Autism spectrum disorder (ASD) is a complex, multifactorial disorder, the prevalence of which is rising. Specific biomarkers are yet to be identified for the classic ASD phenotypes, so despite treatment advances, most interventions focus on the comorbid disorders of ASD and have little impact on the underlying pathogenesis of the disorder. This article describes drug treatments that target the core symptoms of ASD and its comorbid conditions in children and adolescents. Difficulties and challenges encountered when treating the most frequent comorbidities are discussed, with emphasis on the safety, tolerability and efficacy of medications. In view of its widespread use, complementary and alternative medicine is also described.

The traditional approach to selecting antipsychotic medication involves little more than trial and error. Recent advances in genetics and molecular science offer the hope of a ‘personalised medicine’ approach to antipsychotic development and prescribing in schizophrenia. Personalised medicine is the practice of tailoring medical treatment to the individual characteristics of each patient. In schizophrenia, this will involve the identification of more homogeneous subsets of patients through the application of genetics, epigenetics, proteomics and metabolomics, neuroimaging and other biomarkers, and the use of these findings to stratify patients according to their response to treatment. In this article, we focus on the emerging evidence in pharmacogenetics and biomarkers for assessing individual response and tolerability of antipsychotic medication in schizophrenia.

Perinatal psychiatry is a relatively new subspecialty and controversy exists about such specialist provision. Differences can occur in how mental illnesses present in pregnancy, and there is a need to take into account both mother and baby. The risks of not treating perinatal mental illness can be both acute and chronic, and suicide in the context of untreated illness remains a leading indirect cause of maternal mortality. Despite the government's agenda of preventive healthcare, service provision is inequitable across the UK. Advice regarding treatment continues to be complex, and perinatal psychiatrists need to keep abreast of a growing evidence base. This review offers an overview of some current issues in the care of patients in the perinatal period and shows how specialised perinatal services are uniquely placed to meet their needs. Hopefully, it will prove useful to all clinicians responsible for the perinatal care of women and their families.

Glutamate receptor modulators, including ketamine, are possible candidates for new antidepressants with a novel mode of action. The pair of reviews discussed in this month's Round the Corner considered their use in treating unipolar major depression and bipolar depression. Promising results were seen for ketamine, but further studies are needed, in particular to investigate whether the benefits are sustained or can be extended by repeated or adjunctive treatment, whether ketamine is effective in treatment resistance, whether other modes of administration are as effective as the intravenous route and the long-term adverse effects of use.

Ketamine, a synthetic derivative of phencyclidine, is a commonly misused party drug that is restricted in high-income countries because of its addictive potential. Ketamine is also used as an anaesthetic in human and veterinary medicine. In the 1990s, research using ketamine to study the pathophysiology of schizophrenia was terminated owing to ethical concerns. Recently, controversy surrounding the drug has returned, as researchers have demonstrated that intravenous ketamine infusion has a rapid antidepressant effect and have therefore proposed ketamine as a novel antidepressant. This article debates the question of ketamine as an antidepressant, considering the drug's addictive potential, ethical concerns about prescribing a hallucinogen, the evidence base and motives behind ketamine trials.

Mindfulness is a meditation practice defined as a specific way of paying attention. It has been adapted from Buddhist traditions to Western secular use (e.g. in stress reduction, health promotion, treatment of psychological disorders). Despite its widespread application in adult populations, mindfulness remains a neglected topic in the psychological interventions designed for children and adolescents with psychological disorders and/or chronic physical conditions. In paediatric settings, a parent-child perspective may be useful in facilitating processes of adaptation and in improving paediatric outcomes. However, the delivery of mindfulness interventions in paediatric settings raises a number of issues and challenges, which include the developmental appropriateness of mindfulness exercises, the introduction of a parent-child perspective, and specific considerations to condition, treatment and caregiving.

Patients with severe and enduring somatoform disorders (SESD) characteristically present with multiple, recurrent and frequently changing physical symptoms that have usually been present for several years before referral to a psychiatrist/psychologist. Many patients report long histories of contact with both primary and tertiary care services, have undergone repeated fruitless investigations and have high levels of disability. SESD are responsible for disproportionately high healthcare costs and are the third most common cause of workplace absence. Identification of patients with SESD by psychiatrists requires particular skills: collaboration with colleagues is vital and there are risks of iatrogenic harm. We describe the obstacles encountered in identifying these patients as well as methods of assessment and management. Treatment pathways best suited to managing this large and as yet untended group of patients are described.

There is now an established evidence base for the use of information and communication technology (ICT) to support mental healthcare (‘e-mental health’) for common mental health problems. Recently, there have been significant developments in the therapeutic use of computers, mobile phones, gaming and virtual reality technologies for the assessment and treatment of psychosis. We provide an overview of the therapeutic use of ICT for psychosis, drawing on searches of the scientific literature and the internet and using interviews with experts in the field. We outline interventions that are already relevant to clinical practice, some that may become available in the foreseeable future and emerging challenges for their implementation.

