Although recent cases of egregious boundary violations in professional relationships in the UK have led to a concerted and robust government response, the issue of doctors having relationships with former patients is relatively sparsely talked about. Publications by the General Medical Council and the Department of Health deal with this tricky and often contentious matter in some depth. This article discusses the abuse of professional relationships and examines the ethics, law and advances in understanding in the area of doctors' relationships with former patients.

This article asks whether it is ever acceptable for a psychiatrist to form an intimate relationship with a former patient. It explores the tensions that arise between the freedom of autonomous adults, the need to protect vulnerable individuals, and the public interest in maintaining trust in the doctor–patient relationship. It argues that although a complete ban on all sexual relationships between doctors and former patients would be excessively restrictive, a special case can be made for relationships with former psychiatric patients. The particular vulnerability of psychiatric patients, and the resulting need to ensure the highest standards of trust in the profession, strengthen the case for a complete ban.

Sequenced (stepped) treatment approaches are widely endorsed in the management of depression. Combining antidepressants is a recognised step for those failing to respond to monotherapy. Despite the limited evidence base, this strategy is widely used by clinicians in practice. Not every combination used clinically has a sound neuropharmacological rationale and the use of such combinations may increase the side-effect burden without any additional advantage to the patient. Efficacy of various antidepressant combinations along with the data on side-effect profile and toxicity of such combined treatments are reviewed here. The different combinations are considered by each class of antidepressant available in the UK.

The psychiatric problems of combat returnees are a topical and important issue given the ongoing conflicts in Iraq and Afghanistan. Despite the media prominence afforded to post-traumatic stress disorder, the most common disorders in the UK armed forces post-deployment are depression, alcohol misuse and anxiety disorders. Although the majority of service personnel do well after leaving military life, a minority who leave with psychiatric problems appear to be at risk of social exclusion and ongoing ill health. Reserve veterans are at greater risk as they do not have access to the usual support networks of the regular military. Steps to improve the knowledge and expertise of primary care services about veterans' mental health issues and increasing the availability of treatment options are important and are underway.

Depression is an illness that kills. The links between depression and medical illness are well established and bi-directional, but evidence is mounting that depression increases mortality as well as morbidity in adults, particularly older adults. We examine the evidence that the increase in mortality in depression applies to all-cause mortality as well as cardiac mortality, and describe plausible physiological theories for the association. We conclude that excess mortality arising from depression is a major public health problem that is largely unrecognised and needs to be addressed by a range of clinicians.

Assessment is key to the educational process and plays a significant role in looking at the progress trainees make as a result of training and personal development. Recent developments in curricula have led to substantial changes in assessing progress and attainment throughout postgraduate medical education in the UK. This article outlines the framework used to develop the postgraduate curriculum in psychiatry and describes the nature and purpose of the assessment programme that forms part of this new curriculum. The article considers the principles of medical education that are essential for the success of assessments, not only centrally in the development of the assessment system, but also locally in the delivery of these assessments. The overall context of developments in medical education, as well as the relationship between workplace-based assessments (WPBAs) and formal examinations, are described with specific references to developments in psychiatric training, its curriculum and assessments.

Feedback is an essential part of the learning process. Feedback can be positive or negative, constructive or destructive, minimal or in depth. It must always occur and should never be ignored. The role of effective feedback is critical in the modern postgraduate medical educational process in the UK, with its emphasis on competency-based curricula and workplace-based assessment. Feedback is not new in medical education and has been shown in research to be effective in bringing about change, particularly improvement in clinical performance. There are clear principles and features of good and bad feedback and these are highlighted, along with descriptions of models for use in daily practice.

Binge eating occurs across the entire range of eating disorders. It is required for a diagnosis of bulimia nervosa but it is also seen in some cases of anorexia nervosa and in many cases of eating disorder not otherwise specified (usually referred to as eating disorder NOS or atypical eating disorder). This article focuses on the management of those eating disorders in which binge eating is a prominent feature.

This article is based on the idea that paintings carry much of their cultural power by being ways of embodying states of mind in physical material. It follows that the understanding we have of how people infer mental states in others can also be used to address how we respond to visual art: our facility for inferring mental states can help us understand paintings. In pursuing this argument, I discuss first how artists make meaning in paintings by a process that embodies mental states within a formal structure. Second, I support the notion of a link between the formal structure of art and mental states with evidence from my studies of children's drawings. Third, by analogy with the way we relate to another person's mental states, I look in more detail at the process by which we ‘read’ a painting and in consequence develop an aesthetic relationship to it.

This article discusses a cognitive–behavioural therapy (CBT) approach to the treatment of medically unexplained symptoms that is based on the ‘five areas’ model of CBT. We describe a typical course of therapy and some of the common problems encountered during treatment. Emphasis is placed on the practical management of these conditions, and the focus is on symptoms as opposed to cause. We believe that this approach is widely applicable and could be used in a large range of settings to tackle these debilitating conditions. In writing this article we intended to provide an overview of patients with medically unexplained symptoms. The article would be of interest to staff within liaison psychiatry departments looking to set up a medically unexplained symptoms service and general psychiatry teams who may have contact with patients presenting with somatic symptoms. Psychiatric teams without access to a liaison department may also find this article interesting.

The focus of this article is the assessment and management of medically unexplained (‘psychogenic’) amnesia, which we classify here as global or situation specific. Other psychiatric causes for memory disorder and neurological conditions that could cause diagnostic confusion are briefly reviewed, as are forensic aspects of memory complaints. Finally, brain and physiological mechanisms potentially associated with psychogenic amnesia are discussed.