Patients with severe and enduring eating disorders (SEED) may constitute a specific group. It is proposed that patients with anorexia nervosa (SEED-AN) or bulimia nervosa (SEED-BN) that requires the regular attention of a multidisciplinary team and is of a duration known to have a low recovery rate should be included in the SEED group. These patients present with a combination of severe symptoms and long-term illness, and may experience serious chronic physical sequelae (e.g. osteoporosis and renal failure), marked social isolation and stigma. Their carers suffer from the stress of caring for them over a prolonged period. Symptoms, treatment and crisis management of SEED-AN are discussed. SEED is a relatively recently described area of eating disorders psychiatry that requires research and service development so that patients and carers are helped to cope with very serious chronic, but not incurable, conditions.

Challenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.

We consider key facets of the concept of mental health recovery and how they are reflected in other concepts that run through the emerging focus on public mental healthcare. We widen the scene to portray the niche into which recovery fits and show how it and recent research indicate why psychiatrists should use the social sciences more widely to complement neuroscience.

Cognitive analytic therapy (CAT) was formalised in 1984 by Anthony Ryle. It facilitated the clinical integration of psychodynamic therapy and personal construct/cognitive psychology. It is a brief, user-friendly relational therapy, applicable to the wide range of psychological problems typically seen in public mental health settings. It has recently been included in national guidelines for the treatment of personality disorder in the National Health Service. CAT provides a coherent model of development and psychopathology, which centrally views the self as both socially formed and embedded. Owing to its core relational grounding, CAT is being increasingly applied to team contexts/systems, enabling a ‘common language’ for team formulation/practice. It is also being successfully delivered as a group therapy. This article describes the development and unique features of the CAT model, analyses the current evidence base and identifies potential future directions for the model.

Paul Robinson's article provides an excellent summary of some of the challenges faced by clinicians working with patients with severe and enduring eating disorders (SEED) and outlines a robust approach to the recognition and management of this complex group of patients. This commentary expands on some of the points raised, adds some further views and suggests a tailored approach to establishing a therapeutic alliance with patients and carers.

Depression is missed more often in adolescents than in adults, partly because they present with symptoms different from those in adults and because many do not seek help. Early detection or the delay of onset can have a significant effect on a young person's development and social functioning. We briefly discuss diagnosis and screening instruments before presenting the wide range of educational and psychological preventive approaches developed for adolescent depression. Many of the latter are based on the cognitive-behavioural or interpersonal therapy models. We consider how clinicians might use the current evidence base to identify and prevent depression in adolescents, and outline the principles of management of the disorder.

This article reviews the recent changes to the DSM diagnostic classification of feeding and eating disorders with particular reference to children and adolescents. The common clinical presentations of the ‘atypical’ feeding and eating problems of middle childhood and early adolescence are reviewed using clinical case vignettes, and the limited evidence base regarding management is summarised. There are many gaps in the evidence base and this is likely to be an area of rapid development for the field subsequent on the new terminology outlined in DSM-5.

Bipolar depression remains a major challenge for psychiatric therapeutics. It is associated with disability and excess mortality, and accounts for three-quarters of the time spent in morbid states by treated patients with bipolar disorder. Major limitations of research on the treatment of depression in bipolar disorder include a paucity of short-term and lack of long-term trials, probably reflecting concern about inducing mania. In addition, polytherapy with multiple drugs appears to be widespread, but it is virtually untested for efficacy and safety. Here, we summarise the evidence concerning efficacy of treatment of bipolar depression with antidepressants, mood-stabilising anticonvulsants, lithium and second-generation antipsychotics.

Psychodynamic psychotherapy has been criticised as being based on outdated principles of psychoanalysis and lacking an adequate evidence base to convincingly demonstrate its efficacy. This article summarises the recent evidence from high-quality outcome studies to show that psychodynamic psychotherapy is as effective in the treatment of a range of mental disorders as other psychological treatment modalities such as cognitive-behavioural therapy, as well as reviewing process-outcome research aiming to elucidate mechanisms of therapeutic change. A paradigm for psychodynamic psychotherapy research based on attachment theory is introduced, which may inform the development of psychodynamic therapeutic modalities tailored for specific conditions.

This article presents evidence for the efficacy of psychosocial interventions for people with dementia and their carers. The evidence base is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of nonpharmacological interventions, as their properties are distinctly different from those of pharmacological agents.

We outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.

Cognitive and memory testing are a common part of clinical practice, but professional concerns are sometimes raised that the individual being tested might be feigning deficits. Most clinicians have limited experience and training in detecting malingering in such cognitive testing, and the very issue raises considerable ethical dilemmas. Nevertheless, psychiatric work faces ever greater potential for legal scrutiny, and failure to appropriately evaluate potential malingering risks professional embarrassment and distress. There is a need for clinicians to make themselves aware of the ways in which malingered behaviour might be evaluated through the clinical history, the use of routine psychometric testing and, particularly, the use of symptom validity (‘malingering’) tests. This article describes these factors and gives guidance on the appropriate reporting of findings.

