Routine use of Health of the Nation Outcome Scales (HoNOS) has not produced the anticipated benefits for people using mental health services. Four HoNOS-specific reasons for this are: low relevance to clinical decision-making; not reflecting service user priorities; being staff-rated; and having a focus on deficits. More generally, the imposition of a centrally chosen measure on the mental health system leads to a clash of cultures, since frontline workers do not need a standardised measure to treat individuals. A better approach might be to use research from the emerging academic discipline of implementation science to inform the routine use of a standardised measure that is chosen by the people who will use it and hence is more concordant with existing clinical processes. This is illustrated using a case study of successful implementation of the Camberwell Assessment of Need (CAN) in community mental health services across Ontario, Canada.

This second of two articles on the ‘typical’ (‘first-generation’) antipsychotics covers non-phenothiazines: thioxanthenes (flupentixol and zuclopenthixol), butyrophenones/diphenylbutylpiperidines (including one-time world market-leader haloperidol, and pimozide) and sulpiride, for many years the only substituted benzamide available in the UK. Several tolerability issues ascribed specifically or more frequently to older antipsychotics are also discussed.

This article covers the basic principles of systematic reviews and meta-analyses while discussing the problems associated with the traditional narrative review. It explores the role of the overview as a formal method of combining information from all relevant studies about a particular health condition. It also describes how the review tries to minimise bias so as to avoid reaching the wrong conclusions from the available research data. Important issues that need to be considered when appraising an overview are outlined. Some terms used in reporting systematic reviews and meta-analyses are introduced, such as risk ratio, mean difference, confidence interval and the forest plot.

Benzodiazepines are still widely prescribed in psychiatry, mainly for the treatment of anxiety-related disorders. This is not because they are only taken by a hard core component of patients who are addicted and do not need them; it is because they remain the most effective and rapid acting of all drug treatments. Strategies for practitioners to use them more confidently are described.

Frantz Fanon (1925–1961), a West Indian of mixed race, was a French colonial psychiatrist trained in Lyon, France, who worked mainly in colonial North Africa between 1953 and 1957. He was one of the earliest psychiatrists to suggest that the lived experience of ethnic minorities within a discriminatory colonial environment could trigger mental illness. This article focuses on Fanon's work and contributions to psychiatry, as well as his philosophy, advocacy for social inclusion and pioneering work in culturally relevant rehabilitation. It also examines what lessons could be learnt from his life's work as a psychiatrist and traces his influence on a generation of psychiatric researchers, suggesting how his contribution may have influenced critical thought and current views.

There has been little research into the interaction between fraud offences and mental health. Fraud is perpetrated on a massive scale and a number of offenders will have psychiatric pathology either as a primary driver of the offence or as an associated phenomenon that will require psychiatric care and treatment. This article reviews the broad range of psychiatric conditions that have been associated with fraud offending, comments on management and discusses methods of psychiatric assessment in fraud offences.

There is considerable debate about the diagnosis of personality disorder in adolescence. It is argued that, because personality is still developing in the teenage years, it is impossible to state with certainty that a young person's personality is disordered. Alternatively, some researchers and clinicians argue that it is possible to diagnose emerging personality disorder on the basis of trait theories of personality. We review the evidence for both sides of the debate.

Clinical psychiatrists working today owe a great deal to the discoveries of the pharmaceutical industry since 1953, especially in relation to antipsychotic drugs. Yet patients need still better antipsychotics with greater efficacy and fewer side-effects. We should not let nostalgia cloud our judgement.

Obesity is common in patients with mental illness. Weight-loss surgery, known as bariatric surgery, is becoming a familiar intervention for treating people who are morbidly obese and for whom other weight-reduction methods have failed. This article offers guidance for mental health professionals on the assessment and management of patients with mental illness undergoing such treatment. Assessment is of the patient's suitability for surgery, taking into account their mental health diagnosis, expectations, knowledge and insight into the psychological impact of surgery, and ability to address and cope with lifestyle changes before and after surgery. The patient's capacity and ability to cooperate and engage with services are also assessed. Potential risks and complications of bariatric surgery and how the weight-loss procedures may affect patients' mental health and management of their medication are addressed.

In this article, we offer an account of how various psychological therapies address dysfunctional mentalisation and identify pitfalls of therapy that could lead to an impasse or even to negative consequences associated with psychological treatment. Some practical recommendations follow from our model, particularly in relation to the careful monitoring of the intensity of the patient's attachment and the use of interventions aimed at promoting mentalising.

