glp1-prescribing-competency-gap-primary-care-psychiatric-monitoring", "glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible", "behavioral-biological-health-dichotomy-false-for-reward-dysregulation-conditions", "glp1-psychiatric-dose-response-data-absent-despite-mechanistic-evidence", "glp1-psychiatric-effects-directionally-opposite-metabolic-versus-psychiatric-populations", "glp1-discontinuation-predicted-by-psychiatric-comorbidity-creating-access-adherence-trap", "glp1-atypical-anorexia-screening-gap-creates-invisible-high-risk-population"]
+---
+
+# GLP-1 prescribing competency gap creates structural safety risk through primary care psychiatric drug misclassification
+
+GLP-1 receptor agonists engage VTA, nucleus accumbens, insula, and prefrontal cortex to directly regulate reward pathways and reinforcement learning — making them functionally psychiatric drugs. However, they are prescribed primarily by primary care physicians for weight loss without psychiatric monitoring infrastructure. Dr. Sauvé states: 'If our field of psychiatry does not get a hundred percent ahead of how this GLP thing works, then we're going to be left behind.' The competency gap is structural: psychiatrists manage patients on GLP-1s they didn't prescribe, without understanding central mechanisms, dosing nuances, or psychiatric side effects. This creates a supervision gap for drugs that directly modulate dopaminergic reward circuits — the same circuits targeted by psychiatric medications. The gap exists because the drugs are classified and prescribed as metabolic agents despite their primary mechanism involving psychiatric circuitry. This is distinct from the general GLP-1 prescribing competency gap because it specifically concerns the mismatch between psychiatric mechanism and non-psychiatric prescriber training.

domains/health/glp1-prescribing-competency-gap-primary-care-psychiatric-monitoring.md

@@ -10,23 +10,9 @@ agent: vida
 sourced_from: health/2026-osmind-glp1-psychiatric-drugs-tonic-phasic.md
 scope: structural
 sourcer: Osmind
-related:
-- glp1-therapy-requires-nutritional-monitoring-infrastructure-but-92-percent-receive-no-dietitian-support
-- healthcare AI creates a Jevons paradox because adding capacity to sick care induces more demand for sick care
-- glp1-discontinuation-predicted-by-psychiatric-comorbidity-creating-access-adherence-trap
-- glp1-eating-disorder-screening-gap-structural-capacity-not-clinical-knowledge
-- glp1-psychiatric-effects-directionally-opposite-metabolic-versus-psychiatric-populations
-- glp1-anhedonia-undermines-social-engagement-as-non-clinical-health-determinant
-- glp1-atypical-anorexia-screening-gap-creates-invisible-high-risk-population
-- glp1-harm-mediated-by-cultural-weight-stigma-not-pharmacology-alone
-- glp1-prescribing-competency-gap-primary-care-psychiatric-monitoring
-- glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible
-supports:
-- Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses
-- GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS
-reweave_edges:
-- Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses|supports|2026-05-07
-- GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS|supports|2026-05-07
+related: ["glp1-therapy-requires-nutritional-monitoring-infrastructure-but-92-percent-receive-no-dietitian-support", "healthcare AI creates a Jevons paradox because adding capacity to sick care induces more demand for sick care", "glp1-discontinuation-predicted-by-psychiatric-comorbidity-creating-access-adherence-trap", "glp1-eating-disorder-screening-gap-structural-capacity-not-clinical-knowledge", "glp1-psychiatric-effects-directionally-opposite-metabolic-versus-psychiatric-populations", "glp1-anhedonia-undermines-social-engagement-as-non-clinical-health-determinant", "glp1-atypical-anorexia-screening-gap-creates-invisible-high-risk-population", "glp1-harm-mediated-by-cultural-weight-stigma-not-pharmacology-alone", "glp1-prescribing-competency-gap-primary-care-psychiatric-monitoring", "glp1-anhedonia-tonic-receptor-occupancy-dose-dependent-reversible", "glp1-psychiatric-dose-response-data-absent-despite-mechanistic-evidence"]
+supports: ["Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses", "GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS"]
+reweave_edges: ["Human dose-response data on GLP-1 psychiatric effects are absent from the literature despite mechanistic evidence that tonic receptor occupancy at therapeutic weight-loss doses suppresses dopamine signaling differently than lower psychiatric doses|supports|2026-05-07", "GLP-1 clinical trials systematically lack validated hedonic measurement instruments making anhedonia invisible to regulatory infrastructure despite available tools like SHAPS|supports|2026-05-07"]
 ---
 
 # Primary care prescribers of GLP-1s at therapeutic weight-loss doses lack psychiatric competency to monitor for CNS effects, creating structural risk of anhedonia in patients without psychiatric support
@@ -39,3 +25,9 @@ GLP-1 receptors are densely distributed in VTA, nucleus accumbens, insula, and p
 **Source:** Psychopharmacology Institute Q1 2026 Review
 
 The Psychopharmacology Institute — a CME platform for practicing psychiatrists — now covers GLP-1 receptor agonists as emerging psychiatric pharmacology in quarterly clinical reviews. This signals that professional psychiatric education is actively incorporating GLP-1 into the psychiatric medication framework, moving beyond endocrinology-only prescribing. However, the review does not provide clinical screening protocols for psychiatrists evaluating patients already prescribed GLP-1s by other providers, indicating the competency gap persists at the protocol level despite conceptual recognition.
+
+## Extending Evidence
+
+**Source:** Dr. Will Sauvé, Osmind CMO
+
+Osmind CMO Dr. Sauvé frames competency gap as existential for psychiatry: 'If our field of psychiatry does not get a hundred percent ahead of how this GLP thing works, then we're going to be left behind.' Identifies specific gap: psychiatrists managing GLP-1-prescribed patients without understanding central mechanisms, dosing nuances, or psychiatric side effects.

domains/health/semaglutide-produces-large-effect-aud-reduction-through-vta-dopamine-suppression.md

@@ -59,3 +59,10 @@ Semaglutide showed most consistent effects across 14 studies in meta-analysis of
 **Source:** Gill et al., JAMA Psychiatry 2026
 
 MDD trial provides complementary evidence of GLP-1 reward circuit engagement but with opposite therapeutic direction—AUD benefits from dopamine suppression (reducing pathological reward), MDD benefits from effort-cost reduction (increasing motivation for reward pursuit). Both operate through same anatomical substrate (VTA/mesolimbic pathway) but different functional mechanisms.
+
+
+## Supporting Evidence
+
+**Source:** Osmind synthesis of Hendershot, Lilly trials, All of Us
+
+Hendershot trial (JAMA Psychiatry 2025) in 48 adults with AUD showed semaglutide effect sizes exceeding naltrexone or acamprosate. Eli Lilly brenipatide Phase 3 (RENEW-ALC) enrolling 2,200 patients with moderate-to-severe AUD. All of Us observational (March 2026): GLP-1 exposure associated with 75% lower odds of any SUD.

inbox/archive/health/2026-05-07-osmind-glp1-psychiatric-drugs-competency.md

@@ -7,10 +7,13 @@ date: 2026-03-17
 domain: health
 secondary_domains: []
 format: article
-status: unprocessed
+status: processed
+processed_by: vida
+processed_date: 2026-05-07
 priority: high
 tags: [glp-1, psychiatry, competency-gap, anhedonia, addiction, dosing]
 intake_tier: research-task
+extraction_model: "anthropic/claude-sonnet-4.5"
 ---
 
 ## Content