It is appropriate to be writing about psychiatric training in Europe as the joint meeting between the Royal College of Psychiatrists and the Association of European Psychiatrists is being planned for July 1996.

This article provides an overview of classification and outcome of eating disorders, before focusing on current evidence-based treatment for the two main disorders of anorexia nervosa and bulimia nervosa.

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.

Mental health clinicians are expected to offer support and advice to patients to promote smoking cessation. Alongside this is the relatively new and increasingly popular phenomenon of electronic cigarette use. The absence of any long-term evidence regarding safety is recognised and clinicians' awareness of e-cigarettes may be limited to personal experience or media publications, leading to uncertainty in their confidence discussing e-cigarettes with patients, both in general and as an aid to quitting smoking. This article provides a historical and contemporary overview of e-cigarettes and vaping. The reader will gain an understanding of e-cigarette usage, risks and benefits, the current position on use of e-cigarettes in mental health settings, and tips on how to take an e-cigarette/vaping history and how to offer advice about use. This is achieved in the context of recent publications and national recommendations. Although the focus is primarily on the mental health patient, the article is of benefit to all health and social care professionals to help them develop an understanding of e-cigarettes as a tobacco-smoking cessation or harm-reduction aid.

People with mental disorder and intellectual disability have the same rights to sexual expression as other people, albeit that in some cases a lack of capacity may require curtailment of those rights and regard must be had to protecting the vulnerable. Furthermore, the formation or maintenance of sexual relations, or the attainment of sexual fulfilment, may assist in the maintenance or restoration of mental health or well-being. This article demonstrates how the courts in England and Wales, applying statute law and judicial precedent, are largely supportive of the rights of people with mental disorder or intellectual disability to make decisions about sexual expression, sexual relationships and related matters, notwithstanding some societal and staff attitudes that act to prevent them fulfilling their sexual needs and making decisions about sexual and reproductive matters.

Dissociation is a common and often overlooked symptom in traumatised children. Although there is a lack of a scientific consensus as to the nature of dissociation and very limited research about dissociative identity disorder (DID) in children, the authors have seen children given this diagnosis recently referred to their clinic and are concerned about this practice and the parenting approaches that have ensued. The diagnosis of DID in children may be rare or of doubtful validity, but repeated traumatic experiences of an interpersonal nature can have a profound effect on a child's identity, memory and self-organisation. Furthermore, abuse and neglect can increase the risk of dissociative symptoms. This brief article considers dissociation in post-traumatic stress disorder, then outlines developmental factors hypothesised to be associated with dissociation in childhood and early adulthood. It warns that clinicians should keep an open mind about how dissociation may manifest transdiagnostically, and concludes with recommendations for further research.

Sleep disorders are common among elderly people, affecting about 50% compared with about 26% of younger adults. About two-thirds of residents in long-term care have sleep disturbance (Karacan & Williams, 1983; Becker & Jamieson, 1992). This high prevalence of sleep disorders results in excessive daytime napping, fatigue, cognitive impairment, increased psychiatric morbidity and increased prescribing of hypnotics, with an associated increase in mortality (Kripke et al, 1979). Karacan & Williams (1983) quote figures varying from 26 to 100% for the prescribing of hypnotics to residents in institutional care. This has major implications. There is a risk of both accidental and deliberate overdose. There may be interactions with other drugs and a hangover effect can impair daytime functioning. Excessive sedation can make the patient difficult to rouse in an emergency. Dependence may occur and the drugs may further disrupt sleep. They also increase the likelihood of sleep apnoea.

Alzheimer's disease is likely to be one of the challenges for the early part of the 21st century. Better knowledge of the molecular biology, genetics and pathogenesis of the condition have led to a host of psychopharmacological compounds being developed which may help in its the treatment, while epidemiological studies have suggested that existing treatments for other chronic conditions may have an effect on the presentation of Alzheimer's disease.

A significant proportion of individuals in contact with probation services have mental health problems. Joint working between psychiatrists and probation is crucial to both diversion and resettlement of offenders with mental health conditions. In England and Wales, probation services are involved in the supervision and management of offenders if they receive a suspended or community sentence, or when they are released into the community on licence after serving a determinate, extended or life sentence. This article aims to promote awareness of joint working between probation and mental health services and the role of approved premises. It also describes a successful example of such joint working at Elliott House, approved premises for mentally disordered offenders in Birmingham, UK.

