Major depressive episodes are common in bipolar disorder, which consequently may be misdiagnosed as major depressive disorder. Improved detection of bipolar disorder rests upon better ascertainment of a history of hypomania. Antidepressants are of dubious benefit in bipolar disorder and more accurate diagnosis of depression would promote better treatment.

The classification system of atypical and typical antipsychotics has created a lot of confusion and might be abandoned. Nevertheless, to say that all drugs are the same and that therefore it does not matter which drug is given is wrong. Both typical and atypical antipsychotics differ in side-effects, mechanisms of action, cost and efficacy. The available choice of antipsychotics should be adapted to individual patients in a shared decision-making process.

A proposed merging of pathological gambling with the drug addictions in the forthcoming DSM-5 prompts an overview of the neurobiological data showing similarities between these conditions, as well as an update on national trends in gambling behaviour and current treatment provision.

Cox et al's paper addresses an issue that has long been assumed to be a central aspect of brain function – the interplay of different neurotransmitters – but for which we have very little evidence so far. It is currently unclear whether these findings will have implications for the treatment of those with cocaine or other substance dependence.

Here we revisit and reinterpret the original study in which the so-called ‘Maudsley (London) model’ of family therapy was compared with individual therapy for anorexia nervosa. Family therapy was more effective in adolescents with a short duration of illness. However, this is only part of the story. A later study describing the 5-year outcome contains important information. Those adolescents randomised to family therapy achieved a better outcome 5 years later. Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a poor response to both family and individual therapy, suggesting that unless effective treatment is given within the first 3 years of illness onset, the outcome is poor. We examine other evidence supporting this conclusion and consider the developmental and neurobiological factors that can account for this.

Alcohol-related brain damage has a growing impact on service provision. Despite the benefit of therapeutic interventions and a relatively good prognosis in the context of service provision, few services exist. Both national and local initiatives are required in order to provide psychosocial rehabilitation for this marginalised group of patients.

A national survey in 1997 found that Australia had a high prevalence of mental disorders with low rates of treatment. Since then, treatment availability has increased greatly and unmet need has reduced. However, there is little evidence that the nation's mental health has improved.

The Department of Health in England has long encouraged the routine measurement of clinical outcomes in mental health services but has now decided to use outcome measures as part of a new payments system – Payment by Results. We examine how these two policies should or might interact.

Clinicians regularly overestimate patients' capacity to make decisions. This may jeopardise their autonomous decision-making. It may lead to poor clinical outcomes for patients and has potential adverse legal consequences for clinicians. There is a need to use the legal principles of the Mental Capacity Act more rigorously.

Coercion in psychiatric practice appears to be increasing. Is this in patients' best interest? Is it good medical practice?

The diagnostic boundary between recurrent unipolar depression and bipolar disorder may not be clear-cut and, further, the symptoms of unipolar depression compared with bipolar depression (although similar) are subtly different. Here we review the potential implications for clinical practice and research of new thinking about the relationship between recurrent unipolar depression and bipolar disorder.

World Mental Health Survey data demonstrate that a high proportion of people who are suicidal receive no treatment and that, contrary to previous assumptions, attitudes to treatment constitute greater barriers to help-seeking than do stigma or structural/financial constraints. We explore how suicide-prevention policy-makers might respond to Bruffaerts et al's findings.

One in three adults over the age of 60 years will die with dementia. Most will have complex physical and psychological needs. Despite this, many people with dementia receive poor-quality end-of-life care. Recent government strategies have highlighted the importance of improved coordination and provision of services.