Childbearing, from the standpoint of psychological medicine, is the most complex event in human experience (Brockington, 1996). Pregnancy and childbirth involve major biological, social and emotional transitions and expose the mother to a range of psychological and medical complications. There are about 20 psychiatric disorders occurring in the post-partum period (see Table 1).

Personal development plans (PDPs) are a central requirement to remaining in good standing for the Continuing Professional Development programme of the Royal College of Psychiatrists. They are also integral to the framework now agreed for consultant appraisal in the National Health Service. This paper sets out the context which makes PDPs increasingly important and discusses the link between appraisal and revalidation, covering ‘360-degree’ techniques such as Ramsey questionnaires (which may ultimately figure in revalidation mechanisms). It then describes the practicalities of generating PDPs, especially in peer group settings. Experience from pilot workshops is used to illustrate how PDPs can be made to work and how learning/developmental objectives can be made meaningful.

When asked for advice about a survivor of torture (or of some other form of organised state violence), there are at least two people to consider. In addition to the needs of the patient, those of the person asking for advice – the health professional – must be taken into account. There are some forms of violence which can damage others, even in the controlled circumstance of a consulting room. There is a context, often a community or a family, in which the person exists. This paper will first address some of these broader issues before going on to consider some of the narrower, more technical, matters of best available treatment.

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.

Children who have a learning disability are at increased risk of sexual and physical abuse and neglect. They and their families are more likely to be socially isolated and to suffer material and emotional poverty. The range of emotional reactions in carers can vary at different times from extreme overprotection, through relative equanimity, to sometimes outright hatred and rejection of the child. Society largely reflects this, only rarely viewing the individual with learning disability in a positive way, choosing often to pity, patronise, ignore, ridicule or openly despise. These attitudes are internalised by children with the disability, who invariably suffer from low self-esteem. All of these factors combine to facilitate abuse.

Psychiatrists live and work in complex, clinically challenging times. Their paperwork is geared increasingly towards defensive practice, key performance indicators and risk assessment forms. Somewhere in the process, detailed understanding of patient experience and clinical formulation based on key psychiatric expertise and skill in mental state examination have taken a backseat. I review the history behind the Present State Examination, the realisation in the 1980s of the need for a common psychiatric language internationally and the current position on phenomenology in psychiatry curricula in the UK. I conclude that it is time to think seriously about a return to basics in psychiatric phenomenology and psychopathology.

Understanding the philosophical foundations of cognitive–behavioural therapy (CBT) is vital to drive theory and research forwards and to effectively conduct therapy using varied methods and techniques from different CBT models that may be rooted in distinct philosophical tenets. In the evolution of CBT as the most empirically validated form of psychotherapy, each of its three waves (behavioural therapy, cognitive therapy and acceptance-based therapies) has brought unique contributions to improve its effectiveness. Although some of the philosophical assumptions underlying the different CBT waves may be considerably dissimilar, in this clinical reflection I review the distinctive and cross-cutting features of such backgrounds, while suggesting a conciliation of epistemological perspectives that is capable of informing the practice of CBT in a consistent manner.

There is a myth that people with mental disorders comply poorly with treatment. In fact, psychiatric patients are no more likely than patients in other medical specialities to go against the advice of their doctor. However, it is easy to find instances where psychotropic medication is refused by the supposed beneficiary. The value of neuroleptic treatment in schizophrenia is now widely accepted, and failure to take such treatment is associated with relapse. Relapse may endanger the patient and other people. Despite this, people with schizophrenia frequently fail to take their treatment. One-third of patients leaving a general adult psychiatry ward can be expected to be non-compliant within two years (Buchanan, 1992).

Acting as an expert psychiatric witness can be rewarding, but there are potential costs and pitfalls, such that the role should be undertaken only in an informed manner. With reference to the recent disciplinary cases of Dr Richard Pool and Dr Waney Squier, and a judgment of the Supreme Court, advice is offered to potential expert psychiatric witnesses. Suggestions are made as to training, the negotiation of instructions, the citation of published literature, the construction of expert opinion and how to ensure compliance with the ethical duties of the expert witness.

Professionals, patients and patient organisations have advocated for the renaming of ‘schizophrenia’, seeing the term as misleading, stigmatising and a barrier to specialised care. In countries where a name change has occurred (e.g. Japan), the advantages of renaming seem to far outweigh disadvantages. Nevertheless, a name change would be a long and complex process that would not be useful if it were not accompanied by parallel changes in legislation, services and the education of professionals and the public.

With fundamental changes to the way services are commissioned and resourced within the UK's National Health Service (NHS), optimising the efficient and effective use of resources has become a key task for mental health clinicians and managers. A core step in this process is ensuring that resources are optimally allocated across the service. This article outlines steps in resource allocation, including understanding how resources are managed through budgets, the link between resource matching and care delivery, and methods of reallocating resources to improve service performance. Influencing appropriate allocation is a critical role for psychiatrists, working with both managers and commissioners in the decision-making process. Understanding resource allocation from a management perspective should improve the ability of psychiatrists to influence this process more effectively.

