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.

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.

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.

Alexander Crichton’s Inquiry (1798) was one of the first systematic English-language works on mental disorder. Although a general physician rather than a specialist, Crichton sought to explain how emotions, attention and the nervous system interacted to produce disturbance. His description of inattention is now regarded as the earliest English medical account of what we would call an attention disorder. He drew extensively on German case reports, vivid accounts of melancholy, delusion and violence. He highlighted how delusion could coexist with calm, purposeful behaviour, influencing both medical and legal views of responsibility. Modern historians see Crichton as a synthesiser rather than an originator, but his Inquiry remains an ambitious attempt to ground the study of mental disorder in physiology, observation and compassion.

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?

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 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.

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.

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.

Roger Smith’s Trial by Medicine: Insanity and Responsibility in Victorian Trials traced how Victorian Britain defined legal insanity. Through an interdisciplinary approach, Smith demonstrated how determinations of criminal responsibility were shaped by more than legal reasoning alone, with verdicts also influenced by professional ambition among expert witness groups often with divergent medical opinions, in addition to broader factors such as social class, gender and evolving moral values. Given its rigour and societal insights, it represents a landmark achievement in the field.

This article describes a trainee-led women’s health project aimed at connecting psychiatry and gynaecology to better meet the needs of perimenopausal and menopausal women. Cognitive–behavioural therapy (CBT) is a NICE-recommended treatment for menopause-related vasovagal symptoms. A menopause-focused CBT (mCBT) group intervention for women unable to take hormone replacement therapy was developed and piloted in collaboration with local menopause specialists. This article documents some of the challenges experienced and insights gained along the way by the trainees who developed it.

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.

Internet-delivered cognitive and/or behavioural therapy (I-C/BT) for post-traumatic stress disorder (PTSD) addresses problems of access to evidence-based psychological treatments and is becoming more widespread. This commentary explores the effectiveness of I-C/BT for PTSD compared with waiting-list/treatment as usual controls as reported in Simon et al’s (2021) Cochrane Review and in subsequent studies. The results suggest that I-C/BT may reduce PTSD symptoms immediately post-treatment, without long-term effects. However, the very low certainty of evidence and inconsistent quality of I-C/BT interventions prohibits recommendations until further high-quality research becomes available.

Clozapine is the only medication specifically recommended for treatment-resistant schizophrenia, but research suggests that it is universally underprescribed, particularly among children and adolescents. This article discusses clinicians’ reluctance to prescribe clozapine for all age groups, and outlines its benefits for treatment-resistant schizophrenia in young people. It summarises guidelines on clozapine therapy for adults, including initiation, monitoring and adverse and side-effects, and describes how they can be applied to a younger population. Psychiatrists who care for younger people have consistently highlighted a wish for more learning opportunities focusing on clozapine, such as the content of this article.

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.

Scull’s Madhouse gives a meticulously researched account of the actions of Dr Henry Cotton, a psychiatrist working in the New Jersey State Hospital at Trenton in the early 20th century. Cotton believed that mental illness resulted from undetected infection in various parts of the body, and with the aim of eradicating said infections, he and his team operated on hundreds of patients, with significant rates of resulting morbidity and mortality. This article gives a summary of Professor Scull’s book, as well as a series of learning points from the book that can be used to guide reflective practice.

This article presents a narrative review of the literature on hoarding disorder, its aetiology and management. Hoarding disorder is defined by the excessive accumulation of items, leading to living environments that become so cluttered that their functionality and safety are compromised. It is a multifaceted condition that has an impact on both health and social care systems. Some individuals with this disorder show no signs of additional mental health problems, whereas for others, the effects on their mental well-being, their families and the surrounding community can be profound. Given the societal issues that hoarding generates, effective treatment strategies must extend beyond a clinical focus on the individual to encompass a collaborative approach that addresses both the home environment and the potential repercussions for the wider community.

Trauma and Recovery by Judith Herman was published in 1992. This article explores its relevance and legacy for today in the trauma field, particularly with the new ICD-11 diagnosis of complex post-traumatic disorder.