Dementia is is stereotypically associated with older people. However, in a significant minority it can affect people in their 40s and 50s, or even younger. Currently there is a lack of awareness, even among healthcare professionals, and there is a dearth of appropriate services for such patients. Despite the attention given to this condition by National Institute for Health and Clinical Excellence guidelines, provision of specialist early-onset dementia services in the UK remains patchy. Carers and patients often find themselves being passed ‘from pillar to post’ between psychiatry and neurology, and also between adult, old age and liaison psychiatry. The responsibility for identifying available and appropriate help is often left with carers. This leads to unnecessary delays, causes undue distress to patients and places an added burden on carers.

Mortality from causes other than suicide is higher than expected in schizophrenia. Cardiovascular causes are most common, accounting for the majority of the 5% of sudden and unexpected deaths. Most cases have no clear explanation on post-mortem examination (‘sudden unexplained deaths’) and are thought to result from fatal arrhythmias. Prospective studies show that people with prolongation of the QT interval beyond 500 ms are at increased risk of serious arrhythmias such as ventricular tachycardia and torsade de pointes. In about 1 in 10 cases, the torsade is fatal. Most antipsychotics prolong the QTc interval in overdose but some prolong it even at therapeutic doses. Droperidol, sertindole and ziprasidone extend the QT interval by an average of 15–35 ms; quetiapine, haloperidol and olanzapine by 5 ms, to 15 ms. There is only an approximate relationship between QT prolongation and risk of sudden death, and the risk related to antipsychotics is thought to increase in people with pre-existing cardiac disease, those taking multiple QT-acting drugs and those taking antipsychotics at high dose for long periods. There is little evidence of an association with route of administration. More data are required to clarify to what extent people with mental health difficulties who die suddenly have pre-existing cardiac disease.

The recovery approach is much in vogue, initiated by the user movement and embraced by politicians. Users and politicians have a variety of opinions about how it fits with professional psychiatric practice – some view recovery and professional practice as compatible, others view them as mutually exclusive, naming professional practice the ‘medical model’. This editorial explores the relationship between the medical model and the recovery approach. We argue that both have multiple points of similarity, and that applying the medical model to the recovery approach has the potential to significantly influence psychiatric practice.

Psychotic symptoms in elderly people can be seen in a variety of conditions. This article reviews treatment strategies (both pharmacological and non-pharmacological) for such symptoms in schizophrenia and neurodegenerative disorders in this population. Traditionally, antipsychotics have been the most commonly used treatment for psychotic symptoms. Their usefulness in treating schizophrenia, both chronic and late onset, is well established and the atypical antipsychotics, which have a better side-effect profile, are more suitable for elderly people. More recently, there have been increasing concerns about their safety in psychoses due to dementia. The debate about whether an absolute ban on their use is required is still ongoing, but it has highlighted the need for adopting and developing non-pharmacological interventions.

The risk of suicide is higher during the period immediately following discharge from in-patient psychiatric care than at any other time in a service user's life. Demographic and clinical risk factors for suicide in this period are similar to those for suicide at other times and may not be specific enough to enable identification of those at greatest risk. Epidemiological studies suggest that factors related to service organisation and delivery (e.g. social support and continuity of care) are also important in the aetiology of suicide following hospital discharge. Interventions aimed at helping people in the period immediately following discharge from in-patient care have been developed. Although the effect of these interventions on suicidal behaviour has not been examined, available evidence suggests that efforts to increase patients' confidence and level of social support may be of value.

In this article, we offer an account of how various psychological therapies address dysfunctional mentalisation and identify pitfalls of therapy that could lead to an impasse or even to negative consequences associated with psychological treatment. Some practical recommendations follow from our model, particularly in relation to the careful monitoring of the intensity of the patient's attachment and the use of interventions aimed at promoting mentalising.

Autism and schizophrenia were placed in different diagnostic categories in DSM-III, having previously been considered as related diagnostic entities. New evidence suggests that these disorders show clinical and cognitive deficit overlaps and shared neurobiological characteristics. Furthermore, children presenting with both autism spectrum disorder (ASD) and psychotic experiences may represent a subgroup of ASD more closely linked to psychosis. The study of ASD and childhood schizophrenia, and their clinical boundaries and overlapping pathophysiological characteristics, may clarify their relationship and lead to more effective interventions. This article discusses the relationship through a critical review of current and historical dilemmas surrounding the phenomenology and pathophysiology of these disorders. It provides a framework for working with children and young people with mixed clinical presentations, illustrated by three brief fictional case vignettes.

In 2000, about 350 million adults used the internet and people increasingly take articles from websites to medical appointments. The quality and safety of websites vary widely and some users are reluctant to access mainstream sites. People are vulnerable to misinformation and exploitation: there is evidence that online purchases have caused morbidity and mortality. This paper reviews the current evidence on the dissemination of health information on the internet and the various strategies that are developing to assess and screen site quality. Such strategies include ‘quality assurance’ marking, specially designed search engines, and operational criteria for individuals to apply to sites. It also discusses the medical community's roles and responsibilities in relation to this burgeoning area.

