As many as 10% of the population experience post-traumatic stress disorder (PTSD) at some time in their lives. It often runs a severe, chronic and treatment-resistant course. This article reviews the evidence base for typically recommended treatments such as cognitive-behavioural therapy (CBT), eye movement desensitisation and reprocessing and selective serotonin reuptake inhibitors (SSRIs). It tabulates the major randomised controlled trials of SSRIs and trauma-focused CBT and reviews research on novel treatments such as ketamine, MDMA, quetiapine, propranolol and prazosin.

Different forms of excessive reassurance-seeking safety behaviours are explored, along with reasons why these unhelpful responses occur across a range of mental health disorders. This short update covers the rationale for reducing and stopping these behaviours and offers interventions to help people understand and overcome the unhelpful impact that excessive reassurance-seeking can have on them and others.

This article examines the notion of personhood and shows how it offers a robust conceptual underpinning to person-centred care. We use a fictitious case vignette to clarify the nature of personhood. Mental health professionals need a broad view of personhood, which we feel is best captured by regarding the person as a 'situated embodied agent'. Using this characterisation, we aim to demonstrate how it can underpin the notion of person-centred care and show the practical implications of this in connection with our fictitious case. The broad view supports a specific approach to people with dementia, but also shows the challenges that face the implementation of good-quality dementia care. Discussion of this case shows both the relevance of philosophy to clinical practice and the ways in which clinical practice can enrich the debates of philosophy.

Few of us have first-hand experience of military psychiatry. However, as a result of recent conflict and the imminent downsizing of the armed forces we will almost certainly be seeing increasing numbers of ex-servicemen in our clinics. This paper explains what civilian mental health professionals should know when dealing with service and ex-service men and women.

There has been increasing interest in how to assist people to ‘live well’ with advancing and incurable conditions late into life. This article considers the progress made in mental health services for adults of working age which promote active involvement in their care and how these principles can be applied to older adults with dementia. The concept of ‘recovery’ and its applicability to dementia care are discussed. The Wellness Recovery Action Plan (WRAP) and how it could be translated and modified to the needs of people with dementia are explored. This is especially important in light of the UK National Dementia Strategy, which emphasises early diagnosis and intervention to promote improved care and quality of life.

PowerPoint slides are now almost expected of anyone preparing a presentation. The rise of the slide has generated considerable debate, with some people concerned that PowerPoint diminishes the potential of critical thinking by the audience, and others encouraging innovative graphic design as assisting the transmission of information. We examine these two viewpoints and offer steps and resources for incorporating design elements when preparing slides.

Psychological treatments in secure settings have traditionally been based on psychodynamic and cognitive–behavioural approaches. Recent developments, supported by an emerging evidence base, have generated a significant amount of interest in mindfulness-based psychological therapies and their utility in diverse areas of mental healthcare. In this article we analyse the current evidence base and describe possible mechanisms of action of mindfulness-based psychological approaches. On the basis of the evidence, we advocate a cautious but positive approach to using mindfulness-based interventions in secure services.

The mental state examination is unlike any other assessment in medicine. Karl Jaspers is largely attributed with describing the structure and method of its use. In the centenary year of Jaspers' seminal work General Psychopathology, psychiatry can celebrate the mental state examination as part of its rational and secular heritage.

Seclusion is a tool used by psychiatrists primarily to manage aggressive and disturbed behaviour that is presumed to be due to the patient's mental disorder. In most parts of the world there are guidelines to using seclusion that are designed to maximise a patient's freedoms and protect their liberty while providing a safe environment. Arguments against the use of seclusion revolve around the deprivation of liberty, the potential for misuse and the concept of seclusion as a form of social control, and patients generally report seclusion as a negative, coercive experience. There is little evidence that seclusion provides long-term benefits in terms of treating symptoms or reducing aggression, although the literature is mixed in this regard. Expert opinion recommends a combination of national policy, ward management and patient-centred interventions to reduce seclusion rates.