The term ‘schizoaffective disorder’ has meant different things to different people over the 80 years since Kasanin described a series of cases with an admixture of schizophrenia-like and mood-like symptoms. This article provides a brief overview of the history of the concept, and suggests a parsimonious approach for clinicians.

Shopping addiction (compulsive buying disorder) has been an area of increased interest in recent years. Shopping addiction can adversely affect the individual and their family, social and occupational life. The addiction is associated with high rates of psychiatric comorbidity. Early identification and appropriate management can limit the long-term adverse consequences and improve outcome. This article reviews the aetiology, epidemiology, clinical features, psychiatric comorbidity and management of the disorder.

Anxiety has reported prevalence rates between 38 and 72% among people with dementia. It has a negative impact on cognitive impairment and is associated with agitation and poor quality of life. The presence of excessive anxiety can be difficult to establish in people with dementia, especially when expressive or receptive speech is impaired. Unfortunately, there is a lack of research on the treatment of anxiety in dementia, and also on the wider issue of the management of anxiety disorders in old age. We explore the prevalence, presentation and diagnosis of anxiety in dementia and discuss the therapeutic options available.

The provision of mental health teaching and training to staff in the care home sector by a dedicated educational team was established in Bridgend in 2003. A multiprofessional old age liaison psychiatry team was created in 2009 specifically to link closely with the teaching staff, further building on previous work on referral coordination and a single point of access. This article describes the application of barrier analysis to deliver both this new service and mental health education to the care home sector. Imaginative uses of information technology and multimedia to support the efforts of all staff are described, as are some pitfalls and hazards to avoid. The most effective elements of these developments are discussed, using barrier analysis as the explanatory model, with an emphasis on aspects that could be adopted more widely.

The complex nature and consequences of fraud are illustrated by the case of ‘Dr’ Barian Baluchi, who held himself out to be a consultant neuropsychiatrist before being convicted of deception, actual bodily harm and procuring registration by making false declarations. Under the proposed UK Criminal Evidence (Experts) Bill, psychiatric experts in fraud cases are likely to find the admissibility of their evidence tested against statutory criteria. Where they rely on test results, they will need to know the validity of the methods and show that they have taken proper account of the degree of precision or margin of uncertainty affecting the accuracy or reliability of their results. Proposals to reform the law on unfitness also have implications for psychiatric assessment in fraud cases. It will now be even more important for psychiatric opinion evidence to be demonstrably sound and of such evident strength that there is no issue as to its admissibility and the judge can presume evidentiary reliability.

In this article we ask what kind of phenomenon is internet sex addiction. From the perspectives of two practising psychiatrists, one of whom has worked in a weekly sexual disorders clinic for 12 years, and an anthropologist we explore whether a moral panic is emerging over sexual behaviour and the internet, and whether internet sex addiction forms part of any such panic. We ask whether many individuals who diagnose themselves as addicted to internet-based sex do so more out of a media-activated sensibility than a clinical reality. We also consider what developments in DSM-5 hold for this area.

The Bridgend team rightly identifies the need for old age psychiatry services to work effectively with the population and staff of care homes. They describe an interesting and effective approach to this challenge, which will inform others and encourage them to make use of this system or adapt it or other ideas for use in their own locality.

Domestic violence is a major public health problem because it is common and associated with physical and mental health morbidity. It is more common in psychiatric patients but is underdetected by mental health professionals. Routine enquiry increases detection but needs to be introduced in the context of comprehensive training, and only where referral and care pathways have been developed. High-risk patients should be referred to multi-agency risk assessment conferences for multidisciplinary assessment and safe management.

Increasing attention is being paid to the concept of attention-deficit hyperactivity disorder (ADHD) in adults, in concord with evidence that suggests a proportion of children with ADHD continue to manifest symptoms into adulthood. Attention-deficit hyperactivity disorder has some symptoms in common with hypomania, and can co-occur with bipolar disorder. The diagnosis and management of ADHD in adults with bipolar disorder can be complicated, owing to challenges resulting from symptom overlap, questions of diagnostic validity and a paucity of empirical evidence to guide treatment. This article addresses comorbid ADHD and bipolar disorder, and provides practical suggestions for diagnosis and management.