Violence and aggression are relatively common and serious occurrences in health and social care and rates are higher in mental health settings. Despite the National Health Service's policy of ‘zero tolerance’ of such behaviour, reporting of violence and aggression against mental health staff remains low. This article considers the nature of violence and aggression against staff in psychiatric settings and the process of involving the police to ensure an effective outcome. It outlines each step, from the initial the multidisciplinary team assessment of the incident and its reporting to the police to the making of witness statements, should the case come to court. It also explains the discretionary role of the police in deciding whether to charge and of the Crown Prosecution Service (CPS) in deciding whether to prosecute. The article stresses that NHS organisations need to provide an effective, streamlined and time-efficient reporting process, as this should reduce levels of patient violence, improve staff's well-being and morale, save costs and make the working environment safer for all.

Prominent figures are frequently subjected to unwanted and intrusive attentions. Such stalking behaviour is often driven by psychotic illness, angrily blaming the public figure for delusional persecution (resentful motivation), or based on erotomanic delusions (intimacy seeking motivation), for example. This behaviour can cause psychological harm to both perpetrator and victim, and is unlawful. In the rare instances where a public figure has been attacked, the perpetrator has usually had a history of such stalking behaviour and of severe mental illness. For these reasons, early identification and diversion into appropriate care and treatment will be for the benefit of both parties and will prevent more serious violence in a minority of cases. The importance of the provision of education to improve both reporting rates by victims and an appropriate response from the criminal justice system is highlighted. A multi-agency approach involving the criminal justice system and mental health services is the most effective means of achieving these aims.

It has long been recognised that substance use disorders and sexually transmitted infections (STIs) are common comorbid conditions. It is clear that treating one condition while leaving the other leads to increased morbidity and mortality in this patient population. However, engaging patients in treatment is extremely challenging, which is a huge public health concern. This article focuses on various sexually transmitted infections seen in the substance misuse population and means of primary, secondary and tertiary prevention.

Owing to the continuing shortage of organs, the demand for transplantation outstrips supply. Liaison psychiatrists, as part of a multidisciplinary team, have a key role in the assessment of transplant candidates and participate in the decision-making process regarding ‘listing’ the patient for transplantation. Psychiatric and psychosocial factors affect prognosis post-transplantation and there are absolute and relative contraindications to transplantation. The skills of the liaison psychiatrist are employed throughout the patient's illness journey, in the pre-, peri- and post-transplantation periods.

In a previous article in this journal, Turkington et al suggested a number of psychological approaches that an individual can use to reduce the distress caused by hearing voices. Despite having popular appeal, only some of these approaches have evidence for their effectiveness. Within a clinical context where few patients with psychosis have access even to evidence-based approaches, the reader is invited to familiarise themselves with the evidence before selecting which approaches to introduce to their patients.

Multiple sclerosis (MS), an immune-mediated demyelinating condition, is the most common neurological disease affecting young adults in the UK. It has a high psychiatric comorbidity and over half of patients have some degree of cognitive impairment that adds to the burden of disability. This article reviews the psychiatric and cognitive manifestations of MS and their detection and treatment. Recent advances in the treatment of the disease are briefly reviewed and the impact of disease-modifying therapies on psychiatric morbidity and cognitive impairment is discussed.

Older people with mental health problems are entitled to the same level and quality of care as younger people. Several factors continue to influence policy and delivery of older adults' mental health services in the UK. Following the introduction of the Equality Act 2010, there has been a drive to create an ‘ageless’ National Health Service. This has opened up the debate about whether such a service is best equipped to meet the specific needs of older adults. In this contribution we consider the concepts of ‘old age’ and ‘frailty’ and their clinical and service provision implications in psychiatry. The management of late-life depression and early-onset dementia, advance care planning and palliation in dementia are also considered.

Fusion legislation is the latest in a long line of reforms in mental health law that have sought to increase patient autonomy. It has not been without controversy, having been proposed and rejected in various jurisdictions throughout the UK and internationally, while causing considerable debate in the academic literature. This article considers some of the history and debate, along with the criminal justice provisions of the first piece of fusion legislation internationally, the Mental Capacity Act (Northern Ireland) 2016, and their potential implications.

Clozapine is one of the most effective drugs available to psychiatrists for treating psychosis. It is currently licensed for use in treatment-resistant schizophrenia and psychosis in Parkinson's disease, but its use in old age psychiatry is very uncommon. With the ageing population, and the increased incidence of psychosis in older patients, it is important to consider whether this is a drug that is not being used to its full advantage.

This review of available longitudinal structural imaging and immunological findings in first-onset schizophrenia, bipolar disorder, attention-deficit hyperactivity disorder (ADHD) and autism suggests that different patterns of synaptic pruning lead to various phenotypes. Proposals for future research strategies to try to replicate these findings are suggested, potential biomarkers to assist in diagnosis and determining the optimum duration of maintenance treatment are considered and ideas of potential immunotherapy augmentation are outlined.