''Abstract''

''Background''

Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression.

''Methods''

Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale score ≤10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session.

''Results''

In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46 …

Reflective practice is a paper requirement of your career progression in health care. However, if done properly, it can greatly improve your skills as a health care provider. This article provides some structure to reflective practice to allow a health care provider to engage more with reflective practice and get more out of the experience.

This section has been created to support psychiatrists during the difficult time after a patient has died by suicide.

Several free courses on different topics.

This article provides a conceptual overview of the medical model and its application to psychiatry, understanding the medical model in psychiatry as a biopsychosocial model. The article discusses basic concepts relevant to the medical model (illness, disease, disorder, condition, etc.), the nature of medical knowledge and diagnostic construct, medical classifications in psychiatry, and the medical model within multidisciplinary practice. Salient criticisms of the medical model are discussed and addressed at relevant points. It is recognized that concepts such as disease and illness lack uncontested definitions and are not free from value judgements even in general medicine. Diagnostic constructs used in psychiatry are often descriptive heterogenous categories which can nonetheless offer clinical utility. The medical model co-exists with non-medical approaches and perspectives, and psychiatrists work in an interdisciplinary context …

Mental illnesses are common and cause great suffering to individuals and communities everywhere in the world, but many health workers are more comfortable dealing with physical illness. This practical manual of mental health care is vital for community health workers, primary care nurses, social workers and primary care doctors, particularly in low-resource settings. This guide gives the reader a basic understanding of mental illness by describing more than thirty clinical problems associated with mental illness and uses a problem-solving approach to guide the reader through their assessment and management. Mental health issues as they arise in specific contexts are described - in refugee camps, in school health programmes, as well as in mental health promotion. The final section helps the reader to personalise for a particular location, for example …

Most had no history of mental illness and became psychotic weeks after contracting the virus. Cases are expected to remain rare but are being reported worldwide.

The role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this article considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.

Mental health professionals may come into contact with transgender patients under various circumstances. These may range from patients presenting to a psychiatrist for the first time seeking help with cross-gender identification matters, to those with an established diagnosis …

Guidance on writing letters to patients

This qualitative study examined the process of Internalized Sexual Stigma (ISS) in a sample of Egyptian gay men. Participants' experience of ISS was explained using the theoretical understanding that it represents an internal form of minority stress, which is the excess and harmful stress often experienced by individuals from stigmatized social categories due to their minority position. Thematic analysis of interviews with eight Egyptian gay males suggested that these men experienced internal minority stress as a result of the sexually-prejudiced messages they received from different sectors of their society, including its non-affirming religious institutions. Moreover, thematic analysis added cultural understanding to this theoretical explanation by producing an emerging theme that highlighted the possible role of societal pressure to meet gender expectations in perpetuating this problem. Recommendations for mental …

There is a high prevalence and increased likelihood of being a victim of domestic violence in men and women across all diagnostic categories, compared to people without disorders. Longitudinal studies are needed to identify pathways to being a victim of domestic violence to optimise healthcare responses.

Social distancing in a psychiatric facility is easier said than done

In this podcast Dr Gareth Owen gives an overview of phenomenology in psychiatry, discussing some of the historical background to the development of the discipline, some of the problems and how it relates in comparison with other disciplines such as a biological or psychological approach to a psychiatric disorder. He also touches on how we can bring a phenomenological understanding into our daily practice.

• Podcast: Why neuroscience matters
• Video: Integrating neuroscience with psychological and social approaches
• Article: Embedding neuroscience in psychiatry training
• Essential reading on neuroscience in psychiatry

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Among individuals hospitalised with depression, we found no evidence for a clinically significant increased risk for serious medical events with exposure to electroconvulsive therapy, and the risk of suicide was found to be significantly reduced, suggesting the benefits of electroconvulsive therapy for depression outcomes might outweigh its risks in this population.

Helpful resources to guide you on psychiatry training programme in the United Kingdom (UK) and career development.