The precautionary principle has high face validity, but it can favour indeterminate future risks over potential current benefits. It can also have unintended consequences when applied to the design of clinical protocols and health policy. Contemporary pressures in mental healthcare may amplify the precautionary principle in practice. To mitigate against these disadvantages, we need trial designs that assess all risks (including the risk of no treatment) and also the possibility that potential risks may be successfully managed. Critical appraisal of clinical protocols and their impact are also necessary.

Over the past decade there have been few advances and no real breakthroughs in the treatment and management of anorexia nervosa. There has perhaps been a consolidation of opinion and practice. A clinical guideline for eating disorders published under the auspices of the National Institute for Clinical Excellence (NICE) has summarised our present ideas of good practice as well as highlighting the lack of good evidence on which to base this.

Treatment of alcohol use disorders typically involves a combination of pharmacotherapy and psychosocial interventions. About one-quarter of people with alcohol dependence (‘alcoholics’) who seek treatment remain abstinent over 1 year. Research has consistently shown that less intensive, community treatment (particularly brief interventions) is just as effective as intense, residential treatment. Many psychosocial treatments are probably equally effective. Techniques for medically assisted detoxification are widespread and effective. More recent evidence provides some support for the use of drugs such as acamprosate to prevent relapse in the medium to long term.

In this review of recent advances in the sub-specialty, we briefly discuss the current understanding of causes, presentations and evidence-based treatment of the most common disorders seen in clinical neuropsychiatry. Traumatic and acquired brain injury, epilepsy, multiple sclerosis, Parkinson's and Huntington's disease, sleep disorders and delirium are all considered, focusing on the most contentious issues and practical approaches to management and treatment.

Mortality from causes other than suicide is higher than expected in schizophrenia. Cardiovascular causes are most common, accounting for the majority of the 5% of sudden and unexpected deaths. Most cases have no clear explanation on post-mortem examination (‘sudden unexplained deaths’) and are thought to result from fatal arrhythmias. Prospective studies show that people with prolongation of the QT interval beyond 500 ms are at increased risk of serious arrhythmias such as ventricular tachycardia and torsade de pointes. In about 1 in 10 cases, the torsade is fatal. Most antipsychotics prolong the QTc interval in overdose but some prolong it even at therapeutic doses. Droperidol, sertindole and ziprasidone extend the QT interval by an average of 15–35 ms; quetiapine, haloperidol and olanzapine by 5 ms, to 15 ms. There is only an approximate relationship between QT prolongation and risk of sudden death, and the risk related to antipsychotics is thought to increase in people with pre-existing cardiac disease, those taking multiple QT-acting drugs and those taking antipsychotics at high dose for long periods. There is little evidence of an association with route of administration. More data are required to clarify to what extent people with mental health difficulties who die suddenly have pre-existing cardiac disease.

Clinicians have been divided in their views on whether systematic needs assessment leads to an improvement in the outcome of care for people with chronic mental illness. Policy makers assume that assessment and evaluation will improve the clinical and cost-effectiveness of mental health services. Many of these assumptions are already embedded within mental health policy and practice. A decade of research has not resolved this tension. However, clinicians need to know about the options available to guide systematic assessment and evaluation of care. They can then make informed decisions about their use to promote effective care planning or as a tool to direct socially inclusive service development.

Medically unexplained somatic complaints are among the most common clinical presentations in primary care in developing countries and they are a considerable burden for patients and the healthcare system. They are assumed to be the result of psychosocial factors, and the process by which symptoms are experienced is termed somatisation. Common mental disorders, somatoform disorders and socio-economic adversities are the major risk factors for these complaints. There is evidence suggesting that cognitive–behavioural therapy, which has proven efficacy for somatoform disorders in the developed world, can be used in developing countries with some adaptations (e.g. by simplifying the content so that it can be applied in primary care by non-specialist health practitioners; using culturally appropriate analogies; and delivering the intervention over fewer and shorter sessions). The main components of such an intervention are presented in this article.

Stammering results in involuntary disruption of a person's capacity to speak. It begins at an early age and can persist for life for at least 20% of those stammering at 2 years old. Although the aetiological role of anxiety in stammering has not been determined, evidence is emerging that suggests people who stammer are more chronically and socially anxious than those who do not. This is not surprising, given that the symptoms of stammering can be socially embarrassing and personally frustrating, and have the potential to impede vocational and social growth. Implications for DSM–IV diagnostic criteria for stammering and current treatments of stammering are discussed. We hope that this article will encourage a better understanding of the consequences of living with a speech or fluency disorder as well as motivate the development of treatment protocols that directly target the social fears associated with stammering.

Mental health services are moving towards a balanced-care model. The shift recommended by the World Health Organization is currently being reflected only in service delivery, and has not been clearly reflected in the training curriculum. This change in service delivery has implications for teaching and learning. This article looks at how best the curriculum can incorporate aspects of community psychiatry and hospital work for medical students and junior doctors in training. This move towards balanced care also requires teaching staff to consider how to make use of collaborative working and to develop effective working relationships.

Curriculum is not the same as syllabus. The latter is a statement of topics to be studied in a specific course. The former ranges from a statement of purpose, aims and contents (the paper curriculum) to how these are applied in practice, what learners do and the behaviours, knowledge and performances that they see as important. The Postgraduate Medical Education and Training Board (PMETB) defines curriculum as: