Antipsychotics are the cornerstone of schizophrenia management but they are not adequate in treating the negative and cognitive symptoms of the illness. The Cochrane review discussed in this commentary examines the safety and effectiveness of the wakefulness-promoting agent, modafinil, as an adjunct to standard care in the mitigation of negative and cognitive symptoms of schizophrenia. Add-on modafinil, compared to add-on placebo and standard treatment, did not result in a clear benefit. Due to the heterogenous body of evidence, the quality of which ranged from very low to moderate, the review's conclusions are equivocal.

The four main Indian religions – Hinduism, Buddhism, Jainism and Sikhism – have several shared concepts about self and suffering, which are salient to the world-view of the followers of these faiths. Understanding the concepts of mind, self and suffering in these faiths can help clinicians build better rapport and gain deeper understanding of the inner world of patients of these faiths. This article highlights the broad cultural and religious beliefs of these groups, with the hope that increased knowledge among clinicians might lead to better therapeutic engagement.

We now recognise that withdrawal symptoms from antidepressants are common, and can be severe and long-lasting in some people. Many withdrawal symptoms overlap with symptoms of anxiety or depression, making it difficult to distinguish withdrawal from relapse. We describe how their onset soon after dose reduction, the association of psychological with physical symptoms, their prompt response to reinstatement, and their typical ‘wave’ pattern of onset, peak and resolution can help distinguish withdrawal symptoms from relapse. We also examine evidence that suggests that antidepressant withdrawal symptoms are misdiagnosed as relapse in discontinuation studies aimed at demonstrating the ability of antidepressants to prevent future relapse (relapse prevention properties). In these discontinuation studies people have their antidepressants stopped abruptly, or rapidly, making withdrawal symptoms very likely, and little effort is made to measure withdrawal symptoms or distinguish them from relapse. We conclude that there is currently no robust evidence for the relapse prevention properties of antidepressants, and current guidance might need to be re-evaluated.

Distinguishing the symptoms of antidepressant withdrawal from those of relapse is a complex issue that has an impact on a significant number of clinicians and patients. This commentary expands on several important points made by Horowitz & Taylor in their examination of this critically under-researched area and illustrates the relationships between symptoms, and how their onset may provide insights into their aetiology.

No recent pandemic has had such a severe socioeconomic impact as COVID-19. Significant economic uncertainty and social restrictions have led to increased levels of stress for many. There has been increased social isolation, financial stress and alcohol intake, all of which can increase domestic abuse and other forms of household abuse. Increases in abuse in the home found in other public health emergencies and economic recessions can be seen now – reported UK domestic abuse rates have increased since the start of COVID-19. This article focuses on how COVID-19 and its anticipated aftermath exacerbate the risk factors for domestic abuse in the general population and discusses clinical implications for mental health practitioners in the UK. It aims to provide a point of learning based on previous disease outbreaks and recessions, with a focus on specific factors, such as unemployment and alcohol misuse, and how these contribute to increasing incidence and severity of abuse – and more importantly, how mental health professionals can mitigate these for patients, 1 in 3 of whom are estimated to have already experienced abuse before the COVID-19 pandemic.

The rise in domestic violence and abuse has been dubbed a ‘pandemic within a pandemic’. Individuals known to mental health services are particularly vulnerable. Yet despite challenges to mitigating domestic violence and abuse in this group, the COVID-19 pandemic has provided opportunities to develop new interventions to support those affected.

Mental health services are recognised to have an important role in responding to domestic abuse, but approach across the UK's National Health Service (NHS) is inconsistent. We describe an example of taking a whole- organisation approach to responding to domestic abuse in one NHS mental health foundation trust.

After many years of mental healthcare reform there is still a lot of unease among patients about healthcare workers’ lack of attention to their daily needs and to the tensions and ambiguities that accompany their attempts to integrate their condition into their lives. Person-centred care is often presented as a solution, but the term refers to many differing approaches and needs further specification depending on the problem it aims to resolve. This article presents and discusses a clinical and philosophically informed approach that flexibly focuses on the person- and context-bound aspects of the patient's condition and on the co-regulatory role of the clinician in the patient's attempt to regulate their condition. This approach is a way of thinking, rather than yet another model. It will be shown how this approach can be integrated in the core curriculum of specialty (residency) training in psychiatry.