Post-traumatic stress disorder (PTSD) is a common trauma and stressor-related disorder. Trauma-focused psychotherapies and selective serotonin reuptake inhibitors represent current state of the art treatment for PTSD, with current evidence favouring psychotherapy as first-line treatment. Much room remains for development of more effective therapeutics. This article give a brief update on diagnosis and treatment of PTSD.

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.

Clinical governance can be defined as:

This article discusses the misuse of drugs which act as stimulants, an effect mainly produced by enhancement of the central transmission of catecholamines, particularly dopamine. Stimulant misuse is extremely widespread in the UK and elsewhere, but primary users of such drugs present relatively rarely for treatment at drug services. At present such services mainly see heroin users, not only because the greater addictiveness of heroin produces generally higher levels of problems, but because a substitute treatment can be used in that group in the form of methadone.

‘Gulf War syndrome’ was a phrase coined after the 1991 Gulf War. This article looks at the variety of hypotheses that have been put forward about the origins of the concept and the studies attempting to characterise the health manifestations of Gulf service and the lasting effects on veterans. It also serves to bring readers up to date with research on the present deployment in Iraq. Finally, consideration is given to how Gulf War syndrome compares with the rich historical literature of post-conflict medical syndromes and how sociological factors may interact with symptom attribution in veterans.

Hyperkinetic disorder is the generic ICD-10 (WHO, 1992) term used to describe one of the most common childhood psychiatric disorders. It is a severe form of a syndrome which is referred to in DSM–IV (APA, 1994) and the American literature as attention deficit hyperactivity disorder (ADHD). Hyperactivity or hyperkinesis can be defined as “an enduring disposition to behave in a restless, inattentive, distractible and disorganised fashion” (Taylor, 1994). It is thus more than motor overactivity. Diagnostically there are three main groups of symptomatology: overactivity, inattentiveness and impulsiveness.

Behavioural changes associated with epilepsy can be challenging for patients and clinicians. Evidence suggests an association between aggression and epilepsy that involves various neurophysiological and neurochemical disturbances. Anti-epileptics have variable effects on behaviour and cognition that need consideration. Early detection and careful consideration of history, symptomatology and possible common comorbid psychiatric disorders is essential. Appropriate investigations should be considered to aid diagnosis, including electroencephalogram (EEG), video EEG telemetry and brain imaging. Optimising treatment of epilepsy, treatment of psychiatric comorbidities and behavioural management can have a major positive effect on patients' recovery and well-being.

Parent–infant psychotherapy (PIP) is a psychoanalytic intervention that aims to improve parental and infant mental health. There is uncertainty about the clinical effectiveness of this intervention, particularly in comparison with other interventions. Based on a limited number of trials, this month's Cochrane Corner review aimed to summarise the best evidence available. Although the review found some tentative support for PIP in relation to attachment outcomes, overall the evidence was of low quality and PIP was not found to be more effective than treatment as usual or other interventions. This commentary contextualises and summarises the findings, and considers their implications for researchers and clinicians.

There are many difficulties associated with the diagnostic guidelines for personality disorder in the current international classificatory systems such as ICD–10 and DSM–IV. These lead not only to significant overlap with DSM Axis I disorders, resulting in high rates of diagnoses of comorbidities and multiple personality disorders, but also to lack of adequate capture of core personality pathology. The current classifications are also unhelpful in treatment selection, presumably the prime reason for assessing individuals in the first place. In this article we highlight various deficits and inadequacies related to the nosology of the current systems and suggest some strategies for dealing with these. We offer an integrated model of assessing and diagnosing personality disorders. We attempt to demonstrate how using a more integrated approach minimises or even eliminates some of the key problems highlighted in the current systems.

Demands on health and social care are growing in quantity and complexity, with resources and staffing not projected to match this. The landmark NHS Long Term Plan calls for services in England to be delivered differently through integrated care systems (ICSs) that will better join commissioners and providers, and health and social care. The scale of these changes is immense, and the detail can feel confusing. However, they are important and will affect all clinicians in the public service. This three-part series provides a primer on integrated care, explaining why it is happening, how services are changing and why clinicians should get involved. In this first article we focus on the changing demographics, and the workforce and financial resources required to address these.

