Anxiety disorders are common, often have a chronic course and frequently coexist with other psychiatric disorders. Psychological therapy is recommended as first-line treatment, but equitable access remains a challenge. This month's Cochrane Corner review assesses the evidence for the efficacy of therapist-supported cognitive-behavioural therapy (CBT) for anxiety disorders delivered via the internet. Although internet delivery of therapy is attractive for many reasons, and the results of this preliminary review suggest that it is efficacious, this is a rapidly expanding field. Further updates of this review will include more evidence to support or refute the use of this new method of treatment delivery, either alongside or in preference to standard face-to-face CBT.

Although medical experts are valued in the administration of justice, the cases in the UK of Meadow and others, including most recently Pool, have all contributed to understandable anxiety on the part of doctors who carry out court work. This article uses an in-depth analysis of these cases and details of some other medical regulatory cases to draw out some lessons for potential medical expert witnesses. Although the most recent judgment in Pool leaves a number of unanswered questions, steps are identified that may be taken to reduce the risk of regulatory investigation by the General Medical Council.

This piece seeks to complement Professor Rix's article on expert competence and professional misconduct by examining a related issue, namely the increasingly strict approach of the criminal courts to the reception of expert evidence. It considers recent case law, rules of procedure and legislation, and addresses both the admissibility of expert evidence and the duties of expert witnesses.

This article discusses the importance of residence capacity – an individual's mental capacity to decide where they should live – and suggests how it should be assessed. People with dementia or intellectual disabilities, as well as those with other mental disorders, are sometimes required to make this decision. Assessments of capacity must be conducted with considerable care, given the implications for the individual and for their human rights. The assessment must be objective and functional: the assessor must be able specifically to demonstrate a lack of decision-making ability. Yet assessments of capacity still require evaluative decisions to be made. We suggest some basic information that should be conveyed to the person faced by the prospect of a change of residence where there is a doubt about capacity.

Assessment of mental capacity is, or should be, a regular part of daily clinical practice in general hospitals. It is both particularly important and potentially complex in relation to an older person with dementia wishing to return home despite concern over perceived risk. Case law provides some guidance, but an ethical duty remains for clinicians to develop and hone their professional judgement in this increasingly important area of practice.

Persistent major depression that does not respond to adequate first- or second-line treatment is a common problem in psychiatry. This article updates evidence on recommended treatment strategies and reviews the prospects of more experimental approaches. The main pharmacological development in recent years has been the demonstration that several atypical antipsychotic drugs are effective adjunctive agents in improving symptoms in depression unresponsive to selective serotonin reuptake inhibitors, although their adverse effect burden is high. There is optimism about novel pharmacological strategies based on glutamatergic and anti-inflammatory mechanisms. It is important to combine drug and psychological treatments whenever possible. With persistent therapeutic engagement, the majority of patients remit eventually, but subsequent relapse remains a problem. Clinicians should pursue an active and collaborative treatment plan that makes use of all effective therapeutic modalities and continues into the relapse-prevention phase.

Serotonin syndrome (serotonin toxicity or serotonin toxidrome) is a potentially serious and theoretically predictable reaction that appears to be rarely diagnosed in practice in the UK. Some symptoms of serotonin syndrome overlap with features of other presentations in psychiatry and thus may be misattributed to mental illness (‘diagnostic overshadowing’). Further, there may be diagnostic dilemmas in patients on combinations of drugs, those receiving drugs with previously unknown serotonergic properties or where there are drug interactions. Prescriber vigilance and holistic review of the patient, including the pharmacotherapy, may be helpful in avoiding progression of serotonin syndrome to more serious outcomes.

This article summarises new research, together with core features, course and outcome of schizophrenia with onset in childhood and adolescence, and investigates its neurobiology and continuity into adult life. It concludes that, in conformity with other disorders of childhood, adult-based diagnostic criteria have validity in adolescence. Sadly, the disorder has a poorer outcome when onset is in youth.

Akathisia is a common and distressing side-effect of antipsychotic medication. The treatment of this condition is difficult and options are limited. This review of the literature was performed to develop an evidence-based algorithm for the management of antipsychotic-induced akathisia. There is limited high-level evidence to support the use of anticholinergics. Centrally acting β-adrenergic antagonists are potential treatments, although their use is limited by troublesome side-effects. Long-acting benzodiazepines and mirtazapine are potential well-tolerated treatments for the acute management of akathisia.

Economic evaluation involves the comparative analysis of the costs and consequences of alternative (different) treatment options. Economic evaluations provide decision makers with information about the relative value for money, or cost-effectiveness, of various treatment programmes. The relative cost-effectiveness of new interventions is a key consideration in health technology assessments by the UK's National Institute for Health and Care Excellence, and economic evaluations alongside randomised controlled trials are routinely requested by funders such as the National Institute for Health Research. This article outlines some of the key concepts and issues in the economic evaluation of mental healthcare.

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.