Interest in the relationship between mother-child interactions and mental health has two sources: awareness of the importance of correct parenting in personal development; and the exploration of postnatal mental illness.

The dopamine hypothesis for the mode of action of antipsychotic drugs has been with us for some 30 years and has, by and large, withstood the test of time. It simply states that antipsychotic drugs owe their therapeutic effects to an ability to block central dopamine receptors. This has given us a working and testable explanation for the effects of these drugs and it has prompted the synthesis of new agents. While so-called antipsychotic drugs (otherwise known as neuroleptics or major tranquillisers) are known to be effective in schizophrenia and related psychoses, mania, and the agitation associated with severe depressive illness or organic disorder, this paper is only concerned with the pharmacotherapy of schizophrenia.

This article will concentrate on insight into serious mental disorder. Not psychoanalytic insight – nor indeed, the insight all of us have, to a greater or lesser extent, into our own attitudes, motives and behaviour – but the insight which patients with psychosis have into their mental pathology. This is no longer considered an all-or-none phenomenon, but rather a dimensional one, so that subjects can have different levels of awareness into their illness. The suggestion was first mooted by Aubrey Lewis (1934) in his seminal work on insight. Conceptual exploration of insight has been activated in the past decade and is proceeding in parallel with the construction of special scales to measure insight and research into its cognitive, biological, social and cultural basis.

This paper will focus primarily on the most recent research studies involving doctors in the UK. We will not discuss the treatment of doctors who are psychiatrically unwell as this is covered in other papers elsewhere in this issue. Before reviewing specific studies, we will consider the measurement of psychiatric disorder, stress and burn-out.

This paper examines the question of whether chronic fatigue syndrome (CFS), often known as myalgic encephalomyelitis (ME), should be classified as a physical or mental illness.

The term hypochondriasis was first coined over 2000 years ago to describe a physical illness afflicting the hypochondrium. Subsequently the term was used for a variety of physical illnesses, until the 17th century when forms of melancholia were labelled as hypochondriasis. Since then a very large number of psychiatric disorders have been given the term hypochondriasis, for example, a form of schizophrenia, anxiety neurosis and malingering (Kellner, 1986).

The presentation of anxiety disorders in children and adolescents shares similarities and differences with that in adults, and may vary significantly, depending on the age of the individual. Assessment must differentiate anxiety disorders from developmentally appropriate fears as well as medical conditions and drugs that can mimic anxiety states. Aetiology of anxiety disorders in this group encompasses complex genetic and environmental influences. Additional insight into causation is provided by neuroimaging and research into temperament. Recommended interventions include both cognitive-behavioural therapy and pharmacology. Although childhood anxiety disorders generally remit, there remains an increased risk for anxiety and depressive disorders to emerge in adulthood, most likely through heterotypical continuity.

Psychostimulants (dexamphetamine, methylphenidate, modafinil) reduce fatigue, promote alertness and wakefulness, and have possible mood-enhancing properties. In modern psychiatric practice, their use has been limited to attention-deficit hyperactivity disorder and sleep disorders such as narcolepsy. Despite this, research has continued into psychostimulant use in general psychiatry, especially in the treatment of depression and fatigue. This article reviews the recent literature regarding psychostimulant use in general and consultation-liaison psychiatry. Although psychostimulants continue to attract clinical research, there is currently not enough evidence to recommend their routine use for general psychiatric conditions.

Care and follow-up of patients discharged from medium secure units in England and Wales is uncoordinated and inconsistent, although the perceived risk of violence by people with mental disorders is a primary political issue. This article outlines models of community support for these individuals, and describes a forensic mental health liaison service in operation in England.

Recent technological advancements have been used to help people with dementia remain independent. These are reviewed and case vignettes are used to explain their use in common scenarios. The ethical perspective and current evidence are explored in the context of telecare use.

The importance of mental health to our social, financial and physical well-being has gained better recognition in recent years. The work of psychiatry is to understand, prevent and treat mental illness, and should therefore be of compelling interest to the public. Yet few care about the profession or practice of psychiatry other than psychiatrists themselves. The public and the profession would both benefit from a ‘conversation’ about practical, moral and political aspects of contemporary mental health. This should be a dialogue of equals, distinct from didactic approaches to ‘public education’ or from a ‘media psychiatry’ that exists primarily to entertain. This discourse would help to improve care, diminish stigma, promote recovery and improve the status of the profession itself. This article proposes that this kind of ‘public psychiatry’ should take its place as one of four interdependent professional domains.

