Drug treatments are commonly used for sleep disturbance in Alzheimer's disease, although none have a specific licence for this indication. This month's Cochrane review assessed the available evidence of benefit or harm in the use of these medications. The review identified two studies of melatonin, which did not show significant improvement in sleep over placebo. One study of trazodone suggested a beneficial effect on sleep, but its small sample size limits the generalisability of the results. Larger studies are needed, with careful assessment of the evidence for possible improvements in sleep but also of important side-effects such as falls and increased confusion.

Smartphones are equipped with features that enable the rapid assessment of up-to-date evidence-based information. Their role in medical education is gaining recognition, and more and more institutions are providing devices or applications (apps) to medical students and trainees. Recent UK research suggests that most medical students believe smartphones would be a useful addition to their clinical education and that the majority of students and junior doctors own between one and five medically related apps. This article highlights the utility of these devices in education and summarises the existing technologies adopted by other specialties. It gives a framework for how psychiatry could adopt these new technologies in education and highlights the advantages and disadvantages of using this new approach. A brief illustration of how these technologies are being applied in undergraduate and postgraduate psychiatry is included.

We propose a ‘drug-centred’ framework for understanding the nature of drug treatment in psychiatry. In contrast to the prevailing ‘disease-centred’ model, which suggests that drugs work by targeting underlying abnormalities, the drug-centred model maintains that drugs exert their effects through their psychoactive properties. According to this view, distinctive drug-induced alterations to normal cognition, emotion and behaviour can modify the manifestations of mental disorders independent of diagnosis or aetiological theory. The drug-centred approach already forms the basis of some current practice, particularly off-label prescribing. Within this framework, the matching of drug-induced effects to symptoms or difficulties, taking into account the unwanted aspects of the drug-induced state, becomes the focus of a collaborative endeavour between doctor and patient, consistent with the principles of the recovery model. More research into the full range of effects that psychiatric drugs produce is required to ground a judicious drug-centred practice and inform psychiatric training.

‘Drug-centred’ prescribing in psychiatry has been proposed as a new and better approach than the current ‘disease-centred’ alternative. It targets symptoms most important to the patient using the concept that psychotropics act indirectly by altering normal functioning. I contend that it is a straw man: psychiatrists already use ‘drug-centred’ prescribing, applying their knowledge of a drug's pharmacological profile and evidence base to treat each patient's symptoms, not their diagnostic classification. Furthermore, there is no compelling evidence that psychotropics act by altering ‘normal’ functioning: rather, they have diverse effects on different mental states.

This overview explains antipsychotic-induced hyperprolactinaemia and offers guidance on the management of this common and underestimated problem in general psychiatric practice.

This article sets out the complicated and confused law on automatism and identifies the role of the psychiatrist, including paradoxically a role in cases of non-psychiatric disorder where the law requires evidence from a doctor approved under section 12 of the Mental Health Act. Legal definitions of automatism are introduced. The internal/external distinction, evidential burden, burden of proof, standard of proof, prior fault, intoxication and the degree of impairment illustrate how the courts limit the defence. Detailed accounts are given of cases in which the defence of automatism has been based on psychiatric disorder and on the effects of psychotropic drugs. Suggestions are made for approaches to assessment and medicolegal reporting.

Recent years have seen a dramatic increase in the advances and applications of medical imaging techniques. Tools with familiar acronyms such as MRI, EEG/MEG and PET/SPECT have provided invaluable information not only about the brain structure and function associated with psychiatric disorders, but increasingly about the mechanisms underpinning these disorders. This evolving understanding of the specific pathophysiology of mental disorder paves the way for improvement in the diagnosis, treatment and prognosis of the disorders managed in everyday clinical practice. This article gives an overview of the main neuroimaging approaches, contemporary applications of this technology to psychiatric disorder and signposts to the exciting possibilities for the future.

Most individuals who have lived in foster homes, residential care or adoptive families for substantial periods (‘people affected by public care or adoption’) show normal psychological adjustment as adults, although rates of mental disorders, hospital admission and suicide are increased. Research focusing on the experiences of this group of people can help professionals better understand their behaviour and attitude towards help. Psychiatric symptoms can be multifaceted, including complex trauma presentations. The specific mental health needs of this population are increasingly being recognised in child and adolescent mental health services but less so in adult services. In this article we describe life experiences of people affected by public care or adoption, examine the lifelong impact of these experiences on mental health and functioning, and offer practical suggestions for clinical work with them.

A significant proportion of individuals in contact with probation services have mental health problems. Joint working between psychiatrists and probation is crucial to both diversion and resettlement of offenders with mental health conditions. In England and Wales, probation services are involved in the supervision and management of offenders if they receive a suspended or community sentence, or when they are released into the community on licence after serving a determinate, extended or life sentence. This article aims to promote awareness of joint working between probation and mental health services and the role of approved premises. It also describes a successful example of such joint working at Elliott House, approved premises for mentally disordered offenders in Birmingham, UK.

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.