Physical treatments

Physical treatments in psychiatry form the mainstay of psychiatric treatments alongside other psychological therapies. Ethical decision-making in the best interest of the patient should always take precedence over any conflict of interest; however, this is a complex area given multiple competing interests and which requires careful evaluation and reflection. We explore the complex interplay between psychiatrists and the pharmaceutical industry with a particular focus on research, drug development and discovery, publication, and dissemination. We also focus on ethics relating to treatments in special groups such as those experiencing pregnancy and postnatal care, early intervention, pharmacogenomics, or treatment-resistant schizophrenia. We then discuss issues relating to consent that correlate with case law and precedents set, which have impact on daily clinical life. Ethical issues relating to neurostimulation including electroconvulsive therapy or newer treatments such as transcranial magnetic stimulation and deep brain stimulation are also explored, outlining historical issues and contemporary guidelines leading to improvements in care.