Individuals with mental illness have poorer physical health, nutritional status, and lowered life expectancy. Optimising their physical and nutritional status has become an increasingly important therapeutic goal. Current experience with COVID-19 has further emphasised the susceptibility to physical illness and poorer outcomes amongst individuals with mental illness and those who are nutritionally compromised. Although life as we knew it has been suspended until the widespread roll-out of a vaccine, individuals can take immediate action to improve physical and mental health by attending to and optimising their nutritional well-being. Clinicians within mental health services have a crucial role to play in assisting such change, and reminding their patients of the importance of pursuing a healthy and balanced diet.

While the respiratory complications of COVID-19 infection are now well known, psychiatric manifestations are an emerging issue. We report a case of prolonged encephalopathy secondary to COVID-19 which was associated with prominent neuropsychiatric features. The patient went on to develop sub-clinical seizures, a rare but recognised complication of SARS-CoV-2.

This case report highlights the risk of development of Neuroleptic Malignant-Like Syndrome secondary to withdrawal of procyclidine with brief withdrawal of L-dopa and long-term typical antipsychotic depot. The patient responded to reintroduction of procyclidine, sedation and supportive treatment. The mechanism and management of NMS and NMLS is also reviewed. This case emphasises that any changes in antipsychotic and antiparkinsonian medications should be undertaken with extreme caution and patient should be closely monitored for development of NMLS after alteration in these medications.

Mindfulness is everywhere, but the term is often used mindlessly. This article discusses the growth of mindfulness-based interventions in many countries over the past fifty years and, more recently, the emergence of the idea of ‘McMindfulness’, with particular emphasis on the concept of ‘spiritual bypassing’. Critical discourse is a valuable resource in any discipline. Proportionate, mindful incorporation of reasoned critiques strengthens mindfulness, rather than undermining it. Misunderstandings and misinterpretations of mindfulness highlight a need to counter the notions that mindfulness involves avoiding difficult issues in our lives or simply accepting social problems that need to be addressed. The opposite is true: mindfulness of reality inevitably generates insights about change. Before we change the world, we need to see it. Mindfulness practice is opting in, not opting out.

A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnoea (OSA) and no prior psychiatric history presented repeatedly over 6 months with mental and behavioural changes. Laboratory tests, chest X-ray and sleep study diagnosed an infective exacerbation of COPD, type II respiratory failure and OSA. Differential diagnoses included delirium, primary mania in bipolar affective disorder or organic pathology causing secondary mania. Oxygen, steroids, bronchodilators, antibiotics and non-invasive ventilation were administered to treat his infection and respiratory failure. However, blood gas analysis showed persistent hypoxia and hypercarbia, aggravating his ongoing mental state disturbance that required security supervision and sedation with antipsychotics and benzodiazepines. Sudden onset of classic manic symptoms and multiple presentations suggested secondary mania, driven by chronic hypoxia in end-stage COPD and OSA. The challenge was establishing a balance between mental state control and treatment of physical illness.

People with severe mental illness and intellectual disabilities are overrepresented in the criminal justice system worldwide and this is also the case in Ireland. Following Ireland’s ratification of the United Nations’ Convention on the Rights of People with Disabilities in 2018, there has been an increasing emphasis on ensuring access to justice for people with disabilities as in Article 13. For people with mental health and intellectual disabilities, this requires a multi-agency approach and a useful point of intervention may be at the police custody stage. Medicine has a key role to play both in advocacy and in practice. We suggest a functional approach to assessment, in practice, and list key considerations for doctors attending police custody suites. Improved training opportunities and greater resources are needed for general practitioners and psychiatrists who attend police custody suites to help fulfill this role.

Art therapy is a form of psychotherapy that uses art media to improve well-being. This article explores the history and development of art therapy, from the first description of art therapy in the 1940s, to the two main approaches still in use today. The benefits of art therapy with regard to its delivery, patient population, and cost are then broadly discussed. The use of art therapy in psychiatric conditions, specifically in schizophrenia and schizophrenia-like conditions, is highlighted, as well as its role in chronic and physical conditions like asthma and cancer. Furthermore, the potential for art therapy to be more broadly implemented using technological novelties, such as virtual reality, is considered, especially in light of the COVID-19 pandemic.

The COVID-19 pandemic presents unique challenges to high quality, safe Early Intervention in Psychosis (EIP) service provision. Due to the necessity to ensure EIP continues despite this, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of first episode psychosis service users: PERCEPTION. This perspective article aims to: describe PERCEPTION; offer reflections on our experience of delivering it; make recommendations for future research; and synthesise key learning to assist the integration of similar interventions in other EIP services. We provide a descriptive account of PERCEPTION’s development and implementation, with reflections from the clinicians involved, on supporting families using this approach. We experienced telehealth as patient-focused, safe, and efficient and believe the intervention’s blended nature augmented families’ engagement. The approach adopted can assist service providers to attain balance between protecting public health and offering a meaningful, therapeutic intervention to support families in the current epoch.

Since the emergence of the COVID-19 pandemic, there has been increased interest in identifying ways of protecting the mental well-being of healthcare workers (HCWs). Much of this has been directed towards promoting and enhancing the resilience of those deemed as frontline workers. Based on a review of the extant literature, this paper seeks to problematise aspects of how ‘frontline work’ and ‘resilience’ are currently conceptualised. Firstly, frontline work is arbitrarily defined and often narrowly focused on acute, hospital-based settings, leading to the needs of HCWs in other sectors of the healthcare system being overlooked. Secondly, dominant narratives are often underpinned by a reductionist understanding of the concept of resilience, whereby solutions are built around addressing the perceived deficiencies of (frontline) HCWs rather than the structural antecedents of distress. The paper concludes by considering what interventions are appropriate to minimise the risk of burnout across all sectors of the healthcare system in a post-pandemic environment.