High expressed emotion (EE) in families is known to increase risk of relapse for people with schizophrenia. This Cochrane Review by Chien et al suggests that family-based interventions such as psychoeducation may result in a reduction in caregiver burden, a shift from high to low EE, and perhaps also reduce patient relapse rates. However, there was a high degree of heterogeneity in the combined study sample and a significant risk of bias across studies. The authors’ decision to only include studies reporting both a family member and a patient outcome means relevant evidence in this area may not have been incorporated.

Bullying among girls is often subtle and relational, which can go unnoticed by parents, teachers and healthcare professionals. This article explores how covert aggression – such as social exclusion, gossip and emotional manipulation – can cause profound psychological harm to targeted girls, many of whom may not even realise they are being bullied. Through an analysis of defining attributes of girl-to-girl bullying and general implications for mental health, this article aims to highlight the importance of early identification and treatment. The article also points out how social patterns of bullying found predominantly in girls’ social circles carry over well into adulthood, emerging in the work environment, social circles and cyberspace. Focused on practical application, this educational paper aims to enhance clinicians’, caregivers’ and teachers’ recognition of relational aggression, develop collaborative approaches to prevention and facilitate useful interventions for those affected. Ultimately, increased sensitivity to subtle bullying has the power to reduce subsequent harm and result in healthier social contexts.

Barricaded incidents, hostage-taking and sieges occur in the community, where police negotiators are usually called on to bring about a peaceful resolution. They occur also in prisons and psychiatric hospitals, where they will be managed by the institution’s staff, with police support if needed. Psychiatrists and other mental health professionals have been involved in providing training and on-call support for negotiators and decision makers in these crisis situations. This article describes definitions and goals in relation to such incidents, and outlines a five-phase framework for their management (training; first responders, preliminary interventions and inquiries; negotiations; resolution; aftercare), indicating the psychiatrist’s role during each phase. Ethical issues are also discussed.

This article provides a brief introduction (or recapitulation) of what variable types are and how the choice of the variable type may affect which research questions can be answered and the data analysis. The nine-item Patient Health Questionnaire and a simulated data-set are used as an illustration throughout.

The histories of the DSM and ICD classifications are set out so as to identify weaknesses and limitations that can affect their application in medico-legal reporting. These are illustrated by reference to published judgments and three detailed case studies. The analysis and case studies identify how expert witnesses’ reliance on the DSM and ICD can be challenged in order to seek to undermine their evidence.

Analysis of court and tribunal judgments in cases where expert psychiatric evidence has been admitted reveals widespread misunderstandings and misuse of the diagnostic and statistical manuals published by the American Psychiatric Association and the similar publications of the World Health Organization. Examples are given here of cases in which their use has caused difficulties in the delivery of justice. For them to be a help and not a hindrance, it is suggested that when used there should be appropriate explanation as to their status, nature, purposes and limitations and that expert witnesses should handle them with the care that they require.

Lunatic Asylums, published 130 years ago, is a fascinating insight into how these institutions were managed in the late Victorian era. This brief article considers what it reveals about the zeitgeist of the time and the book's author, the remarkable Charles Mercier.

Regardless of any socially held perceptions of privilege or power differentials, boys and men present unique developmental vulnerabilities and disproportionate rates of specific mental health problems, such as disruptive behaviour disorders, substance misuse and completed suicide. Moreover, men are less likely than women to seek help for psychological distress and adhere less well to treatments. In this brief article, some of the unique mental health problems experienced by boys and men are reviewed within a developmental perspective and general clinical guidance is outlined to improve adherence and treatment outcomes.