The principles of recovery have been supported by UK mental health policyand have been incorporated into policy in several countries worldwide. Inthis article we examine the ideas, principles and definitions of recoveryand their origins. Personal recovery is contrasted with clinical recoveryand the nature and development of the recovery movement is outlined. Theprincipal factors influencing personal recovery are hope, control andopportunity. In an accompanying article we discuss the implications of theseprinciples for training and practice.

Most literature discussing the introduction of foundation year 1 (F1)psychiatry posts has focused on recruitment. However, for F1 posts to offera valuable learning experience and a potential recruitment boost,psychiatrists and employing organisations should be aware of general issuesarising in the first postgraduate year. These include the inherentlystressful student-to-doctor transition, the need for bespoke inductionprogrammes for new graduates, F1 doctors' specific needs for support,supervision and peer support, and the centrality of the relationship withthe consultant supervisor to the new doctor. Understanding these themes willenable psychiatrists and mental health organisations to offer better F1psychiatry experiences, which may boost recruitment and could maximise theopportunities for F1 doctors to develop skills and qualities that will be ofvalue in their future careers, whatever specialty they end up workingin.

Different forms of excessive reassurance-seeking safety behaviours areexplored, along with reasons why these unhelpful responses occur across arange of mental health disorders. This short update covers the rationale forreducing and stopping these behaviours and offers interventions to helppeople understand and overcome the unhelpful impact that excessivereassurance-seeking can have on them and others.

Seclusion is a tool used by psychiatrists primarily to manage aggressive anddisturbed behaviour that is presumed to be due to the patient's mentaldisorder. In most parts of the world there are guidelines to using seclusionthat are designed to maximise a patient's freedoms and protect their libertywhile providing a safe environment. Arguments against the use of seclusionrevolve around the deprivation of liberty, the potential for misuse and theconcept of seclusion as a form of social control, and patients generallyreport seclusion as a negative, coercive experience. There is littleevidence that seclusion provides long-term benefits in terms of treatingsymptoms or reducing aggression, although the literature is mixed in thisregard. Expert opinion recommends a combination of national policy, wardmanagement and patient-centred interventions to reduce seclusion rates.

Psychiatric assessment in the community is an important part of both theinitial assessment process and delivery of follow-up care in adultintellectual disability services in the UK. This article examines how suchassessments can be carried out safely and explores the clinical skillsrequired to perform them effectively. Use of the psychiatric interview andmental state examination to elicit information is discussed. Communicationdifficulties experienced by people with intellectual disabilities andstrategies that may be employed to address these in the assessment processare also explored. The article is directed at psychiatrists, in particularspecialty trainees, and other healthcare professionals who work withintellectually disabled people.

For decades society has recognised that children are vulnerable and so ithas sought to protect them. However, similar legal protection for adults whomay be equally vulnerable has been neglected. The incremental introductionof legislation and reports in the UK, along with guidelines on goodpractice, now afford adults safeguarding procedures similar to those forchildren. This article offers a practical overview of these developments. Inaddition, it highlights some of the dilemmas that face practitioners in thisevolving arena, as legislation and policy do not anticipate the diversescenarios in which mental healthcare professionals may be involved.Decisions made can be subject to legal challenge, so it is important thatpsychiatrists understand their role as well as the role of theirorganisation in this complex area.

Young people who cut themselves may do so for reasons that go beyonddiagnosis. Relevant processes include responses to trauma, coping, emotionregulation and cultural identification. Some clinicians regard those whoself-harm negatively or consider one therapeutic approach to be suitable forall. This article explores the possible mechanisms involved when youngpeople cut themselves and discusses therapeutic approaches in the light ofthese. Clinicians and researchers are encouraged to refine, develop andresearch interventions for young people who self-harm by cutting.

Lithium is one of the most effective psychotropic drugs we have, but it isunderused because of its low therapeutic index, the need for regular bloodtests and perceptions about its adverse effects, including renal problems.The last include urinary concentration deficits and diabetes insipidus,chronic kidney disease (including renal failure), nephrotic syndrome,hypercalcaemia, hyperparathyroidism and distal tubular acidosis. Thisarticle reviews these adverse effects with special emphasis on theirmanagement.

This article examines the life and work of John Kennedy Toole, focusing onhis 1981 Pulitzer Prize winning novel A Confederacy of Dunces. Toole finished the novel in 1966 and, after failing torework his manuscript to his editor's satisfaction, he shelved the project.Following this, he displayed symptoms typical of paranoid schizophrenia andhe took his own life at the age of 31. In his novel, Toole parodies bothpsychoanalysis and the practice of psychiatry at the time, with a strongoverlap with the emerging perspectives critical of psychiatry popularised byfigures such as Szasz, Laing and Foucault. Toole's life and work haverelevance for psychiatrists interested in the relationship betweencreativity and mental illness, attitudes towards psychiatry in the 1960s,and the interplay between societal values and judgements of mentalhealth.