The diagnosis of dementia poses several challenges, as a consequence of which the condition has been widely reported to be underdiagnosed in the general population. Currently, there is no single diagnostic test for dementia and the clinical judgement of primary care physicians is therefore a key determinant in identifying which patients are referred to specialist services for further assessment. This month's Cochrane Corner review found that the clinical judgement of general practitioners is more specific (58–99%) than sensitive (34–91%) in diagnosing dementia, although the data were limited by small sample size and significant heterogeneity. This commentary provides a critical appraisal of this systematic review and attempts to extrapolate conclusions relevant to current clinical practice, including potential areas of further research, to facilitate appropriate and timely referral of patients with suspected dementia to specialist services.

There are many pressures on elite footballers. They work in a meritocracy, where only the best are selected and play at the highest levels. From the moment they enter an academy to their retirement there is a fear of deselection and rejection. Elite players need to contend with criticisms from fans and via social media; team and management dynamics can be stressful. Fears of injury are major concerns. In addition, the players are likely to face everyday difficulties experienced by the rest of society, such as relationship, family and financial problems. There is a great deal of stigma associated with mental health problems in footballers, hence approaches are required that are destigmatising. This article presents two frameworks conceptualising stress in footballers: the Power Threat Meaning Framework, which describes stress in non-diagnostic terms; and the Yerkes–Dodson curve, which describes how stress can affect footballers’ mental and physical performances on the pitch. Both frameworks can combine to enable therapists to understand players’ distress and its impact and to guide towards appropriate treatments, as we show in a fictitious case study.

Although hypnosis has played a part in psychotherapy for a long time, it is not yet seen as an evidence-based therapy and is absent from many practice guidelines when it comes to the treatment of psychiatric disorders. At present, the applications and methods of hypnotherapy are poorly understood and other methods of psychotherapy tend to be favoured. This review article aims to introduce the role of hypnotherapy and its application for certain common psychiatric presentations, as well as examine its efficacy by summarising recent evidence from high-quality outcome studies and meta-analyses.

The use of hypnotherapy in psychiatry has been controversial. However, evidence presented by Chan and colleagues shows that it is beneficial to the promotion of good mental health and well-being, specifically being applicable in the management of mental disorders. But what does this mean for practice? This commentary looks at what we agree and disagree with, what we opine is missing from the article and what now needs to happen. Patients should be able to access hypnotherapy or hypnosis routinely on the National Health Service. Since it works, who may it work for and how may we make this available to those who could benefit from it?

This issue of BJPsych Advances includes an article on the use of hypnotherapy in psychiatric practice. The article contains a number of errors and misconceptions regarding the characteristics and practice of hypnosis that we address in this commentary.

Access to private space for psychiatric assessments is crucial to facilitate the effective gathering of salient information while preserving the dignity of patients. In this article, we discuss the current availability of private space for liaison psychiatry services on in-patient wards in general hospitals and reflect on how this affects communication with patients. Additionally, we propose solutions for healthcare trusts in addressing this issue.

Neurosurgery for mental disorder (NMD) is currently performed in the UK for cases of severe depressive disorder and obsessive–compulsive disorder refractory to treatment, under stringent regulations as set out under the Mental Health Act 1983. These surgical procedures appear to be effective for a proportion of individuals in this particularly treatment-resistant cohort. The two ablative procedures currently in use in the UK are anterior cingulotomy (ACING) and anterior capsulotomy (ACAPS). After briefly outlining these procedures, their evidence base and how they compare with other neurosurgical procedures, we suggest two ways in which they could be enhanced in terms of precision, namely the use of stereotactic (Gamma Knife®) radiosurgery guided by magnetic resonance imaging as well as a detailed and expanded standardised psychopathological and neuropsychological assessment both before and after surgery. The latter should involve extended long-term follow-up. We then reflect on how such psychopathological and neuropsychological assessments could help to understand why and how these procedures relieve patients’ suffering and distress.

Neurosurgery for mental disorder is performed in the UK for treatment-refractory obsessive–compulsive disorder and depression. In this commentary, the procedures used are considered alongside other surgical interventions for psychiatric conditions. Given the evidence for efficacy, this commentary agrees with Whitehead & Barrera's assessment that such procedures be considered more widely in treatment-refractory illness and concurs that the advent of minimally invasive radiosurgery is an exciting prospect for patients who have not responded to other treatments.

Mental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.

Clinicians should be aware of the inherent jurisdiction of the High Court in providing a ‘safety net’ to protect ‘vulnerable’ adults who are not within the scope of the Mental Capacity Act 2005 (MCA) or the Mental Health Act (MHA) 1983. Many situations in which the inherent jurisdiction has been deployed have been to safeguard vulnerable adults where there is abuse, coercion or undue influence, but the person does not lack decision-making capacity under the MCA. We explain the nature of the inherent jurisdiction, including descriptions of concepts surrounding ‘vulnerability’; as an intervention of last resort, we consider what statutory alternatives may exist, including safeguarding law under the Care Act 2014; we discuss decision-making capacity in relation to contact with others and, using real cases, the types of order that may be made under the court's inherent jurisdiction. It is important to be mindful that although there may be a legal remedy to safeguard this ‘vulnerable but capacitous’ group, there is a delicate and challenging balance between protecting those at risk and respecting their autonomy.

Psychiatry in Dissent: Controversial Issues in Thought and Practice was published in 1976. In the book, Irish psychiatrist Anthony Clare (1942–2007) both defended and critiqued contemporary psychiatry. He demystified the field, analysed its problems and argued that psychiatry, for all its flaws, offered a reasoned and reasonable path forward. His arguments remain fiercely relevant today, sometimes eerily so.

Advances in data science and machine learning have allowed for the analysis of increasingly complex and large data-sets. Digital devices are a source of such data, given their ability to collect information on users continuously and irrespective of location. Digital phenotyping aims to use these data to build a comprehensive picture of an individual's behaviour. Psychiatry is well-positioned to make use of this, since digital behaviour may be reflective of mental state. This article provides an overview of the field of digital phenotyping as it stands currently, on the verge of large-scale studies which may pave the way for clinical implementation in psychiatry.