Self-harm (intentional self-poisoning or self-injury) is common, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for self-harm, first published in 1998 and previously updated in 1999. We have now divided the review into three separate reviews. This review is focused on pharmacological interventions in adults who self-harm.

Self-harm is a significant social and healthcare problem, with substantial morbidity and healthcare costs. It has strong links to further self-harm and to suicide. The current review is one of three that investigate interventions in preventing recurrence of self-harm, and it focuses on pharmacological treatment. The conclusions are limited by the small number and size of trials identified, and the low quality of evidence. No benefit on recurrence of self-harm was detected in three small trials of antidepressants, but the types studied are ones that are now less commonly used. A small trial of flupentixol suggested a possible benefit on repetition, but this has not been replicated. One small trial of lithium showed no benefit, but this was in contrast to a recent large meta-analysis showing a significant anti-suicidal effect of lithium when used to treat mood disorder. The review highlights important areas for further research.

Psychiatric assessments on medical wards of a general hospital are complicated by various factors, including the lack of privacy, medical illness-related factors such as cognitive deficits and communication barriers, and the vagueness of the referral question asked. In this article, we try to guide general psychiatrists who do not routinely carry out such assessments through practical steps from receiving the referral to signing off the case. The key differences in the process and content of psychiatric assessments are discussed, as are diagnostic dilemmas. Subtle aspects of communicating the outcome of the assessments to patients and referrers are emphasised with specific guidance on writing consultation notes. We conclude with a discussion of the principles of biopsychosocial management and judging the outcomes of consultations on medical wards.

Mindfulness is a meditation practice defined as a specific way of paying attention. It has been adapted from Buddhist traditions to Western secular use (e.g. in stress reduction, health promotion, treatment of psychological disorders). Despite its widespread application in adult populations, mindfulness remains a neglected topic in the psychological interventions designed for children and adolescents with psychological disorders and/or chronic physical conditions. In paediatric settings, a parent-child perspective may be useful in facilitating processes of adaptation and in improving paediatric outcomes. However, the delivery of mindfulness interventions in paediatric settings raises a number of issues and challenges, which include the developmental appropriateness of mindfulness exercises, the introduction of a parent-child perspective, and specific considerations to condition, treatment and caregiving.

Confidentiality in child and adolescent mental health is a complex and often challenging matter. Not only do young people frequently present to services in situations of risk, they often prefer to keep information confidential from parents and/or other professionals. This article explores confidentiality in the context of child and adolescent mental health services (CAMHS), particularly when the clinician is having to make decisions on whether to maintain or to breach it. Ethical principles (both deontological and consequentialist) and legal and regulatory frameworks (relating to human rights, case law and General Medical Council guidance) are outlined. Four hypothetical case scenarios are used to illustrate how to apply such principles: when a young person seeks confidential access to treatment, and when he or she discloses information that could signify a risk to self, to others or from others. Finally, practical suggestions on how to share information are explored.

The traditional disease model, still dominant in psychiatry, is less than ideal for making sense of psychological issues such as the effects of early childhood experiences on development. We argue that a model based on evolutionary thinking can deepen understanding and aid clinical practice by showing how behaviours, bodily responses and psychological beliefs tend to develop for ‘adaptive’ reasons, even when these ways of being might on first appearance seem pathological. Such understanding has implications for treatment. It also challenges the genetic determinist model, by showing that developmental pathways have evolved to be responsive to the physical and social environment in which the individual matures. Thought can now be given to how biological or psychological treatments – and changing a child's environment – can foster well-being. Evolutionary thinking has major implications for how we think about psychopathology and for targeting the optimum sites, levels and timings for interventions.

This article describes how the M'Naghten Rules, which govern the law of insanity in England and Wales, came into existence. In relation to knowledge of the wrongfulness of the alleged act, the article reveals how the Court of Appeal has sought to limit the defence, whereas the courts of first instance, and a number of other jurisdictions, have adopted interpretations of the Rules that accord more closely with the law of insanity as it existed at the time of Daniel McNaughtan's trial and that the Rules were probably meant to formulate. Three cases are used to illustrate the difficulties resulting from the position adopted by the Court of Appeal. It is suggested that in cases where the insanity defence is raised, justice is likely to be better served by addressing specifically and separately the accused's understanding or appreciation of the moral wrongfulness of the alleged act and their knowledge as to whether the alleged act is contrary to the law of the land.

Working with people who are experiencing mental health difficulties brings many challenges about how best to progress towards shared goals. The cognitive-behavioural therapy (CBT) approach can provide a structure and framework for effective treatment. It aims to help people identify goals and work towards them. We describe a practical approach that provides a structure for step-by-step planning, engaging the patient and promoting planned change.

The internet provides access to what is often a bewildering array of medical knowledge on mental health, some (but not all) of which is evidence based. As well as information for clinicians, there has been a dramatic increase in the variety and quality of information available for patients and carers. In this article we discuss the advantages and limitations of the types of information available, with suggested sites and strategies for assessing their relative merits.

When embarking on mental health research it is often necessary to apply for approvals from one or more review bodies to ensure that the research is ethical and that the safety and well-being of participants are safeguarded. This can be complicated and time consuming, particularly to those unfamiliar with the process. In this article we describe the approvals commonly required for National Health Service-based research involving patients and endeavour to clearly explain what is involved at each stage. We then highlight some of the main considerations, including ethical aspects, which are particularly pertinent to conducting research in the field of mental health, and finish with general advice and considerations for future developments in the area.