There has been growing media and political awareness of forced marriage in recent years, and individuals in England, Wales and Northern Ireland are now protected by the Forced Marriage (Civil Protection) Act 2007. Victims of forced marriage can experience significant abuse, which may lead to mental health problems. People with severe mental illness or intellectual disability may be at increased risk of forced marriage and more vulnerable to its negative consequences. We review the current literature on forced marriage, focusing on the way it might affect these two groups, touch on its potential mental health consequences and give practical examples of how to manage situations in clinical practice.

Three main approaches are used to explore the neural correlates of mood disorder: neuropsychological studies, neuroimaging studies and post-mortem investigations. Lesion studies implicate disturbances in the frontal lobe, basal ganglia, striatum and anterior temporal cortex. Early neurocognitive and neuropathological investigations led to a ‘hypofrontality’ hypothesis of unipolar and bipolar depression, but functional neuroimaging has revealed a more complex picture. Thus, increased metabolism may occur in the subgenual anterior cingulate gyrus in resting-state studies of depression and sad-mood induction. Antidepressants may reduce this activity. Amygdala hyperactivation also is associated with affective disorders. Task-related studies reveal abnormal biases in memory, the experience of pleasure and the perception of emotional facial expressions. There is still little clarity whether the abnormalities in brain activation represent state or trait characteristics of affective disorders.

In an earlier article we reviewed the latest research on the relationship between religious involvement and mental health, the effects of religiosity on mental health and well-being over time and the impact of religious interventions. Here we focus on clinical applications that may be useful to psychiatrists and other mental health professionals. We discuss general clinical applications relevant to all patients (e.g. taking a spiritual history, supporting/encouraging religious beliefs, referring to clergy), violations of clinician–patient boundaries and the need to ensure that religious/spiritual interventions are patient-centred. We describe evidence-based religious interventions and how to identify appropriate patients for this approach. Finally, we explore situations in which religious beliefs and practices may be a problem, not a resource, and make recommendations on how to address such cases. Case vignettes illustrate clinical situations that mental health professionals are likely to encounter. Although the focus is on the North American context, we note how practice and culture in the UK may differ.

Patients who repeatedly injure themselves present particular management problems for general psychiatric teams. This article, the first of a series of four, examines the characteristics of those that present to adult mental health services, and the possible underlying background and trigger factors that lead to these anxiety-raising events. Suggestions are made on preventive and assessment procedures, staff reactions and management strategies aimed at helping patients deal with the overwhelming feelings that underlie self-injury.

The relationship between alcohol use and cognitive impairment has been notoriously difficult to disentangle. We present what is known about cognitive impairment associated with alcohol use/misuse, covering the spectrum from mild and subtle cognitive change through to severe alcohol-related brain damage, including Wernicke-Korsakoff syndrome. We highlight aids to the diagnosis and management of these conditions, and emphasise the benefits of prompt treatment on outcome. We also review progress in understanding their neurobiology. Suggestions for possible service configuration based on both our clinical practice and national guidelines are given.

Contextual rating of social adversity has its origins in the work of George Brown and colleagues (Brown & Harris, 1978). This review evaluates its strengths and weaknesses in rating the effects of social adversity on depressive disorder. We write from the perspective of its usefulness for clinical and training purposes both to the consultant psychiatrist and to the community mental health team working in general adult psychiatry.

This article focuses on service user involvement in supporting and undertaking mental health research. It is written from the author's perspective as a service user with bipolar disorder who has built on previous experience as an academic researcher in business and management studies by active involvement in a number of mental health research projects in a service user capacity. The article highlights contrasting approaches taken by different projects in how they involve service users and provides learning points based on the author's and other service users' experiences.

The sexual behaviour of older people is more often the target of jocularity or ridicule than the subject of serious scientific research. As a consequence, relatively little is known about the sexual behaviour of the over-65s and such information as is available shows a polarisation according to gender, male sexual behaviour and dysfunction being viewed very much in the light of physical problems, whereas women's sexual behaviour revolves around attitudes towards sexuality and the psychological effects of ageing. This review will address the biological changes associated with ageing, the psychological and social concomitants, the prevalence of sexual dysfunction, its aetiological factors, and the management of common sexual problems including those found in an institutional setting.

The Human Rights Act 1998 was introduced into UK law in 2000. It must be considered in all clinical cases, including mental health review tribunals. The number of mental health cases brought to the European Court of Human Rights that breach Article 3 has been very few. However, Article 3 will need to be considered in the clinical setting in complaints arising from conditions of detention, seclusion, control and restraint. This article analyses the case law, illustrating its evolution and also demonstrating the fundamental and core concepts that underpin the Act that can be used in clinical practice.

Attention-deficit hyperactivity disorder (ADHD) is a persistent, pervasive disorder characterised by symptoms of inattention, impulsivity and hyperactivity. Although traditionally considered a disorder of childhood, symptoms and associated impairments persist into adulthood for a significant proportion of individuals. Untreated ADHD can have a number of adverse effects for both the individual and wider society. Despite this, ADHD in adults is often misdiagnosed or its diagnosis is ‘missed’ in general psychiatric settings and this article highlights some reasons for this.

