Diabetes mellitus affects about 830 million people worldwide, with 2.5 million diabetes-related deaths per year. The estimated prevalence of diabetes among psychiatric in-patients in the UK is 10%, and the increased risk of poor diabetes-related physical health outcomes among people with a severe mental illness (SMI) is detrimental to their mental health and social functioning. This article uses two fictitious case vignettes inspired by experience in an in-patient psychiatric facility to explore the challenges of managing diabetes in this setting in the UK. The relationship between psychiatric disorders, their symptoms and management of physical health conditions, including health promotion, monitoring and pharmacological therapy, creates a challenge in the optimal management of diabetes. Recommendations for improving diabetes management in people with SMI are divided into those requiring insulin and those not requiring insulin.

This article reflects on a collaborative drawing group in a mother and baby unit, exploring the clinical value of arts-based interventions in perinatal psychiatry. Grounded in an evolutionary and biopsychosocial theory, it highlights how creative practice can reduce hierarchy, support emotion regulation and foster relational safety. A practical group model is described, encouraging clinicians to draw on their own creative skills to enrich care, build connection and hold space for meaning beyond symptom management.

High expressed emotion (EE) in families is known to increase risk of relapse for people with schizophrenia. This Cochrane Review by Chien et al suggests that family-based interventions such as psychoeducation may result in a reduction in caregiver burden, a shift from high to low EE, and perhaps also reduce patient relapse rates. However, there was a high degree of heterogeneity in the combined study sample and a significant risk of bias across studies. The authors’ decision to only include studies reporting both a family member and a patient outcome means relevant evidence in this area may not have been incorporated.

This article provides the general psychiatrist with a pragmatic guide to working confidently and productively in the emergency department (ED). The focus is on effectively navigating the distinctive physical environment, personnel, systems, time pressures, legal boundaries, special challenges and broad scope of practice applicable to this setting to maximally support both patients and staff. It brings to the reader’s attention special considerations at all stages of workflow, including pre-assessment preparations, the assessment process and ongoing planning. It considers common requests and the application of mental health law (in England and Wales) associated with both capacity assessment and involuntary care. Finally, it explores unique challenges associated with risk assessment, physical health advocacy and management of conflict in the ED setting. The specific systems described are those of the UK’s National Health Service, but the principles involved are universal.

This commentary responds to a case study of a drawing group on a perinatal psychiatric ward, framing it as a threshold practice: one that invites creative presence between clinician and mother, between symptom and symbol. The commentary highlights the therapeutic potential of shared non-verbal creative acts, but points to the potential for aesthetic coercion and the ethical tensions that arise when clinicians step into aesthetic space alongside patients. It argues that arts interventions in mental health require neither romanticisation nor reductive measurement, but a critical and generative mode of engagement attuned to thresholds, relationships and the fragile work of recovery.

Validity tests are used in both forensic and clinical settings, but their application in clinical practice is often hindered by misconceptions. These include the assumptions that validity tests imply a medico-legal dimension, primarily detect feigning or malingering, and provide minimal actionable information to clinicians. The authors critically discuss these misconceptions and argue that validity tests may offer significant value in clinical practice by assessing whether patients can describe their symptoms, complaints and impairments with reasonable accuracy, which has important implications for diagnosis and treatment planning. Importantly, in clinical practice, when interpreting validity tests, neutral terminology such as ‘over-reporting’ and ‘underperformance’ is often preferable to – and better to substantiate than – terms like ‘feigning’ and ‘malingering’, which can evoke moral judgements, creating an unnecessary barrier to using these valuable clinical tools.

Functional neurological disorder (FND) is a well-recognised condition often involving a complex interplay of biopsychosocial factors. Although awareness of FND among the general population and clinical staff has increased and improved over recent years, challenges remain for the sufferers across multiple areas. This reflective piece explores these challenges using a relational understanding. The model of cognitive analytic therapy (CAT) is used to examine some of the dynamics and concepts at play in FND.

Bullying among girls is often subtle and relational, which can go unnoticed by parents, teachers and healthcare professionals. This article explores how covert aggression – such as social exclusion, gossip and emotional manipulation – can cause profound psychological harm to targeted girls, many of whom may not even realise they are being bullied. Through an analysis of defining attributes of girl-to-girl bullying and general implications for mental health, this article aims to highlight the importance of early identification and treatment. The article also points out how social patterns of bullying found predominantly in girls’ social circles carry over well into adulthood, emerging in the work environment, social circles and cyberspace. Focused on practical application, this educational paper aims to enhance clinicians’, caregivers’ and teachers’ recognition of relational aggression, develop collaborative approaches to prevention and facilitate useful interventions for those affected. Ultimately, increased sensitivity to subtle bullying has the power to reduce subsequent harm and result in healthier social contexts.

