The differentiation of pathological stress responses from responses that are appropriate and adaptive is a challenge with little to guide the clinician. This refreshment considers adjustment disorder and possible approaches to distinguishing those who have the disorder from those who are responding ‘normally’ to stressful events.

The diagnosis of dissociative identity disorder (DID) remains a contentious area in mental health. Patients experiencing such difficulties are often harshly identified as suggestible neurotics and interested clinicians as fanatics. However, for the sufferer, DID is as real and has as much impact as any other psychiatric diagnosis.

This commentary challenges psychiatry's dismissive and disbelieving attitude towards DID. The authors (a person with DID and a clinician) acknowledge the limited understanding of DID's aetiology and the paucity of associated neurological findings, but ask whether this is not the case for many other accepted psychiatric conditions. They call for UK psychiatric practice to move on from the debate and for the Royal College of Psychiatrists to take the lead, with inclusion of DID in core psychiatric training and guidelines on approaches to diagnosis and treatment.

An article in BJPsych Advances on the topic of dissociative identity disorder gave rise to a number of linked commentaries and a vigorous eLetter debate. This commentary, by the Editor, points out the journal's role as a CPD journal and clarifies its position on the publication of reviews and opinion pieces on controversial topics.

Psychiatrists may be daunted by the prospect of undertaking a neurological examination. In this article we briefly review the neurological signs that may be seen in the context of some common neurological disorders of cognition and movement which may present with neurobehavioural symptoms and therefore may be seen initially by psychiatrists. This approach emphasises that neurological examination is not simply an operationalised procedure but an interpretative process. We propose a minimum neurological examination suitable for use by psychiatrists. Many of the signs included are relatively simple to observe or elicit, require no special equipment, and the examination techniques involved are easy to master.

As experts in disaster mental health push to reframe disaster response as a preventive medicine rather than its actual state of acute management, various factors should be considered. Although a whole population may be victim to the effects of disasters, particularly vulnerable are those with severe mental illness. Therefore, efforts geared to bolster trauma response should centre on these individuals, starting at a community level and reaching organisational and governmental endeavours and funding.

Peer review is widely accepted as essential to ensuring scientific quality in academic journals, yet little training is provided in the specifics of how to conduct peer review. In this article we describe the different forms of peer review, with a particular focus on the differences between single-blind, double-blind and open peer review, and the advantages and disadvantages of each. These illustrate some of the challenges facing the community of authors, editors, reviewers and readers in relation to the process of peer review. We also describe other forms of peer review, such as post-publication review, transferable review and collaborative review, and encourage clinicians and academics at all training stages to engage in the practice of peer review as part of continuing professional development.

Much exists in the literature on filicide and the characteristics of perpetrators and their victims but there is little in the way of practical advice on how to manage perpetrators of filicide in secure psychiatric wards. Clinically, these patients can rapidly respond to medical treatment, only to be faced with the reality of what they have done. In the authors' experiences, certain aspects of their management are particularly challenging due to the emotive nature of their offence. These include managing the interpersonal dynamics on a ward, the media interest that surrounds the case and rehabilitation back into the community. In this article we outline a brief background to filicide in the context of mental illness and describe our experiences of managing the practical difficulties outlined above. The approaches used, outcomes and the supporting evidence base are discussed and illustrated through examples.

In this overview we discuss the role of psychiatry in managing delirium in acute hospital admissions. We briefly discuss the role psychiatry can offer in four main domains: (a) assessment; (b) management; (c) recovery; and (d) paradigm, education and research. In the assessment section we discuss accurately detecting delirium in the context of comorbid mixed neuropsychiatric syndromes, including depression and dementia, and the clinical importance of delirium subtyping. The management section briefly outlines pharmacological and non-pharmacological approaches to delirium and their evidence-based rationale. The recovery section focuses on the effect delirium can have on cognitive decline, mental health and long-term health, including functional outcome and need for institutional care after hospital discharge. Finally, we outline the role of psychiatry in delirium research and education. We hope that this article will encourage clinicians to reflect on their current practice and consider holistic and evidence-based care for this vulnerable population in the acute hospital setting.

Peer reviewing is a hugely important part of the scientific process that ensures published articles are of sufficient quality to deserve dissemination to the wider scientific community. Building on a previous article published in this journal, this article addresses topics that potential or practising peer reviewers may find useful. These include what peer reviewing is, why do peer reviews, how to become a reviewer, what to write in a review and where to find more information. It includes a template for writing a review, and lists various websites and guidelines that can help ease the entire process depending on what type of article is being reviewed. Peer reviewing can be enormously rewarding and help clinicians diversify their scope of work while also benefiting the scientific community by contributing to the quality control of published work.

