Expansion of early intervention services to identify and clinically manage at-risk mental state for psychosis has been recently commissioned by NHS England. Although this is a welcome development for preventive psychiatry, further clarity is required on thresholds for definition of such risk states and their ability to predict subsequent outcomes. Intervention studies for these risk states have demonstrated that a variety of interventions, including those with fewer adverse effects than antipsychotic medication, may potentially be effective but they should be interpreted with caution.

There is increasing recognition of the importance of the humanities and arts in medical and psychiatric training. We explore the poetry of Charles Baudelaire (1821–1867) and its evocations of depression through themes of mood, time and self-consciousness and discuss their relation to images of ‘spleen’, the ‘snuffling clock’ and the ‘sinister mirror’. Following the literary critical commentaries of Walter Benjamin (1892–1940) and Jean Starobinski (1920–2019) we identify some of their roots in the poet's experience of the rapid and alienating urbanisation of 19th-century Paris. Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the ‘social’ as part of the biopsychosocial constellation.

The UK Mental Health Act 1983 does not apply in prison. The legal framework for the care and treatment of people with mental illness in prison is provided by the Mental Capacity Act 2005. We raise dilemmas about its use. We highlight how assessing best interests and defining harm involves making challenging judgements. How best interests and harm are interpreted has a potentially significant impact on clinical practice within a prison context.

Recent surveys have highlighted widespread criticisms of the use of workplace-based assessments (WPBAs) in psychiatric training. We describe our systematic review of psychiatric WPBAs, including a ‘surgical dissection’ of their format and process. From our review, we identified seven overarching WPBA themes, and have drawn on these to make further recommendations to strengthen the wider acceptability of WPBAs in psychiatric settings. We hope this will encourage further debate on ways of improving these tools, rather than them becoming side-lined as ‘top-down’ tick-box exercises.

The 11th International Congress of the World Psychiatric Association (WPA) was held in Hamburg during August 1999. The most memorable feature of the successful event was not the presence of 10 000 psychiatrists from 96 countries, nor their 6000 papers, nor the elegance of the rebuilt city, but a poignant exhibition prepared by the German Society for Psychiatry, Psychotherapy and Neurology. The presentation, titled ‘In Memoriam‘, described the wartime extermination within Germany of 180 000 psychiatric patients. The killers were their psychiatrists.

The American psychologist and philosopher William James drew inspiration from British evolutionary theory, neurology, psychiatry, psychology and philosophy. Trained in anatomy, physiology and medicine, he developed a physiological psychology that offered acute analyses of consciousness and of the relations between mind and brain, habit and thought, cognition and emotion and other aspects of psychology. One of his insights, regarding the relation between attention and will, was based upon his own experience of panic anxiety, which was resolved through his reading of several British authors. The story of his psychiatric experience, practical response and later theoretical conclusion offers a potential contribution to contemporary therapeutic practice.

Antipsychotics and severe mental illness (SMI) are associated with weight gain, and obesity increases the risks of cardiometabolic disease and premature death. These present management and liability issues for psychiatrists. Physical healthcare for people with SMI is poor, and this may partly be owing to training limitations and lack of proactiveness by psychiatrists. Ethically and legally, psychiatrists have a duty to avoid unnecessary harm and to maintain an acceptable standard of care. This would apply particularly to patients receiving compulsory treatment for their SMI owing to their vulnerability. Discrepancy between psychiatric and non-psychiatric approaches to pharmacological treatment creates ambiguity, and weight gain could demotivate antipsychotic adherence. This article explores how the Mental Health Act could be used to address these issues, and the ethical considerations, and proposes how long-acting glucagon-like peptide-1 receptor agonists could be introduced into existing psychiatric practice as a treatment option for antipsychotic-induced weight gain and obesity in SMI.

This study surveyed north-west consultant psychiatrists regarding their clinical electroconvulsive therapy (ECT) practice. A postal questionnaire was sent to all consultants identified by contacting north-west hospitals. Most respondents were in favour of using ECT, primarily for depressive psychosis. Bilateral ECT, twice weekly, was the preferred means of administration. Practice was similar overall to Pippard and Ellam's findings in their national survey. Prior to the latest College ECT guidelines, there had been little change in clinical ECT practice in the north-west since Pippard and Ellam's national survey.

Registered care homes have been developed in Newham, a deprived inner city borough of about 220000 population, by a number of different housing associations. Some of these provide the care component themselves while others purchase it from separate agencies. The formats of the homes also vary. Features common to all the provision include prolonged preparation of future residents in rehabilitation houses on the Goodmayes Hospital campus prior to taking up residence, particular attention to their compatibility and social networks, and regular individual reviews by a community rehabilitation team which also provides training and support to care staff.

The experience of rejection of an article submitted for publication to a scientific journal can be particularly anxiety provoking, especially when the furtherance of an academic career or the gaining of a permanent post might be riding on getting it published. Many papers fail to get past the first hurdle and are not sent out for peer review, often as a result of the most basic of errors: the results are not generalisable, the paper adds nothing new to the subject, there are flaws in the study design or inappropriate statistics were used. Attention paid to formulating a clear research question and the adoption at the outset of a doable, interesting project will often help to avoid disappointment.

Health service provision now lies almost completely within the powers of the Scottish Parliament and accounts for 40% of the Executive's budget. There is a Minister and a Deputy Minister for Health. There are six key groups – the Scottish people, the Scottish Parliament, the Scottish Executive, the health service, the local authorities and the press, all with high expectations that things should get better.

The European Union of Medical Specialists (UEMS) was set up on 20 July 1958, 16 months after the Treaty of Rome was signed. In 1962, the UEMS Section of Psychiatry was established. It was, however, relatively inactive until it was revitalised following a meeting of the European Societies in 1990 called by the Royal College of Psychiatrists and chaired by Dr (now Dame) Fiona Caldicott. The UEMS Board of Psychiatry was established in 1992 as a working group of the Section with a particular focus on training matters. The Section is currently chaired by Dr Anne Lindhardt (Denmark) and the Board is chaired by Professor Manuel Gomez-Beneyto (Spain). Both Section and Board meet twice a year.