The importance of personality is recognised tacitly by the development of the multiaxial classifications of ICD–10 (World Health Organization, 1992) and DSM–IV (American Psychiatric Association, 1993). The separation of axis 1 or current mental state diagnosis from axis 2, on which personality is described, is a recognition that personality is separate from other aspects of the patient's diagnostic status. Nevertheless, many clinicians are sceptical that personality can be assessed reliably and some hold that the diagnosis should be abandoned as being merely judgemental and pejorative (Lewis & Appleby, 1988). There is some basis for scepticism in respect of reliability in view of the evidence that even with operational criteria the clinical assessment of personality is not transportable, and the level of agreement between practising clinicians is much less than that achieved during field trials (Mellsop et al, 1982).

I comment on a new overview of the treatment of delusional infestation. I focus on the challenges of communicating with a patient who has delusions and evaluate practical advice. I look at philosophical models to explain those communication problems as well as theories of delusional formation, and examine how these may help clinicians to understand and overcome those challenges.

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.

In this reflection we summarise the various obstacles to accessing healthcare encountered by people with neurodevelopmental disorders (intellectual disability, autism and attention-deficit hyperactivity disorder) with and without mental health problems. We outline different service models from around the world, ranging from the person centred to the institutional. Finally, we suggest ways of addressing some of the problems identified, including a model of integrated care involving intellectual disability, neurodevelopmental and mental health services that would better serve this population.

Value-based healthcare holds great potential to transform healthcare globally. This commentary reviews the historical milestones in its evolution and raises critical questions regarding how it should proceed.

The language of psychiatry can be ambiguous and idiosyncratic, reflecting the elastic borders of mental illness and psychiatric disorder. This problem is not unique to psychiatry, but as the medical specialty moves closer towards a 'spectrum view’ of mental illness, psychiatric terminology increasingly risks misappropriation and conflation with lay concepts of normal suffering. Deciding what words mean and how psychiatric disorders are defined requires ongoing consideration of the pragmatic consequences, both intended and unintended. Refining the lexicon of psychiatry with an eye towards precision and the minimisation of stigma requires that terms be revised and updated from time to time, but often suitable word replacements remain elusive.

Comorbid anxiety symptoms are common in depression, and adding benzodiazepines to antidepressant treatment may seem a rational clinical solution. Benzodiazepines also have potential to reduce the initial anxiety that may be caused by early antidepressant treatment (owing to their inhibitory effect via GABAA receptor binding). This month's Cochrane Corner review examines the evidence behind combination treatment versus antidepressants alone in major depressive disorder, in terms of both the clinical and neuroscientific context. The review provides evidence that, in the first 4 weeks of treatment, additional medication with a benzodiazepine may lead to greater improvements than antidepressant alone on ratings of severity, response rates and remission rates for depression, but not on measures of anxiety.

Major depression and bipolar disorder in children and adolescents are serious conditions associated with considerable morbidity as well as increased risk of suicide. The treatment of depression in young people is currently controversial and this article reviews the evidence base and potential risks and benefits of antidepressants. Although the diagnosis of bipolar disorder is also controversial, medication is the first-line treatment of choice in cases that meet diagnostic criteria. The limited evidence base in children and adolescents is presented, along with current treatment guidelines. Despite the controversies in this field, this article concludes that medication remains an important part of the treatment approach for both disorders, although the risks and benefits of pharmacotherapy need to be carefully assessed in each patient.