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 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.

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.

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.

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.

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.

Breast cancer is the most commonly diagnosed cancer worldwide. An estimated 1 in 7 women in the UK will receive a diagnosis during their lifetime, and up to 20% of people with breast cancer are treated with selective serotonin reuptake inhibitors (SSRIs). This comorbidity is a particularly important consideration for those co-prescribed hormonal cancer treatments. This article explores the complex relationship between breast cancer and mental illness, examining associations between hormonal breast cancer treatments, the premature menopause they can induce and SSRIs. It addresses prescribing considerations in this population, focusing on the co-prescribing of endocrine treatments such as tamoxifen and aromatase inhibitors with SSRIs and other psychotropic medications.

This article explores the intersection of neurology and psychiatry in the assessment of psychosis. It provides a practical overview of neurological disorders associated with psychosis, including epilepsy, autoimmune encephalitis, neurodegenerative dementias, Parkinson’s disease, Huntington’s disease, Creutzfeldt–Jakob disease, cerebrovascular disease, traumatic brain injury, brain neoplasms, multiple sclerosis and genetic neurodevelopmental syndromes. Accurate diagnosis requires recognising clinical red flags and adopting a multidisciplinary approach that integrates psychopathology, neuropsychology, neuroimaging, electrophysiology and biomarker analysis. Treatment strategies vary according to aetiology and may include antipsychotics and others pharmacological resources, immunotherapy, neuromodulation and behavioural interventions.

Functional neurological disorder (FND) presents with a range of neurological symptoms. Therefore, these patients are usually referred to the neurology team, although mental health liaison teams are also commonly involved in their care as in-patients. This article gives an overview of FND in adults, its diagnosis and management strategies, in the acute hospital. It discusses the common diagnoses it can be mistaken for, some techniques for psychoeducation and the value of the patient perspective. It emphasises the significance of clear communication, appropriate use of resources and considerate discharge planning. The role of liaison psychiatry is key, as an advocate for an improved multidisciplinary approach, establishment of local integrated multidisciplinary pathways, enhanced education for all clinicians and ongoing research to optimise treatment. FND needs an individualised, patient-centred approach to address the complex needs of this patient cohort.

This editorial introduces the first of two special issues of BJPsych Advances devoted to liaison psychiatry, reflecting collaborative healthcare for patients presenting with both physical and mental health conditions, whether in acute general hospitals, out-patient clinics, in-patient wards or accident and emergency departments.

Sleep disturbances are common in dementia and are associated with numerous problems. Medication is not clearly effective and is potentially problematic, giving a clear role for non-pharmacological measures. The Cochrane Review discussed here suggested that physical and social activities and carer interventions potentially improve sleep in dementia, although the evidence was not conclusive. The review was limited by the heterogeneity present and the low quality of evidence. The authors’ choice of primary outcomes leads to a wider discussion on the clinical relevance of available outcomes in evaluating sleep in dementia and the potential role for patients and carers in informing this.

Delirium frequently occurs among hospital in-patients, with significant attributable healthcare costs. It is associated with long-term adverse outcomes, including an eightfold increased risk of subsequent dementia. The purpose of this article is to inform clinicians of the best practices for spotting, stopping and treating delirium and provide guidance on common challenging clinical dilemmas. For spotting delirium, suggested screening tools are the 4 ‘A's Test (in general medical settings) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Prevention is best achieved with multicomponent interventions and targeted strategies focusing on: (a) avoiding iatrogenic causes; (b) brain optimisation by ensuring smooth bodily functioning; (c) maintaining social interactions and normality. Non-pharmacological approaches are the first line for treatment; they largely mirror prevention strategies, but the focus of empirical evidence is on prevention. Although sufficient evidence is lacking for most pharmacological approaches, an antipsychotic at low doses for short durations may be of utility for highly distressing or high-risk situations, particularly in hyperactive delirium, but only as a last resort.

Primary hyperparathyroidism (PHPT) is the presence of hypercalcaemia with an elevated or inappropriately normal parathyroid hormone level. In clinical psychiatry this is often detected on routine blood investigations. This article aims to help mental health professionals understand the relevance of PHPT to psychiatry and offers some guidance about further management of patients presenting with this endocrine abnormality in mental health settings. PHPT can be associated with both mental and physical health problems in some individuals, making it a crucial diagnosis that should not be overlooked.

Suicidal and self-harming behaviours present a significant challenge for mental health services. Recent national guidelines advocate abandoning tools based on box-ticking and a move towards a personalised psychosocial assessment. This article examines evidence from theoretical and empirical research in this area and attempts to integrate it by introducing the source–problem–solution–motive (SPSM) model. The model, which builds on the contributions of other suicidologists, specially Jean Baechler, could be used as a framework for the assessment and management of these behaviours. The four stages of the model provide a comprehensive approach that enables an exploration of the internal logic of the behaviour. The model covers ‘because’ and ‘in-order-to’ motives. This allows a personalised approach, but also a structured one that can be taught and generalised.

Paediatric functional gastrointestinal disorders (P-FGIDs) are common, affecting up to 25% of children worldwide. They are characterised by chronic abdominal pain and/or altered bowel habits without an underlying disease pathology. P-FGIDs are often associated with co-occurring anxiety and depression across all ages and treating P-FGIDs may provide an opportunity to develop a young person's wider emotion regulation capacities. Using a fictitious case vignette, we outline the range of psychosocial and biomedical treatments for the disorder and the need for an integrated and holistic approach. We propose that by intervening early and enabling children to be curious about, rather than fearful of, their bodily sensations, clinicians may be able to alter harmful illness trajectories in both pain and psychiatric domains.

Clozapine remains the only evidence-based treatment for treatment-resistant schizophrenia, supported by guidelines from the National Institute for Health and Care Excellence (NICE) and other authorities. However, clozapine is still underutilised for treatment-resistant schizophrenia, despite its proven benefits, including reduced all-cause mortality. This is attributed mainly to its association with adverse effects, including cardiac adverse effects. This review focuses on the latter, with a detailed exploration of clozapine-induced myocarditis – a potentially fatal acute hypersensitivity reaction – and cardiomyopathy, tachycardia and conduction deficits. Among other things, we discuss their pathophysiology, diagnosis and management, with signposting to international diagnostic criteria and monitoring protocols.