Following ground-breaking work by Shepherd et al (1966) and, more recently, Goldberg & Huxley (1992), primary care is now recognised as the arena in which most contact occurs between the National Health Service (NHS) and people with mental health problems. General practitioners (GPs) remain the first, and in many cases the only, health professionals involved in the management of a whole range of conditions, from common anxiety and depressive disorders to severe and enduring mental illnesses.

Victims of stalking are a diverse group, but most individuals who are subjected to the persistent pursuit of a stalker, regardless of age, gender or socioeconomic background, experience fear. Some suffer profound distress and lifestyle disruptions, and many experience a decline in their psychological and physical well-being. Stalking is not uncommon in today's society and there is evidence to suggest its incidence is increasing (Budd & Mattinson, 2000). It is therefore anticipated that the victims of these behaviours will be presenting to law enforcement and health professionals in ever-expanding numbers. The efficacy of the interventions they receive will determine whether they can reclaim their lives and premorbid functioning or whether, through ignorance, they are condemned to continuing torment and chronic disability, to the detriment of society as a whole.

A new drug is introduced to the market. It has been approved (after stringent scrutiny) by regulators, who require ever more convincing evidence for safety and efficacy. Aside from the increased costs of the new treatment compared with the old, what could the problems be?

It is obvious that learning is an essential part of all successful educational processes, including continuing professional development (CPD). Yet learning can be hard work, especially for the mature adult, and being able to recognise the nature of some of its intrinsic difficulties is likely to be helpful. In educational circles today, it is recognised that engaging experienced or senior people in the educational process of CPD is often difficult.

Cognitive–analytic therapy (CAT) is a brief focal therapy informed by cognitive therapy, psychodynamic psychotherapy and certain developments in cognitive psychology. It was developed by Anthony Ryle specifically in response to the needs of the National Health Service (NHS) for treatment approaches of short duration. However, it has advanced far beyond its initial aims and is now a well-developed self-contained methodology backed by a fully structured theory of mental functioning and therapeutic change.

Treatability is a confused and confusing concept in psychiatry. In its legal sense, it is a measure that limits the involuntary admission of patients with some particular types of mental disorder. The legal term itself has generated considerable discussion and dissent (e.g. Mawson, 1983; Grounds, 1987), and the Government's White Paper on reforming mental health legislation in England and Wales proposes to abolish it (Department of Health, 2000).

It is well recognised that traumatic events can cause psychological disorders in those who experience them. The most common disorders suffered are depression and substance misuse; others include acute stress reactions, anxiety states and personality changes. One disorder following trauma that has received considerable attention over the past 20 years is post-traumatic stress disorder (PTSD). PTSD occurs in 20–30% of people exposed to traumatic events and the prevalence in the general population is 1% (Helzer et al, 1987), with life-time prevalence of 9.2%.

Psychotic disorders in adolescence are uncommon, but often mark the beginning of a lifetime of contact with mental health services. They pose a challenge and anxiety to sufferers, to their families and to professionals involved in assessment and treatment. Accurate and early diagnosis, coupled with appropriate treatment, is essential to minimise secondary handicaps. However, their rarity means that professionals are frequently unfamiliar with some aspects of presentation or management and that appropriate service provision is not readily available (e.g. admission directly into an in-patient bed in an age-appropriate environment). A lack of age-appropriate provision may also mean that adult psychiatrists are occasionally called on to manage and treat a younger teenager presenting with a psychotic disorder.

Women patients suffer from a range of mental disorders similar to those that men may experience. However, there are some striking differences in the prevalence of specific disorders, and in their presentation and management. Some mental illnesses only occur in women. It seems that women patients may have a different experience of treatment, a consequence of differences in their needs and also of the way that health professionals perceive those needs. These differences are embedded in the wider cultural milieu in which we live. There are particular issues for women patients in relation to, for example, childhood sexual abuse, rape and domestic violence. At present, tools to measure needs of individual patients are generally not gender specific.

The need for specific psychiatric services for women has been debated by many practitioners involved in care delivery and management of women with differing degrees of mental health problems.

The selective serotonin reuptake inhibitors (SSRIs) are the most extensively studied of the newer antidepressants and are increasingly being used as first-line treatment for depression (Anderson et al, 2000). In this article we concentrate on issues that need to be taken into account when selecting one of the five SSRIs marketed in the UK (citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) for individual patients. We have concentrated on treatment of depression and have not reviewed their use in anxiety disorders because comparative data are lacking.

The role of the general adult psychiatrist has changed significantly over the past decade. There is a focus (almost exclusively in some cases) on the management of patients with severe mental illness. Within the multi-disciplinary team, the key role of the psychiatrist is often perceived as the management of medication, making decisions about clinical risk and acting as gatekeeper to often restricted in-patient beds. Psychological and social interventions are commonly seen as the remit of other members of the team. Although psychiatric training should equip psychiatrists to have at least a reasonable understanding and practical knowledge of psychological treatments, many consultants in their day-to-day practice do not have sufficient time to utilise such treatments. These factors brought together result in a situation where the practice of many general adult psychiatrists is almost exclusively the treatment of patients with severe illness and within the treatment of such patients, psychiatric practice is much more about medication and risk management than the personal implementation of psychological interventions.