The UK has seen a dramatic increase in alcohol consumption and alcohol-related harm over the past 30 years. Alcohol taxation has long been considered a key method of controlling alcohol-related harm but a combination of factors has recently led to consideration of methods which affect the price of the cheapest alcohol as a means of improved targeting of alcohol control measures to curb the consumption of the heaviest drinkers. Although much of the evidence in favour of setting a minimum price of a unit of alcohol is based on complex econometric models rather than empirical data, all jurisdictions within the UK now intend to make selling alcohol below a set price illegal, which will provide a naturalistic experiment allowing assessment of the impact of minimum pricing.

Proposals by psychiatrists to reclassify conversion disorder in DSM-5 and ICD-11 are proving difficult and controversial. Patients with conversion disorder usually present initially to neurologists, who often use different concepts and terminology. History and clinical practice suggest that the way forward is to seek agreed principles and a common understanding between the two disciplines, preferably in a single universal classification.

Academic psychiatry is in trouble, becoming the narrowest of biological research approaches of decreasing relevance to clinical practice and global health. What is required is a rebalancing of the psychiatric academy to include greater support for researchers conducting social, clinical and community studies within a broad, more humanistic biosocial framework.

The past 20 years have seen a remarkable development of neuroimaging methodologies that allow fine-tuned examination of abnormalities in the structure and function of neural circuitry, supporting cognition and emotion in individuals with psychiatric disorders. This editorial highlights the potential of neuroimaging to address major challenges in psychiatric clinical practice.

Evidence regarding overestimation of the efficacy of antipsychotics and underestimation of their toxicity, as well as emerging data regarding alternative treatment options, suggests it may be time to introduce patient choice and reconsider whether everyone who meets the criteria for a schizophrenia spectrum diagnosis requires antipsychotics in order to recover.

Despite available therapies, mental disorders are the predominant chronic diseases of young people. Increasing the validity of descriptive psychiatry is now essential. Mathematical approaches can help characterise clinical phenotypes and aid both causal research and therapeutics in the community and the clinic.

In this editorial, we propose that the association between depression and cardiovascular disease may be conceptualised as a continuous, bidirectional process that originates in youth. The paper by Åberg and colleagues in this issue adds to this literature showing that low cardiovascular fitness at adolescence increases the risk of future depression.

Symptoms of post-traumatic stress disorder (PTSD), anxiety and depression are prevalent among post-conflict populations worldwide but controversy about the cultural meaning of these symptoms, particularly in relation to PTSD, adds to the challenge for psychiatry in mounting appropriate intervention programmes. Accumulating scientific evidence assists in guiding the focus and scope of emergency mental health programmes, initiatives that can become the vanguard of mental health development and reform for countries recovering from conflict.