This review outlines an unconventional but timely formulation of quantum dynamics of systems in contact with an environment. This alternative approach to traditional quantum mechanics is generic and is currently gaining attention in a number of fields as, for example, quantum scattering and transport, optical waveguides, devices embedded in an environment, oscillatory classical systems, RLC circuits and other open systems with loss and gain. Here we briefly outline this formulation in which the condition of space-time reflection (PT-symmetry) plays a central role. If PT-symmetry is broken upon parametric change, real energy levels generally turn complex. At the onset of such a symmetry breaking levels coalesce at “Exceptional Points” (EP).