Natural disasters occur infrequently in Europe, but the spate of transportation, crowd and other disasters in the late 1980s challenged our collective denial of potential catastrophe. Greater attention is now given also to the frequent small-scale traumatic events which are just as devastating to the many people affected by them, such as violent assaults and road accidents.

‘Best interests' is a key principle of the Mental Capacity Act 2005 (England and Wales), Mental Capacity Bill (2014) (Northern Ireland) and Mental Health Act 2001 (Ireland), although there are currently proposals to remove ‘best interests' from Irish legislation. Legislation in Scotland refers to ‘benefit’ resulting from interventions. Judicious use of ‘best interests', in line with guidelines that prioritise the person's autonomy, will and preferences, is a powerful way to promote the values and rights that underpin the United Nations Convention on the Rights of Persons with Disabilities and to safeguard the dignity of individuals with mental disorder and/or reduced mental capacity.

Healthcare provision in the UK is in a process of continual change. The structures and processes by which people with mental health problems and people with learning disabilities receive support from statutory services have been, and continue to be, subject to many and varied strategic, policy and professional influences. Integrated and collaborative ways of working between generalist (‘primary’) and specialist (‘secondary’) care have become eroded over time and yet they may be needed more than ever. In this editorial we encourage a collaborative approach between practitioners in generalist and specialist care in studying and developing three strands of work: policy and strategy; training; and professional behaviour. Above all, we advocate strongly for a renewed and dynamic dialogue between psychiatrists and general practitioners in working together to provide high-quality mental healthcare.

Significant developments in schizophrenia psychopathology are ready to be incorporated into clinical practice. These advances allow a way forward through the well-described challenges experienced with current diagnostic and psychopathological frameworks. This article discusses approaches that will enable clinicians to access a wider and richer spectrum of patient experience; describes process-based models of schizophrenia in the domains of both the brain and the mind; and considers how different levels of analysis might be linked via the predictive processing framework. Multiple levels of analysis provide different targets for varying modalities of treatment – dopamine blockade at the molecular level, psychological therapy at the level of the mind, and social interventions at the personal level. Psychiatry needs to align itself closer to neuroscientific research. It should move from a symptom-based understanding to a model based on process. That is – after having asked about a patient's symptoms and experience clinicians need to introduce steps involving a consideration of what might be the brain and mind processes underlying the experience.

This article is a practical guide for psychiatrists who want to apply basic and straightforward statistics in their research. It describes ways of summarising data and provides an overview of statistical tests for comparing patients' characteristics. Measures of association such as correlation and regression are also explained, along with principal components analysis, a method for reducing the dimensionality of data. Explanations are clarified using data from the published studies.

Tourette syndrome is a complex neuropsychiatric disorder of juvenile onset, characterised by motor and phonic tics. It is associated with a number of comorbid psychiatric conditions and a reduced quality of life in the young person and with parenting stress, caregiver burden and psychopathology in the parents. The global prevalence (about 1%) is higher than previously thought, with a strong male preponderance. Evidence is emerging that Tourette syndrome is not a unified disorder; rather, it encompasses a number of subtypes, characterised by complexity of tics and the simultaneous presence of other behaviours or disorders. This article discusses the aetiology of the syndrome, and examines its clinical features and comorbid psychiatric conditions and psychopathologies. Assessment and diagnosis are also discussed. Psychoeducation is a cornerstone of management, augmented with behavioural and/or pharmacological treatments. Newer therapies, such as deep brain stimulation, offer tantalising possibilities, but further research is still needed.

Leadership is a key role for psychiatrists, with many models that can be adopted depending in part on the nature of the individual and their training, the primary task of the team and the nature of the organisation. In this article we suggest a new concept and model of leadership, ‘psychotherapeutic leadership’. We discuss the theoretical background to this model, its benefits and the implications for training and professional development.

Post-traumatic stress disorder (PTSD) is a complex, heterogeneous mental health problem that can be challenging to identify, assess, understand, diagnose and treat. This article provides an overview and critique of key topics, literature and principles to inform comprehensive and meticulous assessment of PTSDs. Although expert witnesses are the target audience, this article will have relevance for identifying, assessing, understanding and diagnosing PTSDs in all clinical contexts. A range of topics relevant to assessment are discussed, including: the complex relationship between trauma and PTSDs; DSM-5-TR PTSD and ICD-11 PTSD and complex PTSD diagnoses and the similarities and differences between them; the clinical presentation of PTSDs; psychological models of PTSDs; how to approach assessment and differential diagnosis; the impact of PTSD on neuropsychological abilities and functioning (disability); causation, reliability and assessing PTSDs when this is being considered as a legal defence; evidence-based interventions (medication, psychological therapy, when is the ‘right time’ for therapy, contraindications); and prognosis (if untreated, how long therapy/change takes). Given ongoing debate, the article proposes that trauma exposure is best defined in future iterations of the DSM and ICD as exposure to one or more psychologically threatening or horrific experiences that are overwhelming.

