Dr Dignan’s poetry, her care, and her enthusiasm should be lauded. There are also many other non-medical pursuits that may make us better doctors. But it is difficult to know which of these are effective or practicable.

The topic of this article is the biopsychosocial model. My main contention is that – notwithstanding doubts as to what exactly it is, or indeed whether it is anything – there is a coherent account of it, in terms of both applications to particular health conditions and mechanisms with wide application. There is accumulating evidence from recent decades that psychosocial as well as biological factors are implicated in the aetiology and treatment of a large range of physical as well as mental health conditions. The original proposer of the biopsychosocial model, George Engel, back in 1977, was substantially correct about what he saw was on its way.

Can delusions, in the context of psychosis, enhance a person’s sense of meaningfulness? The case described here suggests that, in some circumstances, they can. This prompts further questions into the complexities of delusion as a lived phenomenon, with important implications for the clinical encounter. While assumptions of meaninglessness are often associated with concepts of ‘disorder’, ‘harm’ and ‘dysfunction’, we suggest that meaning can nonetheless be found within what is commonly taken to be incomprehensible or even meaningless. A phenomenological and value-based approach appears indispensable for clinicians facing the seemingly paradoxical coexistence of harmfulness and meaningfulness.

Globally, there has been an emphasis on the importance and value of involving people with lived experience of mental health conditions in service delivery, development and leadership. Such individuals have taken on various roles, from peer support specialists and other specialised professions to leadership in mainstream industries. There are, however, still obstacles to overcome before it is possible to fully include people with lived experience at all levels in the mental health and related sectors. This article discusses the benefits, both to the individual and to the public, of involving persons with lived experience in service delivery, development and leadership.

COVID-19 has transformed healthcare service provision. In addition to the spread of a virus, there has been an equally concerning emergence and spread of conspiracy theories. Such theories can threaten societal cohesion and adherence to the necessary public health guidance. In a forensic in-patient setting, such difficulties can be amplified. In this paper, we outline the key theory in relation to the development and spread of conspiracy theory memes. We propose primary, secondary and tertiary level responses to tackle the possible generation and spread of harmful conspiracies in the forensic in-patient setting. We consider this to be important, as there is a risk that such beliefs could affect patients’ mental health and, in extremis, undermine physical health efforts to reduce the spread of COVID-19.

The number of people following a vegan diet in the UK is increasing. Eating disorder clinicians are anecdotally reporting that more of their patients with anorexia nervosa are wanting to follow a vegan diet. The relationship between veganism and eating disorders is unclear. A fictitious scenario is used to explore these issues. An approach is described that clinicians may follow to help patients to understand the potential relationship between their eating disorder and veganism. The human rights issues this involves are also explored. It is hoped that this article will make readers more aware of this complex issue and the impact it can have on engagement with services and on treatment options.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis predominantly presents with psychiatric symptoms. Psychiatrists need to be alert to this diagnostic possibility, especially in female adolescents and young adults, as exemplified by the real (de-identified) case outlined below. Earlier diagnosis and immunotherapy improves long-term outcomes. Collaboration with neurology colleagues is essential for optimal care. ‘Red flags’ for autoimmune encephalitis and ‘diagnostic clues’ act as helpful aide memoires for this uncommon condition. The gold standard for testing is the detection of NMDAR antibodies in cerebrospinal fluid, but serum can be tested as a more accessible (but less reliable) preliminary step. The results of routine blood tests, magnetic resonance imaging of the head and electroencephalograms can be normal or show non-specific changes. Diagnostic criteria exist to define probable and definite cases. Immunotherapy for anti-NMDAR encephalitis is effective for many patients, but recovery is prolonged and relapses can occur.

The free energy principle (FEP) is a new paradigm that has gain widespread interest in the neuroscience community. Although its principal architect, Karl Friston, is a psychiatrist, it has thus far had little impact within psychiatry. This article introduces readers to the FEP, points out its consilience with Freud's neuroscientific ideas and with psychodynamic practice, and suggests ways in which the FEP can help explain the mechanisms of action of the psychotherapies.

The Royal College of Psychiatrists’ Leadership and Management Fellow Scheme aims to develop and support a new cohort of leaders within psychiatry. This article provides an introduction to the scheme, which is accessible to all higher trainees with the support of their host organisation. We explore its development, structure and how it is evolving to provide a strong platform for achieving the College's ambition to benefit patient care by embedding a culture of medical leadership within mental health services.

Many examinations are now delivered online using digital formats, the migration to which has been accelerated by the COVID-19 pandemic. The MRCPsych theory examinations have been delivered in this way since Autumn 2020. The multiple choice question formats currently in use are highly reliable, but other formats enabled by the digital platform, such as very short answer questions (VSAQs), may promote deeper learning. Trainees often ask for a focus on core knowledge, and the absence of cueing with VSAQs could help achieve this. This paper describes the background and evidence base for VSAQs, and how they might be introduced. Any new question formats would be thoroughly piloted before appearing in the examinations and are likely to have a phased introduction alongside existing formats.