Risk management is a requirement of clinical governance and a new paradigm for child and adolescent mental health services. Issues are different from those of adult services and a wide range need to be considered, which include not only the risk of harm to self, to others and from others but also from the system (by omission or commission) and to the staff. Systematic policy development, using information from audits, complaints, incidents and inquiries, will be helpful and interagency agreements necessary to promote coordination. The complex regulatory framework is discussed.

Psychiatry receives less media coverage than general medicine, and the coverage it does receive is four times as likely to be negatively framed. In addition, coverage of mental health problems is often negative in tone and mental health research tends to be underrepresented in the media. As the media is likely to be a key source of information for the general public about mental health and psychiatry, this is worrying. There are opportunities, however, to change this landscape; the UK national news media are keen to cover more stories about mental health problems and to feature more psychiatrists' comments in their coverage. By engaging with the media, psychiatrists have the chance to create better-informed media narrative.

Eye Movement Desensitisation and Reprocessing (EMDR) is an established psychotherapy that utilises repetitive, bilateral stimulation, such as saccadic eye movements, to treat the symptoms associated with traumatic experiences. Much of the attention EMDR has received has focused on its use in treating post-traumatic stress disorder (PTSD), which has resulted in its inclusion in several treatment guidelines. There is, however, emerging evidence that suggests a promising role for EMDR in managing a wide range of other mental and physical health conditions. High-quality studies demonstrate the efficacy of EMDR in managing conditions such as anxiety disorders, obsessive–compulsive disorder, major depressive disorder and chronic pain. Preliminary studies have also investigated its use in conditions such as bipolar disorder, eating disorders, substance misuse, psychotic disorders and sleep disturbances. The major studies exploring these applications of EMDR, outside of PTSD, are reviewed in this article.

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a higher prevalence rate in people with intellectual disability compared with their peers without such disability. The classic presentation is that of inattention and/or hyperactivity and impulsivity, but these symptoms can manifest differently in people with intellectual disability. Despite a higher prevalence, the rate of diagnosis and treatment of ADHD in intellectual disability remains low. This article discusses the clinical presentation of ADHD in people with intellectual disability and the relationship between ADHD and other comorbid conditions, such as autism and bipolar disorder. Pharmacological and non-pharmacological interventions are discussed from a practical and a clinical point of view.

The development of atypical antipsychotics has stimulated research on the treatment of mania. Several well-established options now exist for monotherapy of mania. None of the atypicals has shown greater efficacy than haloperidol in improving manic symptoms, but they all produce fewer extrapyramidal side-effects and they may differ in their effects on depressive symptoms. Combinations of an antipsychotic with lithium or valproate offer further options, with somewhat greater efficacy in treating mania but also with more side-effects.

Religious laws do not usually forbid the use of psychotropic medication, but many do forbid the consumption of animal-based derivatives of bovine and/or porcine origin (e.g. gelatin and stearic acid) such as are found in many medications. Demonstrating awareness of this, combined with a genuine concern about how it affects the patient, may strengthen the doctor—patient relationship and avoid non-adherence. In this article, we outline dietary requirements of key religions and belief systems that may have a bearing when prescribing medication containing animal-based ingredients. We identify common psychotropics that contain animal-based derivatives and suggest alternative prescribing options and approaches to dealing with sensitive ethical issues.

In this review of recent advances in the sub-specialty, we briefly discuss the current understanding of causes, presentations and evidence-based treatment of the most common disorders seen in clinical neuropsychiatry. Traumatic and acquired brain injury, epilepsy, multiple sclerosis, Parkinson's and Huntington's disease, sleep disorders and delirium are all considered, focusing on the most contentious issues and practical approaches to management and treatment.

The author reflects on discoveries over the course of a century concerning histamine as a potent chemical signal and neurotransmitter, the development of antihistamines, including promethazine, and chlorpromazine from a common precursor, and the recognition of a major brain pathway involving histamine. Although chlorpromazine has been succeeded by numerous other antipsychotics, promethazine remains the antihistamine recommended for sedation in acutely disturbed patients, largely because it is potently anticholinergic at atropinic muscarinic receptors and therefore anti-Parkinsonian: this means it is also useful in combination with older antipsychotics such as haloperidol.

The purpose of this first article of four addressing the electronic approaches to psychotherapy (e-therapy) is to introduce the equipment (computers) and systems (the World Wide Web and the internet) involved. I describe some of their many elements (e.g. bits and bytes), uses (such as search engines, email, web mail) and a few abuses (e.g. spam, spyware).