We outline the huge literature on the potentially negative impact onchildren of growing up with a parent who has an alcohol or drug problem, therisk factors that can exacerbate this effect, and resilience and theprotective factors that can reduce it. Clear ways that practitioners canintervene to reduce risk and to increase resilience are discussed. Allpractitioners have a responsibility to work in holistic ways if damage tochildren and families is to be avoided, and we summarise the key commonskills needed to work with individuals (children as well as adults) andfamilies. The differences between a resilience and a deficit approach areoutlined.

Few tests address the types of memory problem commonly reported afterelectroconvulsive therapy (ECT). Here, we focus on the importance ofneuropsychological assessment in ECT-treated patients and describe a numberof tasks that may be useful in measuring the everyday memory problems ofsuch patients with ongoing memory difficulties. At the time of writing, noattempts have been made to rehabilitate patients who experience persistentadverse cognitive effects, but clinicians should be aware of the potentialbeneficial role of cognitive rehabilitation in the treatment and managementof these effects.

Subscribers to the medical model of the causation of madness and distressemphasise the role of genes and can severely underestimate the impact oftraumatic events on the development of the human mind. This bias persistsdespite the worldwide popular wisdom that mental illness arises when badthings happen to people. Childhood physical and sexual abuse and neglect areextremely common experiences among those who develop serious mental healthproblems. Unfortunately, victims are typically reluctant to disclose theirhistories of abuse and practitioners are often reluctant to seek it. Weexplore the nature and extent of the problem and the apparent reasons forthe pervasive neglect of this important area of care. Then, on the basis ofour experience in New Zealand, we provide guidelines on asking patientsabout childhood abuse and describe an ongoing initiative in the UK tofurther advance our understanding of the impact of abuse and our skills todetect it and treat survivors.

Cognitive–behavioural therapy (CBT) is an effective treatment for a numberof psychiatric disorders in adults of all ages. With the proportion of thepopulation aged 65 or over increasing steadily, it is important to be awareof how the CBT needs of this age group can be best met. This articleprovides an overview of CBT and the historical context of using it witholder people. Although an understanding of the individual, irrespective ofage, is at the core of CBT, potential modifications to the procedure andcontent aimed at optimising its effectiveness for older people arediscussed.

Post-traumatic stress disorder (PTSD) causes significant distress and isoften associated with markedly reduced functioning. Recent reviews haveconsistently recommended trauma-focused psychological therapies as afirst-line treatment for PTSD. Pharmacological treatments have also beenrecommended but not as consistently. This article reviews the availabletrials of the pharmacological treatment of PTSD and discusses theirimplications.

I explore some of the ways in which intellectual disability (learningdisability) is depicted in fiction. My premise is that literature bothreflects and shapes societal attitudes to people in this vulnerable minoritygroup. People with intellectual disabilities are seldom able to determine,confirm or counter narratives about themselves. This situation, in which thesubject is fundamentally unable to participate in their representation,raises unique ethical considerations. I use examples from variousEnglish-language novels to discuss how subjective accounts, observablebehaviours and physical attributes are all employed to characterise peoplewith intellectual disabilities.

Patient suicide is a relatively common event: 50–70% of consultantpsychiatrists and 40–50% of psychiatric trainees have experienced at leastone patient suicide. Patient suicide can have significant personal andprofessional effects on psychiatrists, including increased stress, socialwithdrawal, disruption to relationships, symptoms of post-traumatic stressdisorder and consideration of early retirement. Following patient suicide,psychiatrists derive most support from informal contacts with team members,family and friends; additional support may be available through formalsupport structures or local team initiatives. It is important to placeappropriate emphasis on the effects of patient suicide in psychiatrytraining programmes; to maintain awareness of the importance of informalsupports following patient suicide; to strengthen formal systems of support;to identify other potential forms of assistance (e.g. spiritual support);and to develop local team initiatives in this area.

This article reviews our understanding of the epidemiology and aetiology ofpremenstrual syndrome and premenstrual dysphoric disorder, and itsassessment and management. It also addresses the concerns of the feministcommunity and the views of women themselves about this condition and itsmanagement. Service provision in the UK for women with these problems isunfocused and greatly varying, and they might be better assessed and treatedby psychiatrists.

‘Mindfulness' has become a popular topic among psychological therapists.This introductory article explains what mindfulness is and how it can bedeveloped, before exploring how it has been incorporated withinpsychoanalytic and cognitive–behavioural psychotherapies. These reflectgeneral as well as specific presumed therapeutic actions. At present,variations in the way mindfulness is understood, taught and applied meanthat it is too early to fully assess its potential. They demonstrate how theuse of attention and awareness in therapy cuts across traditional divisionsand where mindfulness in therapy is most in need of furtherinvestigation.