Post-traumatic stress disorder (PTSD) is a common trauma and stressor-related disorder. Trauma-focused psychotherapies and selective serotonin reuptake inhibitors represent current state of the art treatment for PTSD, with current evidence favouring psychotherapy as first-line treatment. Much room remains for development of more effective therapeutics. This article give a brief update on diagnosis and treatment of PTSD.

Homelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.

Attention-deficit hyperactivity disorder (ADHD) is a persistent, pervasive disorder characterised by symptoms of inattention, impulsivity and hyperactivity. Although traditionally considered a disorder of childhood, symptoms and associated impairments persist into adulthood for a significant proportion of individuals. Untreated ADHD can have a number of adverse effects for both the individual and wider society. Despite this, ADHD in adults is often misdiagnosed or its diagnosis is ‘missed’ in general psychiatric settings and this article highlights some reasons for this.

Balancing risk and safety in long-term care settings can be challenging while providing and respecting patients’/residents’ needs and rights in terms of sexual expression. We look at factors affecting the expression of sexuality, including staff attitudes and reactions, and the lack of policies governing sexuality. We review the various statute and case law, other legislative and quasi-legal provisions governing sexuality and sexual expression. Finally, we consider the need for clear policies and training for both staff and family members.

Sleep is essential for survival and humans spend approximately one-third of their life asleep. Adequate sleep is needed to maintain both physical and psychological health. Routinely getting less than the recommended amount of sleep for your age can have profound negative effects on health, such as increasing the likeliness of psychiatric illness, diabetes, cardiovascular disease and stroke. In children and adults with neurodevelopmental disorders, the prevalence of sleep disorders is significantly higher than in the general population. Given the relationship between sleep and psychiatric disorders, it is essential that psychiatrists have knowledge of the principles of sleep medicine. In this article, we focus on the common sleep disorders found in those with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and give an overview of screening, diagnosis and management.

If a Mental Health Act section 136 lapses at 24 h because no in-patient bed is available, the legal grounds to continue holding an individual in the place of safety are dubious. Duty of candour and a senior clinical review are essential. The use of common law and the Mental Capacity Act have limitations, the latter also raising a question about whether deprivation of liberty safeguards would also apply. Clarity of this dilemma is needed through legislation.

Socratic questioning is at the core of collaborative clinical communication, with a wide array of applications in behavioural medicine and psychotherapy. This brief article describes the process of therapeutic Socratic questioning, illustrates its clinical applications in therapy and provides a brief update on its recent developments.

The phenomenon of acute behavioural disturbance (ABD) (also known as acute behavioural disorder or excited delirium) is an underrecognised and potentially life-threatening syndrome, and an emergency in psychiatric settings. Causes are discussed and the pathophysiology explained. The challenges faced by practitioners are highlighted, including how ‘standard’ control and restraint can exacerbate symptoms. Initial treatment strategies are suggested.

When a patient in an in-patient psychiatric setting allegedly commits a crime, psychiatrists are sometimes asked to assess their fitness to be interviewed by the police. This article describes how to conduct this assessment, outlines the criminal justice process leading to police interviews (with particular reference to the legal system in England and Wales) and highlights practical issues to consider when assessing fitness to be interviewed in this context.

Measuring outcomes is becoming an increasingly standard (and highly complex) part of what mental health services are expected to do. Practising psychiatrists will need to have a good understanding of approaches to outcome measurement: used well, they have the potential to amplify the patient voice, promote good-quality services and facilitate research. We discuss what constitutes an outcome measure, the different ways that such measures can be obtained and the mechanisms for assessing the quality and appropriateness of an outcome measure. We outline the rapidly evolving research and policy context regarding outcome measurement, with particular reference to the UK's National Health Service. We also consider the potential pitfalls to outcome measurement, such as added clinical burden, inappropriate incentivisation of behaviour and incorrect interpretation of results. We discuss ways that such difficulties can be avoided or their effects mitigated.

It is generally believed that the physiological consequences of stress could contribute to poor outcomes for patients being treated for cancer. However, despite preclinical and clinical evidence suggesting that stress promotes increased cancer-related mortality, a comprehensive understanding of the mechanisms involved in mediating these effects does not yet exist. We reviewed 47 clinical studies published between 2007 and 2020 to determine whether psychosocial stress affects clinical outcomes in cancer: 6.4% of studies showed a protective effect; 44.6% showed a harmful effect; 48.9% showed no association. These data suggest that psychosocial stress could affect cancer incidence and/or mortality, but the association is unclear. To shed light on this potentially important relationship, objective biomarkers of stress are needed to more accurately evaluate levels of stress and its downstream effects. As a potential candidate, the neuroendocrine signalling pathways initiated by stress are known to affect anti-tumour immune cells, and here we summarise how this may promote an immunosuppressive, pro-tumour microenvironment. Further research must be done to understand the relationships between stress and immunity to more accurately measure how stress affects cancer progression and outcome.