The management of delirium requires careful consideration of the potential value both of pharmacological interventions and of a range of non-drug strategies. Although placebo-controlled studies of delirium treatment are lacking, less robust evidence can still inform practice. This review makes the case for more active management of delirium on the basis of recent studies of prevention, early identification and treatment both during an episode and managing the aftermath in survivors. A drug-treatment algorithm for delirium advising how drug treatments can be tailored to the specific needs of individual patients is described.

This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces.

This article explores the uses of the terms social exclusion and social inclusion in a mental health context. We briefly describe the origins of the term social exclusion and analyse its connotations in relation to four key dimensions: the relative, multifactorial, dynamic and transactional. We discuss Levitas's three discourses concerning social exclusion (the redistributionist, moral underclass and social integrationist) and present a case in favour of a fourth perspective, societal oppression. Focusing on social inclusion as a remedy for the ills of social exclusion, we discuss implications for contemporary mental health policy, practice and research. We highlight the potential contribution of social psychology to social inclusion theory. We conclude that a better theoretical understanding of causal mechanisms is needed to enable the development of more socially inclusive mental health services.

Recent technological advancements have been used to help people with dementia remain independent. These are reviewed and case vignettes are used to explain their use in common scenarios. The ethical perspective and current evidence are explored in the context of telecare use.

The Human Rights Act 1998 was introduced into UK law in 2000. It must be considered in all clinical cases, including mental health review tribunals. The number of mental health cases brought to the European Court of Human Rights that breach Article 3 has been very few. However, Article 3 will need to be considered in the clinical setting in complaints arising from conditions of detention, seclusion, control and restraint. This article analyses the case law, illustrating its evolution and also demonstrating the fundamental and core concepts that underpin the Act that can be used in clinical practice.

A significant proportion of people live and work in rural areas, and rural mental health is important wherever psychiatry is practised. There are inherent difficulties in conducting rural research, due in part to the lack of an agreed definition of rurality. Mental health is probably better in rural areas, with the exception of suicide, which remains highest in male rural residents. A number of aspects of rural life (such as the rural community, social networks, problems with access, and social exclusion) may all have particular implications for people with mental health problems. Further issues such as the effect of rural culture on help-seeking for mental illness, anonymity in small rural communities and stigma may further affect the recognition, treatment and maintenance of mental health problems for people in rural areas. Providing mental health services to remote and rural locations may be challenging.

This article outlines the majority of the adverse physical effects that have been described secondary to the consumption of alcohol at levels above recommended sensible limits. These conditions are cited according to the organ system they belong to. Only brief descriptions are provided because of the vastness of this topic. The underlying pathophysiology of tolerance and withdrawal is touched upon as this is of relevance to the psychiatrist. Definitions of the terms used describing alcohol misuse, and sensible upper limits of alcohol consumption are also mentioned.

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.

A good medical history is an essential starting point in ensuring that the physical health needs of people with severe mental illness are addressed. Psychiatrists have an important role in helping to tackle the general ill health, excess of undiagnosed physical illness and reduced survival rates among their patients. To do this they need to use their medical training, communication skills and regular contact with patients. Assessments should include family history, past and current physical health, medication, lifestyle, healthcare and physical symptoms. Some groups of patients will need more detailed assessments.

There is a field of knowledge that speaks of the promotion of positive mental health, well-being and happiness yet it may not be well-known to all psychiatric practitioners. Economists, geneticists, positive psychologists, evolutionary psychologists, neuroscientists and sociocultural researchers have all contributed to what might be termed the emerging science of well-being. This article provides a brief introduction to this complex topic. We outline some of the findings, theories and arguments from this comparatively new but burgeoning research area. We also rehearse some critical responses to this field which indicate that both the evidence on well-being and the implications for practice and policy might be less straightforward than researchers sometimes imply. We conclude by suggesting that psychiatrists, as leaders in the field of mental health, might want to consider the implications (positive and negative) of well-being research for the development of their own discipline and professional practice.

A growing body of evidence suggests that late-onset depression (depression occurring for the first time in later life) differs from early-onset (recurrent) depression in terms of clinical features, aetiology, neuroanatomical substrates and prognosis. Some evidence suggests that late-onset depression is more associated with somatic symptoms, cognitive deficits, cerebral structural abnormalities, vascular disease (‘vascular depression’) and poorer treatment outcomes than is early-onset depression. Both general adult and old age psychiatrists face the challenges of managing late-onset depression. In this article we attempt to clarify specific issues relating to late-onset depression in terms of clinical features, aetiology, treatment response and prognosis.

Intellectual and other more specific neurocognitive impairments in schizophrenia are important for understanding the aetiology of the condition and its likely outcome. However, these impairments are not usually considered important for supporting a diagnosis in suspected early schizophrenia. IQ testing is widely available and probably acceptable to most people likely to be experiencing the early stages of psychosis and who might be unable or unwilling to disclose details of their history and mental state or to cooperate with more comprehensive neuropsychological assessment. Although in general IQ tests have only limited diagnostic value in schizophrenia, the finding of a substantial decline in IQ score from the estimated premorbid level may be helpful in supporting a provisional diagnosis of early schizophrenia in cases without organic signs in which the clinical picture is unclear or incomplete. More important, the results of IQ tests may contribute to a better understanding of patients' impairments and assist clinical management in a number of ways, as illustrated here by three fictional case studies.