When admitting patients to hospital and treating them, psychiatrists and other health professionals may need to deprive them of their liberty. Where this occurs, professionals will need to work within a statutory framework to practice legally and protect their patients’ right to liberty under Article 5 of the European Convention on Human Rights. Within England and Wales, some clinical scenarios will require a choice to be made between the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA) and its Deprivation of Liberty Safeguards (DoLS). This choice can be complex, is often overlooked and frequently misunderstood in clinical practice. Deciding between the two frameworks must be done on a case-specific basis. With the use of code of practice guidelines, case law and an unfolding clinical scenario we aim in this article to support clinicians in taking a clear-sighted approach to the dilemma and the factors to consider when deciding between the two regimes.

Despite being the most prevalent personality disorder, borderline personality disorder remains a diagnosis with many unanswered questions, particularly concerning pharmacological management. Although many clinical practice guidelines suggest not prescribing medication unless there are significant clinical comorbidities, it is one of the psychiatric diagnoses with the highest rates of polypharmacy. This commentary on a BJPsych Advances article aims to raise clinical questions regarding the voids of knowledge and the appropriateness of medicating and, perhaps, overmedicating in this particular group.

Complex post-traumatic stress disorder (CPTSD) was adopted as a new diagnosis in ICD-11. Trauma-focused cognitive–behavioural therapy (CBT) is effective in treating PTSD but with CPTSD being a recently defined diagnosis, the evidence for its effectiveness in that disorder is not as clear, but it is still promising. This article reviews the diagnosis, psychopathology and some key differential diagnoses, and looks at the two CBT approaches that are currently used in clinical practice: the phase-oriented approach and the unimodal approach. The key aims of this article are to clarify the concept of CPTSD, its differentiation from borderline personality disorder and prominent comorbidities, how it develops and how CBT is used to treat it.

Paediatric functional gastrointestinal disorders (P-FGIDs) are common, affecting up to 25% of children worldwide. They are characterised by chronic abdominal pain and/or altered bowel habits without an underlying disease pathology. P-FGIDs are often associated with co-occurring anxiety and depression across all ages and treating P-FGIDs may provide an opportunity to develop a young person's wider emotion regulation capacities. Using a fictitious case vignette, we outline the range of psychosocial and biomedical treatments for the disorder and the need for an integrated and holistic approach. We propose that by intervening early and enabling children to be curious about, rather than fearful of, their bodily sensations, clinicians may be able to alter harmful illness trajectories in both pain and psychiatric domains.

This article discusses the importance of personal recovery in psychiatry and proposes a new socially constitutive process. The author, an expert by experience, emphasises that recovery is not only an individual endeavour but also an intersubjective one. Moreover, social relationships and external factors such as community, family, health service culture and social norms influence the recovery process. The socially constitutive process posits that support from professionals and family members is crucial, significantly reducing the burden of responsibility carried by individuals with mental illness.

This article responds to Wells & Giacco’s discussion of the theoretical frameworks that guide qualitative research. In addition to the methods they explore, I describe ethnography, focusing on the anthropological investigation of culture. I use examples from the research literature to highlight the unique values of ethnography. I describe what ethnography entails, before outlining illustrations of how ethnographic research has contributed to psychiatric clinical practice. Although it is difficult to generalise from the findings of ethnographic research, its focus on how social processes work and how people perceive them in a particular context makes it useful for advancing improvements in clinical care.

Personality disorders can worsen with age or emerge after a relatively dormant phase in earlier life when roles and relationships ensured that maladaptive personality traits were contained. They can also be first diagnosed in late life, if personality traits become maladaptive as the person reacts to losses, transitions and stresses of old age. Despite studies focusing on late-life personality disorders in recent years, the amount of research on their identification and treatment remains deficient. This article endeavours to provide an understanding of how personality disorders present in old age and how they can be best managed. It is also hoped that this article will stimulate further research into this relatively new field in old age psychiatry. An awareness of late-life personality disorders is desperately needed in view of the risky and challenging behaviours they can give rise to. With rapidly growing numbers of older adults in the population, the absolute number of people with a personality disorder in older adulthood is expected to rise.

Clozapine is the only evidence-based intervention for treatment-resistant schizophrenia. One of the drug's most well-known and potentially fatal adverse effects is agranulocytosis (severe neutropenia). Hence, regular blood tests are an essential component of clozapine treatment. This article presents a narrative review of the history, incidence, potential aetiology and management of clozapine-associated neutropenia. It gives an overview of clozapine monitoring requirements, including those for benign ethnic neutropenia. We point to the growing body of evidence that the risk of clozapine-induced agranulocytosis is mostly confined to the first year of treatment and that the risk of fatality is considerably lower than previously assumed. Given the absence of alternative evidence-based interventions for treatment-resistant schizophrenia, we suggest that rechallenging with clozapine should be considered in most patients with clozapine-associated mild to moderate neutropenia who do not respond to other treatments. A more careful risk–benefit analysis is needed in cases of severe neutropenia (agranulocytosis).

