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.

There has been a boom in the availability of wearable neuromodulator devices for the treatment of mental health problems. These can be purchased outside of medical practitioner oversight or prescription. Psychiatrists need to know what these can offer and consider whether, and how, they may be integrated into psychiatric practice. This article briefly considers examples of these devices and their evidence base. It describes the experiences of the author and her husband in using such devices for their own mental healthcare and well-being.

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.

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.

Only a minority with mental disorders worldwide receive treatment with negligible coverage of interventions to prevent associated impacts, prevent mental disorders or promote mental well-being. Reasons include insufficient public mental health (PMH) skills and training. An electronic search found limited availability of PMH courses globally. Improved access to PMH training informed by a core curriculum will support sustainable reduction of mental disorders, promotion of population mental health well-being and broad associated impacts across sectors. Regular assessment of PMH training coverage and impact will support sustainable progress.

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.

This article aims to help clinicians better assess and manage patients who show ‘problematic detachment’: interpersonal distancing that is resulting in functional impairment or distress. It considers both the possible relevant social contextual factors and the wide range of possible underlying psychopathologies that can result in problematic detachment, including mental illnesses, neurodevelopmental disorders and personality pathology. After giving a practical framework for diagnostic formulation, it summarises key aspects of best practice when working with such individuals. The article covers four key questions that the clinician must address. Is problematic detachment present? If so, what specific challenges underlie and maintain it in this person? Based on that, what diagnostic formulation makes sense for this individual? Finally, using this understanding, how can they best treat this individual?

Psychiatry education at both undergraduate and postgraduate level plays a critical role in shaping the future of psychiatry services. South Asia varies in the training offered and this article captures this aspect.

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.

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.

Large language models (LLMs) like OpenAI’s ChatGPT, Google’s Gemini and Anthropic’s Claude can be useful tools in psychiatric practice, helping with tasks such as searching for information, managing administrative work and supporting education. This article demystifies how these tools work by explaining their core operational principles and noting their key limitations, including the risks of confabulation (fabricating information), sycophancy and knowledge cut-offs. It provides practical guidance on mitigating these risks through structured ‘prompt engineering’ and offers a safety framework for integrating LLMs into low-risk administrative and educational workflows. The article stresses the importance of approaching these technologies with caution by independently verifying information, adhering to UK data protection laws and upholding the principles of best practice in patient care. The goal is to help clinicians use these powerful but fallible technologies wisely, ensuring that patient safety and professional responsibility remain paramount as they explore these new tools.

This reflection explores the unique challenges and opportunities in psychiatric medical education in the Middle Eastern region. The variation in aspects of teaching across the region can be explained by the influence of cultural and religious perspectives on the understanding of mental illness. Key barriers include pervasive stigma, shortages of teaching staff and limited clinical placements. Innovations like virtual learning and regional collaboration offer pathways to strengthen curricula, enhance competency-based assessment and further improve the future of psychiatry education.

Selective serotonin reuptake inhibitors (SSRIs) are a key treatment for adolescent depression and anxiety, yet their sexual side-effects are often overlooked. Although well-documented in adults, sexual side-effects in adolescents remain under-researched and rarely discussed in clinical practice. This lack of awareness can contribute to distress, self-esteem issues and treatment non-adherence. Adolescence is a crucial time for sexual development, making recognition of sexual side-effects particularly important. However, young patients may not report these effects because of embarrassment or unawareness, and clinicians may avoid the topic because of discomfort or time constraints. By addressing sexual side-effects proactively, as highlighted in this article, clinicians can improve patient engagement, treatment or management adherence and overall mental well-being.

Hong Kong has two established medical schools, at the University of Hong Kong and at the Chinese University of Hong Kong (CUHK), and these are soon to be joined by a new school at the Hong Kong University of Science and Technology (HKUST). This article outlines undergraduate psychiatry education in the 6-year MBChB programme at CUHK and in a new medical school at HKUST.

Analysis of court and tribunal judgments in cases where expert psychiatric evidence has been admitted reveals widespread misunderstandings and misuse of the diagnostic and statistical manuals published by the American Psychiatric Association and the similar publications of the World Health Organization. Examples are given here of cases in which their use has caused difficulties in the delivery of justice. For them to be a help and not a hindrance, it is suggested that when used there should be appropriate explanation as to their status, nature, purposes and limitations and that expert witnesses should handle them with the care that they require.

Obsessive–compulsive symptoms (OCS) and obsessive–compulsive disorder (OCD) are commonly observed to be associated with clozapine, but are often underdiagnosed in clinical practice. This can have a negative impact on a patient’s quality of life and prognosis. This article provides a brief guide for clinicians on managing clozapine-associated OCD/OCS to optimise patient care.

Experiences in Groups is a revolutionary text in the understanding and analysis of group dynamics which remains highly relevant to mental health practice today. This article considers its key themes as well as its development in the context of Wilfred Bion’s work as a doctor and a psychoanalyst.

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.