As an increasing number of psychiatrists complete training in the UK and move into post-qualification specialist practice in Canada, challenges can arise with adaptation and professional recognition. In this reflection, we examine our experiences over the past 5 years working in and delivering undergraduate and postgraduate medical education in Canada. Patients recognise the unique value of UK psychiatry training; however, this training can also present challenges. We explore some of these issues across the domains of undergraduate medical education, postgraduate psychiatry education and post-qualification specialist practice, using a comparative narrative.

To mitigate the risk of harm to themselves or others, people with mental disorders may require compulsory admission to hospital for in-patient treatment. In England and Wales this is authorised under the Mental Health Act 1983 (MHA). Patients have the right to appeal against this involuntary detention at a hearing before the First-tier Tribunal (Health Education and Social Care Chamber) Mental Health, and psychiatrists may be called on to provide written and oral evidence to the tribunal. The purpose of this article is to help psychiatrists, particularly trainees, understand the sections of the MHA involved, the patient’s right of appeal, the role of the tribunal, their own role as a professional witness, and how to improve the quality of evidence they provide.

Lunatic Asylums, published 130 years ago, is a fascinating insight into how these institutions were managed in the late Victorian era. This brief article considers what it reveals about the zeitgeist of the time and the book's author, the remarkable Charles Mercier.

Despite the recent advances in its diagnosis (heralded by the revisions in ICD-11 and DSM-5) and the introduction of new approaches to treatment, managing personality disorder remains challenging to the psychiatric practitioner. I believe that one of the main reasons for this is that the condition lacks an overall theory that might guide practitioners in their assessment of it and what they might do to intervene. In this article, I suggest that interpersonal theory might be such a candidate, enabling practitioners to manage this condition more effectively. My aim is to provide a brief introduction to this theory in the hope that practitioners might be encouraged to explore its implications more fully.

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.

Children with social communication difficulties or an autism diagnosis and co-occurring mental health needs can struggle to access and engage in psychological treatment. This can have a negative effect on well-being and recovery. A service improvement pilot study investigated the impact of a values-focused intervention on the well-being of this patient group. Here, an anonymised clinical case demonstrates the key phases of the intervention. Reflections highlight the importance of a flexible and person-centred approach for these young people.

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.

The number of academic psychiatrists has fallen in recent years, partly owing to limited academic opportunities for the future professors of psychiatry. In 2019, Koelkebeck et al looked at barriers and facilitators experienced by early career psychiatrists (ECPs) in developing academic capabilities. In a literature review that also used systematic review techniques, the authors searched two databases, the grey literature and conference proceedings, and contacted experts on the topic. Despite the limited number and quality of studies identified, and limitations in data analysis and presentation of results, this review is an important contribution to an under-researched field. The findings are relevant to the design of psychiatry training programmes in the UK and the provision of other academic opportunities to ECPs.

Regardless of any socially held perceptions of privilege or power differentials, boys and men present unique developmental vulnerabilities and disproportionate rates of specific mental health problems, such as disruptive behaviour disorders, substance misuse and completed suicide. Moreover, men are less likely than women to seek help for psychological distress and adhere less well to treatments. In this brief article, some of the unique mental health problems experienced by boys and men are reviewed within a developmental perspective and general clinical guidance is outlined to improve adherence and treatment outcomes.

There is growing concern regarding the increasing prevalence of synthetic opioids and their association with mortality and a range of health and social harms. Recognition, assessment and management of synthetic opioid use is a key challenge for practitioners working in hospitals, prisons and community services. This article gives an overview of the range and characteristics of synthetic opioids, key risks, the prevalence of synthetic opioid-related deaths in England, and prevention and management approaches. It highlights five areas critical to addressing the synthetic opioid crisis: improved access to medication for synthetic opioid addiction; increased naloxone availability and referral to addictions services following opioid overdose; strengthening prevention efforts targeting risk factors such as illicit drug markets and emerging trends in drug use; optimising pain management to reduce the use of prescription opioids and minimise the risk of associated synthetic opioid addiction; raising awareness among healthcare providers, patients and the general public about the dangers of synthetic opioids, including their potency, addictive nature and potential for overdose.

In this clinical reflection, we briefly overview how physicians’ emotion regulation has been addressed within communication training in the context of Western European medical undergraduate, postgraduate and continuing medical education. For illustrative purposes, two examples of recently developed training programmes targeting both communication skills and physicians’ emotion regulation are described. We also discuss the existing gaps in emotion regulation-based communication training, as well as future directions for medical education regarding these skills.

Most psychiatric disorders in adulthood originate in childhood or adolescence. Hence, managing mental health in children and adolescents is crucial. This clinical reflection aims to capture some of the contemporary and emerging trends in teaching and training in child and adolescent psychiatry worldwide. Future directions for child and adolescent psychiatry training programmes are also highlighted.