Family therapy for schizophrenia began in the early 1950s, inspired by theories that located the cause of the illness in family dysfunction. The family pathology was seen as stemming from disturbed relationships (Fromm-Reichmann, 1948; Lidz et al, 1956; Laing & Esterson, 1964) and / or distorted communication (Bateson et al, 1956; Wynne & Singer, 1963).

The number of beds available in the UK for the treatment of mental illness has fallen by over two-thirds since its peak in the mid-1950s. There is a worldwide trend of closure of large mental hospitals and integration of services for the mentally ill in their own local community. Community surveys have shown that an overwhelming majority of mentally ill people are treated in primary care or by specialists, but without being admitted to a hospital. This is now the preferred clinical practice (Shepherd et al, 1981).

Persistent major depression that does not respond to adequate first- or second-line treatment is a common problem in psychiatry. This article updates evidence on recommended treatment strategies and reviews the prospects of more experimental approaches. The main pharmacological development in recent years has been the demonstration that several atypical antipsychotic drugs are effective adjunctive agents in improving symptoms in depression unresponsive to selective serotonin reuptake inhibitors, although their adverse effect burden is high. There is optimism about novel pharmacological strategies based on glutamatergic and anti-inflammatory mechanisms. It is important to combine drug and psychological treatments whenever possible. With persistent therapeutic engagement, the majority of patients remit eventually, but subsequent relapse remains a problem. Clinicians should pursue an active and collaborative treatment plan that makes use of all effective therapeutic modalities and continues into the relapse-prevention phase.

Auditory hallucinations (voices) are the most common symptom in schizophrenia, occurring in 70% of those with the diagnosis. A proportion respond to antipsychotic medication, but despite adequate concordance with prescribed medication, voices may still remain. Voice hearers often inadvertently activate coping strategies that maintain the symptoms and linked distress. Assessment can identify ineffective strategies. Effective strategies can then be initiated, starting with distraction to reduce distress in the short term and leading to focusing approaches that give an improved understanding of voice maintenance. This article describes how to recognise voice hearers' ineffective coping strategies and how to teach effective approaches that are a crucial catalyst in the recovery process.

We try to demonstrate that using psychodynamic principles as part of case formulation is both possible and useful in everyday practice. We consider steps to developing a psychodynamically informed formulation, frameworks that can be used to structure this, and processes and resources needed to support good-quality formulation. We discuss the potential value of incorporating psychodynamic thinking and emphasise that this is complementary to other frameworks for understanding psychosis. Detailed case studies are provided.

Up to 40% of people with depression do not recover following standard treatments such as medication and psychotherapy. Transcranial magnetic stimulation (TMS) is a treatment used worldwide for adult patients with severe clinical depression when antidepressants have repeatedly failed to control their symptoms. This article explains the use of TMS in clinical practice.

This article describes how the core principles and techniques of transference-focused psychotherapy (TFP) can be used in general psychiatry to help in the management of patients with borderline personality disorder (or other moderate to severe personality disorders). It focuses on: knowledge – appreciating how an understanding of object relations assists the clinician in assessment and treatment; attitude – developing a stance to manage the confusing and negative feelings that may arise in both clinician and patient; and skills – describing how use of TFP techniques (technical neutrality, analysing the transference and countertransference, and judicious use of interpretation) helps the clinician to continue thinking in the fraught clinical encounter. The structural (including contemporary object relations) and structured approach in TFP are exemplified in clinical vignettes.

The article covers the state of play of adoption from local authority care in the UK and research into the factors influencing placement outcomes. The major contentious issues about placement are discussed in relation to competing opinions and available evidence. Ways of intervening in adoptive families in difficulty are considered, together with current efforts to establish what makes for effective support services. This article recommends comprehensive assessments of the children to be placed and carefully targeted adoption-aware psychosocial interventions.

Depression is a common and important cause of morbidity and mortality worldwide. It is commonly treated with antidepressants and/or psychological therapy, but some people prefer alternative approaches such as exercise. There are a number of theoretical reasons why exercise may improve depression. This is an update of a review first published in 2009.