Palliative care is the active, total care of patients whose disease is not responsive to curative treatment. Psychological problems such as depressive illness, anxiety, delirium, problems coping and body image disturbances are common in the palliative care setting, although they are often missed. A full assessment of these patients should take into account physical, emotional and spiritual factors; therapeutic work should include the patient's family. Pharmacological (antidepressants, anxiolytics and antipsychotics) and cognitive–behavioural treatments are often effective in allaying distress in this group of patients, and can improve coping skills and quality of life. Liaison psychiatrists have a role in teaching palliative care staff to recognise psychiatric disorders. A number of case studies are presented to illustrate these points.

Looked after children are disadvantaged with regard to their mental and physical health and education. Research is limited on this population, but dramatic findings prompted the Government to produce a number of guidance and policy documents over the past 5 years. This paper discusses the available research and highlights the problems that looked after children face. The new policy initiatives are listed, along with a number of obstacles to be overcome if the care of these young people is to be improved.

Social phobia (or social anxiety disorder) manifests as a marked and persistent fear of negative evaluation in social or performance situations. The epidemiology, diagnosis and psychopathology are reviewed, including clinical presentation, cultural aspects and the differences between agoraphobia and social phobia. Behavioural treatments, including graded self-exposure and cognitive restructuring, are considered. A cognitive model of the maintenance of social phobia is discussed. It is hypothesised that attentional shifting towards imagery, safety behaviours and ‘post-mortem’ analyses play a key role in symptom maintenance. The implications of this for treatment are described, and guidelines for pharmacological treatment are summarised.

This paper addresses how mental illness and psychiatry are presented in autobiographical narratives. The richness of clinical psychopathology unmediated by the expectations of psychiatry is described. The rituals of psychiatry, the importance of the personal relationships between patients and clinicians, and the subjective beliefs of people about mental illness are explored.

Doctors, like other health professionals, show increased rates of psychological morbidity, including anxiety, depression, suicide, drug and alcohol misuse and professional exhaustion (burnout). This might be due in part to the pressures of clinical work, but might also reflect Malan's ‘helping profession syndrome’, in which an individual chooses, usually unconsciously, to work as a carer as a response to personal vulnerability, or ‘the patient within’. This paper reviews the literature relating to the complex relationship that health professionals have with their work role, discusses the implications for the profession, and proposes areas of prophylactic or remedial action.

Treatment of illicit drug dependence typically involves a combination of pharmacotherapy and psychosocial interventions. Efficacy research supports methadone maintenance in opiate dependence. There is less evidence to support buprenorphine (an opiate receptor partial agonist), lofexidine (an α2-adrenoreceptor agonist) and naltrexone (an opiate receptor antagonist). Evidence for the effectiveness of detoxification, which one of the most widely used treatments, is poor. Of the psychosocial interventions, reasonable evidence exists for the effectiveness of motivational interviewing. Other psychosocial treatments have rarely been compared with no or minimal contact conditions in randomised trials, and their reported effectiveness is often weak. Residential treatments are not demonstrably more effective than community programmes.

This paper reviews the evidence base supporting the use of pharmacological treatments for child and adolescent psychiatric disorders. Recent advances in knowledge are highlighted, with some of the controversies. New evidence supports a role for selective serotonin reuptake inhibitors in the treatment of anxiety disorders and obsessive–compulsive disorder. Educational and behavioural approaches remain the mainstay of treatment for children and adolescents with autism, but there is evidence that adjunctive medication may be effective. Atypical antipsychotics have been investigated in the treatment of Tourette syndrome and early-onset schizophrenia. Many questions remain unanswered and further research is needed in all areas of paediatric psychopharmacology.

Since the start of the National Health Service, data have been collected on admissions to psychiatric in-patient units, first as the Mental Health Enquiry, then as part of Hospital Episode Statistics. Some details have changed but many have stayed remarkably consistent. Published literature on the wide range of research and policy work undertaken using this data source is reviewed. Early work was central to the government's deinstitutionalisation policy in the early 1960s. Subsequent studies cover a wide range of epidemiological and health services research issues. A new statistical base, the Mental Health Minimum Data Set, covering individuals receiving all types of health care is currently being set up. This will supplement (but not replace) admission statistics.

The teaching of medical skills to medical students and to other doctors is a skill in itself. The traditional ‘apprenticeship’ system of learning within medicine is now known to be inefficient and flawed, in both the UK and in other countries where it has been scrutinised. This article sets out guiding principles to help doctors set up ‘teaching the teachers' courses, which teach the skills of teaching. Psychiatrists at all grades, from senior house officer up to consultant, need some teaching skills, and the authors outline how to plan a course, determine the needs of potential learners and set its objectives and content. Guidance is given on some of the opportunities that are available to obtain formal qualifications in medical education.