Stress-related disorders are diverse and they may be mental and physical. Often, several body systems and organs are involved simultaneously. The pathophysiology of stress-related disorders involves many factors: an observable or perceived stressor, an individual dynamically evolving vulnerability and maladaptation leading to imbalance, as well as environmental, cultural, gender and life-cycle variables. There is a need to develop a comprehensive quantifiable stress assessment instrument. It would be based on the ‘stress factor’, a dimension that would integrate biological, psychological, social, economic and spiritual parameters and would allow for cultural sensitivity. It would contribute to clinical operational sophistication and would illuminate treatment options and multidimensional well-being interventions. Hopefully, it would facilitate development of culturally sensitive pharmaceutical or biophysiological adaptogens and homeostatic interventions.

Neuropsychological assessment, in the broader sense, is common clinical practice with older adults because of the widespread use of mental status examinations and dementia rating scales. In the more narrow sense, a neuropsychological assessment conducted by a clinical psychologist or clinical neuropsychologist is used less frequently and for more specific purposes. This paper outlines these uses and provides a brief overview of the different types of test that might be used, with a clinical example to illustrate the type of information gained. This review is designed not to be comprehensive, but to provide a pointer towards the latest trends in test development.

Peer review is widely accepted as essential to ensuring scientific quality in academic journals, yet little training is provided in the specifics of how to conduct peer review. In this article we describe the different forms of peer review, with a particular focus on the differences between single-blind, double-blind and open peer review, and the advantages and disadvantages of each. These illustrate some of the challenges facing the community of authors, editors, reviewers and readers in relation to the process of peer review. We also describe other forms of peer review, such as post-publication review, transferable review and collaborative review, and encourage clinicians and academics at all training stages to engage in the practice of peer review as part of continuing professional development.

UK guidelines for treating people diagnosed with schizophrenia currently emphasise the primacy of antipsychotic medication, with or without psychosocially based interventions as circumstances dictate. We now see increasing calls, most notably from mental health service users, for the provision of ‘whole-person-based’, minimal-medication approaches to treating people with this diagnosis. This article is intended to locate the development of such approaches within the history of modern and pre-modern psychiatry and, in doing so, summarise the available evidence base that underpins their efficacy.

This article argues that the current approach to guideline development for the treatment of depression is not supported by the evidence: clearly depression is not a disease for which treatment efficacy is best determined by short-term randomised controlled trials. As a result, important findings have been marginalised. Different principles of evidence-gathering are described. When a wider range of the available evidence is critically considered the case for dynamic approaches to the treatment of depression can be seen to be stronger than is often thought. Broadly, the benefits of short-term psychodynamic therapies are equivalent in size to the effects of antidepressants and cognitive–behavioural therapy (CBT). The benefits of CBT may occur more quickly, but those of short-term psychodynamic therapies may continue to increase after treatment. There may be a ceiling on the effects of short-term treatments of whatever type. Longer-term psychodynamic treatments may improve associated social, work and personal dysfunctions as well as reductions in depressive symptoms.

The deprivation of liberty safeguards were introduced into the Mental Capacity Act in 2008 to enhance the protection of adults in residential homes or hospitals who lack capacity in relation to their care arrangements and who are or may be deprived of their liberty. Deprivation of liberty itself is an imprecise concept and there may be difficulty in applying the appropriate authority where there is a choice between the Mental Capacity Act 2005 and the Mental Health Act 1983. Therefore, this article explains the evolution of mental capacity legislation and the concept of deprivation of liberty, how it may be recognised, prevented and authorised by deprivation of liberty safeguards, along with some of the interface issues with the Mental Health Act 1983.

The management of anxiety and depression in primary care presents significant issues for workload and understanding the patient in terms of a bio-psychosocial model. There is no shortage of policy in this area, but finding effective and innovative ways of implementing that guidance is only just beginning. This article discusses some of the ways that implementation is happening for adults of working age.

This article addresses how mental illness and psychiatry are dealt with in fictional narrative. The starting point is Charlotte Bronte's novel Jane Eyre. The characterisation of madness in that novel provides the basis for exploring how the physical and psychological differences of mentally ill people are portrayed, and how violence and the institutional care of people with mental illnesses are depicted. It is also argued that the fact that in Jane Eyre, Bertha Mason, the madwoman in the attic, is rendered voiceless is not accidental but emblematic of the depiction of mentally ill people in fiction. A number of novels are used to illustrate these issues.

It is deeply satisfying to all mankind that many ailments, once dangerous, mysterious and worrying, now offer the therapist of today wonderful opportunities for the exercise of his skill; but with recalcitrant distress, one might almost say recalcitrant patients, treatments tend, as ever, to become desperate and to be used increasingly in the service of hatred as well as love; to deaden, placate and silence, as well as to vivify. (Main, 1957, in The Ailment)

Psychiatry in the UK and in many other countries is facing a fundamental crisis in attracting new graduates. This poorly understood problem may be related to negative undergraduate experiences. Many clinicians have learnt through an ‘apprenticeship’ model and few are formally taught how to teach students in a modern clinical setting. Learning theory provides useful models for learning and teaching that can improve undergraduate clinical experiences. A variety of means are available to help teaching clinicians apply these theories, including self-help using published literature and gaining teaching qualifications. As the majority of modern undergraduate psychiatry teaching occurs during clinical placements, the incorporated techniques will need to be sensitive to the teaching environment. Application of these principles to day-to-day teaching practice may help to reverse the current staff shortages.