Adjustment disorder has been included in psychiatric classifications for over 40 years but has received little attention from the research community. It is particularly common in consultation liaison psychiatry. Evaluation is problematic since it may be mistaken for major depression, generalised anxiety or non-pathological reactions to stress. Its measurement by structured interview is difficult since it is not included in many instruments and, in others, cannot be diagnosed once the threshold for another disorder is reached. There are few evidence-based treatments and it is possible that these transient reactions may not require any formal intervention. Adjustment disorder generally carries an excellent prognosis but in some individuals is associated with self-harm and suicide.

Psychiatric assessment in the community is an important part of both the initial assessment process and delivery of follow-up care in adult intellectual disability services in the UK. This article examines how such assessments can be carried out safely and explores the clinical skills required to perform them effectively. Use of the psychiatric interview and mental state examination to elicit information is discussed. Communication difficulties experienced by people with intellectual disabilities and strategies that may be employed to address these in the assessment process are also explored. The article is directed at psychiatrists, in particular specialty trainees, and other healthcare professionals who work with intellectually disabled people.

The death of a patient by suicide can severely affect mental health professionals, particularly if it occurs despite major efforts to intervene. Notwithstanding the difficulties faced by clinicians, suicide prevention remains of paramount importance in order to help save lives. This article seeks to promote a pragmatic and compassionate biopsychosocial response using evidence-based interventions to reduce suicide. It introduces practical strategies that psychiatrists can use in everyday clinical practice, in particular the paradigm shift of suicide mitigation to help prevent suicide. We believe that every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life. We believe that it is no longer acceptable for clinicians to state that if patients wish to kill themselves they can do so, in the absence of any attempt at a compassionate intervention.

Gamblers Anonymous (GA) is perhaps the least used of the twelve-step approaches to dealing with addictions. This relative lack of visibility and use, at least in the UK, is reflected in healthcare professionals' lack of awareness and knowledge of gambling addiction and its treatment, including GA. In this article, we introduce the basic tenets of GA and discuss how these translate into treatment.

The Department of Health's best practice guidelines on risk management and violence prevention in UK mental health services highlight the importance of transparency and collaboration with service users. The recovery philosophy echoes the importance of service user inclusion and empowerment in treatment. Our experience in a medium and low secure hospital was that patients were largely excluded from the risk assessment process. In this article, we describe a model for achieving inclusion and transparency in the use of risk assessment tools based on structured professional judgement.

Eating disorders encompass physical, psychological and social pathologies that increase health risk. Anorexia nervosa has the highest mortality of any psychiatric disorder, but patients are not always managed by specialist eating disorders services and the duty of care sometimes falls to the general psychiatrist. This article is an aide-memoire for assessing and managing physical risk in patients with anorexia nervosa.

Risk assessment and management is an integral part of modern clinical practice. In this article we discuss best practice in the assessment and management of risk of harm to others. Unstructured clinical judgement methods have been used for many years, but it is only more recently that actuarial and structured clinical judgement methods have been introduced. These methods are discussed and compared. We describe a process that could be followed by a clinical team and give an illustrative case example. Last, we reflect on aspects of current practice and consider the possible direction of developments in the field.

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

Healthcare professionals require an understanding of how the behaviour and characteristics of both patients and assessors can affect suicide risk identification and response. This article reviews the literature on how we currently assess suicide risk and considers the need for a paradigm shift in how healthcare professionals engage with and assess suicidal patients. It also reviews some of the evidence base for interventions to mitigate the risk of suicide and promotes pragmatic and compassionate interventions.

The General Medical Council suggests that leadership skills are a core requirement for all doctors. The NHS Institute for Innovation and Improvement goes further, stating that doctors have not only an intrinsic leadership role but also a responsibility to contribute to the effective running of healthcare organisations. The Medical Leadership Competency Framework (MLCF) outlines a structure with domains, elements and competency outcomes, all of which are clearly spelled out with examples and methods of learning for different stages of a medical career. The revised curriculum for postgraduate training in psychiatry contains many aspects of the MLCF, both complementing and supplementing its emphasis on the development of personal qualities and skills. This article highlights this approach and describes how the development of leadership and management skills fits with the current structures for training in psychiatry.