Cognitive—behavioural therapy (CBT) provides a structure to inform safe and effective practice. It can be helpful for understanding and working with patients, but it can have a wider potential benefit, offering clinicians and teams a self-reflective approach to how they respond to the challenge of working in busy clinical and managerial environments.

The interpersonal dynamics between patient and doctor remain a daily challenge for clinicians, and reflective practice is a tool that allows them better understanding of how patients engage with treatment. The interpersonal dynamics consultation is a form of group-based reflective practice for patients with difficult relational (interpersonal) styles. It includes the whole multidisciplinary team in a systematic consultation in order to arrive at new understanding and management plans for these patients. Interpersonal dynamics consultations have been used successfully for many years in mental healthcare, and this article has arisen from a project exploring their application in physical healthcare settings. The project works to promote effective working at the interface of physical and mental healthcare and facilitates the important translational work of making psychiatry and psychotherapeutic ideas applicable in a broader context. This article outlines the interpersonal dynamics consultation model and illustrates its use in three fictitious cases from different medical specialties.

This article considers the role of experts and their interaction with the legal system to better understand the benefits and potential dangers of expert evidence to fact-finders in trials. Medical experts are indispensable to the administration of justice as litigation ranges beyond what judges or juries comfortably deal with as facts of everyday life. This would render courts, absent expert evidence, vastly under-equipped in making decisions of fact. However, the dangers of surrendering authority to experts or of misunderstanding their role must be considered to ensure that expert evidence is used to benefit the administration of justice.

Autoimmune disorders in children and adolescents can have significant neuropsychiatric complications and there is growing interest in the association between autoimmune conditions and psychiatric syndromes, particularly in Down syndrome. Acute presentations with psychiatric symptoms require careful assessment in order to recognise and plan treatment of underlying autoimmune disease in collaboration with paediatric colleagues. Difficult treatment decisions arise in children with established autoimmune diagnoses and psychiatric symptoms that may be a result of neuroimmunological processes associated with their condition, psychiatric side-effects of drug treatments or psychopathology resulting from other factors in the history that may or may not have a direct relation to the autoimmune diagnosis. This article illustrates these complexities through discussion of specific autoimmune disorders and three case histories.

There is no direct coherence between medical and legal concepts or between medical and legal ways of thinking (Eastman, 1992). As a result, there are often substantial difficulties in translating the findings of one (medicine) into the decisions of the other (law). In order to minimise interdisciplinary confusion, it is necessary for each to have an understanding of the approach of the other. This paper attempts to elucidate the relationship between law and psychiatry as it is played out specifically in personal injury litigation and in relation to civil legal claims for (legal) ‘nervous shock’. It is not confined solely to claims arising out of the development of post-traumatic stress disorder (PTSD) (Eastman, 1995; Napier, 1995), but is applicable to any psychiatric sequelae of events for which legal liability of a defendant can be established. It also offers general comments about the provision of civil psycho-legal assessments, advice and opinion writing (Carson et al, 1993) as a backcloth to its more specific purpose.

Psychiatry faces a number of external and internal challenges. At the heart of its difficulties is an identity crisis and attempts to resolve this have so far split the specialty. British psychiatry has in recent years taken an increasingly ‘neurophobic’ stance. This article argues that, despite the current situation, opportunities remain for a medicine of the mind to thrive. Neuroscientific advances in our understanding of psychiatric disorders need to be made more explicit in training and in the structure of mental health services.

A 19-year-old student, wandering the streets of a Northern city, is picked up at 3am by a taxi driver. The student requests delivery to a fictitious destination. The student recounts to the driver a series of events including abandonment by parents at the age of six in a forest in the West Country, and subsequent adoption by an elderly couple who live in Birmingham. The taxi driver takes the student to the central police station, where, after a brief interview, sectioning under the Mental Health Act 1983 takes place.

This article gives an update for practitioners on recent developments in the use of electroconvulsive therapy (ECT) and related treatment modalities in the contemporary treatment of depression in the UK. Details are provided on new information on the efficacy and side-effects of ECT both in research studies and in the real world, together with recent research on ECT's mode of delivery. There is a focus on the safe administration of ECT in clinical practice. An update on the regulatory framework for ECT in the UK is provided, together with up-to-date information on the legal situation regarding its prescription. Finally, brief summaries of the current position for other neuromodulatory treatment modalities are given.