Compared to other graduate students, law students are less fulfilled, and they handle the culture of intense competition by binge-drinking and using more marijuana, than other graduate students. The culture of law practice is not an improvement, due to the steep billable hour requirements and responsibility for client outcomes. Lawyers suffer from anxiety and depression at higher rates than the general population, and they are at the greatest risk of suicide among professionals behind only those in the medical field. Alcohol misuse is a significant problem, with one study finding that 20 percent of lawyers are problem drinkers and another revealing that 46 percent of male and 60 percent of female attorneys abuse alcohol. Lawyers in the first 10 years of their career have the most problematic drinking habits. The lawyering culture, featuring extreme stress, intense competition, and overwork, can drive lawyers to succumb to mental and physical health problems. International Bar Association research indicates there is a global crisis in lawyer well-being. Young, minority-identifying, and female-identifying lawyers, and lawyers with disabilities, all fall below the WHO Mental Wellbeing Index threshold requiring a mental health assessment, and suggesting a connection between well-being and issues with diversity, equity, and inclusion.

Depressive disorders have been recognised since antiquity, although how they have been described and understood has changed considerably over time. In this chapter, we outline key aspects of the history of depression as well as some of the limitations in its current classification in ICD-11 and DSM-5. We describe the range of symptoms experienced in depressive disorders, together with the recognised variations in clinical presentation and how these are conceptualised and classified. The relationship between depression and related disorders including anxiety disorders, premenstrual dysphoric disorder and grief is discussed, as well as boundary issues with bipolar disorder and primary psychotic disorders. We review current knowledge about depression’s considerable psychiatric and medical comorbidity, along with its epidemiology, natural history and health burden. A brief practical guide to assessing depressive disorders is given, together with rating scales that are useful for clinical assessment and monitoring.

The core foundation of excellent psychiatric treatment starts with obtaining a coherent history, preferably as a longitudinal narrative that follows a chronological timeline, with an emphasis on parsing relevant pertinent “positives” and “negatives” from that narrative. A simple organizing principle is to have patients present their concerns from a chronological perspective, in order for the clinician to develop a clear narrative. “When was the very first time you recall having any problems involving your mental health?” provides a good starting point, followed by “When was the first time you sought any kind of treatment for those problems?” A chronologically organized narrative gives some sense not only about the backdrop and longevity of a psychiatric disorder but, moreover, clues about the degree of distress and disruption caused by symptoms, the potential duration of untreated illness, and symptom severity as reflected by the kinds of interventions that previously occurred. A clinical timeline that starts with years of psychotherapy differs from one that begins with an involuntary psychiatric hospitalization or a suicide attempt; low-grade symptoms that persist for extended periods unnoticed by others, or cause no outward functional impairment, imply a different level of severity and debilitation, and possible prognosis, from those linked with more obvious outward signs of disability. For persistent problems, one always wonders why the patient is seeking help now and not a week or month or two ago.

Does ketamine or esketamine worsen dissociation in patients with post-traumatic stress disorder (PTSD)?

This chapter seeks to promote both awareness and understanding of evidence-based psychosocial factors that enhance well-being, adjustment, and recovery in older people admitted to hospital.

The chapter begins by exploring ageing from biological, psychosocial, and existential perspectives. It then focusses upon the psychological sequel of illness and disability in this population and goes on to identify components of psychological well-being drawn from both qualitative and quantitative research studies that promote recovery in older people who have been admitted to hospital.

The chapter also explores the role of culture, faith, and ethnicity in the well-being of hospitalised older people and concludes by highlighting essential components in the development of a positive, recovery-focused culture of care.

Doing research on the impact of traumatic experiences can be both heartening and heart-rending. People and situations are encountered that would touch the hardest of hearts, and others are met who inspire with their tenacity and strength to go on. Psychological trauma and adaptation to traumatic events is without question a truly fascinating and important field. You don’t have to look hard to find stories of stress and trauma. Crisis and catastrophe happen with remarkable regularity. Yet the attributes that help or hinder people when they meet misfortune are not well understood. In this chapter contemporary models and definitions of trauma are reviewed. And research that shows us that traumatic experiences are shaped by social and political factors is briefly considered to highlight the relevance of social sciences and social psychology, specifically to the study of trauma, as they offer a set of analytical tools. This allows us to unravel the social and political processes that matter to how people cope with adversity, which leads to a conclusion that emphasises that a social psychological perspective on trauma is useful and necessary.

Early childhood is a time of profound growth and development and early experiences during this period have important implications for life-long health and development. Evidence for the benefit of investing in early childhood is so strong that it is considered a public health issue by many researchers and policymakers. This chapter explores efforts within Cooperative Extension in fostering health and well-being among young children, suggesting a holistic approach that involves supporting children’s parents and caregivers, early childhood educators, and fostering a positive context in which children can thrive. Extension continues to play important roles in providing culturally responsive education to families, working with families to cocreate knowledge, and assisting communities in supporting the well-being of young children for lifelong success. Specific examples of promising programs are provided to highlight the impactful work conducted by Extension to support young children around the country.

