This article reviews the putative role of emotion dysregulation in diverse clinical presentations and considers some of its aetiological factors, such as insecure attachments in early life and traumatic experiences in later life. The neurobiology of emotional processes is described in relation to the ‘window of tolerance’ model of arousal levels optimal for information processing. Treatment options are considered and ways to regulate distress, derived from different approaches, are summarised in a ‘toolbox’. Fictitious case vignettes illustrate clinical applications.

The role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this article considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.

The evidence, which is summarised in this editorial, shows that the circumstances in which people are born, grow, live, work and age are powerful determinants of health and of the unfair distribution of health – health inequity. Discrimination against people with mental illness shows how the relation can go the other way: for example, when people with mental ill health cannot get back into work.

An initial psychiatric assessment of elderly people at home is an important component of many old age psychiatry services. This article explores the clinical aspects of conducting such assessments and the skills required in addition to those brought to a standard psychiatric interview. Safety considerations and risk management when conducting home assessments are also discussed.

There is now extensive evidence that different types of psychological therapy are effective for various psychiatric disorders, both in terms of symptom reduction and in improving the patient's capacity to function adaptively. In two articles, we set out some current ideas of how psychological therapies might ‘work’, drawing on neurobiological studies of brain plasticity and therapeutic efficacy. In this first article, we review the evidence that disorders of self-experience are common to many psychiatric disorders, and that psychological therapies ‘work’ on those disorders. The second article will appear in the next issue of Advances.

The lack of a medically grounded approach to personality disorder and its management has led to its comparative neglect as a topic by many clinicians in the UK. In this article we present evidence that personality disorders are, like other mental disorders, the social manifestations of a pathological process. This process presents with characteristic clinical features that are developmental in nature. These cause disturbances in arousal, affect and reality testing that have an impact on interpersonal social functioning. Personality disorder may therefore be conceived of primarily as a socioemotional disability, not dissimilar to Axis I conditions.

Benzodiazepines still play an important role in the management of anxiety disorders but dependence is associated with their therapeutic use. The key to effective and safe long-term use of benzodiazepines is: the careful selection of patients who might benefit from them; administration in clinical situations in which they are more likely to be beneficial; use of lower doses and in conjunction with an antidepressant, if possible; monitoring and managing their side-effects; and minimising the risk of withdrawal symptoms and relapse, mainly through tapering the dose and/or combining with effective psychological interventions.

A number of pragmatic trials have cast doubt on the concept of ‘atypicality’ in relation to antipsychotic drugs, and some commentators have argued that the dichotomy between ‘typical’ (‘first-generation’) and ‘atypical’ ('second-generation’) compounds is artificial and should be abandoned, leaving the entire class of antipsychotics available for consideration in more individualised treatment planning. However, younger psychiatrists now gain little or no experience in the use of older antipsychotics. This is the first of two articles addressing practical issues for consideration in prescribing the older antipsychotics available in the UK. It covers background, including the fundamental clinical action of antipsychotics, the nature of drug licensing and identification of pharmacological parameters that may be of value in prescribing decisions, and discusses the phenothiazines: chlorpromazine, promazine, levomepromazine, pericyazine, perphenazine, trifluoperazine and prochlorperazine.

Charcoal-burning has become a common method of attempted suicide in Asia and survivors are often intoxicated with carbon monoxide (CO). Reports of the neuropsychiatric aspects of CO poisoning date back to 1914. This article outlines the neuropsychiatric sequelae that have been described secondary to CO poisoning. The underlying pathophysiology and management strategies, including acute management and cognitive rehabilitation, are discussed as these topics are of relevance to psychiatrists.

Once a formal diagnosis of gender dysphoria is established and comorbid disorders addressed, it is the role of the gender specialist to facilitate treatment according to agreed goals. This article reviews the treatment of gender dysphoria, including psychotherapy, and how eligibility and readiness for surgery are assessed. It considers issues facing transgender individuals detained in prison or psychiatric hospital, the factors that affect patients' satisfaction with gender reassignment surgery and how the specialist can ensure a satisfactory outcome.

Care and follow-up of patients discharged from medium secure units in England and Wales is uncoordinated and inconsistent, although the perceived risk of violence by people with mental disorders is a primary political issue. This article outlines models of community support for these individuals, and describes a forensic mental health liaison service in operation in England.

Routine outcome measures are essential to chart individual patient progress and evaluate models of service provision. The Health of the Nation Outcome Scales (HoNOS) were commissioned by the Royal College of Psychiatrists as a simple, brief measure for this purpose. It is one of the most widely used outcome measures in mental health services globally and has been translated into at least seven languages. Its use has broadened beyond its original purpose and in several countries collection of HoNOS data is mandatory. We review 585 potential articles to chart the development and evolution of HoNOS, as well as its psychometric properties, qualitative attributes and uses in clinical practice and research. The potential barriers to implementation of HoNOS on a wide scale are considered and its future role in evaluating effectiveness and benchmarking of services are discussed.

Supervision, both managerial and clinical, is integral to all areas of practice in health and social care and arguably constitutes the most important aspect of our work. Through supervision, we demonstrate our own suitability and can offer others support in identifying strategies for improvement. It is surprising that many healthcare organisations either do not have a supervision policy or do little to monitor the effectiveness of the supervisory process. The aim of this brief article is to offer a starting point for thought, discussion and reading to motivate and encourage readers to improve their own supervisory practice as supervisor and supervisee.

This article describes a special adaptation of group psychotherapy as a psychological treatment for people with a variety of gender identity disorders. It can be used as an alternative to or concurrently with hormonal and/or surgical interventions for transgender people. It is also suitable for individuals whose gender identity disorder remains after physical interventions. The article draws from a UK specialist pilot for such a treatment service and describes the explicit aims of the psychotherapy, the specialist adaptation of therapeutic technique required and observed thematic features relevant to working in this specific field.