We had rather hoped that this fourth edition would be a ‘fresh start’, incorporating the major revisions to both classifications of psychiatric disorders. DSM-5 did finally arrive in 2013 ( DSM-5 and all that …, p. [link]), but unfortunately, although ICD-11 has been ‘launched’ in June 2018, it is unlikely to be fully ratified until 2019 and implementation will not be before 2022 ( Wait, what … ICD-11? p. [link]). We have tried to integrate DSM-5, while keeping one eye on the current proposals for ICD-11 and still retaining ICD-10 categories and codes as far as possible (as it is likely that we will all still be using these for the foreseeable future). Hopefully you will agree that we have struck a pragmatic balance between being useful and yet informative. Full assimilation of ICD-11 will have to wait until the fifth edition!
Nevertheless, we have undertaken a major revision of the overall text, and the scope of these changes has meant a reorientation of the content to reflect the evolution of ideas that directly and indirectly have influenced psychiatric thinking over those last few years such as global mental health and gender-related issues. Equally, advances in research have increased our understanding of the biological basis of mental disorder, hence our inclusion of a new neuropsychiatry section (and a lengthy explanation of what neuropsychiatry actually is; pp. [link]–[link]).
When we first approached this project, over 15 years ago, we tried to produce the book we wished we had when starting training. Our core aim was to provide a practical guide for anyone entering this medical specialty, which would help them to gain a working knowledge of the diagnosis and management of mental disorders and a deeper understanding of the functioning of the brain in health and disease. While that experience will always be daunting and sometimes overwhelming, perhaps this fourth incarnation of the handbook can still act as a companion in the early days and a familiar source of reassurance as experience is gained. At the same time, we hope it will encourage you to think more deeply about the wider reaching scientific, philosophical, ethical, social, and legal issues that you encounter in your medical practice.