Barricaded incidents, hostage-taking and sieges occur in the community, where police negotiators are usually called on to bring about a peaceful resolution. They occur also in prisons and psychiatric hospitals, where they will be managed by the institution’s staff, with police support if needed. Psychiatrists and other mental health professionals have been involved in providing training and on-call support for negotiators and decision makers in these crisis situations. This article describes definitions and goals in relation to such incidents, and outlines a five-phase framework for their management (training; first responders, preliminary interventions and inquiries; negotiations; resolution; aftercare), indicating the psychiatrist’s role during each phase. Ethical issues are also discussed.

Alcohol use disorders (AUDs) often coexist with psychotic disorders. Both are common and each can cause or perpetuate the other. Comorbid diagnoses are multifactorial in origin, and both diagnostically and therapeutically challenging. This article is a narrative review of the epidemiology, diagnosis and management of comorbid AUDs and psychotic disorders. Although there is a lack of robust evidence on many aspects of this association, AUDs have been repeatedly shown to worsen outcomes in individuals with schizophrenia. The importance of a rigorous approach to diagnosis is emphasised. Three main treatment strategies emerge: considering particular antipsychotic drugs, relapse-prevention medication and engagement with a number of psychosocial interventions.

Although published over 30 years ago, Motor Disorder in Psychiatry remains a thought-provoking consideration of motor disorder in the context of the psychiatric patients. Rogers hypothesises a common aetiology of motor disorder regardless of a predominating psychiatric or neurological presentation, arguing that the former demands further scrutiny within a neurological/neuropsychiatric framework.

This article is a concise refreshment for psychiatrists to update their knowledge and understanding of corticosteroid-induced psychiatric symptoms. It summarises the diverse presentation associated with this clinical phenomenon, how frequently it occurs and some pathophysiological considerations. There is a focus on early identification and management, highlighting the importance of an integrated multidisciplinary approach, withdrawal or reduction of the corticosteroid treatment and adjunctive psychotropic medication options for clinicians to consider.

This article provides a brief introduction (or recapitulation) of what variable types are and how the choice of the variable type may affect which research questions can be answered and the data analysis. The nine-item Patient Health Questionnaire and a simulated data-set are used as an illustration throughout.

Sex and gender are often overlooked factors in the delivery of mental healthcare, resulting in a gender blindness that ignores the specific needs of women and, in some circumstances, men. A lack of gender-disaggregated data and balanced sex and gender representation in clinical research has led to knowledge gaps in women’s health overall. This article explores the influence of gender bias across a spectrum of conditions where disparities in diagnosis, treatment and research exist, including psychosis, mood disorders, neurodevelopmental disorders, eating disorders and substance use disorders. The influence of female reproductive hormones (oestrogen and progesterone) on symptom onset, presentation and treatment response is also discussed where clinically relevant. Gender-aware approaches to delivering mental healthcare are needed, including trauma-informed care, in order to deliver equitable and effective mental healthcare for all.

Persistent physical symptoms (PPS) are associated with functional impairment, psychological distress and high healthcare costs. They often span multiple diagnostic categories, resulting in substantial challenges for patients and healthcare systems. Understanding the shared processes underlying PPS is crucial to improving outcomes. PPS are shaped by complex and interacting psychological and physiological mechanisms, which interact to perpetuate the condition. A transdiagnostic approach, which targets shared underlying processes, may offer a more efficient and effective framework for treatment compared with traditional disorder-specific interventions. This article describes the theory for a transdiagnostic approach and evidence for its effectiveness. We describe several theoretical models and approaches to understanding the underlying mechanisms of PPS, including central sensitisation, avoidance behaviours, emotion dysregulation and cognitive distortions. We describe interventions, particularly those incorporating key principles of cognitive–behavioural therapy. The proposed approach integrates these insights to inform a comprehensive treatment model.

The histories of the DSM and ICD classifications are set out so as to identify weaknesses and limitations that can affect their application in medico-legal reporting. These are illustrated by reference to published judgments and three detailed case studies. The analysis and case studies identify how expert witnesses’ reliance on the DSM and ICD can be challenged in order to seek to undermine their evidence.