Major depressive disorder in children and adolescents is common and associated with significant morbidity and mortality. This 2012 meta-analysis by Hetrick et al shows statistically significant, but small, improvements in depressive symptom scores and probability of remission with second-generation antidepressants (SGAs) compared with placebo. SGAs lead to a small, but significant, increase in risk of suicidal thoughts/attempts compared with placebo. Patients included in the primary studies had milder depression, less psychiatric comorbidity and less suicidality than those normally seen in clinical practice in the UK's National Health Service. However, primary studies had significant methodological shortcomings. Therefore, caution is needed when trying to generalise results to clinical practice.

Taking risks is a fundamental part of the human experience that supports personal growth. Therapeutic risk-taking enables patients to make decisions about their level of safety and to pursue goals. Promoting therapeutic risk-taking can be complex. Professionals can experience tension striving for a balance between the interests of the individual and societal pressures to control risk. This article examines therapeutic risk-taking, recognising the challenges to supporting it in practice and debating how they may be overcome.

Deafness is a common and varied medical, social and psychological construct that affects a significant proportion of the population. Restricted communication and uninformed attitudes have adverse effects on the physical and mental health of deaf people. Clinicians need to know how to recognise and resolve these difficulties.

Clinical formulation was introduced in its present form a little over 30 years ago and is, in essence, a concise summary of the origins and nature of a person's problems, together with opinion on what may go wrong in the future and what steps should be taken to improve matters. In our article we discuss how, in recent times, the task of preparing a clinical formulation has rightly become a multidisciplinary exercise involving the whole clinical team and, even more important, that nowadays the patient – the subject of the clinical formulation – together with their carers should also be actively involved in the process and feel some ownership of the conclusions and decisions. In addition, we compare these developments in clinical formulation with similar developments, arising for the same reasons, in clinical teaching and education.

Bipolar disorder is a common mental disorder that can be challenging to diagnose. This brief article outlines how bipolar disorder is diagnosed and how it can be distinguished from other disorders with similar phenotypes.

Explanatory models of illness – the way people perceive, interpret and respond to it – are mediated not only by the illness itself, but also by cultural and social contexts. This article discusses recent evidence showing how the exploration of explanatory models can help to shape treatment and outcomes for some of the most common categories of mental illness, and presents case studies illustrating dilemmas clinicians face when their explanatory models differ from those of their patients. It concludes with recommendations on how a culturally sensitive clinical approach based on the exploration of explanatory models during assessment and treatment can be used as an effective way of dealing with the complexity of patients' and families' needs.

In this second part of a two-article review on malingering we consider the challenges of presenting clinical and psychometric findings. Numerous clinical and demographic factors are statistically associated with malingering but applying them to an individual case risks challenges to the expert psychiatric witness's evidence. Although psychometric data can usefully help strengthen or challenge a diagnosis, expert witnesses must recognise and report the limitations of these tests. We recommend that psychiatric expert witnesses do not try to look for or to link any external incentives with clinical findings, and indeed we suggest that they should, other than exceptionally, avoid using the term ‘malingering’. It is the job of the court, not the expert witness, to ascertain an individual's credibility and motives. We suggest a framework for presenting expert psychiatric evidence in this area.

Health Education England's 2014 report Broadening the Foundation Programme has led to a rapid increase in the number of psychiatry placements for foundation doctors. This will have implications for existing psychiatrists in that they will start to teach, train and supervise foundation doctors. This article outlines how to develop high-quality foundation posts and how to support doctors in meeting the foundation curriculum competencies, which include experience of working in multidisciplinary teams and developing communication skills. The knowledge and skills gained in psychiatry placements will be valuable to all doctors, no matter what their future career intentions.

Psychiatrists have a role in teaching all medical undergraduates and foundation year doctors generic skills to become good doctors, but they also have to appeal to and nurture the interests of future psychiatrists by maintaining core psychiatric skills/knowledge in their teaching. They must tackle poor recruitment to psychiatry and stigma against both the profession and its patients. Medical students and junior doctors tend to be strategic learners, motivated by passing assessments, and psychiatrists are often guilty of gearing their teaching only to this. This article explores the assessment process itself and ways to optimise it, and presents a case for going beyond teaching how to pass exams in order to address wider issues relating to psychiatry.