In psychiatric and psychotherapeutic practice, ‘boundaries' delineate the personal and the professional roles and the differences that should characterise the interpersonal encounters between the patient/client and the professional. Boundaries are essential to keep both parties safe. The author outlines the various types of boundary violation that can arise in clinical practice, their consequences (both clinical and legal), how professionals can avoid them and how health care institutions might respond, should they occur. He concentrates on sexual boundary violations, because these have been the subject of most empirical study.

This article presents evidence for the efficacy of psychosocial interventions for people with dementia and their carers. The evidence base is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of nonpharmacological interventions, as their properties are distinctly different from those of pharmacological agents.

There is now an established evidence base for the use of information and communication technology (ICT) to support mental healthcare (‘e-mental health’) for common mental health problems. Recently, there have been significant developments in the therapeutic use of computers, mobile phones, gaming and virtual reality technologies for the assessment and treatment of psychosis. We provide an overview of the therapeutic use of ICT for psychosis, drawing on searches of the scientific literature and the internet and using interviews with experts in the field. We outline interventions that are already relevant to clinical practice, some that may become available in the foreseeable future and emerging challenges for their implementation.

Antisocial personality disorder is a complex condition carrying high rates of comorbidity and mortality for individuals as well as harmful consequences for their families and society. Despite the publication of National Institute for Health and Care Excellence (NICE) guidelines for the disorder, the evidence base and provision of effective treatments remain inadequate, and the belief that the condition is untreatable remains widespread among psychiatrists and other professionals. This article highlights current diagnostic controversies and summarises the evidence for conceptualising antisocial personality disorder as a disorder of attachment. Informed by this developmental perspective, we provide a framework for the management and treatment of adults with antisocial personality disorder, highlighting the importance of creating a safe setting and recommending adaptations of therapeutic technique to facilitate the engagement of this ‘treatment-rejecting’ patient population. We conclude with an outline of the current government policy on the treatment of high-risk offenders with personality disorder.

This commentary aims to support and elaborate on some of the specific issues raised by Dein & Woodbury-Smith. Although I agree with many of their comments, I believe that the role of neuropsychological and sensory impairments, as well as dysfunctional coping strategies among individuals with an autism-spectrum disorder who offend, need to be expanded from a psychological perspective. In my experience, the assessment of these factors plays a crucial role in guiding opinions on mental capacity, individual interventions, risk assessment and management. Elements of psychopathy in autism also require clarification. It could be argued that by understanding these issues, any attempts at social inclusion and preventing offending will be more successful.

Both primary and secondary care practitioners often wish to offer their patients access to effective psychosocial interventions, yet the lengthy waiting-lists for specialised psychological or psychotherapeutic services create frustration among both referrers and their patients. There is therefore a need for new ways of accessing such treatments that can be delivered in most psychiatric team settings. For this to be realistic, such delivery must be possible within the time available to most practitioners (10–20 minutes for many consultant psychiatrists). One approach is to offer structured self-help materials.

I explore implementation of the National Institute for Clinical Excellence's clinical guidelines for schizophrenia at an individual practitioner level and at an organisational level. Integrating effective individual and team approaches into a systematic organisational approach with collaborative working between managers, clinicians and service users will be essential to successful implementation and is likely to require a strong lead from senior clinicians. Implementation is likely to be best achieved through a sense of ownership of the guidelines and a process that borrows from their spirit, which emphasises collaboration, building on the strengths and good practice already present. Although full implementation will require additional resources, current resources must be employed effectively. The task of implementation is immense, however, and in some areas resource deficiencies and other structural problems might present insurmountable obstacles.

Depression in schizophrenia has been a neglected field for some time, but much evidence exists as to the common occurrence of affective disturbance in so-called non-affective psychosis. Depression is related to poor outcome in terms of functional recovery, relapse rate and suicide, and there is increasing evidence that it also precedes the onset of first-episode psychosis for many individuals. This article reviews recent steps forward in the evidence base for depression in schizophrenia in terms of prevalence, importance, assessment and treatment implications, with the aim of providing useful information for practising psychiatrists.

This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces.

Most of the excitatory neurotransmission in the central nervous system (CNS) is mediated by the endogenous excitatory amino acids (EAAs) glutamate, aspartate and homocysteine. Most of the endogenous inhibitory neurotransmission is mediated by gamma-aminobutyric acid (GABA). EAAs modulate the firing of almost all neurons in the CNS, as excitatory neurotransmission can result in both neuronal inhibition and excitation. The glutamate system is the best characterised of the EAA systems (Box 1).

Most articles on the management of the premenstrual syndrome (PMS) begin by noting that the term “premenstrual tension” was first coined by R. T. Frank in 1931 and “pre-menstrual syndrome” by Greene & Dalton in 1953. However, in 1847, Dr Ernst F. von Feuchtersleben wrote:

We discuss the complicated nature of communication between people from different cultural groups, perhaps using a second language. We focus on the fact that mental health practitioners and service users often have in common neither their cultural backgrounds nor their explanatory models of illness. Communication even in a shared language can be less than optimal as words carry multiple meanings. Consequently, consultations that involve culturally grounded explanatory models of illness challenge the professional. We give examples showing that reconciling different explanatory models during the consultation is a core task for psychiatrists and mental health practitioners working in multicultural settings.