Although there is an increasing focus on recovery within mental health services, there has been limited exploration of the applicability of these principles within forensic services. The authors draw on their experiences within forensic rehabilitation services to discuss the potential obstacles to secure recovery, exploring the systemic and risk management aspects of such a setting as well as considering attachment theory within this context. Some proposals based on clinical experience are given on how such obstacles are faced and tackled.

Psychiatrist Thomas Szasz fought coercion (compulsory detention) and denied that mental illness existed. Although he was regarded as a maverick, his ideas are much more plausible when one discovers that between 1939 and 1941, up to 100 000 mentally ill people, including 5000 children, were killed in Nazi Germany. In the course of the Nazi regime, over 400 000 forced sterilisations took place, mainly of people with mental illnesses. Other countries, including Denmark, Norway, Sweden and Switzerland, had active forced sterilisation programmes and eugenics laws. Similar laws were implemented in the USA, with up to 25 000 forced sterilisations. These atrocities were enabled and facilitated by psychiatrists of the time and are only one example of the dark side of the profession. This article reviews some of these aspects of the history of psychiatry, including Germany's eugenics programme and the former USSR's detention of dissidents under the guise of psychiatric treatment.

Benjamin Britten's opera Peter Grimes premiered in 1945 and has since enjoyed lasting popular and critical acclaim. Its central character is a fisherman driven to suicide by circumstances beyond his control. It has a wide political and social resonance and is a testament to the damaging psychological effects of exclusion and stigma.

Interprofessional education, learning which brings together different professional groups, helps to prepare practitioners for effective team-based collaborative practice and is now included in all undergraduate training programmes in the health professions. We explore the merits of team-based interprofessional learning, drawing on learning theory and mental health policy. We endorse the use of a practice-based interprofessional education model involving patients in which students experience the complexity of team working and the clinical team gain a more detailed analysis of team processes, which can enhance the quality of patient care. The model has been replicated for undergraduate education in mental healthcare and could easily be used for postgraduate staff. Interprofessional education at postgraduate level could foster the ongoing team-based reflective learning needed to enable mental health services in the UK to adapt to the dramatic changes both in their organisation and in the roles and responsibilities of individual professions.

There have been many developments in addiction psychiatry over the past decade. Some of these are political, such as preference for recovery-/ abstinence-based programmes. Prohibition is becoming increasingly unrealistic, especially considering the effective legalisation of recreational cannabis in Uruguay and two US states. Legal highs and diversion of prescribed drugs (such as methadone, gabapentinoids, methylphenidate and benzodiazepines) are now a major problem. Furthermore, diversion of opioid drugs that are prescribed for pain is reaching epidemic proportions, causing a significant change in the nature of patients being referred to addiction services.

Mental disorder and criminality are separate entities but some people with a mental disorder commit criminal offences and some criminals have a mental disorder. Before 1800 there was no separate category of mentally disordered offenders (referred to as criminal lunatics until 1948) in UK legislation. The provision of facilities for mentally disordered offenders in Britain and Ireland overlapped with, but was also separate from, provision for the mentally ill generally. The interface between general and forensic psychiatry is an area of tension and of collaboration. To understand how contemporary general and forensic psychiatry interact, it is useful to have an understanding of how factors have evolved overtime.

Antisocial personality disorder is a complex condition carrying high rates of comorbidity and mortality for individuals as well as harmful consequences for their families and society. Despite the publication of National Institute for Health and Care Excellence (NICE) guidelines for the disorder, the evidence base and provision of effective treatments remain inadequate, and the belief that the condition is untreatable remains widespread among psychiatrists and other professionals. This article highlights current diagnostic controversies and summarises the evidence for conceptualising antisocial personality disorder as a disorder of attachment. Informed by this developmental perspective, we provide a framework for the management and treatment of adults with antisocial personality disorder, highlighting the importance of creating a safe setting and recommending adaptations of therapeutic technique to facilitate the engagement of this ‘treatment-rejecting’ patient population. We conclude with an outline of the current government policy on the treatment of high-risk offenders with personality disorder.

Most disorders in medicine are classified using the ICD (initiated in Paris in 1900). Mental and behavioural disorders are classified using the DSM (DSM-I was published in the USA in 1952), but it was not until DSM-III in 1980 that it became a major player. Its success was largely influenced by Robert Spitzer, who welded its disparate elements, and Melvyn Shabsin, who facilitated its acceptance. Spitzer pointed out that most diagnostic conditions in psychiatry were poorly defined, showed poor reliability in test-retest situations, and were temporally unstable. The consequence was that the beliefs of the psychiatrist seemed to matter much more than the characteristics of the patient when it came to classification. Since DSM-III there has been a split between those who adhere to DSM because it is a better research classification and those who adhere to ICD because it allows more clinical discretion in making diagnoses. This article discusses the pros and cons of both systems, and the major criticisms that have been levelled against them.