This brief article outlines a training programme, implemented during day-to-day practice, to teach psychodynamic skills to resident doctors in a variety of specialties and at all levels of training. By identifying and exploring the interpersonal dynamics between individual patients and staff, psychiatry residents learn skills such as psychodynamic assessment and formulation, intervention planning and risk reduction.

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 burden of cancer worldwide is rising, with 20 million new cases diagnosed in 2022. In Europe, 1.2 million women are diagnosed with cancer annually and an estimated 600,000 women die from cancer each year. International research and data from Ireland demonstrate that women with cancer face a particular set of challenges, including increased psychological distress compared to men. As a result, Ireland’s Model of Care for Psycho-Oncology could usefully place greater emphasis on gender-specific provisions which address the increased psychological needs of women. To date, Ireland has made some progress in recognising the physical and mental healthcare needs of women and developing gender-informed policies. It is essential that such policies are implemented fully so as to reduce and eliminate disparities in care. A more tailored, gender-informed approach would also help ensure the provision of gender-aware psycho-oncological care for all women and men as they navigate their cancer journeys.

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.

Sleep disturbances are common in dementia and are associated with numerous problems. Medication is not clearly effective and is potentially problematic, giving a clear role for non-pharmacological measures. The Cochrane Review discussed here suggested that physical and social activities and carer interventions potentially improve sleep in dementia, although the evidence was not conclusive. The review was limited by the heterogeneity present and the low quality of evidence. The authors’ choice of primary outcomes leads to a wider discussion on the clinical relevance of available outcomes in evaluating sleep in dementia and the potential role for patients and carers in informing this.

This article is a concise refreshment for psychiatrists to update their knowledge and understanding of corticosteroid-induced psychiatric symptoms. It summarises the diverse presentation associated with this clinical phenomenon, how frequently it occurs and some pathophysiological considerations. There is a focus on early identification and management, highlighting the importance of an integrated multidisciplinary approach, withdrawal or reduction of the corticosteroid treatment and adjunctive psychotropic medication options for clinicians to consider.

This editorial introduces the first of two special issues of BJPsych Advances devoted to liaison psychiatry, reflecting collaborative healthcare for patients presenting with both physical and mental health conditions, whether in acute general hospitals, out-patient clinics, in-patient wards or accident and emergency departments.

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.

Domestic abuse harms children and families. Self-harm is associated with exposure to and perpetration of domestic abuse, but research on health service responses to self-harm in the context of domestic abuse is limited. We discuss recent work examining the response of mental health professionals to domestic abuse in the emergency department by Knipe and colleagues. Thematic analysis of interviews with 15 mental health professionals working in consultation and liaison settings helped to construct themes including a fear of deeper exploration and tensions between identification and response (‘between knowing and acting’). The paper raises important issues for quality improvement in responses to self-harm in liaison settings, including balancing time and resources across different management needs (including domestic abuse response) and professional perceptions of their own actions in clinical settings, such as acknowledging harmful behaviour. The paper demonstrates opportunities for strengthening responses to domestic abuse in professional training.

Primary hyperparathyroidism (PHPT) is the presence of hypercalcaemia with an elevated or inappropriately normal parathyroid hormone level. In clinical psychiatry this is often detected on routine blood investigations. This article aims to help mental health professionals understand the relevance of PHPT to psychiatry and offers some guidance about further management of patients presenting with this endocrine abnormality in mental health settings. PHPT can be associated with both mental and physical health problems in some individuals, making it a crucial diagnosis that should not be overlooked.