The problems associated with alcohol and drug misuse are diverse and make a major impact on the health of the nation (Anderson, 1991; Royal College of Psychiatrists, 1992). A recent survey showed that the prevalence of alcohol dependence in the population (aged 16–64 years) was 47 in 1000 and of drug dependence 22 in 1000. (This compares with a prevalence for functional psychosis of 4 in 1000) (Office of Population Censuses and Surveys, 1994).

There are many different course designs for the teaching of old age psychiatry. It may be taught in blocks or spread over the undergraduate curriculum and/or integrated with either psychiatry or medicine for the elderly. Whichever approach is used, at the end of their undergraduate training, students should have the same core knowledge, skills and attitudes.

Psychiatric expert witnesses instructed to undertake assessments of defendants charged with murder should be familiar with the partial defences of diminished responsibility and loss of control. The Coroners and Justice Act 2009 enacted major amendments to the partial defence of diminished responsibility and introduced a new defence of loss of control to replace the provocation partial defence. In this article, the changes to the law are described with particular focus on the implications for the psychiatric assessment.

Currently, network meta-analyses (NMAs) are the only technique that allow us to compare and rank numerous treatments across trials. Evidence produced by NMAs relies on pooled data from both direct and indirect comparisons within studies. Consequently, NMAs are invaluable tools for informing clinical guidelines.

This article discusses dopamine partial agonism, which is the main mechanism of action of the psychiatric drugs aripiprazole, brexpiprazole and cariprazine. It outlines the principles of receptor theory and the structure of dopamine receptors; characterises agonists, antagonists and partial agonists; and summarises the dopamine hypothesis of psychosis and the role of dopamine and serotonin in depression.

This is the second of a pair of articles reviewing the topic of consent in minors. Both articles have a particular emphasis, drawing on theory and case law, on the differential treatment of acceptance and refusal in minors. This article considers the concept of capacity in young people (aged 16 and over) and competence in children (under the age of 16) by reviewing underpinning statute and case law with particular reference to England and Wales. This provides a platform for consideration of the reach of capacity in minors with regard to acceptance and refusal of treatment. In doing so the article explores the key, but still elusive, ingredient of maturity, which has significance to the process. Fictitious vignettes allow consideration of the application of the concepts of maturity and autonomy in clinical practice. The article also considers the potential for the UK's Parliament to make changes to current statute regarding consent in minors.

The Defence Mental Health Services (DMHS) provide an occupationally focused service for the UK armed forces when deployed and when at home. Although much of the work is similar to that carried out by National Health Service community mental health teams, there are many unique aspects to working with the military. Although carrying out operational duties is a key function of the armed forces, the majority of cases managed by the DMHS are not related to traumatic exposures; instead, adjustment, mood and substance use disorders form the bulk of the case work. However, DMHS personnel carry out a considerable amount of psychological education and command liaison functions to support the concept that the psychological welfare of troops is primarily a chain of command responsibility. This article outlines the structure and function of the DMHS and its approach to risk management.

Most individuals who have lived in foster homes, residential care or adoptive families for substantial periods (‘people affected by public care or adoption’) show normal psychological adjustment as adults, although rates of mental disorders, hospital admission and suicide are increased. Research focusing on the experiences of this group of people can help professionals better understand their behaviour and attitude towards help. Psychiatric symptoms can be multifaceted, including complex trauma presentations. The specific mental health needs of this population are increasingly being recognised in child and adolescent mental health services but less so in adult services. In this article we describe life experiences of people affected by public care or adoption, examine the lifelong impact of these experiences on mental health and functioning, and offer practical suggestions for clinical work with them.

We outline benefits and problems of introducing internet-based approaches (e.g. e-learning, social networking) into journal clubs. We also look at potential risks to the continuing existence of clubs posed by the changing health economy and the move in psychiatry from clinical medicine to community care. Overall, we are optimistic for the journal club's survival.

The category ‘somatoform disorders' was introduced comparatively recently in DSM–III and thereafter in ICD–10: it is the umbrella term currently favoured to cover a heterogeneous group of interrelated and overlapping syndromes, which have been given many names over the years. All these syndromes have in common the process of somatisation: that is, the presence of physical symptoms unexplained by physical disease, with variable degrees of distress and loss of function, about which the patient consults doctors.

The artist Arshile Gorky played a central role in the development of Abstract Expressionism during the 1940s. Born in Armenia, his early figurative works recall a childhood of persecution by Ottoman Turks, a period during which he suffered a number of significant losses. The painting The Artist and His Mother (c. 1926–1936) is based on a photograph showing the 7-year-old Gorky with his mother, 7 years before she starved to death during the Armenian Genocide. This article explores the early experiences that haunt this painting and the difficulties Gorky struggled with during his adult life as an immigrant to the USA – factors that contribute to an understanding of his suicide in 1948.

At a time when patients are challenged to cope adaptively with both the diagnosis and treatment of cancer, clinicians need to respond appropriately to the many inevitable questions about the causes of cancer and contributing factors, including ‘Is this my fault?’. The evidence guiding answers to such questions has been confounded by many methodological challenges, but personality, stress and life events are no longer considered causes of cancer. However, social isolation, untreated depression and social deprivation continue to influence quality of life and reduce cancer survival times. Psychiatry might play a role in promoting lifestyle changes that reduce the risk of cancer, but more importantly it can influence disease progression by optimising patients' adaptation to the many challenges that cancer brings.

Formal communication skills training is the norm at UK medical schools, and evidence is mounting that it is effective in a number of domains, including patient satisfaction and shared decision-making, leading to improved treatment adherence. However, applying these models in mental health settings is challenging, despite the fact that positive therapeutic relationships and an ability to actively manage consultations are the cornerstone of psychiatric practice. Communication skills training is still too often regarded as better suited to physical health consultations than more complex psychiatric interviews. Here, it is considered why this might be, with reference to the one eligible randomised controlled trial identified in this systematic literature review.

We have arrived at our current descriptive classifications, with their many and varied array of categories, through the committee processes of DSM and ICD. To date, expert opinion, rather than solid science, has been the driver for change and this helps to explain the bewildering number of diagnostic categories and the fact that many patients meet criteria for several categories. Over the coming years, advances in neuroscience will offer the opportunity to base classification on robust evidence with diagnostic entities mapping more closely onto the workings of the brain. There are major shortcomings to the current classifications but all changes come at a cost to their users. We should be fully aware of the shortcomings and be thinking about the future. However, major changes to classification should await the emergence of robust empirical data and proven clinical utility. This will be the best way to benefit patients.