About 85% of women experience some type of postpartum mood disturbance. Generally, the symptoms are mild and short-lived, but a minority of women develop depressive illness or sudden psychosis. About half of episodes of apparently postnatal depression start during pregnancy and some seemingly postpartum psychoses start before delivery. Untreated antenatal depression can lead to poor obstetric outcomes, subsequent depression in the mother, and developmental disadvantage and depression later in life in the offspring. In this article we discuss the aetiology of perinatal depression and consider recommended pharmaceutical and psychosocial management of postpartum blues, perinatal depression and postpartum psychosis.

I review some of the evidence that parental personality disorder represents a risk to child development, in terms of both transmission of genetic vulnerability and the environmental stress of living with a parent who has a personality disorder that negatively affects their parenting capacities. I argue that there are two compelling reasons to impose a duty on mental healthcare providers to offer services for adults with personality disorders that specifically focus on their parenting identity: first, because effective therapies for personality disorder are now available; and second, because there is a strong utilitarian and economic argument for improving parental mental health so as to reduce the economic and psychological burden of their offsprings' future psychiatric morbidity.

Mindfulness is a meditation practice defined as a specific way of paying attention. It has been adapted from Buddhist traditions to Western secular use (e.g. in stress reduction, health promotion, treatment of psychological disorders). Despite its widespread application in adult populations, mindfulness remains a neglected topic in the psychological interventions designed for children and adolescents with psychological disorders and/or chronic physical conditions. In paediatric settings, a parent-child perspective may be useful in facilitating processes of adaptation and in improving paediatric outcomes. However, the delivery of mindfulness interventions in paediatric settings raises a number of issues and challenges, which include the developmental appropriateness of mindfulness exercises, the introduction of a parent-child perspective, and specific considerations to condition, treatment and caregiving.

In recent decades there has been much interest in using cognitive–behavioural therapy (CBT) with children, young people and families. CBT is a collaborative approach, based on shared building of a hypothesis (the formulation) about causative and maintaining factors. When working with children, young people, their families and wider systems (e.g. a support network), therapy should incorporate interpersonal, family and systemic factors, together with developmental and attachment issues and phenomena more commonly expressed through other psychotherapeutic modalities. There is growing clinical experience that systemic cognitive–behavioural formulation can lead to systemic-process working on an individual, parent–child, family or wider-system basis. Formal evaluation of this approach is needed to consider where it fits among established psychotherapies in mental health work with young people and their families.

Confidentiality in child and adolescent mental health is a complex and often challenging matter. Not only do young people frequently present to services in situations of risk, they often prefer to keep information confidential from parents and/or other professionals. This article explores confidentiality in the context of child and adolescent mental health services (CAMHS), particularly when the clinician is having to make decisions on whether to maintain or to breach it. Ethical principles (both deontological and consequentialist) and legal and regulatory frameworks (relating to human rights, case law and General Medical Council guidance) are outlined. Four hypothetical case scenarios are used to illustrate how to apply such principles: when a young person seeks confidential access to treatment, and when he or she discloses information that could signify a risk to self, to others or from others. Finally, practical suggestions on how to share information are explored.

The traditional disease model, still dominant in psychiatry, is less than ideal for making sense of psychological issues such as the effects of early childhood experiences on development. We argue that a model based on evolutionary thinking can deepen understanding and aid clinical practice by showing how behaviours, bodily responses and psychological beliefs tend to develop for ‘adaptive’ reasons, even when these ways of being might on first appearance seem pathological. Such understanding has implications for treatment. It also challenges the genetic determinist model, by showing that developmental pathways have evolved to be responsive to the physical and social environment in which the individual matures. Thought can now be given to how biological or psychological treatments – and changing a child's environment – can foster well-being. Evolutionary thinking has major implications for how we think about psychopathology and for targeting the optimum sites, levels and timings for interventions.

This article outlines the rationale for dedicated specialist services for high-risk young people about whom there may be family or professional concerns in relation to mental disorder. It provides an overview of the development and remit of such services and emphasises the need for them to form part of overall service provision for children and young people.

The risks and benefits of psychopharmacological treatment in pregnancy need careful consideration. Conventional antipsychotics and tricyclic antidepressants are relatively safe for the foetus. Selective serotonin reuptake inhibitors appear to be safe, but mood stabilisers such as lithium, sodium valproate and carbamazepine are associated with increased foetal malformations. Benzodiazepines in the first trimester are teratogenic, and in high dosage can also cause withdrawal symptoms, hypotonia and agitation in the newborn. Women taking atypical antipsychotics should be switched to conventional antipsychotics before they conceive. In women with long-term mental illness necessitating psychotropic medication, effort should be made to stop polypharmacy and non-essential medication (e.g. benzodiazepines) and to decrease the dose of essential drugs, after full assessment. There is rarely a valid reason to stop essential drug treatment during pregnancy.

This article gives a general overview of the current situation in relation to a range of widely recognised and also newly identified types of child maltreatment. The academic and clinical evidence relating to the impact of child maltreatment on the mental and physical health of child victims is substantial and steadily increasing in volume. New types of abuse are being identified, and changing environmental circumstances, which exacerbate the possibility of widely recognised types of child maltreatment occurring, are also being described. These include multi-type maltreatment, female genital mutilation and online child maltreatment. Serious questions may arise regarding neglect of the moral and social development of children and young people who become addicted to online gaming and pornography. Multiple national and local definitions of each of these existing and new forms of maltreatment have been created, some of which are covered here. The impact of these abuses on the physical and mental health and development of child victims in families or settings where abuse or neglect has occurred is discussed.

