The Asylum Journal, first published in 1853, is now, as the British Journal of Psychiatry, in its 200th volume. It has changed greatly in its breadth and scope, but its core values and concerns – professional respect, removal of stigma, delivery of care, understanding of pathology, and informed treatment – have remained at its heart throughout. We predict some changes for the future, but not dramatic ones, and conclude that the impinging advances of science will elucidate and refine, but not remove, the need for a journal that is proud to represent psychiatry or, in the words of John Bucknill, its first editor, ‘to render prominent its characteristics and to stamp it as a specialty’.

Current knowledge of the role of autoimmunity in the pathogenesis of the main psychiatric disorders is briefly outlined. The significance of immunological effects on synaptic transmission and associated neuropsychiatric syndromes is emphasised. Clinical psychiatrists are encouraged to keep abreast of developments in this increasingly important area.

Psychodynamic psychiatry makes a significant educational, scientific and therapeutic contribution to contemporary psychiatry. Recent developments in gene–environment interaction, neuropsychoanalysis and the accumulating evidence base for psychoanalytic therapies and their implications for practice are reviewed.

After decades of ignoring or minimising the prevalence and effects of negative events in childhood, researchers have recently established that a broad range of adverse childhood events are significant risk factors for most mental health problems, including psychosis. Researchers are now investigating the biological and psychological mechanisms involved. In addition to the development of a traumagenic neurodevelopmental model for psychosis, the exploration of a range of psychological processes, including attachment and dissociation, is shedding light on the specific aetiologies of discrete phenomena such as hallucinations and delusions. It is argued that the theoretical, clinical and primary prevention implications of our belated focus on childhood are profound.

Psychopathy is not included in either of the main classification systems (ICD-10 or DSM-IV). Research has now extended the concept of psychopathy to childhood and has produced evidence that it is meaningfully distinct from antisocial behaviour. It is proposed that psychopathy should be accepted as a meaningful diagnosis in childhood.

In this editorial we argue for the need for better research evidence on the prevalence of child mental health problems in minority ethnic groups, service utilisation among these groups and whether some service barriers are specific for certain groups. Without such evidence it is not possible to influence policy and practice so that evidence-based and appropriate services can be designed and offered to these populations. The terms ethnicity, race and migration are often imprecisely defined, and mental health needs and outcomes vary between immigrants from different generations. There is also a complex interplay between minority status and social class, with terms such as ethnicity being a proxy for multifaceted sociocultural and economic variables. However, we need to start collecting better data on children from minority ethnic groups so that these relationships can be understood, services tailored on the available evidence and ultimately better care delivered to this group of children.