Less-common personality disorders affecting patients admitted to in-patient units are discussed in some detail. These disorders are rarely a direct cause of admission, but they are often associated with other Axis I disorders and can therefore be obstacles to successful treatment. A knowledge of the clinical picture and underlying dynamics and an awareness of countertransference feelings that these patients are likely to provoke can enhance therapeutic alliances and improve the chance of effective care plans.

Electroconvulsive therapy (ECT) for depression is a controversial treatment with highly polarised views about the balance between therapeutic benefits and adverse effects. Studies investigating whether ECT is more effective than a placebo treatment started in the 1950s, with the most important randomised controlled trials carried out about four decades ago in which ECT was compared with sham ECT (SECT) involving anaesthesia but no electrically induced seizure. Subsequently the data have been pooled in a number of meta-analyses which have found that ECT is an effective treatment. However, a recent review of the quality of the SECT-controlled studies, and the meta-analyses based on them, concludes that their quality is too poor to allow assessment of the efficacy of ECT and that, given its risks (permanent memory loss and death), the use of ECT should be suspended. This commentary critically discusses the methodology of this review and its conclusions.

The current National Health Service (NHS) approach to commissioning health services is in flux. The purchasing of care from providers by general practitioner fundholders (GPFHs) and health authorities has changed with the new White Papers. GPFHs no longer exist and the commissioning role is being handed over from health authorities to primary care groups (PCGs). An understanding of the reasons for change and current arrangements will aid the consultant psychiatrist in influencing this process.

Patients with psychiatric illness present a unique challenge to clinicians: in contrast to the traditional medical model, in which patients are conceptualised as being stricken by a disease, patients with certain psychiatric illnesses may seem complicit in the illness. Questions of free will, choice and the role of the physician can cause clinicians to feel helpless, disinterested or even resentful. These tensions are a lasting legacy of centuries of mind–body dualism. Over the past several decades, modern tools have finally allowed us to break down this false dichotomy. Integrating a modern neuroscience perspective into practice allows clinicians to conceptualise individuals with psychiatric illness in a way that promotes empathy and enhances patient care. Specifically, a strong grasp of neuroscience prevents clinicians from falling into the trap in which behavioural aspects of a patient's presentation are perceived as being separate from the disease process. We demonstrate the value of incorporating neuroscience into a biopsychosocial formulation through the example of a ‘difficult patient’.

The UK's Postgraduate Medical Education and Training Board (PMETB) went live on 30 September 2005. This editorial summarises the state of play and informs members of the Royal College of Psychiatrists and stakeholders of the changes that have taken place in the intervening year and of the College's response. The College has received provisional approval of its core curriculum, and specialty curricula have been submitted for approval. We are in the middle of pilot work on workplace-based assessments and preliminary results should be available in the early part of 2007, when trainees and educational supervisors will begin training in the preparation for and carrying out of these assessments.

The economically developing countries face a perpetual challenge to provide essential health care. The available health care delivery systems are primitive and lack organisation and resources. Mental health care suffers even more acutely for want of attention, widespread ignorance and prejudice. The services in this field are inadequate and often inappropriate. The urge for a qualitative change has led to a focus on higher training of specialist doctors.

Cannabis is the most commonly used illicit drug in the UK and a significant proportion of users have symptoms of dependence. In addition, there are a number of adverse consequences of use, including an association with psychotic disorders. Thus there is a need for effective treatment of cannabis misuse. Psychological therapies have been developed based on principles of motivational interviewing, cognitive–behavioural therapy and relapse prevention. The evidence base for these therapies is explored in this review, and studies targeting both adult users and young people are considered. Possible new pharmacological treatments are also discussed.

The manifestations of stress are diverse and culturally and individually determined, but it is present in every culture, every socioeconomic level and – it is global. Introducing a special BJPsych Advances issue on stress, this editorial outlines research questions to be examined and first actions to be taken in the multidimensional sphere of stress, highlighting the need for a collaborative interdisciplinary approach in both research and practice.

Advance statements, originally designed for situations of terminal illness, are becoming increasingly relevant in psychiatry. This article examines their background, rationale and use in old age psychiatry. The difference between advance statements and advance directives is highlighted, and different roles are suggested for each. We discuss the advantages, and the possible limitations, of advance statements, including the unique issue of the Mental Health Act 1983.