This chapter defines the terminological differences between the terms ‘fire-setting’, ‘arson’ and ‘pyromania’, including their place in current diagnostic manuals. An epidemiological perspective on fire-setting in those with mental disorder as well as classification systems and theories of fire-setting with prevailing conceptual models of fire-setting and mental disorder is described. Current approaches in the risk assessment of fire-setting and psychological and pharmacological interventions in fire-setting are discussed. Finally, a care pathway to guide clinical and risk assessment of the patient with fire-setting as a feature of their behaviour or history is suggested.

The promotion of suicide and description of suicide methods on the Internet have led to widespread concern that legal control is mandated. Apart from value concerns pertaining to attitudes about suicide, the guarantee of freedom of expression presents a serious challenge to the introduction of restrictive laws. Recent developments in Australia and Europe are presented, noting jurisdictional complexity as an obstacle to effective application. Scientific data of an epidemiological nature are revealed to be insufficient to warrant making causal assertions about the Internet and its relation to suicidal acts, including those of vulnerable populations. Regardless of restrictions, the uncontrolled Darknet hosts suicide encouragement and information on methods to kill oneself. Recommendations are made with respect to public education, suicide prevention and future research.

Students and staff are provided with a range of mental health supports, many of them boasting excellent outcomes, but not always adequately connected up. Counsellors, Mental Health Advisors and Mental Health Mentors are available without fee to most university students. These are well researched and evidenced in the treatment of mild to moderate mental illnesses and in the support of people with longer term disorders. Chaplaincy takes many forms and is also a widely available but less well evidenced. There is still much work to do in terms of integrating different services around a vulnerable student. The challenge is greatest when NHS as well as in-house university services are needed. Students with severe mental disorders require longer courses of therapy than university Counselling services routinely offer, and arrangements for treatment during vacations are essential. Integrative models such as that piloted in Greater Manchester show promise, but smaller, less urban universities need different solutions. More than half of universities have no GP on campus. Workforce shortages and funding anomalies make it ever more difficult for GPs to co-ordinate the care of their university patients.

Substance use and substance use disorders (SUD) are highly (and increasing) prevalent both as single disorders and within the context of complex psychiatric and somatic comorbidities. In parallel with the impact of these disorders, research on addictive processes has significantly expanded in recent decades. However, several challenges remain to be addressed on multiple levels. Within the context of continuing evolution of new (illicit and prescription) drugs of abuse and changes in the growing field of behavioral (nonchemical) addictions (gambling, gaming), the epidemiological situation is rapidly changing. On the level of disorder conceptualization and underlying pathogenetic mechanisms many challenges remain to be addressed, impacting a broad spectrum from legislation and public mental health issues to underlying neurobiological processes such as neuroimmune mechanisms and microbiome, and cognitive dimensions. These provide new targets of therapeutic approaches such as neuromodulation, personalized pharmacotherapy, and contingency management.

Any discussion of the classification of psychiatric disorders should begin with the frank admission that any definitive classification of disease must be based on aetiology. Until we know the causes of the various mental illnesses, we must adopt a pragmatic approach to classification that will best enable us to care for our patients, to communicate with other health professionals and to carry out high-quality research.

In physical medicine, syndromes existed long before the aetiology of these illnesses were known. Some of these syndromes have subsequently been shown to be true disease entities because they have one essential cause. Thus, smallpox and measles were carefully described and differentiated by the Arabian physician Rhazes in the tenth century. With each new step in the progress of medicine, such as auscultation, microscopy, immunology, electrophysiology and so on, some syndromes have been found to be true disease entities, while others have been split into discrete entities, and others still jettisoned.

I grew up in a divided community where people had conflicting views on many issues, because of their differing religious, political, social, and cultural backgrounds. As I trained in psychiatry, I learned how biological, psychological, and sociological perspectives competed for allegiance in the profession. Later the diversity of views within our scientific communities was brought home to me when I was invited by the World Federation of Scientists to help them with a major division that had opened up as they tried to apply their expertise in the aftermath of the 9/11 terrorist attacks. Western scientists wanted to assist in the fight against Al Qaeda, whereas those from Eastern countries insisted that we must understand why the attacks were taking place. These conflicting perspectives among scientists showed how, even within the rational scientific community, we develop different narratives to explain and explore traumatic events and major incidents.

It is well established that people suffering from a mental disorder have poorer physical health outcomes, including increased mortality, than those without such a disorder (1). In addition, people with severe mental illness are more likely to be admitted to non-psychiatric medical services, have longer admissions and present with more emergencies (2). The mental health consultation-liaison (CL) team is perfectly placed to ensure holistic assessment and integrated care of this population, with the opportunity to improve both physical and mental health outcomes.