Objectives: During the COVID-19 pandemic, our mental health service experimented with working from home. The flexibility of this practice can enable improved efficiency, staff well-being and expanded operating hours in the longer term. This paper shares our experiences and makes recommendations for being a part of and leading distributed clinical teams. Conclusions: We saw a 3% increase in total appointment bookings and a 7% reduction in cancellations/non-attendance compared to the same period in 2019. Based on our experience and the literature, effective distributed teams have leaders that connect via video at least weekly; focus on transparency and output over micromanagement; prioritise staff relationships and err towards overcommunication.

Conversion disorder (CD) is a syndrome of neurological symptoms arising without organic cause, arguably in response to emotional stress, but the exact neural substrates of these symptoms and the underlying mechanisms remain poorly understood with the hunt for a biological basis afoot for centuries. In the past 15 years, novel insights have been gained with the advent of functional neuroimaging studies in patients suffering from CDs in both motor and nonmotor domains. This review summarizes recent functional neuroimaging studies including functional magnetic resonance imaging (fMRI), single photon emission computerized tomography (SPECT), and positron emission tomography (PET) to see whether they bring us closer to understanding the etiology of CD. Convergent functional neuroimaging findings suggest alterations in brain circuits that could point to different mechanisms for manifesting functional neurological symptoms, in contrast with feigning or healthy controls. Abnormalities in emotion processing and in emotion-motor processing suggest a diathesis, while differential reactions to certain stressors implicate a specific response to trauma. No comprehensive theory emerges from these clues, and all results remain preliminary, but functional neuroimaging has at least given grounds for hope that a model for CD may soon be found.

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The traumatic event is a core requirement in the diagnosis of Post-Traumatic Stress Disorder (PTSD), and is defined in the Diagnostic and Statistical Manual’s (DSM’s) criteria of PTSD as Criterion A. This remains the case, despite opposing views from prior literature that the trauma response can occur without Criterion A. This article explores a definition for psychological trauma, from its etymology to a historical perspective, before examining the evolution of PTSD’s Criterion A across time in various editions of the DSM. The concept of moral injury is also examined, in terms of its correlation with psychological trauma and its impact on the pathological trauma response. A case series of vignettes from the authors’ clinical experience is presented, where PTSD symptoms have been noted in the absence of Criterion A. This is supplemented by the authors’ analyses about how the various life adversities across the cases fall short of Criterion A. Two key features (the imminence of a perceived threat, and the perceived loss of control experienced as a result) of a traumatic event are proposed to refine the definition of psychological trauma. It is hoped that these would serve to improve the current understanding and definition of psychological trauma. Keywords: Psychological trauma; Traumatic event; PTSD.