The chapter provides an introduction to neurodevelopmental disorders and summarises recent advances in published research, focusing on the very early development and function of the human brain. The main influences on the current delivery and development of forensic healthcare services is set within the context of available policy and guidance, which is limited in part by the available research evidence to inform it. The book is divided into three sections. The first provides an overview with an introduction to individual disorders and covers aetiology, prevalence, comorbid mental disorder and relevant policy to date. The second section focuses on the clinical aspects of the range of disorders including screening, assessment, diagnosis, risk assessments and therapeutic approaches. The final section examines the pathways through the criminal justice system from police to court to disposal and addresses the specific aspect of fitness to plead or stand trial for those with neurodevelopmental disorders. This section also describes current relevant legislation within the UK as well as forensic services for those with such disorders from a national and international perspective.

Violence and aggression never present themselves in a vacuum, yet this is typically the way policymakers approach the subject, its prevention and its management. Although guidelines exist in different sectors, too often little or no consideration is given to many of the wider issues in play, particularly the use of restraint when it becomes necessary. Despite the long-standing call for a common set of guidelines, we are only now looking at the introduction of the Restraint Reduction Network training standards, and it seems that anything approaching a set of common guidelines that all settings can embrace is a long way off. The aim of any good guidance seeking to influence practices in the prevention and management of violence and aggression should be to minimise the need for any restrictive intervention but where necessary to apply techniques as safely as possible within the relevant legislative framework. Certain staff in healthcare settings need to receive training to increase the organisation’s capacity and capability to deal with potentially violent situations without recourse to external agencies, such as police, who operate to a different set of standards to those within healthcare settings and who use techniques that healthcare staff would not wish to see used in their settings.

The potential negative effects of exercise addiction (EA) were first reported over 50 years ago, but it has only recently been formally recognized as a disorder in the leading clinical manuals. The inclusion of exercise behaviour as a potentially addictive behaviour will require greater consensus on how to define this disorder, with diagnostic criteria and course descriptions clearly supported by scientific evidence, and on how to categorize it in relation to other mental disorders. This chapter presents an overview of attempts to identify the defining features of EA, the development of instruments to measure it, estimates of its prevalence, and the main strategies for treating it. The diverse terminology used to describe this disorder reflects both the range of perspectives from which it has been examined, and the different manifestations of EA. The chapter concludes by recognizing that the development and validation of specific diagnostic criteria for EA pose many challenges.

This chapter defines fads and fallacies, and relates them to cognitive errors. It discusses broader problems with determining causality in science, and the reasons for the replication crisis in research. Examples of medical and surgical fads, namely chronic fatigue syndrome, chronic pain, and non-evidence-based surgical procedures, are examined. The chapter also discusses the role of the pharmaceutical industry in medical fallacies. It concludes by explaining how fads can be understood in the context of the challenges of chronicity in medicine.

Medicine is a rapidly developing field. Much of what many of us learned in medical school is now obsolete, and an expanding knowledge base has led to increasingly specialized services. If you add to this the fact that many doctors – by choice or as the result of service changes – change their areas of clinical practice, the need to continue learning and developing after completion of formal training is undeniable.

We learn on a day-to-day basis in our clinical practice. As well as taking the relatively obvious forms of reading a literature review or asking the advice of a colleague, learning will also be through continuous feedback, for example from patients about a particular approach we take or a good clinical outcome. Being open to everyday feedback and thoughtfully working in teams is therefore an important part of remaining a safe and effective practitioner.

This introductory chapter outlines the structure of the book and some of the themes that appear throughout the book. The themes include intersectionality, the role of social factors in causing and maintaining mental ill-health, the need for a public mental health approach, and the role of mental health professionals and services in facilitating social inclusion. We discuss why social exclusion violates social justice and social solidarity, and put forward ten reasons why mental health professionals should be concerned with social exclusion.

Chapter 1 examines a range of biological processes which affect mental health, including attachment, genes and inheritance, the developing brain and puberty.

Historically, mental health care was provided within a religious context. As scientific approaches to the study of mind and brain developed from the seventeenth century onwards, the spiritual and religious elements of care became separated from the biological, psychological and social elements. The rift grew under the combined influences of biological reductionism, Darwinism, behaviourism and psychoanalysis. In the later twentieth century, a new wave of scientific research on spirituality and religion began to reverse this trend. Spirituality came to offer a more subjective and individualised approach to transcendence, which did not necessarily require religious affiliation. Psychiatrists have found a more positive place for spirituality in both clinical practice and research. This has been reflected internationally, in professional organisations, policy, debate and training. A growing evidence base demonstrates the positive benefits of spirituality/religion for mental health, and patient-centred care requires that spiritual/religious issues be addressed with sensitivity and respect.

This document provides a new edition and an update to the 2015 NEPTUNE guidance on the clinical management of harms resulting from acute intoxication and from the harmful and dependent use of ‘club drugs’ and ‘novel psychoactive substances’ (NPS).

This chapter introduces the role of The Teacher within medical education and considers how this has changed in recent years. There is reflection on what it means ‘to teach’, as well as the importance of attitudes and role-modelling. The Hidden Curriculum is considered, with discussion of why it is important and how it can be influenced by the medical educator. This chapter also acknowledges the peculiarities of teaching psychiatry, and how this can be a rich vehicle for teaching values and attitudes – directly through the content, and indirectly through the hidden curriculum.

This introductory chapter serves multiple purposes. Its primary aim is to introduce psychiatrists and other mental health professionals who are new to Darwinian thinking to some of the basic concepts and terminology of evolutionary science in order to ease their progress through the remaining chapters of this volume. Another aim is to provide a distillation and update of some significant theoretical and other developments in a variety of evolutionary disciplines relevant to psychiatry and psychology that would be of benefit to all readers, including existing evolutionists. Given the constraints of space, there will inevitably be significant omissions. We have elected to cover the basics of standard evolutionary theory, as well as some of the basic principles of evolutionary psychology and medicine. We also briefly survey some of the recent developments in the evolutionary literature on cultural evolution and related fields. We recognise that a balance needs to be struck between covering as wide an area as possible without the chapter becoming a glossary of terms. Readers unfamiliar with specialised evolutionary terms are advised to consult the glossary on the Evolutionary Psychiatry Special Interest Group at the Royal College of Psychiatrists’ website: www.epsig.org (click on ‘About us’ then ‘Resources’).

Work with people seeking asylum brings unfamiliar experiences, challenges, rewards, and dilemmas. Resonances for the therapist and sharing the client’s pain and hopelessness can be distressing. Power, powerlessness and privilege are common themes. Facing the limits of our own compassion, and of what it is possible to do, can be hard. How can we ‘do differently’ and what new skills are needed? The work can be isolating, and exhaustion, burn out, vicarious traumatisation and other existential reactions can arise.Clinicians face many dilemmas, such as over boundaries, neutrality and self-disclosure, overt political action, and how to deal with different perspectives in the same organisation. What helps clinicians do well is a focus on reflection, and accessing supervision and other reflective spaces, such as Balint groups or solidarity teams. Pitfalls of not attending to our own responses are highlighted, as is the need to protect reflective spaces. Remote meetings make access easier for both training and peer support. Meetings in non-clinical settings with people who have sought asylum can also be enlightening.