Faster internet speeds and ever-present mobile phones present a new challenge to psychiatric wards – the ability for patients to live stream their in-patient stays. What are the benefits and the risks to the patient streaming and the ward as a whole? This article is to help start a conversation about this unique problem and how health professionals might go about addressing it.

‘Digital’ is an omnipresent yet often vague, misunderstood or feared topic in health services. There are many current and potential gains for individual patients and local populations, clinicians and organisations through optimisation of digital technologies. We argue that understanding the various aspects of digital psychiatry is an essential contemporary need. This is the first of two articles on the subject, exploring the gains and challenges of virtual/online assessments, including ethical considerations and the use of virtual reality and electronic prescribing.

Digital psychiatry has become increasingly important and understanding of certain aspects is essential for practising clinicians. This article discusses electronic patient records (EPRs), from their origins to current and future use, the growth and embedding of outcome measurements, the use of social media, and learning and research in virtual arenas.

Michaelson & Rahim describe a very welcome sustainable training framework for teaching clinical communication skills to trainees on MRCPsych courses. This commentary expands on their article, noting how psychiatrists listen and ask questions affects the therapeutic relationship and patients’ willingness or ability to disclose sensitive information, which is particularly important in risk assessment. Extending videorecording role-plays in training to routine (including remote) clinical consultations and involving patients and carers in training will be key to identifying communication that has a positive impact on patient experience and outcomes.

Light is the most important environmental influence (zeitgeber) on the synchronization of the circadian system in humans. Excess light exposure during the evening and night-time affects secretion of the hormone melatonin, which in turn modifies the temporal organization of circadian rhythms, including the sleep–wake cycle. As sleep disturbances are prominent in critically ill medical and psychiatric patients, researchers began to examine the impact of light exposure on clinical outcomes and length of hospitalization. In psychiatric inpatients, exposure to bright morning light or use of blue blocking glasses have proved useful interventions for mood disorders. Recently, knowledge about light and the circadian system has been applied to the design of inpatient facilities with dynamic lighting systems that change according to time of day. The installation of ‘circadian lighting’ alongside technologies for monitoring sleep–wake patterns could prove to be one of the most practical and beneficial innovations in inpatient psychiatric care for more than half a century.

Open access publishing has a dark side, the predatory publishers and journals that exist for revenue rather than scholarly activity. This article helps researchers to: (1) identify some of the commonly used tactics and characteristics of predatory publishing; and (2) avoid falling prey to them. In summary, authors should choose the journal for submission themselves and never respond to unsolicited emails. It is also important to check blacklists such as ‘Stop Predatory Journals’ and whitelists such the Directory of Open Access Journals.

Autism spectrum disorder (ASD) is a heterogeneous disorder with clearly recognisable core features, but without reliable biomarkers as yet. It has a high rate of comorbid psychiatric disorders which need to be identified and appropriately treated. Emerging concepts in genetics, pathobiology and outcome measurement have potential to significantly advance the treatment of both ASD and its comorbidities over the following decades.

Sexual and relationships difficulties are not uncommon among psychiatric patients. A presenting complaint of anxiety or depression may relate to an underlying sexual or relationship difficulty; commonly used psychotropic medications cause sexual side-effects that can have a significant impact quality of life, relationship maintenance and treatment adherence; patients may exhibit unusual or excessive sexual behaviours when acutely unwell, including risky use of apps to meet sexual partners and accessing online pornography in unsafe ways; patients may have used technology such as the internet to harm others or they may be victims of such harm; the internet and social media might even be influencing sexual expression, for example gender identity. Therefore, psychosexual history-taking remains a key competency for psychiatrists. They must also understand the new language used to describe sexuality, sexual behaviours and the use of social media, apps and so on to form relationships. This article outlines the key areas to consider in carrying out a structured psychosexual assessment. It also gives an overview of current sexual terminology, observed influences of the internet on sexuality and sexual behaviour, and its implications for mental health and potential sexual offending.

The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.

Depression and anxiety are common in adolescents, but most affected will not get any formal help. Digital mental health technologies (i.e. resources and interventions to support and improve mental health) are a potential way to extend the reach and increase adolescents’ access to therapies, at a relatively low cost. Many young people can access the internet and mobile technologies, including in low- and middle-income countries. There has been increased interest in integrating technologies in a range of settings, especially because of the effect of the COVID-19 pandemic on adolescent mental health, at a time when services are under pressure. This clinical review gives an overview of digital technologies to support the prevention and management of depression and anxiety in adolescence. The technologies are presented in relation to their technological approaches, underlying psychological or other theories, setting, development, evaluations to date and how they might be accessed. There is also a discussion of the potential benefits, challenges and future developments in this field.