Community mental health teams (CMHTs) have their origin in the American Community Mental Health Centre programme of the 1960s. The teams were mandated to provide services with an emphasis on the needs of the severely mentally ill (SMI). However, over time the focus of work became ‘the worried well’, to the neglect of those with severe mental illness. CMHTs are now a firm feature of British psychiatry. A Sainsbury Centre study recently identified over three hundred CMHTs across England, defining themselves as comprising at least four members, from two or more disciplines, with a caseload of individuals with mental health disorders, largely residing in the community.

The aim of this article is to set the teaching of child and adolescent psychiatry to medical undergraduates in the framework of current educational theory and General Medical Council (1993) curriculum guidelines. The objectives are to:

(a) outline the main reasons for teaching child and adolescent psychiatry in the medical undergraduate curriculum;

(b) discuss placement of child and adolescent psychiatry teaching in the curriculum;

(c) outline relevant content;

(d) describe appropriate teaching methods; and

(e) describe assessment and evaluation procedures.

Hormones are widely considered to cause powerful psychological effects and because of this psychiatrists may be asked to advise general practitioners, consultants in other specialities or patients about the relationship between hormones (including sex hormones) and psychiatric disorder. Sex hormones may be relevant to psychiatry in three ways:

(a) Sex hormones may play a role in the pathophysiology of psychiatric disorders.

(b) These agents may be utilised for treatment of psychiatric disorder.

(c) Administration of sex hormones may cause psychiatric side-effects.

Despite the dearth of recent psychiatric literature on the subject of grief, mental health professionals continue to see patients suffering from complex responses to grief. This article reviews psychological theories about normal and abnormal grief, drawing particularly on the work of Freud, Klein, Bowlby and Parkes. It describes the principles of grief work, using as illustration clinical examples of adults grieving as a result of bereavement. These principles also apply to work with adults grieving other forms of loss (e.g. breakdown of a love relationship, loss of employment or loss of physical health).

The evidence, which is summarised in this editorial, shows that the circumstances in which people are born, grow, live, work and age are powerful determinants of health and of the unfair distribution of health – health inequity. Discrimination against people with mental illness shows how the relation can go the other way: for example, when people with mental ill health cannot get back into work.

Issues such as sexual dysfunction, hypersexuality, risky sexual behaviour and mental capacity in relation to sexual activities arise frequently in people with psychosis. However, they may not always be given a priority in doctor-patient interactions, despite their often critical importance from the patient's perspective. Having a working knowledge of these topics may improve the quality of psychiatric intervention for people with severe mental illness. This article explores these topics, with a particular emphasis on assessment and management in everyday practice.

We review thought disorder in psychopathology, including how one can assess it clinically, useful psychometric measures and its clinical importance. In the final section we discuss how recent studies in neuropsychology and neuroimaging have helped understand the mechanisms of abnormal speech and languages in psychotic illnesses.

There is growing evidence from smaller evaluative studies in the USA and anecdotal papers in the UK that supported volunteering can help recovery and can be a pathway into paid work for people with serious and fluctuating mental health conditions. It allows the person to take risks and test out a working environment. This opportunity can integrate their experience of mental illness into a valued identity and provides opportunities to engage with a world of work. We recommend that mental health professionals consider ways of providing volunteering opportunities as part of a recovery-oriented service within their organisations.

Since the Woolf reforms were incorporated into legal practice in civil cases in England and Scotland, there has been a distinction between expert and professional witnesses. A common feature is the appointment of an agreed expert to give evidence on aspects of a case that require expert testimony. These changes do not apply in criminal cases nor in other jurisdictions such as the Republic of Ireland. However, all witnesses, whether professional or expert, must be objective, since their role is to assist the court. There is little or no training of clinicians in how to become an expert and suggestions for improving this are discussed. Practical aspects of accepting a brief from a solicitor are considered.

The ongoing impact on global mental health of the COVID-19 pandemic and the isolation measures used to combat its spread is increasingly acknowledged. This reflection focuses on the effect the pandemic has had specifically on the mental health of women in the peripartum period, using recent case examples from a busy and diverse south London community perinatal psychiatry service.

Although hypnosis has played a part in psychotherapy for a long time, it is not yet seen as an evidence-based therapy and is absent from many practice guidelines when it comes to the treatment of psychiatric disorders. At present, the applications and methods of hypnotherapy are poorly understood and other methods of psychotherapy tend to be favoured. This review article aims to introduce the role of hypnotherapy and its application for certain common psychiatric presentations, as well as examine its efficacy by summarising recent evidence from high-quality outcome studies and meta-analyses.