Men are a numerical minority group receiving a diagnosis of, and treatment for, depression. However, community surveys of men and of their mental health issues (e.g. suicide and alcoholism) have led some to suggest that many more men have depression than are currently seen in healthcare services. This article explores current approaches to men and depression, which draw on theories of sex differences, gender roles and hegemonic masculinity. The sex differences approach has the potential to provide diagnostic tools for (male) depression; gender role theory could be used to redesign health services so that they target individuals who have a masculine, problem-focused coping style; and hegemonic masculinity highlights how gender is enacted through depression and that men's depression may be visible in abusive, aggressive and violent practices. Depression in men is receiving growing recognition, and recent policy changes in the UK may mean that health services are obliged to incorporate services that meet the needs of men with depression.

Psychiatrists rarely enquire about caffeine intake when assessing patients. This may lead to a failure to identify caffeine-related problems and offer appropriate interventions. Excessive caffeine ingestion leads to symptoms that overlap with those of many psychiatric disorders. Caffeine is implicated in the exacerbation of anxiety and sleep disorders, and people with eating disorders often misuse it. It antagonises adenosine receptors, which may potentiate dopaminergic activity and exacerbate psychosis. In psychiatric in-patients, caffeine has been found to increase anxiety, hostility and psychotic symptoms. Assessment of caffeine intake should form part of routine psychiatric assessment and should be carried out before prescribing hypnotics. Gradual reduction in intake or gradual substitution with caffeine-free alternatives is probably preferable to abrupt cessation. Decaffeinated beverages should be provided on psychiatric wards.

Depression is a frequently occurring symptom in schizophrenia. While today it is often underrecognised and under-treated, historically such symptoms were the focus of much attention. Affective symptoms were used by Kraepelin as an important criterion with which to separate dementia praecox from manic–depressive illness. Kraepelin also recognised the importance of depression as a symptom in schizophrenia and identified several depressive subtypes of the illness. Mayer-Gross emphasised the despair that often occurs as a psychological reaction to acute psychotic episodes and Bleuler considered depression to be one of the core symptoms of schizophrenia.

Vocational rehabilitation for people with severe mental health problems is poorly developed in the UK. Although there is a clear evidence base indicating the effectiveness of approaches to helping people with severe mental health problems gain and retain employment there is generally a lack of awareness of this evidence. As a result there has been a lack of implementation within routine clinical practice of the most effective approaches to improving employment outcomes for such individuals.

We review how research over the past decade both supports existing knowledge about the risk factors that children in the UK affected by parental substance misuse face, and adds to our knowledge about the protective factors, protective processes and evidence of resilience which can reduce the likelihood that children will experience poor outcomes. Further research is needed to understand what areas of resilience are most important to target and how other variables, such as gender or age, may influence how protective factors affect the development of resilience. Longitudinal research is also needed to better understand how an individual's resilience may change over time. Finally, there remain many considerable challenges which practitioners, service providers, commissioners and policy makers face in better meeting the needs of this population of children.

Migration and its associated processes can produce considerable stress on those who are migrating as well as on those around them. Depression should be a common sequel of the process, but is not consistently found to be so. This paper reviews the literature and suggests that various vulnerability factors, including culture shock and changed cultural identity, can play a role in the genesis of depression. Clinicians must be aware of patterns of migration and resilience factors in order to plan any intervention strategies. Stresses due to political and economic factors will have differing influences on the mental state of individuals. One possible contribution may be a discrepancy between aspiration and achievement, which can result in poor self-esteem, leading to depression.

The World Health Organization's proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). This article sets the new diagnosis of CPTSD within the context of previous similar formulations, describes its definition and requirements, and reviews the evidence concerning its epidemiology, differential diagnosis, assessment and treatment.

The term ‘therapeutic community’ is usually used in the UK to describe small cohesive communities where patients (often referred to as residents) have a significant involvement in decision-making and the practicalities of running the unit. Based on ideas of collective responsibility, citizenship and empowerment, therapeutic communities are deliberately structured in a way that encourages personal responsibility and avoids unhelpful dependency on professionals. Patients are seen as bringing strengths and creative energy into the therapeutic setting, and the peer group is seen as all-important in establishing a strong therapeutic alliance. The flattened hierarchy and delegated decision-making are sometimes misunderstood as anarchy by outsiders. However, staff in modern therapeutic communities are deeply aware of the need for strong leadership and their responsibility to provide a safe ‘frame’ for therapeutic work (Association of Therapeutic Communities, 1999).

In social science research and clinical practice, and in educational settings, psychological tests/scales are being increasingly used because of their reliability and the ease and speed of gathering, comparing and differentiating data. A new scale is usually created when instruments or questionnaires to measure the construct of interest are not be readily available or if existing questionnaires do not fully satisfy requirements. Scales are also translated and revalidated if they are not in the language required. This article takes the reader through steps in developing, validating and translating tests in the field of social sciences.

