The perinatal frame of mind is a concept aiming to capture the unique mental state, context and experiences of individuals planning a pregnancy and during the perinatal period. It implies that every aspect of the physical, social, psychological and psychiatric care of women in this period requires a deep understanding of them as individuals. This encompasses many aspects of a woman’s life experience: from childhood to her current context, including traumatic and more positive experiences, cultural factors, relationships, mental and physical illness and their risks and relevance to the perinatal context, her journey to becoming pregnant, and her strengths. The term asks that we think not only about the woman, her well-being and needs, but also those of the fetus or infant, the intimate partner and/or co-parent, and other family members. We should consider the relationships between the parents and the infant, as well as within the couple and among other family members. So, we don’t just think about the woman, but the community and cultural context surrounding her, which includes the partner, family, friends, and often, and importantly, health and social professionals and services, who can provide the right kind of support to help navigate any mental health challenges.

The aim of this book is to provide evidence to inform the development and implementation of suicide prevention globally. It covers a range of topics that are relevant from local to national levels. It has an unapologetic emphasis on social determinants of suicide and a global perspective, with utility across the world as a primary resource by practitioners and policymakers. It aims at accessibility, with an emphasis on what can be achieved given the current knowledge base.

A central message of this book is the importance of using rigorous evidence to guide suicide prevention, whilst recognising that the best evidence is always partial. Key research is cited in the text and readers are, in places, directed to public-domain digital resources. The book aims to have relevance in low- and middle-income countries, as well as in high-income countries. It is not a country-by-country international overview.

Research involvement is good for both patients and clinicians. In healthcare organisations that are research active, not only are mortality outcomes better, but clinicians are happier and retention rates better. In this chapter we consider how early career clinicians can involve themselves in research, for the benefit of your clinical practice and your patients. It is important to foster early exposure to research, which also makes further involvement in research a less intimidating venture. The only warning attached to that is that once you’ve had a taste of research involvement, and seen your first publication in print, you may find it hard to leave it behind! Establishing research skills early in one’s career can have advantages; firstly, it encourages critical thinking on how to approach any patient, their presenting difficulties and the selection of appropriate interventions. Further, being able to appraise the expanding and complex (and often contradictory) evidence base is a vital skill any clinician will utilise throughout their career. Finally, it is, or can be, enormous fun!

Children and young people’s mental health services continue to remain a high priority for government and the NHS. Delivering good outcomes for young people will require coordinated action across health, education, third sector and local government departments and between national and local bodies. There are opportunities through increased investment and more collaborative commissioning and service delivery arrangements to deliver a systems wide approach to providing care for children and young people. The COVID-19 pandemic has affected everyone although children and young people have been disproportionately adversely affected, as they have had to adapt to extraordinary changes to the world around them. New models of care can stimulate effective collaboration between commissioners and providers to develop integrated, accessible services for all in community based settings. Expanding access through digital support can enable more people to receive effective care providing greater accessibility and choice. A focus on quality improvement can support staff and patients to improve care through effective use of data, with support from professional networks. However, all new models must be developed in partnership with experts-by-experience, carers, and community and voluntary organisations. Systemic investment in services and the staff who provide them is needed to meet the ambitions set by governments.

Chapter 1 covers the topic of schizophrenia. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the management of a patient with schizophrenia from first presentation to subsequent complications of the conditions and its treatment. Things covered include the different forms of delusions, psychopathology, negative and positive symptoms of schizophrenia, co-morbid conditions, typical investigations carried out, the use of pharmacological treatment, adverse effects of commonly used medications, extrapyramidal side effects and treatment-resistant schizophrenia.

