The treatment of longstanding severe eating disorders is a public concern amid rising service pressures and legal cases. These cases raise complex issues about the interface between legislative schemes, restrictive practices, best interests, treatment refusal and potential interaction with assisted dying legislation, when patients lack capacity yet clearly express wishes.

People living with severe mental illness (SMI) experience a shorter life expectancy and poorer physical health than those without SMI. Cardiometabolic illness accounts for a significant proportion of this health inequality. Pharmacological management could reduce the noted inequalities.

Attention-deficit hyperactivity disorder (ADHD) in childhood is associated with various adverse long-term outcomes.

Children and young people are increasingly being referred to specialist gender services, and available data on their characteristics are limited. The Longitudinal Outcomes of Gender Identity in Children (LOGIC) study is the first independently funded UK research programme to comprehensively assess quality of life, autism, service use and the psychological well-being of children and adolescents referred to gender services.

Shame is a pervasive, multidimensional emotion influencing brain, body and social life. While shame can foster accountability, its toxic forms drive stigma, withdrawal and mental illness. We call for systemic, culturally sensitive interventions to transform phatological shame into healing, fostering empathy, accountability and psychological safety in care, education and policy.

Resource restrictions and changes to the ways in which psychiatrists are managed threaten professional autonomy and motivation. With examples from English National Health Service practice, maintaining knowledge and expertise, involvement in education and training, supporting research delivery and developing active followership skills represent transferable and realistic strategies that can improve psychiatrists' autonomy wherever they work.

Benzodiazepine receptor agonists (BZRAs), including benzodiazepines and Z-drugs, are frequently prescribed during pregnancy but their long-term neurodevelopmental safety remains uncertain.

Epilepsy affects ~50 million people worldwide and is associated with increased psychiatric comorbidities, including depression, anxiety, psychosis and suicidality. Despite this, current epilepsy management primarily focusses on seizure control, potentially overlooking mental health concerns. This article explores the challenges of integrating psychiatric care into epilepsy treatment and proposes solutions for a more holistic approach. Using a consensus development panel method, a multidisciplinary team of neurologists, psychiatrists and a lived-experience expert identified key challenges to optimising the mental health of people living with epilepsy, such as healthcare system fragmentation, underdiagnosis of mental health conditions and inadequate resources. Among the proposed solutions, the need for routine mental health screening, interdisciplinary support and collaboration, and increased research into the neuropsychiatric aspects of epilepsy were highlighted. A shift from a seizure-centric model to a patient-centred approach is advocated, emphasising biopsychosocial care and improved access to psychiatric services. We also discuss prospective practical strategies to tackle the issues identified, including collaborative care models, structured decision trees and AI-driven screening tools, to enhance diagnosis and treatment. Addressing these challenges through systemic change, research investment and service innovation should significantly improve the care and quality of life for individuals with an epilepsy and co-occurring mental health disorders.

It is often assumed that relapse leads to poor long-term outcomes, but new data question this in regard to symptoms, social function, quality of life and, possibly, employment. We consider this together with other impacts, risks and costs and how individual circumstances all influence decisions about antipsychotic maintenance treatment to prevent relapse.

Eating disorders are severe psychiatric conditions associated with high mortality rates, particularly among young people. These disorders often co-occur with self-harm and suicidal ideation, yet the temporal dynamics between these variables remain poorly understood.

Research suggests there are alterations in the cortisol awakening response (CAR) in patients with premenstrual dysphoric disorder (PMDD), as demonstrated by delayed cortisol peaks and flatter diurnal cortisol slopes compared to healthy controls. While inconsistent, previous work also demonstrates a relation between alterations in CAR, prefrontal serotonin transporter (5-HTT) binding and severity of depressive symptoms.

Clozapine is licensed for treatment-resistant schizophrenia (TRS). Because of the risk of clozapine-induced agranulocytosis, its use requires regular haematological monitoring. Substantive evidence supports revisions of absolute neutrophil counts (ANCs) for clozapine discontinuation and ceasing of indefinite haematological monitoring.

Ethnic inequalities in compulsory psychiatric hospital detentions are well-documented in the UK and internationally. It is unknown how UK coronavirus disease 2019 (COVID-19) lockdown measures, which led to restrictions in public movement, gatherings, in-person health service delivery and changes to police powers, further impacted inequalities.

Eating disorders, particularly anorexia nervosa and bulimia nervosa, are significant global health challenges.

Internationally, drug- and alcohol-related morbidity is at its highest recorded levels yet these modifiable risk factors often remain overlooked within systems of healthcare delivery and research. We seek to reaffirm the ongoing commitment of to publishing and promoting drug and alcohol research and encourage submission of high-quality articles.

This commentary examines Thomas Adeoye Lambo's seminal 1955 article 'The Role of Cultural Factors in Paranoid Psychosis among the Yoruba Tribe,' published in the , as the was then known. Seventy years later, this groundbreaking work remains profoundly relevant to contemporary psychiatric practice and research.

A phenomenon distinctive to attention-deficit hyperactivity disorder (ADHD) is that the effects of stimulants are evident in domains of attention, mood, energy and focus, independent of the presence of an ADHD diagnosis. This reflects recreational use of stimulants for these and other effects. Perceived treatment response probably reinforces diagnosis, and hence diagnostic and prescribing habits.

User engagement remains a challenge in digital mental health. This editorial reconsiders engagement as a process rather than an outcome, introducing a four-step model to define, measure and link engagement to outcomes. The approach promotes standardisation, interpretability and scalability, advancing the science and implementation of digital health interventions.

The smallest worthwhile difference (SWD) represents the smallest beneficial effect of an intervention that patients deem worthwhile given the harms, expenses and inconveniences of the intervention. The SWD facilitates interpretation of the patient-perceived importance of intervention effects. We previously estimated the SWD for antidepressants for depression, but the SWD for psychotherapy remains unknown.

Cue-reactivity responses in addictive behaviours are triggered by cues associated with the addictive activity itself. Although such cues may depict the rewarding aspects of the behaviour, responses may also generalise to more distal cues that do not directly convey this content.

There is an urgent need for better evidence-based interventions in mental health. High-quality randomised controlled trials in humans are often lacking, especially when dealing with complex situations or novel therapeutic targets. Other potentially useful data may be available, such as from early-phase trials, observational or mechanistic studies or animal experiments. Triangulation offers an opportunity to consider a wider variety of evidence together to prioritise future research directions, and ultimately to inform clinical decisions. Here we describe GATE (the GALENOS Approach to Triangulating Evidence). This is the methodology of triangulation, co-produced with people with lived experience, and applied as an integral part of the GALENOS project (Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis; https://www.galenos.org.uk/). We outline the considerations of triangulation in psychiatry and our experience to date in assessing animal and human data together, using triangulation to prioritise future research directions. With GATE at its core, GALENOS not only enables novel insights to emerge, but points us towards a future of collaborative research better equipped to examine the most pressing questions in mental health.

Suicides in children and young people are a major public health concern. Prevention of Future Death (PFD) reports are an underutilised resource detailing coroners' concerns which, if actioned, are believed to be able to prevent future deaths. Research has investigated common themes for suicide during 2021 and 2022 but there are no published studies that thematically analyse these reports for children alone.