Coughlan & Cannon have provided an extremely useful review, highlighting the evidence for the association between childhood trauma and psychosis. This is relevant to those working with individuals with psychosis across all age ranges. This commentary discusses further some of the points raised, the complexity of the association and developmental aspects.

The article reviews some basic statistical concepts used in medicine, including the mean, standard deviation, sensitivity and specificity. Using this background the authors describe how these can be applied to cognitive tests, taking the Montreal Cognitive Assessment (MoCA) as an example. Two different approaches to using the MoCA in diagnosing dementia are considered: one using a fixed cut-off score, the other taking account of normative data about the effects of age and educational level on MoCA scores. It is recommended that clinicians assessing cognitive function should not rely on a fixed cut-off score, but where possible compare the patient's result with those of people of comparable age and educational background, although normative data of this kind are not always available.

Major depression and bipolar disorder in children and adolescents are serious conditions associated with considerable morbidity as well as increased risk of suicide. The treatment of depression in young people is currently controversial and this article reviews the evidence base and potential risks and benefits of antidepressants. Although the diagnosis of bipolar disorder is also controversial, medication is the first-line treatment of choice in cases that meet diagnostic criteria. The limited evidence base in children and adolescents is presented, along with current treatment guidelines. Despite the controversies in this field, this article concludes that medication remains an important part of the treatment approach for both disorders, although the risks and benefits of pharmacotherapy need to be carefully assessed in each patient.

Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.

In their recent articles in APT Mace & Binyon described a four-level approach to the teaching of the psychodynamic formulation. The fourth level requires development of confidence in the use of an operationalised psychodynamic diagnostics (OPD) manual. Here I critically reconsider the aspects necessary to develop the ability to arrive at a psychodynamic formulation. I argue that as one develops more sophistication and clinical confidence, one needs to move from a manualised to a more open-minded reflective mode.

The Government White Paper ‘Working for Patients' (1989) incorporated the idea of general practitioners (GPs) managing funds in order to purchase health services for the patients under their care. The aim was for decisions about purchasing and providing health care to be taken as close to the patient as possible, by their own GP. It has meant that two forms of purchasing have grown side by side – health authority and GP fundholding. Subsequent policy changes have made fundholding accessible to more practices, and have extended the fundholders' areas of purchasing. More than 50% of the population in England are now covered by fundholding GPs. The proportion of GPs who are fundholders varies enormously geographically, with high levels in the West Midlands, Trent, South Thames, Oxford and Anglia regions, where the collective purchasing function of GP fundholders is now very considerable.

Although mentoring has been widely accepted as a support mechanism for newly appointed consultants, there are many other applications of coaching and mentoring that are less widely appreciated, such as in the development of leadership skills or in having coaching conversations with trainees to facilitate learning. This article summarises some of the basic principles and practices of coaching and mentoring, with a focus on useful knowledge for psychiatric trainers. It describes some of the qualities and skills needed in a coach or mentor; the use of questioning techniques and models; and how the coach or mentor needs an awareness of the importance of the contract in the coaching and mentoring relationship, of the role of coaching or mentoring supervision, and of the ability to evaluate coaching or mentoring. It also discusses some of the organisational context, challenges and opportunities of embedding coaching and mentoring more deeply into the work culture. It is argued that coaching and mentoring as supportive interventions have not been prioritised in the National Health Service in the same way that they have been in the private business sector, where performance and financial success are measurably increased by these techniques.

Agitation and psychosis are two common distressing symptoms of dementia. The results of this issue's Cochrane Corner review suggest that, if a pharmacological approach is required, the use of risperidone and other atypical antipsychotics for the purpose of managing these symptoms seems questionable. Furthermore, typical antipsychotics, haloperidol in particular, might have a greater impact on agitation and psychosis than already recognised. This commentary critically appraises the evidence on the efficacy of typical and atypical antipsychotics for agitation and psychosis in dementia.

The language of psychiatry can be ambiguous and idiosyncratic, reflecting the elastic borders of mental illness and psychiatric disorder. This problem is not unique to psychiatry, but as the medical specialty moves closer towards a 'spectrum view’ of mental illness, psychiatric terminology increasingly risks misappropriation and conflation with lay concepts of normal suffering. Deciding what words mean and how psychiatric disorders are defined requires ongoing consideration of the pragmatic consequences, both intended and unintended. Refining the lexicon of psychiatry with an eye towards precision and the minimisation of stigma requires that terms be revised and updated from time to time, but often suitable word replacements remain elusive.