Psychopathology is an integral part of the theory and practice of psychiatry. This commentary explores the importance of psychopathology, especially with regard to clinical practice. The concept of lifeworld is introduced as an important component of attributing meaning to a person's experience of mental disorder. It is also argued that the advance of neuroscience does not preclude the importance of psychopathology.

At a time when patients are challenged to cope adaptively with both the diagnosis and treatment of cancer, clinicians need to respond appropriately to the many inevitable questions about the causes of cancer and contributing factors, including ‘Is this my fault?’. The evidence guiding answers to such questions has been confounded by many methodological challenges, but personality, stress and life events are no longer considered causes of cancer. However, social isolation, untreated depression and social deprivation continue to influence quality of life and reduce cancer survival times. Psychiatry might play a role in promoting lifestyle changes that reduce the risk of cancer, but more importantly it can influence disease progression by optimising patients' adaptation to the many challenges that cancer brings.

In this article we start with the effectiveness paradox between different psychotherapeutic modalities, considering common factors, before moving on to give a brief overview of the three main psychotherapeutic approaches – psychoanalytic, cognitive–behavioural and humanistic – and their developments. We conclude that it is the therapeutic relationship – considered in the context of the above – that is core to all therapeutic engagement, medical or otherwise.

This article examines how madness is depicted in the work of Dostoyevsky. It gives a brief account of Dostoyevsky's life before looking at the many ways in which he portrayed insanity. It suggests that he provided a sophisticated and complex picture of mental illness which has relevance for how contemporary clinicians conceive of psychiatric illness.

The artist Arshile Gorky played a central role in the development of Abstract Expressionism during the 1940s. Born in Armenia, his early figurative works recall a childhood of persecution by Ottoman Turks, a period during which he suffered a number of significant losses. The painting The Artist and His Mother (c. 1926–1936) is based on a photograph showing the 7-year-old Gorky with his mother, 7 years before she starved to death during the Armenian Genocide. This article explores the early experiences that haunt this painting and the difficulties Gorky struggled with during his adult life as an immigrant to the USA – factors that contribute to an understanding of his suicide in 1948.

The January 1997 issue of this journal contained four reviews that compared tricyclic antidepressants with selective serotonin reuptake inhibitors (SSRIs) and other newer antidepressants in terms of their pharmacology (Palazidou, 1997), adverse effects, potential drug interactions and toxicity (Henry, 1997), efficacy in the prevention of relapse and recurrence (Edwards, 1997), and findings from meta-analyses (Anderson, 1997). In July 1997 reboxetine was promoted as the first selective noradrenaline reuptake inhibitor (NARI), and in October of the same year mirtazapine was promoted as the first noradrenergic and specific serotonergic antidepressant (NaSSA). Milnacipran is presently being registered by the manufacturers, after which it will be the second antidepressant drug promoted as a specific serotonin and noradrenaline reuptake inhibitor (SNRI).

Mental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.

In recent years, there has been growing recognition of the significant incidence of child abuse and neglect in the population, and of its adverse effect on the development of children and their mental and physical health. This awareness has led, especially following the implementation of the Children Act 1989, to an increased demand for psychiatric assessments of children for the courts by social services, solicitors, guardians adlitem and the courts themselves. There has been some reluctance to take up this work, for two main reasons. First, there has been concern that these time-consuming assessments will result in a shift of resources away from treatment, thus having an adverse impact on the balance of child mental health services. In some areas, the need has been recognised within the commissioning and contracting processes. Provision has been increased accordingly, acknowledging that it is part of the responsibility of the health authorities to assist the local authorities in this way.

Since 2018, the International Task Force on Benzodiazepines (ITFB), a group of academic psychiatrists and academic psychologists, has advocated that clinical guidelines should change to promote benzodiazepines from second- to first-line treatment for anxiety disorders, accept their use as maintenance treatment for anxiety conditions (in particular, panic disorder) and increase their use in gastrointestinal disorders. There is merit in much of what the ITFB argues, but in this article I analyse four major claims it has made in opinion editorials that I believe are not fully supported by the available evidence.

Gamblers Anonymous (GA) is perhaps the least used of the twelve-step approaches to dealing with addictions. This relative lack of visibility and use, at least in the UK, is reflected in healthcare professionals' lack of awareness and knowledge of gambling addiction and its treatment, including GA. In this article, we introduce the basic tenets of GA and discuss how these translate into treatment.

Although psychiatrists in England and Wales are generally familiar with the Mental Health Act 1983 and the Mental Capacity Act 2005, there is a body of law that is available to assist patients in the community with which they are generally less familiar. There are two main reasons for this. The first is that it is a rather confused amalgam of different statutes and case law affecting each other in ways that are less than clear. The other is that the care programme approach (CPA) was meant to cut through all this and make care provision straightforward. In fact, the latter has never been the case and community care law has always sat uneasily alongside the CPA, but in October 2008 the CPA was withdrawn from some patients with mental health problems. This article explains what is meant by community care law and how psychiatrists can use it to help their patients.

In medical practice it is crucial that symptom descriptions are as precise and objective as possible, which psychiatry attempts to achieve through its psychopathological lexicon. The term ‘autism spectrum disorder’ has now entered psychiatric nosology, but the symptom definitions on which it is based are not robust, potentially making reliable and valid diagnoses a problem. This is further compounded by the spectral nature of the disorder and its lack of clear diagnostic boundaries. To overcome this, there is a need for a psychopathological lexicon of 'social cognition’ and a classification system that splits rather than lumps disorders with core difficulties in social interaction.

The Government White Paper ‘Working for Patients' (1989) incorporated the idea of general practitioners (GPs) managing funds in order to purchase health services for the patients under their care. The aim was for decisions about purchasing and providing health care to be taken as close to the patient as possible, by their own GP. It has meant that two forms of purchasing have grown side by side – health authority and GP fundholding. Subsequent policy changes have made fundholding accessible to more practices, and have extended the fundholders' areas of purchasing. More than 50% of the population in England are now covered by fundholding GPs. The proportion of GPs who are fundholders varies enormously geographically, with high levels in the West Midlands, Trent, South Thames, Oxford and Anglia regions, where the collective purchasing function of GP fundholders is now very considerable.

This paper explores the range of expectations of psychiatrists held by those in general management in the health service.

In most Western countries, including the UK, comprehensive mental health services are predominantly funded from State resources. The role of the psychiatrist has changed in the past 20 years and will without doubt change further in the next 20 years. Expectations of psychiatrists have changed and will continue to do so. We take the position that psychiatrists should continue to have the major leadership role in mental health and in so doing must become increasingly responsive to the changes taking place in health care planning and provision.

This article examines Charles Baudelaire's life, works and his most important collection, The Flowers of Evil. Baudelaire is regarded as one of the most important 19th-century French poets. He revolutionised the content and subject matter of poetry and served as a model for later poets around the world. He continues to exert immense influence on writers. He contracted syphilis early in life, experienced episodes of depression, and had intense and complicated relationships with his mother and other women in his life.