Eating disorders are historically underserved in healthcare, but are increasingly prevalent and recognised for their high costs regarding mortality, quality of life and the economy. Those with longstanding eating disorders are commonly labelled ‘severe and enduring’ (SEED), which has been challenged for its conceptual vagueness and potential to discourage patients. Attempts to define individuals from this cohort as having ‘terminal’ illness have also gained traction in recent years. This paper is grounded in lived/living experience and relevant research. It challenges the logical coherence and utility of SEED, arguing that the word ‘enduring’ unhelpfully situates intractability of longstanding illness within patients themselves and the nature of their illness. This risks a sense of inevitability and overlooks the important role of contextual factors such as lacking resources and insufficient evidence for withholding active treatment. Recommendations suggest approaches to dismantling unhelpful binaries between early intervention and intensive support, recovery and decline.

This commentary explores issues of professional identity, fairness and discovery in the history of psychiatry in the light of Walter Benjamin's (1892–1940) philosophy of history, especially his concept of Jetztzeit (now-time) and the profession's relationship with the founder and owners of Purdue Pharma LP.

Previous research has revealed that stigma is not restricted to people with mental health problems but extends to the professionals involved in their care and treatment. Unlike other artistic manifestations, the study of the depictions of psychiatry in popular music is still a less-explored topic. This article addresses the subcultural portrayals of the psychiatrist and psychiatric treatments within Spanish popular music. The predominance of negative depictions of mental health professionals as social control agents was a striking finding, given the topicality that characterises punk music. It is suggested that the allegorical role assigned to the psychiatrist in such a specific narrative framework, marked by ideological factors, could potentially explain these findings. In contrast to other cultural manifestations that show a tendency towards more balanced views of psychiatric treatment and practice, the negative representations in Spanish punk songs seem to have evolved little over decades, reflecting outdated views of the psychiatric approach.

Psilocybin is a classic psychedelic drug that has attracted increasing research interest over the past 10 years as a possible treatment for mood, anxiety and related conditions. Initial phase 2 clinical trials of psilocybin given alongside psychological support for major depression and treatment-resistant depression (TRD) demonstrated encouraging signs of basic safety, further confirmed by a large study in groups of healthy volunteers. The first international multi-centre randomised controlled trial was published in 2022, with signs of efficacy for the 25 mg dose condition in people with TRD when compared with an active placebo. Phase 3 trials in TRD are scheduled to start in 2023. Early evidence suggests that single doses of psilocybin given with psychological support induce rapid improvement in depressive symptoms that endure for some weeks. We therefore provide a timely update to psychiatrists on what psilocybin therapy is, what it is not, and the current state of the evidence-base.

The variants of frontotemporal dementia (FTD) require careful differentiation from primary psychiatric disorders as the neuropsychiatric manifestations can overshadow the unique cognitive deficits. The language variants of FTD are less readily recognised by trainees despite making up around 43% of cases.1 This educational article presents an anonymised case of one of the language variants: semantic dementia. The cognitive deficits and neuropsychiatric manifestations (delusions and hyperreligiosity) are explored in terms of aetiology and management. By the end of the article, readers should be able to differentiate FTD from Alzheimer's disease, understand the principles of management and associated risks, and develop a multifaceted approach to hyperreligiosity in dementia.

The recent Draft Mental Health Bill for England and Wales proposes changes to the Mental Health Act 1983 which will include, for the first time, a legal definition of autism. This article explores the specific potential issue that the definition, owing to its breadth, potentially encompasses a number of conditions other than autism, consequently leaving the definitionally dependent concept of ‘psychiatric disorder’ significantly narrowed in scope. The potential implications of this – primarily the concern that a range of other conditions and presentations could be unintentionally excluded from the scope of the civil powers in the Mental Health Act – are discussed.

This brief commentary reflects on navigating two dangers of historical research into psychiatry: hagiographic representations of psychiatrists; and accusations of their self-interest and oppression of vulnerable people.

Domestic abuse often begins or escalates during the perinatal period, increasing the risk of adverse pregnancy outcomes and death of the woman and infant. The hidden nature of domestic abuse, compounded by barriers to disclosure, means many clinicians are likely to have unknowingly encountered a patient who is being abused and missed a vital opportunity for intervention. This educational article presents the experience of a woman who was abused during pregnancy. It describes how to facilitate a disclosure and conduct an assessment and illustrates safeguarding duties alongside interventions.

Electroencephalogram-based evidence was accepted in a UK law court for the first time in 1939. This paper gives an account of that case, not previously clinically reported, and the individuals involved. Why it was not published in the literature at the time is explored and parallels with more recent technologies are highlighted.

Chronic insomnia is undertreated in the UK despite being a common mental disorder that severely affects quality of life. The lead author, a psychiatry trainee, implemented a new group cognitive–behavioural therapy for insomnia (CBT-I) service for secondary care patients in London with chronic insomnia and comorbid mental illness. Expertise was propagated by trainees teaching other trainees. Nine patients completed all sessions, all with moderate-to-severe insomnia on the Insomnia Severity Index (ISI) at baseline assessment (mean score 21.6). All patients seen at follow-up had improved, scoring in the ‘subthreshold’ or ‘no clinically significant insomnia’ ranges on the ISI (mean 6.6), and all with improvements in comorbid psychiatric symptoms and functioning. This evaluation demonstrates that group CBT-I can be easily learned and delivered by those without formal CBT or sleep medicine training. This could increase the availability and accessibility of treatment. However, bureaucratic challenges were faced, and trainee-led innovations should be better facilitated.

This article uses three fictitious case vignettes to raise questions and educate on how clinicians can appropriately approach patients experiencing spiritually significant hallucinations. Religious hallucinations are common but are not pathognomonic of mental illness. They are often intimate experiences for the patient that raise complex questions about psychopathology for clinicians. When assessing a patient with religious hallucinations it is important that clinicians hold at the centre that person's personal experience and create a safe space in which they are listened to and epistemic injustices are avoided. Involvement of chaplaincy services is important not just to support the patient but also to ensure that as clinicians we seek support in understanding the religious nature of these experiences.