Schizophrenia is a devastating chronic disorder that typically presents in early adult life and impacts on a broad swathe of social and psychological functioning. It is not surprising that psychiatrists have tended to be circumspect about making this ominous diagnosis in children and adolescents. Genuine concerns about the validity of applying ‘adult’ psychotic diagnoses in this young age group, together with the lack of diagnosis-specific interventions, have suggested a cautious approach to diagnosis. Furthermore, the relative rarity of schizophrenia in this age group has meant that most psychiatrists have relatively little experience with ‘atypical’ early presentation of the disorder.

Women patients suffer from a range of mental disorders similar to those that men may experience. However, there are some striking differences in the prevalence of specific disorders, and in their presentation and management. Some mental illnesses only occur in women. It seems that women patients may have a different experience of treatment, a consequence of differences in their needs and also of the way that health professionals perceive those needs. These differences are embedded in the wider cultural milieu in which we live. There are particular issues for women patients in relation to, for example, childhood sexual abuse, rape and domestic violence. At present, tools to measure needs of individual patients are generally not gender specific.

Avoidant/restrictive food intake disorder (ARFID) was a new diagnosis in DSM-5 and is due to be included in ICD-11. However, confidence in making the diagnosis seems to be low among clinicians. Furthermore, there is no national consensus on care pathways for ARFID and therefore patients tend to be managed across core child and adolescent mental health services, specialist eating disorder services and paediatric services. If not adequately treated, ARFID can result in stunted growth, nutritional deficiency and impaired psychosocial functioning. Research and guidelines for managing this disorder are scarce, owing to low rates of diagnosis. This article aims to improve clinician confidence in the use of ARFID as a diagnosis and explores current consensus on treatment approaches, in order to progress future service planning for this complex and diverse patient group.

Dissociation is a common and often overlooked symptom in traumatised children. Although there is a lack of a scientific consensus as to the nature of dissociation and very limited research about dissociative identity disorder (DID) in children, the authors have seen children given this diagnosis recently referred to their clinic and are concerned about this practice and the parenting approaches that have ensued. The diagnosis of DID in children may be rare or of doubtful validity, but repeated traumatic experiences of an interpersonal nature can have a profound effect on a child's identity, memory and self-organisation. Furthermore, abuse and neglect can increase the risk of dissociative symptoms. This brief article considers dissociation in post-traumatic stress disorder, then outlines developmental factors hypothesised to be associated with dissociation in childhood and early adulthood. It warns that clinicians should keep an open mind about how dissociation may manifest transdiagnostically, and concludes with recommendations for further research.

In this article three main issues are addressed using anecdotal and anonymised illustrations of situations in which the author has been engaged, during 35 years of medico-legal practice, to assist in the process of obtaining and analysing the evidence of children to facilitate decision-making by various authorities and tribunals. Those issues are: the competence of a child to be a witness in the Crown Court; the process by which a child's evidence has been elicited; and the use of an analytical approach to the content (verbal, behavioural and emotional) of a child's evidence as an aid to jurists who have the task of reaching a decision as to the child's reliability, as distinct from their competence.

Disordered sleep has long been recognised as both a consequence of psychiatric illness and a contributory factor to its development. Significant sleep disturbance occurs in about 25% of children and adolescents and 80% or more of children in high-risk groups; it often continues into adulthood. All psychiatrists should therefore be familiar with the principles of sleep medicine and the impact of sleep and its disorders. In this article, the relationship between sleep disorders and the breadth of child and adolescent psychiatry in particular is explored. The classification, aetiology and implications of sleep disorders are discussed, as well as the practicalities of screening, diagnosis and management, with a view to informing readers how accurate diagnosis, prevention and successful treatment of sleep disorders can benefit patients and their families.

Children with either normal or impaired cognitive abilities presenting to child and adolescent mental health services (CAMHS) with psychiatric or behavioural problems may have an underlying syndromic or neurological diagnosis. Diagnostic clues exist in the measurement of growth and head circumference, recognition of dysmorphism and in the full physical and, in particular, neurological examination of the individual. Recognition of these clues will allow referral, as necessary, for further investigation or surveillance. Prompt diagnosis of disorders is important for many reasons: the provision of an explanation for the child's current difficulties and the anticipation of further difficulties; the recognition of genetic, and therefore reproductive, implications for parents and siblings; the recognition of a grim prognosis; and access to any available treatments.

Domestic violence is a major public health problem because it is common and associated with physical and mental health morbidity. It is more common in psychiatric patients but is underdetected by mental health professionals. Routine enquiry increases detection but needs to be introduced in the context of comprehensive training, and only where referral and care pathways have been developed. High-risk patients should be referred to multi-agency risk assessment conferences for multidisciplinary assessment and safe management.

Family therapy is recommended by the National Institute for Health and Care Excellence (NICE) for the management of anorexia nervosa in children and young people, but there is limited evidence to back this recommendation. The Cochrane Review under consideration evaluates the efficacy of different family therapy approaches compared with other treatments for anorexia nervosa, and this commentary puts the findings into clinical perspective.

Most children and young people who have a parent with mental illness will not think of themselves as carers. They may think of themselves as surviving, as lonely and isolated, and of suffering all the common experiences listed in this article. Many parents with mental illness will not acknowledge that their child has become their carer rather than the converse. So many children and young people may be left vulnerable to sometimes extremely damaging and distressing situations but without a role that recognises their contribution or even commands appropriate respect. There is a danger that simply defining these children and young people as ‘young carers’ may provide a cloak of acceptability for allowing quite intolerable demands to be made on them. However, young carers do have some level of support in the UK in the form of young carers' groups. So, with the above provisos, that is the focus of this article.