The British Journal of Psychiatry

Revisions of DSM and ICD are forthcoming. Should the old categories of psychotic disorder, in particular the construct of schizophrenia, be retained or is a new system of representation of psychosis in order? It is argued that both scientific and societal developments point to a system of classification combining categorical and dimensional representations of psychosis in DSM and ICD. Furthermore, it is proposed to introduce, analogous to the functional descriptive term ‘metabolic syndrome’, the diagnosis of salience dysregulation syndrome. Within this syndrome, three sub-categories may be identified, based on scientific evidence of relatively valid and specific contrasts: with affective expression; with developmental expression; and not otherwise specified.

An emerging appreciation by practitioners and researchers, long held by patients and carers, is that neuropsychiatric features of dementia and the challenges they present are as important as those of cognitive losses.

The Hungarian psychiatrist Laszlo Meduna was the first who induced epileptic fits to influence the course of mental illness. The following account, based on a review of Meduna's recently unearthed files and his writings, traces the beginnings of convulsive therapy.

The original vision of psychiatry was as a medicine – or physic – of the mind. If psychiatry aspires to be a progressive modern medicine of the mind, it should be fully engaged with the science of the brain. We summarise and rebut three countervailing or ‘neurophobic’ propositions and aim to show that not one provides a compelling argument for neurophobia. We suggest that there are several ways in which psychiatry could organise itself professionally to better advance and communicate the theoretical and therapeutic potential of a brain-based medicine of the mind.

A recent meta-analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos, a conclusion at some variance with their commonly judged clinical effectiveness. The ‘disconnect’ between randomised controlled trials and clinical practice would benefit from dissection of contributing factors, and redressing limitations to current trial procedures.

Mental illness is now the leading cause of both sickness absence and incapacity benefits in most high-income countries. The rising economic and social costs make health and work an increasing priority for policy makers. We discuss the findings from Dame Carol Black's recent review of the health of Britain's working-age population and examine how her recommendations may impact and challenge mental health services.

Preventive intervention for first-episode depression is an exciting, emerging field. Many questions remain, however. Should we target patients who have sub-syndromal symptom elevations (i.e. indicated intervention) or should we intervene in high-risk groups (i.e. selective intervention)? Furthermore, should primary outcomes be incident depressions or long-term decreases in morbidity or mortality?