The recovery approach is much in vogue, initiated by the user movement andembraced by politicians. Users and politicians have a variety of opinionsabout how it fits with professional psychiatric practice – some viewrecovery and professional practice as compatible, others view them asmutually exclusive, naming professional practice the ‘medical model’. Thiseditorial explores the relationship between the medical model and therecovery approach. We argue that both have multiple points of similarity,and that applying the medical model to the recovery approach has thepotential to significantly influence psychiatric practice.

In this issue of APT Mountain & Shah seek to reconcilethe currently fashionable ‘recovery’ paradigm of mental healthcare with thedistinctly unfashionable ‘medical model’ of psychiatric practice. I arguethat their article raises more questions than it answers – not least whetherthe recovery concept is amenable to empirical analysis.

Depression is increasingly recognised as a major public health problemworldwide. The heterogeneity of this condition implies that there may beseveral neurobiological pathways to depression. This article attempts toexplore a pathway that links depression with the inflammatory response.Associations linking inflammation and chronic immune activation withdepression have been noted, particularly in the context of (a) medicaldisorders with inflammatory pathophysiology and (b) immunotherapy for cancerand hepatitis C. Acute coronary syndrome is given as an example of how theinflammatory process might result in depression, and potential mechanismsare discussed. These include: direct action of pro-inflammatory cytokines onthe serotonin system, with specific reference to the serotonin transporter;action of cytokines on the hypothalamic–pituitary–adrenal axis; and effectsof pro-inflammatory cytokines on neurogenesis in the hippocampus. Referenceis made to the potential anti-inflammatory effects of antidepressant drugsand antidepressant effects of anti-inflammatory treatments.

Men are a numerical minority group receiving a diagnosis of, and treatmentfor, depression. However, community surveys of men and of their mentalhealth issues (e.g. suicide and alcoholism) have led some to suggest thatmany more men have depression than are currently seen in healthcareservices. This article explores current approaches to men and depression,which draw on theories of sex differences, gender roles and hegemonicmasculinity. The sex differences approach has the potential to providediagnostic tools for (male) depression; gender role theory could be used toredesign health services so that they target individuals who have amasculine, problem-focused coping style; and hegemonic masculinityhighlights how gender is enacted through depression and that men'sdepression may be visible in abusive, aggressive and violent practices.Depression in men is receiving growing recognition, and recent policychanges in the UK may mean that health services are obliged to incorporateservices that meet the needs of men with depression.

Do men comprise a minority group whose distress would be better understoodby positing a new ‘male depressive syndrome’? Or have gender differencesbeen overemphasised for political reasons that are clinically unhelpful? Anunedifying list of mistaken categories of depression advocates caution.

He could not die when trees were green,
For he loved the time too well.
His little hands, when flowers were seen,
Were held for the bluebell,
As he was carried o'er the green.

The Disability Discrimination Act, passed by Parliament in 1995 and amendedin 2001 and 2005, covers people in Britain with physical or mentalimpairments that have a substantial and long-term adverse effect on theirability to carry out normal day-to-day activities. The Act has beenimportant in setting a framework for good practice and it can stimulate moresystemic change through formal investigations of organisations or wholesectors, and through the Disability Equality Duty, in force since December2006. The Disability Discrimination Act has implications for people workingin mental health services when they are considering employment andeducational opportunities for service users, and when they are consideringhow to redress systemic disadvantage, including inequalities in physicalhealth.

In 1951 Asher described chronic factitious disorder characterised bydramatic presentations, histories and recurrent admissions. Asher initiallydescribed three types of presentation – acute abdominal (laparotamophilia migrans), haemorrhagic (haemorrhagia histrionica) and neurological (neuropathica diabolica). Factitious disorder is nowincluded in both DSM–IV and ICD–10. Numerous case reports exist but theevidence base for effective management strategies remains relatively sparse.It is an uncommon disorder most often encountered in liaison psychiatry thatremains difficult to manage and characteristically stimulates strongcountertransference reactions in the teams involved. Psychiatric involvementremains vital in such cases although poor engagement is often a significantobstruction. As an illustration, we present a vignette based on case of apreviously unreported variant of the neurological category involvingGuillain-Barré syndrome.

This commentary questions whether the usual ethical and legal requirementsfor maintaining confidentiality of individuals who fabricate illness shouldbe breached in order to prevent further harm to themselves as well as costto society. A case report of an individual with Munchausen's syndromesubmitted for publication in Advances in Psychiatric Treatment provoked considerable Editorial discussion regardingthe absence of written informed consent from the individual described. It ishoped that this commentary will widen the debate regarding the requirementfor confidentiality in the exceptional circumstances of patients withMunchausen's syndrome.

Multicultural societies offer a significant challenge to mental healthservices. Different groups have different rates of illness, illness models,ideas of what a suitable pathway of care is and what suitable care lookslike. Trying to set up services to meet all these needs can be difficult.There may need to be modifications in clinical practice, serviceconfiguration and the way services are commissioned. Ethnic minoritycommunities face complex problems and, consequently, strategies to deal withthem can be complex, requiring support from the non-statutory sector, socialservices and other branches of medicine. Service development often needsresearch, staff training, race-equality schemes and sufficient funding tomake change possible. I offer here a scheme for considering how to thinkthrough service development in this area as well as introducing thegovernment strategy, Delivering Race Equality.

The management of delirium requires careful consideration of the potentialvalue both of pharmacological interventions and of a range of non-drugstrategies. Although placebo-controlled studies of delirium treatment arelacking, less robust evidence can still inform practice. This review makesthe case for more active management of delirium on the basis of recentstudies of prevention, early identification and treatment both during anepisode and managing the aftermath in survivors. A drug-treatment algorithmfor delirium advising how drug treatments can be tailored to the specificneeds of individual patients is described.

A significant proportion of people live and work in rural areas, and ruralmental health is important wherever psychiatry is practised. There areinherent difficulties in conducting rural research, due in part to the lackof an agreed definition of rurality. Mental health is probably better inrural areas, with the exception of suicide, which remains highest in malerural residents. A number of aspects of rural life (such as the ruralcommunity, social networks, problems with access, and social exclusion) mayall have particular implications for people with mental health problems.Further issues such as the effect of rural culture on help-seeking formental illness, anonymity in small rural communities and stigma may furtheraffect the recognition, treatment and maintenance of mental health problemsfor people in rural areas. Providing mental health services to remote andrural locations may be challenging.

There is a field of knowledge that speaks of the promotion of positivemental health, well-being and happiness yet it may not be well-known to allpsychiatric practitioners. Economists, geneticists, positive psychologists,evolutionary psychologists, neuroscientists and sociocultural researchershave all contributed to what might be termed the emerging science ofwell-being. This article provides a brief introduction to this complextopic. We outline some of the findings, theories and arguments from thiscomparatively new but burgeoning research area. We also rehearse somecritical responses to this field which indicate that both the evidence onwell-being and the implications for practice and policy might be lessstraightforward than researchers sometimes imply. We conclude by suggestingthat psychiatrists, as leaders in the field of mental health, might want toconsider the implications (positive and negative) of well-being research forthe development of their own discipline and professional practice.