There is much Mental Capacity Act 2005 (MCA) case law emanating from the Court of Protection. This article reviews an important and unique case when the court specifically addressed for the first time the question of fluctuating capacity, a not uncommon clinical problem that can often be complex. It describes how the Court of Protection in Royal Borough of Greenwich v CDM [2019] legally approached an issue of fluctuating capacity in a 64-year-old woman with a personality disorder and chronic diabetes. In doing so it elucidates a new conceptual framework to apply when assessing fluctuating capacity in terms of considering micro- and macro-decisions which can be used in routine clinical practice.

Addiction is a global health problem with a chronic relapsing nature for which there are few treatment options. In the past few decades, neuroimaging has allowed us to better understand the neurobiology of addiction. Functional neuroimaging paradigms have been developed to probe the neural circuits underlying addiction, including reward, inhibitory control, stress, emotional processing and learning/memory networks. Functional neuroimaging has also been used to provide biological support for the benefits of psychosocial and pharmacological interventions, although evidence remains limited and often inconclusive in this area, which may contribute to the variability in treatment efficacy. In this article, we discuss the changing definitions and clinical criteria that describe and classify addictive disorders. Using examples from functional neuroimaging studies we summarise the neurobiological mechanisms that underpin drug use, dependence, tolerance, withdrawal and relapse. We discuss the links between functional neuroimaging and treatment, outline clinical management in the UK and give an overview of future directions in research and addiction services.

In social science research and clinical practice, and in educational settings, psychological tests/scales are being increasingly used because of their reliability and the ease and speed of gathering, comparing and differentiating data. A new scale is usually created when instruments or questionnaires to measure the construct of interest are not be readily available or if existing questionnaires do not fully satisfy requirements. Scales are also translated and revalidated if they are not in the language required. This article takes the reader through steps in developing, validating and translating tests in the field of social sciences.

This reflection summarises the evidence regarding the management of bipolar II disorder in the perinatal period, compares this to the authors’ clinical experience using case studies and considers the treatment of patients in current clinical practice.

Training in neuroscience is vital to the future of psychiatry as a medical specialty. Trainees and trainers alike demonstrate a desire to keep up to date with developments in the associated scientific fields. Neuroscience increasingly underpins clinical assessments, treatment options and patients’ expectations. Psychiatry training in the UK can embrace neuroscience at many levels, from discussing patient presentations with supervisors, to teaching programmes supported by the Royal College of Psychiatrists’ activities. Although challenges remain, neuroscience literacy enhances the specialty and will improve patient care.

Stratified medicine has been successfully used in many areas of medicine, perhaps most notably oncology. There is now both a growing evidence base and mounting enthusiasm, supported at a governmental level and across industry, academia and clinical medicine, to apply this approach to neurodegenerative illnesses, including dementia, as these provide the greatest clinical and social challenge of our times. In this article we consider definitions of stratified medicine, look at its application in other medical specialties, review the national context in the UK and consider the current state, future potential and specific considerations of applying stratified medicine to dementia.