One of the ironies of writing books is that the preface, that part to which the reader comes fi rst, is the very part to which the writers come last of all. Once the rest of the book is fi nished, composing the preface can allow the authors an opportunity for refl ection and an attempt at summing-up their initial aims and current hopes for the book as it leaves their hands for the fi nal time. While writing this third preface we found it interesting to examine its two predecessors, to see what they revealed about our thoughts at those times. Reading the fi rst preface it’s clear we were writing to ourselves, or at least to our slightly younger selves, refl ecting on the book we wished we’d had during our psychiatric training. The emotions conveyed are those of anxiety and hope. Moving on to the second, it is addressed to our junior colleagues, and seems to us to convey a mixture of indignation and pride. In this third edition we have continued to revise and update the book’s contents in line with new developments in clinical practice.
While these changes refl ect ongoing and incremental improvement, one cannot fail to be struck by how unsatisfactory the state of our knowledge is in many areas and how inadequate many of our current treatments are. On this occasion we fi nished the book with the hopes that it would continue to serve as a useful guide to current best practice and an aid in the management of individual patients, and that these current inadequacies would inspire, rather than discourage, the next generation of clinicians and researchers. Our feelings at the end of a decade of involvement with this handbook are therefore of realism mixed with optimism.