The role of pharmacotherapy in the management of depressive disorders is well-established and frequently reviewed. This paper focuses on the prospects for reducing the incidence, prevalence and morbidity of depression through psychosocial interventions. A central requirement in prevention is a knowledge of the epidemiology of the disorder being investigated. This data can be used to identify high-risk groups. By comparing the number of known cases with population levels of morbidity, it allows comment on help-seeking behaviour and accessibility of services. Also, differences in incidence and prevalence rates give some indication of the chronicity of the disorder.

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.

This brief article gives key demographic, socio-economic and health information for the Argentine Republic, with special emphasis in the field of psychiatry and mental health. It also informs about the country's mental health legislation and ongoing epidemiological research projects. It points out deficiencies and obstacles encountered in meeting the population's healthcare needs, and suggests developments to improve this situation.

Engaging patients in first-episode psychosis services is critical in maximising the effect of early intervention and establishing a framework for longer-term treatment. Biopsychosocial assessments determine a working diagnosis and inform evidence-based treatment. Atypical antipsychotics should be used at doses that maximise therapeutic benefit and adherence while minimising side-effects. Patients are helped to construct a narrative of their illness, including a shared understanding of the contribution of biological and environmental risks, and early warning signs. Common comorbid conditions, including depression, suicidal ideation, substance misuse and anxiety, should be addressed. Management of comorbid borderline and antisocial personality disorders is difficult; their nexus with psychosis is discussed. Cognitive–behavioural therapy is a mainstay of treatment, with specific interventions developed for problems typical in first-episode presentations. Core psychosocial interventions include psychoeducation, vocational and educational support, family interventions and multimodal group programmes.

This review highlights some of the recent advances in the psychopharmacology of major depressive disorder (MDD). We synthesise evidence on emerging pharmacological therapies targeting the serotonergic system, before exploring several novel treatment targets: the glutamatergic system, the GABAergic system and inflammation. When describing new treatment avenues, we examine the evidence base and how far these new treatments are from routine practice.

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.

Alcohol is the most commonly used recreational drug in the world and the third leading cause of preventable death. Alcohol consumption and alcohol problems have increased steadily over the past six decades. Methods likely to reduce alcohol problems (e.g. minimum pricing, restricting licensing hours and increasing the availability of alcohol treatment) tend not to be supported by the drinks industry. Methods favoured by the industry (e.g. public education, industry self-regulation and product warning labelling) are less effective or do not work. The recent history of alcohol policy clearly demonstrates how the financial power of industry can influence governments and undermine effective public health measures, for instance by lobbying, political donations, confusion marketing and creating fnancial vested interests by grants from industry-sponsored 'social aspect organisations'.

Multi-agency public protection arrangements (MAPPA) have been in operation for around 18 years in England and Wales. The primary purpose is for the sharing of information between agencies regarding the risk management of offenders returning to the community from custodial and hospital settings. The legal framework regarding information by psychiatrists is not dealt with in one single policy or guidance document. Psychiatrists must use their clinical and professional judgement when engaging with the MAPPA process, mindful of guidance available from professional bodies such as the Royal College of Psychiatrists, General Medical Council and British Medical Association.

A recent working party report published by the Nuffield Provincial Hospitals Trust (1996) made a series of recommendations for the improvement and better coordination of existing services. This comes at a time when new and expensive counselling services are springing up everywhere, the most ambitious being the British Medical Association's 24-hour counselling service for doctors and their relatives.

People with mental illness have always been marginalised and economically disadvantaged. Warner (1987) has shown that this is particularly true in times of high unemployment. Poor inner-city areas have excessive rates of severe mental illness, usually without the health, housing and social service provisions necessary to deal with them (Faris & Dunham, 1959). The majority of those who suffer major mental illness live in impoverished circumstances somewhere along the continuum of poverty. Homelessness, however defined, is the extreme and most marginalised end of this continuum, and it is here that we find disproportionate numbers of the mentally ill.

The history and meaning of doctors' approval by the Secretary of State under Section 12(2) of the Mental Health Act 1983 is discussed. The definition for approval is examined with relevant rulings on interpretation. Training requisites of such doctors are examined, outlining a framework of educational aims and objectives, with suggestions for delivery. The aims must include direct factual content and also the skills, values and attitudes required for humane and consistent practice. The particular needs of some specific groups and individuals are highlighted. The continual learning for updating skills and knowledge, including event-based learning, audit and reflection, is placed in the context of clinical governance wherein doctors must ensure that they continue to be ‘fit for purpose’. The case is made for ‘nationalisation’ of the syllabus and standards.

This article gives an overview of the profile of Alzheimer's disease, its pathophysiology and recent developments in technology that enable better understanding of the mechanism of disease. The diagnostic criteria and role of biomarkers proposed are explained. The new subgroups described are outlined in table form for easy reference. Subtypes of mild cognitive impairment (MCI) are reviewed and the conversion of amnestic MCI to Alzheimer's disease is considered. The implications and change to current clinical practice form the basis of the conclusion of the article.

Bipolar illnesses are typically considered as disorders primarily occurring in adult life, but a substantial number have their onset during the teenage years. Any acute illness in the teenage years affects social, emotional and educational development disproportionately, as it may prevent the normal transitions and learning experiences inherent in adolescence. Additionally, there is some evidence for a lack of early recognition or for misdiagnosis in early-onset cases of psychiatric disorders in general and the psychotic disorders in particular, with consequent increased suffering and impairment of functioning. Finally, bipolar affective disorders rarely present with one single episode followed by full and permanent recovery, but are usually illnesses characterised by a relapsing and remitting course through adult life. Prompt and effective recognition and treatment may therefore not merely reduce immediate impact but may also set up patterns of understanding and treatment compliance with longer-term implications. In this paper, I consider the particular features of bipolar affective disorder in adolescence and to describe a practical framework for its management. In view of the relative lack of age-specific research findings, particularly in respect of treatment effectiveness, I draw heavily upon clinical practice and extrapolation from studies carried out among adult sufferers.

Srinivas et al provide a comprehensive guide to the law, regulations and practice concerning the management of ‘restricted patients', who are the responsibility of both the clinical services treating them and the Home Office. In doing so, they make the assumption, with apparent approval, that there is a ‘partnership’ between clinicians and the Home Office. However, partnership assumes parties working towards a common goal on an equal footing. Neither assumption is correct here. Although forensic mental health services direct themselves explicitly towards enhancing public safety, they do so in conjunction with treatment aimed at the relief of dysphoria in the patient. The interest of the Home Office in the patient's mental health is solely in terms of its impact on the risk of harm to others. There is therefore no ‘partnership’. Rather, there is constructive tension between agencies working towards differently valued and balanced objectives. Certainly the relationship is not one of equal power.

Over the past decade there have been few advances and no real breakthroughs in the treatment and management of anorexia nervosa. There has perhaps been a consolidation of opinion and practice. A clinical guideline for eating disorders published under the auspices of the National Institute for Clinical Excellence (NICE) has summarised our present ideas of good practice as well as highlighting the lack of good evidence on which to base this.