Autism spectrum disorder (ASD) is a heterogeneous disorder with clearly recognisable core features, but without reliable biomarkers as yet. It has a high rate of comorbid psychiatric disorders which need to be identified and appropriately treated. Emerging concepts in genetics, pathobiology and outcome measurement have potential to significantly advance the treatment of both ASD and its comorbidities over the following decades.

Up to 40% of people with depression do not recover following standard treatments such as medication and psychotherapy. Transcranial magnetic stimulation (TMS) is a treatment used worldwide for adult patients with severe clinical depression when antidepressants have repeatedly failed to control their symptoms. This article explains the use of TMS in clinical practice.

Tourette syndrome is a complex neuropsychiatric disorder of juvenile onset, characterised by motor and phonic tics. It is associated with a number of comorbid psychiatric conditions and a reduced quality of life in the young person and with parenting stress, caregiver burden and psychopathology in the parents. The global prevalence (about 1%) is higher than previously thought, with a strong male preponderance. Evidence is emerging that Tourette syndrome is not a unified disorder; rather, it encompasses a number of subtypes, characterised by complexity of tics and the simultaneous presence of other behaviours or disorders. This article discusses the aetiology of the syndrome, and examines its clinical features and comorbid psychiatric conditions and psychopathologies. Assessment and diagnosis are also discussed. Psychoeducation is a cornerstone of management, augmented with behavioural and/or pharmacological treatments. Newer therapies, such as deep brain stimulation, offer tantalising possibilities, but further research is still needed.

Research into the use of digital technology to deliver treatment for psychosis is turning up some fascinating applications, but enthusiasm for these products must be tempered with a realistic appraisal of the steps from initial proof of concept to a marketable device.

Confidentiality in child and adolescent mental health is a complex and often challenging matter. Not only do young people frequently present to services in situations of risk, they often prefer to keep information confidential from parents and/or other professionals. This article explores confidentiality in the context of child and adolescent mental health services (CAMHS), particularly when the clinician is having to make decisions on whether to maintain or to breach it. Ethical principles (both deontological and consequentialist) and legal and regulatory frameworks (relating to human rights, case law and General Medical Council guidance) are outlined. Four hypothetical case scenarios are used to illustrate how to apply such principles: when a young person seeks confidential access to treatment, and when he or she discloses information that could signify a risk to self, to others or from others. Finally, practical suggestions on how to share information are explored.

The traditional disease model, still dominant in psychiatry, is less than ideal for making sense of psychological issues such as the effects of early childhood experiences on development. We argue that a model based on evolutionary thinking can deepen understanding and aid clinical practice by showing how behaviours, bodily responses and psychological beliefs tend to develop for ‘adaptive’ reasons, even when these ways of being might on first appearance seem pathological. Such understanding has implications for treatment. It also challenges the genetic determinist model, by showing that developmental pathways have evolved to be responsive to the physical and social environment in which the individual matures. Thought can now be given to how biological or psychological treatments – and changing a child's environment – can foster well-being. Evolutionary thinking has major implications for how we think about psychopathology and for targeting the optimum sites, levels and timings for interventions.

Mindfulness is increasingly being recommended to help patients with recurrent depression and anxiety stay well. However, current treatment recommendations ask a lot in terms of commitment, with around 100 hours of practice and learning over a 2-month period. There is therefore increased interest in approaches that deliver key mindfulness skills in a shorter time frame.

Hallucinations (erroneous percepts in the absence of identifiable stimuli) are a key feature of psychotic states, but they have long been known to present in children with non-psychotic psychiatric disorders. Recent epidemiological studies of child populations found surprisingly high rates (about 10%) of hallucinatory experiences. These hallucinatory phenomena are most likely to occur in the absence of psychiatric disorder and are usually simpler, less elaborate and less distressing than those observed in children with psychiatric disorders. This article details the clinical assessment of hallucinations in children and adolescents, taking into account developmental considerations and paediatric organic associations. It describes hallucinations in young people with psychoses (schizophrenia spectrum and mood disorders) and non-psychotic psychiatric disorders (emotional and behavioural disorders), and it addresses therapeutic aspects.

This article explores the philosophical concept of akrasia, also known as weakness of will, and demonstrates its relevance to clinical practice. In particular, it challenges an implicit notion of control over one's actions that might impede recovery from substance misuse. Reflecting on three fictional case vignettes, we show how philosophical work on akrasia helps avoid this potentially harmful notion of control by supporting a holistic engagement with people for whom substance misuse is a problem. We argue that such engagement enhances their prospects of recovery by focusing on agency over time, as opposed to individual lapses.