Language is the essential psychiatric tool for eliciting both history and mental state. Both diagnosis and treatment are handicapped if there is no common language between doctor and patient and understanding is facilitated through a third party, who usually has no psychiatric training. Many factors can affect this process resulting in a convoluted interview and greater potential for misunderstandings and diagnostic errors. Linguistics and the use of interpreters are rarely mentioned in standard psychiatric texts. The different processes of translation and interpretation and their use in psychiatry are explored here. The variety of errors and pitfalls described in the literature are considered. The authors offer advice on the use of trained and untrained interpreters in order to minimise errors and make the most of the information available.

There is encouraging evidence that some patients with personality disorder are treatable. Psychotherapeutic interventions show promise, although interpretation of the literature is problematic: the number of patients in most trials is small, outcome measures are questionable, follow-up is limited, and treatments are multifaceted, complex interventions in which the effective components are unclear. The evidence base can be assessed according to efficacy and generalisability, and when both are taken into account the best verification is for psychodynamic therapy. However, there is inadequate evidence to make specific recommendations for any particular therapy.

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.

There is widespread support for a positive and lasting relationship between participation in regular exercise and various indices of mental health, and several consensus documents and reviews (e.g. Biddle et al, 2000; Craft & Landers, 1998) have been published in this field. The evidence for psychological benefits, although impressive for mentally healthy individuals, is even stronger for psychiatric populations (Martinsen & Stephens, 1994). For example, a number of studies have demonstrated a positive relationship between exercise and mental health in people with alcohol misuse problems (Donaghy et al, 1991), people with schizophrenia (Chamove, 1986; Faulkner & Sparkes, 1999) and those with clinical depression (Mutrie, 1988; Martinsen, 1993; 1994; Martinsen et al, 1989a, b).

Depersonalisation disorder involves an unpleasant, chronic and disabling alteration in the experience of self and environment. In addition to these classic features of depersonalisation and derealisation, symptoms may also encompass alterations in bodily sensation and a loss of emotional reactivity. Primary depersonalisation disorder is probably more common than previously thought, and here we discuss the diagnosis, assessment and treatment of the condition, with particular reference to our experiences in a specialist depersonalisation clinic. We also consider psychological and biological aspects of the condition. Although there is as yet no recognised treatment for this disorder, various pharmacological interventions, particularly a combination of lamotrigine and a selective serotonin reuptake inhibitor, have shown promise. We discuss these drug treatments, together with psychological approaches, in particular a recent cognitive–behavioural conceptualisation and treatment approach.

Expressed emotion has been used as a construct in understanding the interaction between patients and their carers and families. A considerable amount of data from Western cultures suggests that high expressed emotion can lead to relapse in vulnerable individuals, even when they are on medication. However, the data from other cultures are less solid. This paper reviews some of the existing findings and recommends that various components of expressed emotion must be seen in the cultural context and embedded in the normative data of the population before the concept can be considered in association with the pathogenesis of relapse.

A series of psychoanalytic theorists and clinicians have suggested that conflicts about anger play a central role in the development of depression. Research data have supported the notion that patients struggle with the experience and expression of angry feelings. Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships. These conflicts lead to anger being directed inwards, further lowering self-esteem, creating a vicious cycle. Defence mechanisms that are triggered, including passive aggression, reaction formation, denial and identification with the aggressor, are ineffective at managing these conflicts and further prevent the appropriate expression of anger. This article discusses how to identify and detoxify angry feelings and fantasies using a psychodynamic approach.

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%.

There is some evidence that antidepressants, particularly the selective serotonin reuptake inhibitors and the monoamine oxidase inhibitors, have some benefits in the management of borderline personality disorder, and lesser evidence (partly because of limited trial data) for the benefits of antipsychotic drugs and mood stabilisers. There is not sufficient distinction between the different personality disorders to recommend that any one disorder should be treated by any one drug, and successful treatment is dependent on careful management, sensitive to the patient's expectations.

Motivational interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. The core principle of the approach is negotiation rather than conflict. In this article I review the historical development of motivational interviewing and give some of the theoretical underpinnings of the approach. I summarise the available evidence on its usefulness and discuss practical details of its implementation, using vignettes to illustrate particular techniques.

Functional near-infrared spectroscopy (fNIRS) has been used in healthcare and medical research for the past two decades. In particular, the use of fNIRS in academic and clinical psychiatry has increased rapidly owing to its advantages over other neuroimaging modalities. fNIRS is a tool that can potentially supplement clinical interviews and mental state examinations to establish a psychiatric diagnosis and monitor treatment progress. This article provides a review of the theoretical background of fNIRS, key principles of its applications in psychiatry and its limitations, and shares a vision of its future applicability in psychiatric research and clinical practice.