Ruth starts with details from her childhood, when she tended to be a perfectionist and had obsessions around contamination. Ruth suffered with episodes of depression herself, but they were short lived and didn’t require treatment. Her severe depression started while on a long travel in two continents. She developed delusions of guilt and was receiving messages, resulting in an admission to a hospital in Canada, and then permitted to fly back home under sedation. Several years later, after severe social stressors, she relapsed and remained depressed for several years. She was again psychotic, believing that she had ‘killed the world’ and eventually became almost mute. Her sister, aware that their grandfather had received ECT, researched the topic and felt that it should be tried, especially after listening to a talk by Dr Sherwin Nuland, who had ECT himself. It was him who used the phrase ‘rising like a phoenix’, which was chosen as the title of this chapter. Ruth had twenty-three sessions before she felt better. She describes in detail her memory problems. She has since followed Sherwin Nuland’s lead by talking about her ECT experience publicly.

Doppelgänger is a term drawn from the writing of Jean Paul Richter in his novel Siebenkäs. This term is examined and discussed in this chapter. It stands for the possibility of the existence of a double of a living person and therefore raises questions about the nature of the self and of mind too. The concepts of self and mind are explored and the implications for philosophy of mind are examined. The importance of attending to the empirical literature rather than using thought experiments is emphasized.

This chapter provides a brief review of basic neuroanatomy, followed by a more detailed description of structures and pathways important for neuropsychiatric practice. The focus will be on the limbic brain and the functional anatomy of emotion, memory, cognition and behaviour. A more comprehensive review of general neuroanatomy can be found in standard textbooks such as Johns, Clinical Neuroscience.

• Drug use is common. It is estimated that one in ten people in the UK have tried an illegal psychoactive drug in the last year.

• Young people use more drugs than any other age group, many by their mid-teens.

• Cannabis is the most commonly used illegal psychoactive drug.

• People use psychoactive drugs to change the way they feel.

• Psychoactive drug use can result in new feelings that would otherwise be hard to experience, or take away unwanted feelings. To feel good, or stop feeling bad.

• Sometimes psychoactive drugs are used for social gain, bringing a sense of belonging and identity.

• As we will see in Chapter 11, some people experience mental health problems which increase their risk of using drugs

• The UK has two drug laws, the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016. These laws place all psychoactive drugs under control and rank some drugs according to their potential to cause harm.

• The UK drug laws make it an offence to produce, supply, import or export and, in some cases, possess a psychoactive drug.

Moving to Edinburgh from Glasgow to study medicine at the age of 17. A brief description of teaching methods as they were then. My experience of psychiatry as a medical student, and a discussion of self-harm. Met my future husband, who was to spend a lot of his life as an agricultural economist, working in Mexico.

People reasonably expect their healthcare professionals to avoid causing harm. In the UK, there are various clinical and governance checks and balances to ensure that the individual is safe and treated with appropriate evidence-based care, and safeguards by the state to explore and investigate when these appear to have been breached. These include internal organisational disciplinary proceedings, public complaints processes, ombudsman investigations, civil claims for compensation, and criminal prosecutions, among others. In England and Wales, the coroner’s inquest is one such check and balance.

An introduction and overview of intellectual disability. The American Psychiatric Association (APA) diagnostic criteria for intellectual disability (DSM-5 criteria) are covered: Deficits in general mental abilities; Impairment in adaptive functioning for individual’s age and sociocultural background which may include communication, social skills, person independence, and school or work functioning; All symptoms must have an onset during the developmental period; The condition may be subcategorised according to severity based on adaptive functioning as mild, moderate, or severe. The chapter also covers the role and evidence base for medication and key issues when prescribing for people with intellectual disability.

Chapter 1 provides an overview of the field of cultural psychiatry before focusing on the UK context. Salient factors in the national context of cultural psychiatry include the history of imperialism and the impact of postwar migration on the development of a multi-ethnic society. This has necessitated research in the following priority areas: the recognition of the effects of racism and discrimination on mental health, and, relatedly, efforts to achieve services that meet the needs of ethnic minority groups. Current areas of research are outlined before a deeper discussion of two strands that will be explored more widely in the book. These are, in order: the need to recognise more fully cultural hybridity with ethnic minority populations and the perspectives of South Asian psychiatrists within the white spaces of psychiatry and the impact this has on practice. All too often ethnic minority populations, historically within the UK, from non-white ethnicities are clumped together for statistical reasons. This leads to gross oversimplifications that flattens differences. Addressing the complexity of identity in its intersectionality and that too through the interviews with South Asian psychiatrists leads to a more developed understanding about identity, which is necessary in improving mental health services for South Asian patients.

The aims of this chapter are firstly to help trainees refine forensic assessments of offender patients so they can give advice to courts in determining an offender’s legal responsibility for a criminal act. Secondly, the chapter aims to help illuminate the motivation for violent offending and the pathways to violence. This is not only necessary for giving expert evidence in courts but is also essential in choosing the treatment that should be offered to a patient and the level of security required in which to deliver treatment. In some cases it may be relevant to the likelihood of a successful response to treatment. Thirdly, associations between criminal behaviour and mental disorder may be highly important in the assessment of risk of future offending. Finally, and most importantly, a good forensic assessment should concentrate on the future management and prevention of further violence. Although forensic psychiatrists should be experts in the assessment of violence among people with mental disorder, it is essential to develop expertise with those who have no evidence of mental disorder. Paradoxically, these cases are often the most challenging to understand and evaluate.

Psychosis is the generic name given to a range of illnesses that can affect the mind and interfere with how a person thinks, feels and behaves. The term psychosis covers several different conditions, for example, drug-induced psychosis, psychotic depression, schizoaffective disorder and schizophrenia spectrum disorders. The precise name used can change over time and will depend upon the pattern and length of difficulties that an individual has. A diagnosis of schizophrenia is considered the most severe type of psychotic illness and almost one person in every hundred people will be diagnosed at some point in their life. It used to be thought that schizophrenia was a discrete illness that was quite separate from other psychotic illnesses such as depressive psychosis.

This chapter gives an introduction to key concepts in epidemiology for the clinician, student, trainee or early career researcher interested in psychiatry and mental health. Following a brief introduction to the history of epidemiology, we provide a comprehensive, yet accessible introduction to key epidemiological concepts and how these apply to psychiatry and mental health. We introduce the major observational (cohort, case-control, cross-sectional, ecological) and experimental (randomised controlled trial) designs used in epidemiology, their strengths and limitations and specific issues for their use in psychiatry. We also cover measures of disease frequency (incidence, prevalence), measures of effect (risk, rate and odds ratios) and measures of impact (population attributable risk). Our chapter then provides a comprehensive introduction to traditional and contemporary approaches to understanding the critical issue of causation, illustrated via the use of causal diagrams known as Directed Acyclic Graphs. Throughout, we use accessible examples from published research and hypothetical worked examples to consolidate the reader’s knowledge about key methods in psychiatric epidemiology.