For the purpose of this article, I am using a definition of whistle blowing which was used at a conference in November 1995 at the Royal Society of Medicine:

I read Culliford's article (2002, this issue) with keen interest. I am pleased to comment on some of the aspects from the traditional view of my Islamic faith. Let me begin with the terminology. In Islam, the term spirituality is inseparable from the awareness of the One, of Allah (God), and a life lived according to His Will. This principle of Oneness (Al-tawheed –unity) must be taken into consideration in any study of Islamic spirituality. In the Qur'an, God has manifested that which is within the soul of man. He has ‘breathed into man’ His own spirit. The word that Muslims use for spirituality is ruhaniyyah. Ruh, which means spirit, is mentioned in the Qur'an; ‘The Spirit is from the command of my Lord’ (Chapter 17, verse 85).

Psychiatric services for children and adolescents with learning disabilities have been subject to fashion and aspiration rather than pragmatic planning, at different times being claimed by different specialties. As services have atrophied, it has become clear how distinct are the clinical issues that arise in this group; issues that show developmental psychiatry at its starkest with a combination of organic, dynamic and systemic factors that require community teamwork. As services and specialties regroup, this evolving area is likely to continue defining itself, perhaps taking in adults with developmental disorders, to emerge as a new specialty, developmental psychiatry. It remains to be seen where this will sit within the health service.

Much attention has focused on prompt, accurate identification and treatment of depression and anxiety in primary care settings. Less is known about what to do when treatment is unsuccessful or the initial opportunity to intervene is missed. The long-term prognosis of depression and anxiety in primary care settings is not good: half of sufferers experience a relapsing remitting course and a quarter become chronic. There is also a relationship between chronicity and high service utilisation. The label “heartsink” has sometimes been applied to these patients, often pejoratively.

Dreams have been described as “an endangered species” in general psychiatry nowadays (Holmes, 1991). Liam Hudson (1985) suggests the danger derives from a society which has embraced a naïvely reductionist, oversimplified understanding of neurophysiology. But Hudson also sees a threat to dreams from the increasing variety of visual imagery available for personal creative adaptation through television, computer programs and video recording. Researching this article, I was unable to find a single reference to dreams in the British Journal of Psychiatry over the past 12 years. Theories about dreams are taught to trainee psychiatrists as historical background. In recent years there has been a revival of psychiatric interest in only one kind of dream –‘flashbacks' of traumatic experiences as a feature of post-traumatic stress disorder.

All forms of teaching, including giving a lecture or a seminar, are intended to fulfil one or more particular aims. In planning a presentation, it is helpful to begin by defining the intended aims of the presentation and associated objectives. The aims and objectives will help to determine what methods to use, and what teaching aids might be appropriate. For example, if the main aim of a presentation is to provoke thought and discussion among the audience on a controversial topic, a didactic talk in a large auditorium to a widely dispersed audience is less likely to fulfil this aim than a facilitated interactive discussion in a smaller room with seating not fixed in rows.

This article describes research ethics and the UK research ethics system for psychiatrists who are engaged in research or in supporting trainees with research projects. The emphasis on practical aspects should ensure that submissions to research ethics committees are improved, and consequently the likelihood of a successful outcome is increased.

With the subspecialisation of psychiatry in the UK, clinicians may encounter problems at the interface between specialties. This article focuses on the interface between general adult psychiatry and behavioural neurology/neuropsychiatry. Important interface issues include the identification of psychiatric symptoms in patients with organic brain pathology and the remit and organisation of general and specialist services. Options for optimum cooperation are presented alongside practical examples of clinical issues of neuropsychiatric relevance.

The rise in domestic violence and abuse has been dubbed a ‘pandemic within a pandemic’. Individuals known to mental health services are particularly vulnerable. Yet despite challenges to mitigating domestic violence and abuse in this group, the COVID-19 pandemic has provided opportunities to develop new interventions to support those affected.

Victims of child and other forms of sexual abuse receive increasing attention and resources but it is often difficult to extend the same kind of understanding and possibilities of treatment to their perpetrators. Many of the perpetrators have been victims themselves, which is often a major reason for their having developed in such a way; sometimes the offenders are virtually children themselves (Royal College of Psychiatrists, 1994b).

This is areview of an early and important textbook published by Sir William Norwood East.

This commentary questions whether the usual ethical and legal requirements for maintaining confidentiality of individuals who fabricate illness should be breached in order to prevent further harm to themselves as well as cost to society. A case report of an individual with Munchausen's syndrome submitted for publication in Advances in Psychiatric Treatment provoked considerable Editorial discussion regarding the absence of written informed consent from the individual described. It is hoped that this commentary will widen the debate regarding the requirement for confidentiality in the exceptional circumstances of patients with Munchausen's syndrome.

What cardiovascular screening is needed before prescribing cholinesterase inhibitors in the memory clinic has led to much debate and contradictory advice – especially concerning the need for electrocardiograms (ECGs). Having looked at the current evidence base Rowland et al have produced simple and pragmatic advice that should be adopted immediately across the many memory clinics currently in operation. It is rare to have simple protocols these days – it is a relief to have such a breath of pragmatism.

Traditionally, service provision for neurodevelopmental disorders such as attention-deficit hyperactivity disorder, intellectual disability and autism – where this has been available – has focused on the needs of children, but there is now increased understanding of neurodevelopmental disorders as lifelong conditions, often with an ongoing need for health and social care provision. Medical and allied professionals frequently report limited education in neurodevelopmental disorders both during their training and post-qualification. This article gives an overview of theoretical and practical considerations for training of psychiatrists and allied healthcare professionals in relation to neurodevelopmental disorders. Key UK policy drivers and capability frameworks pertaining to this training are discussed. The Royal College of Psychiatrists’ 2022 revised curricula for medical trainees in psychiatry are examined in relation to neurodevelopmental disorders and ongoing CPD requirements in this area for career psychiatrists are considered. A brief overview of multidisciplinary training in neurodevelopmental disorders and the role of the psychiatrist in this is discussed. An international perspective on training in this area is touched on and current challenges in low- and middle-income countries are outlined. Last, the future direction of training in neurodevelopmental disorders is considered.

In this article it is suggested that empathy is a core component of musical appreciation and particularly of the relationship between the singer and the audience. The brain pathways activated in musical appreciation are outlined and the nature of the empathic process considered with reference to Robert Schumann's songs and his experience of severe mental disorder. The article suggests that listening to Schumann's song cycle Dichterliebe (Poet's Love), or to other great music, is a useful component of continuing professional development and that such experience enhances therapeutic effectiveness and empathy, as well as increasing the understanding of the relationship between creativity and mental health.

Byrne provides an excellent clinical overview. However, I have selected four areas of clinical interest for more detailed consideration.

Fyodor Dostoyevsky is widely regarded as the greatest 19th-century Russian writer and a giant in world literature. He is familiar to literary-inclined psychiatrists for his rich and accurate portrayal of mental illness in several of his works. But his own chronic addiction to gambling and its consequent perils are less well-known. This article discusses The Gambler, one of Dostoyevsky's early (1866) semi-autobiographical novellas, inspired by his own addiction to roulette, focusing on its depiction of gambling. To better understand Dostoyevsky the gambler, the article also presents brief excerpts from letters that he wrote to his wife in 1867, when his gambling addiction appears to have been at its worst. Finally, the relevance of the central theme of this work, gambling addiction, to the present-day psychiatrist is discussed.