This chapter explores why we decided to write this book about compassion in healthcare. Despite choosing our professions in order to help others, many healthcare professionals feel chronically tired, emotionally drained, deeply heart-sore, and ultimately burnt-out. Too often, moments of connection with patients and their families, although magical at the time, also highlight the uncertainties and even the darkness that surrounds them. Commonly, staff struggle to make sense of healthcare systems that seem to value neither ‘health’ nor ‘care’. The message of this book is that we can do better. Perhaps the first step in resolving these matters lies in recognising that while we do not have full control over the shape of the healthcare systems within which we work, or indeed the societies in which we live, we can control how we navigate these contexts, how we respond to them, and how we seek to be in the world. In parallel, we can also seek to change health systems in the direction of more compassionate care. Compassion is always essential in these processes, especially in the settings of health and social care. That is why we wrote this book: to try to make compassionate care a day-to-day clinical reality for everyone: patients, families, and healthcare professionals who constantly seek to do more and better.

The chapter reviews the past literature on this topic, identifies some areas where Eastern religious cults may impact our life in the West, and also raises new questions and ideas for future scholarship. The study of all cults has been hampered by problems of definition and such problems (Eurocentric bias, Orientalism) are even more relevant in the study of Eastern religion. We review religious cults from three contrasting parts of the East, including the Middle East, South Asia, and East Asia. We review a true Western court case in which a mental health defense (insanity) was indirectly inspired by the theology of an Eastern religious cult after the defendant admitted killing, but claimed “God told me to Kill!” This raised new questions for the forensic psychiatrists in the case, who found it difficult to accept the unpopular “cultish” view that God may indeed command one to kill. Whereas some Western religious cult leaders are available for psychiatric interview in the West, most Eastern ones are not so available, so our knowledge of their characteristics is based less on rigorous psychiatric interview, and more on soft historical records, often written by their enemies and therefore of questionable value. Lastly, we review some differences between Western and Eastern psychology / logic, which may be relevant to the dynamics of the seduction process for indoctrination into an Eastern religious cult.

Introduction to ECT

Introduces and elaborates a distinction between the ‘classic’ and ‘romantic’ perspectives. Contextualises the terms using Goethe’s idea of ‘world literature’. Draws out qualities such as the ‘Olympian detachment’ of the classic perspective and the temporality, self-awareness and will to action of the romantic perspective with right and left political hues. Explores prototypes both in and out of psychiatry and outlines how the perspectives will be used in the book.

Examines the concept of hoarding, what it is and how some animals and most people have a tendency to collect items beyond their immediate requirements. The distinction is made between a hoard and a collection. The types of items which are hoarded are discussed along with a description of animal hoarding.

Social aspects of hoarding. We address the stigma of hoarding and how this can be treated by society, along with discussion of the shame and humiliation which prevents many people with hoarding problems from seeking help. This stigma can be reinforced by “helping” agencies who may view it as a “lifestyle choice” rather than a condition which requires help. Then looking at the role the media has played in perpetuating the myth that hoarders should be able to deal with it themselves.

Hoarding is a symptom rather than a distinct diagnosis and may be found in many conditions but there is a specific condition with characteristic features known as Hoarding Disorder. Some possible causes of hoarding are then described followed by a more detailed examination of the diagnosis of Hoarding Disorder

Finally, the chapter examines t what age hoarding arises and introduces the idea of hoarding in childhood.

Doppelgänger is a term drawn from the writing of Jean Paul Richter in his novel Siebenkäs. This term is examined and discussed in this chapter. It stands for the possibility of the existence of a double of a living person and therefore raises questions about the nature of the self and of mind too. The concepts of self and mind are explored and the implications for philosophy of mind are examined. The importance of attending to the empirical literature rather than using thought experiments is emphasized.

This chapter provides a brief review of basic neuroanatomy, followed by a more detailed description of structures and pathways important for neuropsychiatric practice. The focus will be on the limbic brain and the functional anatomy of emotion, memory, cognition and behaviour. A more comprehensive review of general neuroanatomy can be found in standard textbooks such as Johns, Clinical Neuroscience.