Clozapine remains the only evidence-based treatment for treatment-resistant schizophrenia, supported by guidelines from the National Institute for Health and Care Excellence (NICE) and other authorities. However, clozapine is still underutilised for treatment-resistant schizophrenia, despite its proven benefits, including reduced all-cause mortality. This is attributed mainly to its association with adverse effects, including cardiac adverse effects. This review focuses on the latter, with a detailed exploration of clozapine-induced myocarditis – a potentially fatal acute hypersensitivity reaction – and cardiomyopathy, tachycardia and conduction deficits. Among other things, we discuss their pathophysiology, diagnosis and management, with signposting to international diagnostic criteria and monitoring protocols.

Reduced access to dementia healthcare services by elders from ethnic minority backgrounds is often a manifestation of underlying systemic disadvantages within dementia assessment and treatment services. In this narrative review of current literature on UK dementia healthcare services we identify risk factors contributing to the inequalities faced by people with dementia from ethnic minorities, point to major knowledge gaps in dementia diagnosis, management and long-term care for these groups and highlight clinical challenges arising in delivering services to them. We describe the inequity in diagnostic rates, their poorer treatment outcomes and the lack of culture-specific support for people from ethnic minority communities. We present proposals for South Asian and the Black ethnic minority groups by which local healthcare systems may minimise some of these disadvantages. This will enhance our understanding of the aetiology and management of long-term conditions such as dementia by improving access to and dialogue with ethnic minority communities and healthcare providers.

The Bell Jar (1963) is a semi-autobiographical novel written by the confessional poet, novelist and short-story writer Sylvia Plath (1932–1963). It has been often cited as a recommended reading within the medical humanities, because of its powerful description of depression and the understanding-by-experience of the related psychiatric treatments. This brief article, primarily directed at the clinically oriented reader, presents a selection of excerpts from The Bell Jar to illustrate the main diagnostic features of clinical depression and the vital role of therapeutic relationship quality in hindering or facilitating treatment outcomes and recovery.

Essays on Partial Derangement of the Mind in Supposed Connection with Religion, written amidst the illness of its author almost two centuries ago, was the little-known work of a distinguished physician. Seeking to rebut the argument that religion is causative of ‘derangement of the mind’ it takes a surprisingly biological view of such conditions while, at the same time, affirming the importance of faith, hope and love in human well-being. Despite its limitations, it makes observations that remain relevant to debates about religion and psychiatry today.

This article reviews the seminal work of Jaak Panksepp: Affective Neuroscience: The Foundations of Human and Animal Emotions. It outlines the basis of his theory of Basic Emotional Command Systems as common to all mammals and goes on to specify some of the key fields that have grown out of his research.

Cognitive–behavioural therapy (CBT) has been widely used for a broad range of mental health problems for several decades and has been researched extensively. Its techniques are relatively easy to learn and follow in treatment protocols. Many new CBT-based psychotherapies have been developed that go further than traditional CBT, some specifically addressing personality disorders. These so-called third-wave approaches target emotional responses to situations by using strategies such as mindfulness exercises and acceptance of unpleasant thoughts and feelings (observing thoughts as ‘from afar’). In this article, we discuss the historical context of these therapies, dissect common and specific factors in some treatment modalities often used to treat personality disorders, and suggest potential future directions for research and treatment.

John Thomas Perceval (1803–1876) was confined first to Dr Fox's private madhouse (asylum) in 1830 and transferred to Mr Newington's madhouse at Ticehurst, Sussex, in 1832 until his release in 1834. His account of his incarceration and treatment was published in two versions, the first in 1838 and the second in 1840. In this article I describe Perceval's psychosis, his treatment and management at Dr Fox's madhouse and his reforming and advocating contributions to psychiatry in the period following his release.

The interface between the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA) can throw up complex issues. This article reviews a Court of Protection case that considered this interface specifically in the context of physical healthcare for a patient detained under the MHA. The court analysis also included consideration of the European Convention on Human Rights, the Mental Health Units (Use of Force) Act 2018 and the concept of residual liberty. The judgment describes principles to be applied when considering whether non-consensual physical health treatment for detained patients could result in a further deprivation of liberty. Discussion of other Court of Protection cases considers the issue of communication during a capacity assessment, the MHA/MCA interface in obstetric cases and what test to apply in determining whether a patient could be detained under the MHA. Such principles and guidance are helpful in clinical practice for healthcare professionals who deal with the MHA/MCA interface.

This commentary responds to Carona & Atanázio's discussion of Sylvia Plath's novel The Bell Jar in this issue of BJPsych Advances. Although I agree with their emphasis on empathy and sensitivity in medical practice, I argue that they overlook the broader insights of the medical humanities. By examining themes of suicide and patriarchy in The Bell Jar, I highlight how the novel itself, and the humanities scholars who have studied it, provide a counternarrative to the biomedical model, urging a more holistic understanding of psychological distress. I advocate engaging with Plath's work beyond diagnostic criteria, appreciating its cultural and structural dimensions.