The different needs, concerns, and preferences of the professions constituting the multidisciplinary team (MDT), including medicine, psychology, nursing, and social work, reflect the hybrid nature of psychiatry and the knowledge and skills required for clinical practice.

Neuroscience has evolved at impressive speed over recent decades. Many of its findings have relevance to psychiatry but are rarely directly translatable into clinical practice. Improving understanding of the psychological dimension of mental illness has led to new treatments with similar efficacy to medications. Our current approach to treating mental illness has also benefited greatly from insights from sociology and anthropology. The value conflicts relating to liberty and personal autonomy versus the medical value of restoring health and societal values around managing risk have led to the development of legal frameworks to aid clinical decision-making. These are, however, far from perfect, and values-based practice (VBP) principles could meaningfully contribute to improving them.

Although traditionally medicine sat at the top of the hierarchy in the MDT, this hierarchy has become more horizontal in recent decades. Close working together with social care is key, but there are pros and cons for both integrated and separate services. Values-based practice can ease some of the tensions in MDT working.

A primary brain injury occurs at the time of initial mechanical trauma. An additional secondary brain injury begins immediately after impact. Inflammatory and neurotoxic processes result in raised intracranial pressure, decreased cerebral perfusion and ischaemia. This secondary injury is worsened by further physiological insults such as hypotension and hypoxia.

Assessment of the patient begins with an ABCD approach and should take place alongside resuscitation. Airway management is the priority, and this must be safely secured when indicated. Cervical spine injury is often associated with a head injury. The neck should be immobilised. Hypoventilation causes hypoxia and hypercapnia. Controlled ventilation to achieve a PaCO2 of 4.5 - 5 kPa and a PaO2 of > 13 kPa is recommended to control intracranial pressure. Hypotension reduces cerebral perfusion; a mean arterial pressure of > 90 mmHg should be targeted. Neurological assessment is undertaken using the Glasgow Coma Scale (GCS). A GCS less than 8 is considered a serious head injury and is often an indication for tracheal intubation. Other indications are described. Transfer to a neurosurgical unit is often required. Safe transfer guidelines must be followed.

In times past, an inquisitive physician-scientist must have pondered these questions: How do we unknowingly breathe? What brain structures control our breathing? Why is breathing so perfectly rhythmic? Is there a lung-brain communication, and if so, how? But an even more fundamental question must have been: how much brain injury can one sustain before breathing stops?

It took two centuries (more or less) to answer the above-mentioned questions and gradually add small pieces to a large (still incomplete) puzzle. The respiratory center in the brainstem was identified and characterized in the late 1800s and early 1900s. Similarly, the function of the respiratory muscles and its neural connection with cranial nerves (CN) became better known.

This chapter recounts the history of the neurology of breathing and, thus, the discovery of the respiratory center and the respiratory mechanics. Sections of the chapter review experimental and clinical discoveries of those parts of the central and the peripheral nervous system involved with breathing while acknowledging their interplay.

Tracheotomy is inevitable in long-term critical illness. Similarly, tracheotomy is warranted in neurocritically ill patients with anticipated long recovery trajectories. Using tracheal cannulas for patients with neurogenic diseases is a common method to facilitate weaning from mechanical ventilation, endotracheal suctioning and/or reduce aspiration. Tracheal cannulas can also be used outside the hospital for the long-term care of patients, when mechanical ventilation and or when endotracheal suctioning is needed, due to tracheobronchial secretions and insufficient cough. This chapter presents in detail the different procedures of tracheotomy and associated complications. Different types of tracheal cannulas are introduced and the management of tracheostomy and tracheal cannulas is outlined. The use of a tracheal cannula entails selecting the right cannula for the patient’s needs and rehabilitation goals. Handling a tracheal cannula also consists of changing the cannula and cannula care. The aim of speech and language therapy along with dysphagia therapy is to enable the patient to participate in society.

Anne Young, a neurologist at Harvard and Mass General, experiences a traumatic life change when her husband, a neurologist and collaborator in her field, returns from a week of neuroscience meetings in Aspen, Colorado, complaining of pain in his throat and dies suddenly in his sleep from a heart attack. Anne tries to be strong for her daughters, Jessie and Ellen. She gains comfort from friends in her field and family, who give her the strength to cope. Most of all, Anne is comforted by Nancy Wexler, a dear friend who is like a second mother to her daughters. Having Nancy by her side lightens the burden and impossibility of caring for herself and her daughters while experiencing an unbearable loss. Nancy accompanies Anne to the Ether Dome for Neurology Grand Rounds for a presentation on organ donation. It is an opportunity for Anne to thank her colleagues and friends during this terrible time and tell them how she donated as many of Jack’s organs as she could for research. The courageous steps she takes to express herself are cathartic, yet, in times of desperation and loneliness, she doesn’t know how her future will unfold.

Many young people report that anxiety in the face of climate change causes impairing levels of distress. Understanding their anxiety includes understanding neurochemical changes to their brains in the face of rising temperatures, natural disasters, disease pandemics, and other stressors. By learning about the ways in which the developing brain balances safety and exploration behaviors, we can encourage resilience and avoid climate-related despair, helping children and adolescents navigate this unprecedented crisis.

Historically, the boundaries between neurology, neuropathology and psychiatry were somewhat blurred as clinicians were encouraged to see disorders of brain and mind as arising from a common organic denominator. It was not uncommon to see psychiatrists at the microscope making landmark discoveries (Alois Alzheimer and Solomon Carter-Fuller, to name just two of them), yet the twentieth century saw these three disciplines fractionate. Neurology and neuropathology retained collaborative threads as neurology became established as the speciality of organic brain disease, while psychiatry did not regain traction as a credible medico-scientific discipline for several decades. Thankfully, the boundaries between the three disciplines are once again blurred as it has become clear that many neurological conditions include symptoms commonly recognised and treated by psychiatrists. This chapter outlines how to approach assessment and diagnosis and gives an overview of psychiatric presentations in several core neurology topics including stroke, epilepsy, Parkinson’s disease and autoimmune disorders.

Until the late twentieth century, literary scholars often assumed that Victorian scientific advances challenged the dominance of religion, theorizing that religious institutions and beliefs decline with modernity. More recently, scholars affiliated with the “religious turn” in Victorian studies have suggested Christian denominations gradually embraced scientific ideas, with new religious movements such as Spiritualism and Theosophy enabling Victorians to preserve elements of Christianity (e.g., belief in an afterlife) in a rapidly changing world. This chapter intervenes in these debates using two very different novels as case studies: Oscar Wilde’s The Picture of Dorian Gray (1890, 1891) and Marie Corelli’s The Sorrows of Satan (1895), both of which freely mix Christianity with science: Wilde blends Catholicism, neuroscience, and aestheticism, while Corelli creatively revises scientific theories to align with her heterodox faith. With their occult and pseudoscientific leanings these works ask us to reconsider what counted as religion or science and to redraw the boundaries of faith to encompass unorthodox trends.