Maintenance drug treatment in bipolar disorder is a key component of management. There is clinical uncertainty about the relative efficacy of valproate, either alone or in combination, particularly in comparison to lithium. This month's Cochrane corner review aimed to summarise the best evidence available. This commentary puts the findings into their clinical context and updates them in the light of subsequent analyses and the recent revision of the NICE guidelines on bipolar disorder.

About 85% of women experience some type of postpartum mood disturbance. Generally, the symptoms are mild and short-lived, but a minority of women develop depressive illness or sudden psychosis. About half of episodes of apparently postnatal depression start during pregnancy and some seemingly postpartum psychoses start before delivery. Untreated antenatal depression can lead to poor obstetric outcomes, subsequent depression in the mother, and developmental disadvantage and depression later in life in the offspring. In this article we discuss the aetiology of perinatal depression and consider recommended pharmaceutical and psychosocial management of postpartum blues, perinatal depression and postpartum psychosis.

I review some of the evidence that parental personality disorder represents a risk to child development, in terms of both transmission of genetic vulnerability and the environmental stress of living with a parent who has a personality disorder that negatively affects their parenting capacities. I argue that there are two compelling reasons to impose a duty on mental healthcare providers to offer services for adults with personality disorders that specifically focus on their parenting identity: first, because effective therapies for personality disorder are now available; and second, because there is a strong utilitarian and economic argument for improving parental mental health so as to reduce the economic and psychological burden of their offsprings' future psychiatric morbidity.

Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous neurobehavioural syndrome, complex in aetiology and presentation. It is characterised by symptoms of inattention, hyperactivity and impulsivity of varying combinations and degrees of severity. This article seeks to elucidate the different components of the assessment and diagnosis of ADHD in comparison with various differential diagnoses that must also be considered. Despite its complexities, ADHD can be effectively managed using a comprehensive approach advocated by the National Institute for Health and Care Excellence (NICE). The article discusses the combination of medication, psychoeducation and parental handling that has been shown to be effective in containing the problematic symptoms of ADHD. It also highlights the difficulties that can persist into adulthood and potential strategies to improve prognosis.

The past three decades in the UK have seen a prolonged experiment in community mental healthcare that has attempted to address the problem of the disgorgement of institutional psychiatry into a poorly prepared community service. The effectiveness of new ‘functionalised’ service models is considered, together with a reminder of the fundamental components of community mental healthcare and a statement of the principles that should inform future service models.

Over the past decade, important research has been performed into the therapeutic use of dihydrocodeine, injectable opioids (diamorphine) and supervised disulfiram in addiction treatment. There have also been interesting developments regarding baclofen for alcohol problems and use of stimulants in adult Attention-deficit hyperactivity disorder (ADHD). However, evidence for the effectiveness of medication to promote alcohol abstinence remains modest at best.

Spirituality and religion have assumed importance in psychiatric practice in recent years because of both a growing evidence base and the desire of patients that such matters should be better addressed as an aspect of their care. However, there has been controversy regarding interpretation of the evidence base and issues of good practice, notably about defining appropriate professional boundaries. A sensitive and patient-focused clinical enquiry is therefore needed to discover whether and how spiritual/religious concerns are important to patients and, if they are, how they might most appropriately be addressed in treatment. Many of the concerns of patients and professionals regarding spirituality overlap with the recovery agenda and so are easily addressed implicitly and without need to impose the language of spirituality or religion. However, for some patients, transcendent concerns that are not a part of this agenda are easily overlooked.

The psychological state of an individual affects the way in which they express themselves. Art has long been an outlet for self-expression, and painting is just one art form that individuals use to articulate their ideas and emotions. Edvard Munch (1863–1944) was an influential Norwegian artist who led a tortured life; his greatest artworks reflect the struggles he faced. This piece narrates the story of his life, exploring the ways in which his mental illnesses were related to his art, and how his art evolved as a result of this.

Matters relating to human rights arise in almost every area of psychiatric practice. Although some statements of rights are non-binding declarations (e.g. the United Nations' Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care), others are legally binding (e.g. the European Convention on Human Rights) and actively shape national laws. Persons with mental illness commonly experience violations of rights, including their economic and social rights. Psychiatrists can promote human rights through high-quality, evidence-based clinical practice; patient-centred service management; social awareness and engagement; and international activism to enhance protection and promotion of the rights of people with mental illnesses at global level.

Boredom is highly prevalent among general hospital in-patients. Self-help strategies suit some patients, but for others hospitals need to stimulate opportunities for them to experience meaningful relationships and roles and a sense of control. In-patients' well-being and levels of boredom may be affected by no-smoking policies, hospital design, access to natural light, nature scenes and indoor or outdoor gardens. Alleviating boredom in elderly patients with reduced cognitive function may be particularly challenging. Healthcare professionals may face the wider challenge of fully engaging with patients' psychosocial needs, given the biomedical model that privileges the ‘traditional medical history’ over the more holistic communication model. Engaging with patients' psychosocial needs is consistent with managing their experience of 'sickness' rather than focusing on the narrower concept of ‘disease’.

From a very deprived baseline, mental health services in Hong Kong have undergone some growth over the past decade. The number of inpatient beds for psychiatric treatment dropped by one-third, but the community mental health service expanded significantly. A number of low-resource phase-specific and age-specific treatment programmes were introduced, with promising initial results. However, there remain many challenges, including a serious shortage of well-trained mental health professionals. Much more investment in mental health workforce development is required to meet the service needs not only of today, but also of tomorrow.