Mental health services are increasingly supporting recovery-oriented practice as a basis for service delivery. There is considerable overlap between the values and approaches associated with recovery-based practice and those already endorsed as good psychiatric practice. However, these agreed principles may not be consistently applied and further steps may be needed if the reorientation of the relationship between psychiatrists and people using psychiatric services is to fully reflect recovery principles. This article describes ways in which psychiatric practice could develop, including conceptualising medication as one of many possible recovery tools that a person can actively use to support their well-being, and a range of practices available to professionals to support people in taking up an active stance in relation to medication. It also identifies recovery-supportive practices for when someone is unable to fully participate in decision-making, owing to crisis, loss of capacity or concerns about safety.

Recent advances in high-throughput genotyping have made possible genome-wide association studies (GWAS) in which hundreds of thousands of common DNA variants spread across all the chromosomes are examined in a large number of individuals rapidly and for a realistic cost. The GWAS approach has been successfully used to identify common susceptibility variants involved in many non-psychiatric diseases, such as heart disease, diabetes, Crohn's disease, and in normal traits such as height. The typical finding is numerous susceptibility loci, each of which has a small effect size. Genome-wide association studies are similarly providing robust and replicable evidence for genes and, hence, proteins and biological systems/pathways that are involved in the aetiology and pathogenesis of major psychiatric disorders, including schizophrenia, bipolar disorder, attention-deficit hyperactivity disorder, autism and Alzheimer's disease. This article outlines for the busy psychiatrist some of the key messages emerging from this line of research.

A genuinely critical and reflective approach to psychiatry can potentiate learning, improve practice and promote personal development. To support this assertion, I attempt to link theory and practice. Following a brief overview of the seminal ideas that permeate the literature on critical thinking, I present three perspectives of reflective practice – those of the psychiatric trainee, the teacher and the practitioner – through examples of reflective exploration of personal experience, under the light of relevant evidence. I conclude with a critique on the limitations of reflective psychiatry.

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.

The principles of recovery have been supported by UK mental health policy and have been incorporated into policy in several countries worldwide. In this article we examine the ideas, principles and definitions of recovery and their origins. Personal recovery is contrasted with clinical recovery and the nature and development of the recovery movement is outlined. The principal factors influencing personal recovery are hope, control and opportunity. In an accompanying article we discuss the implications of these principles for training and practice.

This article, the first of two on placebo effects, provides a broad overview of placebo in the field of medicine. A brief conceptual history is followed by some basic facts about placebos. Problems of definition are identified. Additive and non-additive models of treatment effects, and problems of measurement of placebo effects are described. The role of placebo in the pharmacotherapy of depression and complementary and alternative medicine is discussed. The ‘efficacy paradox’ (that placebo treatments can have larger effects than ‘evidence-based treatments’) is introduced. Finally, ethical issues are discussed.

In this issue of Advances, Baker et al describe a ‘recovery-focused approach’ to prescribing. They believe that there is a need for a paradigm shift in psychiatric practice. This commentary offers a brief introduction to the ‘recovery’ literature and a sceptical analysis of this bold claim.

This article outlines proximate (physical and mental) and ultimate mechanisms of placebo effects. Interpersonal processes contributing to placebo effects are reviewed and illustrated through research into the process of psychotherapy. Evolutionary theories of how and why the capacity for placebo effects might have evolved are described. The components of treatment and placebo effects are defined. It is concluded that maximising therapeutic placebo effects is effective and a valid clinical goal.

The use of portfolios has rapidly expanded in recent years and is now relevant to a number of different aspects of professional practice in medicine in general and psychiatry in particular, including training, appraisal and revalidation as well as continuing professional development. In this article I will examine the background of important changes and new trends in medical education on which the increasing use of portfolios is based, their potential value as learning and assessment tools, and some of the challenges and dilemmas associated with their use.

Using a new treatment is not an instantaneous act. There is a gap between research and practice and carefully evaluated evidence often fails to achieve widespread use. Various factors intercede along the pathway from knowledge generation to knowledge utilisation. These can hinder, or indeed facilitate, the use of research evidence in psychiatry. Knowledge translation is a discipline that attempts to identify and understand these barriers and facilitators to knowledge transfer. In this article, the terminology and key concepts of knowledge translation will be outlined, the evidence transfer pipeline described and obstacles and facilitators to uptake of evidence explored. The article also identifies sources of information on knowledge transfer. Innovative approaches designed to enhance the uptake of evidence from research, such as summaries, systematic reviews and targeted messaging, are also described.

Most literature discussing the introduction of foundation year 1 (F1) psychiatry posts has focused on recruitment. However, for F1 posts to offer a valuable learning experience and a potential recruitment boost, psychiatrists and employing organisations should be aware of general issues arising in the first postgraduate year. These include the inherently stressful student-to-doctor transition, the need for bespoke induction programmes for new graduates, F1 doctors' specific needs for support, supervision and peer support, and the centrality of the relationship with the consultant supervisor to the new doctor. Understanding these themes will enable psychiatrists and mental health organisations to offer better F1 psychiatry experiences, which may boost recruitment and could maximise the opportunities for F1 doctors to develop skills and qualities that will be of value in their future careers, whatever specialty they end up working in.

With an ageing population and more drivers on the road, the number of drivers with dementia is due to grow exponentially over the next 50 years. Although decisions regarding possession of a driving licence in the UK are made by the Driver and Vehicle Licensing Agency (DVLA), psychiatrists have a duty to advise patients who are unfit to drive to cease driving and to inform the DVLA of patients who pose a risk to the public by continuing to drive when advised not to. This article offers a review of the literature on dementia and driving and summarises the evidence and advice for navigating this minefield. The use of psychological test batteries in clinical practice is discussed, along with the most useful questions to ask in memory clinics. Legal guidance for various countries is considered, as is the important (but often overlooked) issue of helping older people prepare for retirement from driving.

Many psychiatric in-patients report boredom. Such complaints may appear trivial, but this literature review by a clinical librarian suggests that boredom is more complex than may initially appear and relates to wider areas of importance for in-patient psychiatric teams. Boredom may relate to the internal experience of meaning, which itself encompasses meaningful relationships and roles and a sense of control. Although meaningful therapeutic activities are vital, mental health professionals should focus on the internal as well as the external dimensions of boredom. Medications, particularly dopamine antagonist antipsychotics, may be a contributing factor. This article highlights the benefits of the clinical librarian role in synthesising research in mental health. Research can illuminate psychiatric practice in a more holistic way than purely by applying 'scientific' evidence in the practice of ‘biological’ psychiatry.