Months later, Harry has changed his mind. He found that his drug use started to affect important parts of his life. His academic performance dropped further, and cannabis made him increasingly paranoid. With support, he has stopped using drugs completely, although he has not ruled out trying them again in the future. He has needed to change some of his friends but seems happier for this. The paranoia has improved, and he is able to study again.

Writing about mental illness, treatment and stigma; being a mother, wife and friend as well as doctor and patient.

People reasonably expect their healthcare professionals to avoid causing harm. In the UK, there are various clinical and governance checks and balances to ensure that the individual is safe and treated with appropriate evidence-based care, and safeguards by the state to explore and investigate when these appear to have been breached. These include internal organisational disciplinary proceedings, public complaints processes, ombudsman investigations, civil claims for compensation, and criminal prosecutions, among others. In England and Wales, the coroner’s inquest is one such check and balance.

An introduction and overview of intellectual disability. The American Psychiatric Association (APA) diagnostic criteria for intellectual disability (DSM-5 criteria) are covered: Deficits in general mental abilities; Impairment in adaptive functioning for individual’s age and sociocultural background which may include communication, social skills, person independence, and school or work functioning; All symptoms must have an onset during the developmental period; The condition may be subcategorised according to severity based on adaptive functioning as mild, moderate, or severe. The chapter also covers the role and evidence base for medication and key issues when prescribing for people with intellectual disability.

The death of George Floyd in 2020 spurred the Black Lives Matter movement and generated widespread social consciousness about the persistence of institutional racism in its many forms and the impact it has had in creating disparities in healthcare, education and criminal justice. One significant response was in the push for educational reforms, particularly in North America and parts of Europe, to decolonise. This book continues the decolonising work done in the pioneering field of cultural psychiatry, focusing on the UK context. Cultural psychiatry has made headway in decolonising former traditions of psychiatry. A gap that needs to be addressed with some urgency, however, is the representation of views of non-white psychiatrists. An assumption when discussing therapeutic relationships is that the patient is from an ethnic minority background, often from a BAME group, and by implication, the psychiatrist is white and from the majority group. The second part of this assumption overlooks the experiences of psychiatrists from non-white ethnicities, and it is this that defines the scope of the book. Elicited through interview, the accounts explored the lived experiences of South Asian psychiatrists in the UK, negotiating the shifts between their cultural identities especially framed as the culture of their ethnicity and British culture.

It is a privilege to edit a textbook in the subject to which we devote our professional lives. We were both influenced by Derek Chiswick and Rosemary Cope’s text that set out a list of essential topics. Part of the reward for the work of renewing this textbook has been to nudge new topics into the canon of forensic psychiatry.

Psychosis is the generic name given to a range of illnesses that can affect the mind and interfere with how a person thinks, feels and behaves. The term psychosis covers several different conditions, for example, drug-induced psychosis, psychotic depression, schizoaffective disorder and schizophrenia spectrum disorders. The precise name used can change over time and will depend upon the pattern and length of difficulties that an individual has. A diagnosis of schizophrenia is considered the most severe type of psychotic illness and almost one person in every hundred people will be diagnosed at some point in their life. It used to be thought that schizophrenia was a discrete illness that was quite separate from other psychotic illnesses such as depressive psychosis.

Psychiatry, according to Johann Christian Reil (1759–1813), the German anatomist who first coined the term, consists of the meeting of two minds, the mind of the patient with the mind of the doctor. As the patient’s story unfolds, the doctor’s task is to recognise the pattern and to do so with compassion. Pattern recognition lies at the heart of the diagnostic process throughout medicine and none more so than in psychiatry, which lacks almost all the special investigations that help clarify diagnosis in other medical specialities. Thus, detailed knowledge of the key features of all the psychiatric disorders, both common and rare, is the core body of information that the psychiatrist will need to acquire during their training years. Because of this, we have provided detailed descriptions of each and every disorder as well as their diagnostic criteria according to DSM-5 and ICD-11.