Recent years have seen a dramatic increase in the advances and applications of medical imaging techniques. Tools with familiar acronyms such as MRI, EEG/MEG and PET/SPECT have provided invaluable information not only about the brain structure and function associated with psychiatric disorders, but increasingly about the mechanisms underpinning these disorders. This evolving understanding of the specific pathophysiology of mental disorder paves the way for improvement in the diagnosis, treatment and prognosis of the disorders managed in everyday clinical practice. This article gives an overview of the main neuroimaging approaches, contemporary applications of this technology to psychiatric disorder and signposts to the exciting possibilities for the future.

There is now an established evidence base for the use of information and communication technology (ICT) to support mental healthcare (‘e-mental health’) for common mental health problems. Recently, there have been significant developments in the therapeutic use of computers, mobile phones, gaming and virtual reality technologies for the assessment and treatment of psychosis. We provide an overview of the therapeutic use of ICT for psychosis, drawing on searches of the scientific literature and the internet and using interviews with experts in the field. We outline interventions that are already relevant to clinical practice, some that may become available in the foreseeable future and emerging challenges for their implementation.

Functional near-infrared spectroscopy (fNIRS) has been used in healthcare and medical research for the past two decades. In particular, the use of fNIRS in academic and clinical psychiatry has increased rapidly owing to its advantages over other neuroimaging modalities. fNIRS is a tool that can potentially supplement clinical interviews and mental state examinations to establish a psychiatric diagnosis and monitor treatment progress. This article provides a review of the theoretical background of fNIRS, key principles of its applications in psychiatry and its limitations, and shares a vision of its future applicability in psychiatric research and clinical practice.

Peer-supported open dialogue is a variant of the ‘open dialogue’ approach that is currently practised in Finland and is being trialled in several countries around the world. The core principle of the approach is the provision of care at the social network level, by staff who have been trained in family, systems and related approaches. These staff include peer workers, who will help to enhance the democratic nature of the meetings around which care is centred, as well as enabling such meetings to occur where networks are fragmented or lacking. Certain organisational and practice features and underlying themes are key to the approach. Crucially, open dialogue is also a system of service provision. Staff trained in peer-supported open dialogue from six National Health Service (NHS) trusts will launch pilot teams in 2016, as part of an intended national multicentre randomised controlled trial.

Previous studies have demonstrated that smartphones are useful tools in everyday, evidence-based medical practice. This article gives an overview of the current use in psychiatry of smartphone apps aimed at patients and the general public, highlighting associated benefits and disadvantages. It also outlines how practising psychiatrists could embrace such technologies at an individual, organisational and national level.

Many people with mental health problems spend a large proportion of their life online and an increasing number of apps address mental health and well-being. This article offers reasons why psychiatrists should learn how to use mental health apps to enhance patient care and gives some caveats for both professionals and patients regarding their use.

Internet gaming disorder (IGD) is a condition in which the individual is preoccupied with playing online video games and unable to regulate this behaviour, resulting in adverse physical and psychological consequences. Although there is some debate about whether IGD is an addiction or a coping mechanism, global evidence indicates that the condition is increasing in prevalence with recent advances in technology and its higher penetration into routine life. Male children and adolescents located in East Asian countries are at higher risk than others in the world. Attention-deficit hyperactivity disorder, depression and anxiety are typically associated with IGD. Given the continuing ambiguity regarding the diagnosis and screening tools for the disorder, it has become all the more relevant for mental health practitioners and academics to attend to this condition and develop evidence-based treatments. This review summarises both the existing evidence for the disorder and the debates that surround it.

Clinical neuromodulation began in psychiatry with electroconvulsive therapy (ECT), but in recent years several new techniques have been developed: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagal nerve stimulation (VNS), trigeminal nerve stimulation (TNS) and deep brain stimulation (DBS). Each works in a different way, although the principle remains to effect therapeutic change through physically modifying brain activity. Their use in different clinical groups varies between techniques, as does their underlying evidence base. Most support currently exists for rTMS, with a more modest, but growing database for tDCS. Understandably, but problematically, most research in the other techniques has, to date, been in unmasked open trials. This article describes the mechanism of action and current evidence base for each technique, and notes the challenges facing future work in this potentially important field and new clinical avenue.

The use of PowerPoint has become nearly ubiquitous in medical education and continuing professional development; however, many alternatives are emerging that can be used in its place. These may confer some advantages, but they also have potential drawbacks. It is helpful that educators are aware of these new presentation options and their pros and cons, including any financial implications and issues of data protection. This article considers the role of technology in teaching and learning, identifying underlying assumptions that are often made. It identifies and appraises technology that can be used with or instead of PowerPoint to best facilitate deep learning. The potential pedagogical benefits and practical limitations of these technologies are considered, and strategies are highlighted to maximise the impact of PowerPoint where it is the software of choice.