A patient on clozapine has an absolute neutrophil count (ANC) of 1200. What do the prescribing guidelines recommend as the next step?

Which of the following classes of medication should not be considered for long-term adjunct therapy for treatment-resistant schizophrenia (TRS)?

What therapeutic intervention is indicated for treatment-resistant psychiatric/aggressive symptoms in a patient with CTE and a comorbid primary psychotic disorder?

What treatment poses the best likelihood of ameliorating the negative symptoms of schizophrenia?

What is the next step in treating a primary psychotic illness with aggression when high-dose/high-level clozapine treatment only provides a partial response?

What is the first-line treatment for catatonia?

This chapter explores the diverse therapeutic approaches to catatonia, integrating insights from both national and international guidelines. The primary treatment typically include benzodiazepines, such as lorazepam and diazepam, which are widely recognized for their efficacy in alleviating catatonic symptoms. Electroconvulsive therapy (ECT) remains a cornerstone for more severe, treatment-resistant and malignant cases (e.g. febrile catatonia), with recent evidence suggesting its effectiveness across various psychiatric populations, including children, adolescents, older adults, and patients with dementia. However, in cases of ultra-resistant catatonia – where up to 40% of patients do not respond to benzodiazepines or ECT – new treatment options such as intranasal esketamine are emerging, showing promise in cases unresponsive to conventional therapies. Additionally, treatments such as dopamine receptors antagonists and partial agonists (=antipsychotics) must be used with caution, particularly in cases of substance-induced catatonia, where they may exacerbate symptoms. Noninvasive brain stimulation techniques like repetitive transcranial magnetic stimulation and transcranial direct current stimulation are also gaining attention for their potential therapeutic benefits in catatonia, though further research is needed. Finally, the chapter underscores the importance of individualized treatment plans, carefully considering the underlying cause of catatonia to optimize outcomes and ensure the most effective intervention.

This was a happy and productive time. Increase in writing and work productivity. Explored theories for my illness, and did lots of music, reading, and socialising, with generally elevated mood. Diagnosis was revised again to bipolar disorder, well controlled on lithium. Further ECT continued as an out-patient; unilateral treatment has less affect on memory.

Birth of daughter. Briefly well afterwards but relapsed and was admitted to hospital again with my baby.

Working as a consultant psychiatrist and started doing GMC. I Depressed again and tried various antidepressants, hating being off work. Admitted to the Scottish Borders Hospital, where I had been a consultant, and had ECT; I also started olanzapine and put on a lot of weight. A change in psychiatrist and also in diagnosis was difficult.

Returned to Edinburgh five months pregnant, admitted immediately to local psychiatric hospital with psychotic depression. Treated with medication (antidepressants and antipsychotics) and ECT for the first. Poor with medication and relapse.

Poor memory for this time due to repeated admissions, ill-health, and ECT. I was acutely aware and frightened of detention under the Mental Health Act, and of compulsory treatment. Susceptibility to mental illness in families, and how friends and families attempted to explain things. Discussion of my feelings about my psychiatrists and hope that they could help me – also that it was difficult for them as they had never known me well.

Catatonia is a severe neuropsychiatric condition characterized by a state of immobility, stupor, and unresponsiveness to the environment. Signs and symptoms can be thought of in terms of motor signs, affective features, and cognitive-behavioral features. Common symptoms of catatonia can include stupor, rigidity, posturing, mutism, or prolonged excitement and agitation. Benzodiazepines and electroconvulsive therapy are the most commonlly used treatments for catatonia. Both treatments have shown similar efficacy.

Why is it so difficult for older women in our society to feel that they are seen and heard? What matters in our society is not the quality of a woman’s mind, but her appearance of aging. Yet older women are still trying to find meaning in life, despite the impact on their mental and physical health of the menopause, children leaving home, retirement from work, problems in relationships, caring for others and coping with chronic ill health. Women carry a heavy burden of intergenerational caring – for partners, parents, children and grandchildren. As they age, women experience sequential losses in life, of roles that have been important to us. Suicide rates are rising in older women for reasons unknown, and depression can be more severe. Electroconvulsive therapy (ECT) can be life-saving. Alzheimer’s disease is twice as common in women, but we do not know why. Given the massive impact of dementia on women, research is still inadequately funded. Together with younger women we must consider what a feminist old age might look like and, as we age, work at staying engaged with the world. There are things older women can both share with, and learn from, younger women.

Energy intersects with the environment at every stage of its life cycle. The energy supply chain can have adverse effects on nature and public health, including GHG emissions, air, land and water pollution as well the generation of harmful waste, among others. In order to reduce our dependence on high-carbon energy, more needs to be done to increase renewable energy generation and improve energy efficiency. As energy is involved in trade and investment projects, it is covered by the trade and investment branches of international economic law and regulated in these fields mainly by the rules of the World Trade Organization (WTO), the Energy Charter Treaty (ECT), regional trade agreements (RTAs) and international investment agreements (IIAs). This book aims to contribute to the existing scholarship by providing a comprehensive analysis of the energy–environment nexus under trade law and investment law, showing, where relevant, their similarities, differences or even (potential) conflicts at the energy–environment interface. It examines the legal foundations of the energy–environment nexus and associated issues regarding trade control, subsidies, technical standards, investment protection and technology policies.

This chapter examines investment-related aspects of the energy–environment nexus. State actions against fossil fuel investments often have an environmental cause, raising the issue of policy space under the investment regime. The doctrine of ‘police powers’ provides grounds for qualifying some pro-environmental interventions as non-compensable non-expropriatory measures. In addition to seeking policy flexibilities, many States wish energy investors to voluntarily bear social responsibility on the environmental front. As a result, a number of IIAs provide for responsible business conduct, bringing some changes to the ‘investor vs. State’ asymmetry in the investment system. A surge in renewable energy ISDS cases in the last ten years is another noticeable trend. High upfront costs of renewable energy projects recoupable in a long run necessitate FIT or other long-term benefits to investors. But when the government suddenly cancels or cuts promised incentives, this frustrates investors’ legitimate expectations under IIAs but may also be welcomed under trade law as a way of getting rid of distortive subsidies. Thus, some discrepancy or tension between the trade and investment regimes can arise.