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 reflects on a collaborative drawing group in a mother and baby unit, exploring the clinical value of arts-based interventions in perinatal psychiatry. Grounded in an evolutionary and biopsychosocial theory, it highlights how creative practice can reduce hierarchy, support emotion regulation and foster relational safety. A practical group model is described, encouraging clinicians to draw on their own creative skills to enrich care, build connection and hold space for meaning beyond symptom management.

Medical education has had a strong tradition of building reflective skills and concrete experimentation on a foundation of new ideas and knowledge. The BJPsych Advances special issue ‘Psychiatry in medical education’ introduced in this editorial is a feast for readers, inviting them to learn the latest advances in teaching and assessment across the world and to reflect on how this new knowledge might change their own practice, ultimately benefiting patient care.

High expressed emotion (EE) in families is known to increase risk of relapse for people with schizophrenia. This Cochrane Review by Chien et al suggests that family-based interventions such as psychoeducation may result in a reduction in caregiver burden, a shift from high to low EE, and perhaps also reduce patient relapse rates. However, there was a high degree of heterogeneity in the combined study sample and a significant risk of bias across studies. The authors’ decision to only include studies reporting both a family member and a patient outcome means relevant evidence in this area may not have been incorporated.

Entrustable professional activities (EPAs) have gained traction in the medical education field as a means of assessing competencies. Essentially, an EPA is a profession-specific task that a trainee is entrusted to conduct unsupervised, once deemed competent by their supervisor through prior evaluations and discussions. The integration of EPAs into postgraduate assessment strategies enhances the delivery of capability-based curricula. It strategically bridges the theoretical–practical divide and addresses existing issues associated with workplace-based assessments (WBPAs). This article aims to (a) provide an overview of EPAs, (b) review the application of EPAs in postgraduate psychiatry so far, exploring their conceptual framework, implementation, qualities and potential benefits and concerns, and (c) propose a theoretical framework for their integration into the UK psychiatry curriculum.

Alzheimer’s disease is a progressive and incurable condition and the leading cause of dementia worldwide. Lim et al’s (2024) Cochrane Review on the acetylcholinesterase inhibitor galantamine and its effects in Alzheimer’s disease and mild cognitive impairment (MCI) concluded that the drug slows cognitive and functional decline in Alzheimer’s disease, but not in MCI. However, in several studies the handling of data after drop-out was a potential source of bias. In this month’s Round the Corner, we also propose that the characteristics of the patient sample limit the external validity of the findings, and that the research question, although valid, is of limited practical importance.

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.

This commentary responds to a case study of a drawing group on a perinatal psychiatric ward, framing it as a threshold practice: one that invites creative presence between clinician and mother, between symptom and symbol. The commentary highlights the therapeutic potential of shared non-verbal creative acts, but points to the potential for aesthetic coercion and the ethical tensions that arise when clinicians step into aesthetic space alongside patients. It argues that arts interventions in mental health require neither romanticisation nor reductive measurement, but a critical and generative mode of engagement attuned to thresholds, relationships and the fragile work of recovery.

Validity tests are used in both forensic and clinical settings, but their application in clinical practice is often hindered by misconceptions. These include the assumptions that validity tests imply a medico-legal dimension, primarily detect feigning or malingering, and provide minimal actionable information to clinicians. The authors critically discuss these misconceptions and argue that validity tests may offer significant value in clinical practice by assessing whether patients can describe their symptoms, complaints and impairments with reasonable accuracy, which has important implications for diagnosis and treatment planning. Importantly, in clinical practice, when interpreting validity tests, neutral terminology such as ‘over-reporting’ and ‘underperformance’ is often preferable to – and better to substantiate than – terms like ‘feigning’ and ‘malingering’, which can evoke moral judgements, creating an unnecessary barrier to using these valuable clinical tools.

Mirroring the general population, the number of medical students, doctors and, indeed, psychiatrists disclosing being neurodivergent is rising. These individuals commonly have a variety of strengths that can enhance their work, but these strengths may go unrecognised. All too often such individuals have been labelled ‘doctors in difficulty’. We begin this article with a review of contemporary thinking regarding neurodiversity, before considering specific issues facing neurodivergent doctors, specifically psychiatrists. We explore neurodivergent strengths and the evidence regarding career outcomes and mental health. We discuss the stigma that many neurodivergent psychiatrists face in the medical sphere and how difficulties may be reframed as unmet needs. We highlight initiatives that aim to change workplace culture, before discussing the concept of reasonable adjustments, alongside a wide range of practical suggestions of adjustments to consider, using the Autistic SPACE framework and the Royal College of Psychiatrists’ reasonable adjustments guidance. Finally, we consider how those in senior leadership roles can contribute to this field and provide role modelling and signposting to further information and support for neurodivergent doctors and their supervisors and line managers.

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.

Bullying among girls is often subtle and relational, which can go unnoticed by parents, teachers and healthcare professionals. This article explores how covert aggression – such as social exclusion, gossip and emotional manipulation – can cause profound psychological harm to targeted girls, many of whom may not even realise they are being bullied. Through an analysis of defining attributes of girl-to-girl bullying and general implications for mental health, this article aims to highlight the importance of early identification and treatment. The article also points out how social patterns of bullying found predominantly in girls’ social circles carry over well into adulthood, emerging in the work environment, social circles and cyberspace. Focused on practical application, this educational paper aims to enhance clinicians’, caregivers’ and teachers’ recognition of relational aggression, develop collaborative approaches to prevention and facilitate useful interventions for those affected. Ultimately, increased sensitivity to subtle bullying has the power to reduce subsequent harm and result in healthier social contexts.

Perceptual disturbances are common in psychiatric and neurological conditions, yet some rare, non-psychotic disorders remain poorly recognised. This review examines two such syndromes: visual snow syndrome (VSS) and exploding head syndrome (EHS). VSS is marked by continuous ‘static’ across the visual field, often accompanied by palinopsia, photophobia and entoptic phenomena. EHS involves sudden, loud auditory sensations – like explosions or crashes – occurring during transitions between sleep and wakefulness. Although distinct in modality, both share common challenges: subjective distressing symptoms, normal investigation findings, frequent misdiagnosis and psychiatric comorbidities such as anxiety, sleep dysfunction and depersonalisation. The article synthesises emerging evidence on their neurobiological underpinnings, including cortical hyperexcitability, thalamocortical dysrhythmia and impaired sensory gating, and on pharmacological and non-pharmacological treatment options. Enhancing clinical awareness and adopting a multidisciplinary approach are essential for improving diagnosis and care. This article aims to support psychiatrists in recognising, differentiating and managing these complex perceptual disorders.