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.

This article reviews the current literature regarding treatments for smokingcessation in both the general population and in those with mental healthproblems. The gold-standard treatment for the general population ispharmacotherapy (nicotine replacement therapy, bupropion or varenicline)coupled with individual or group psychological support. This is alsoeffective in helping people with mental illness to reduce or quit smoking,but care must be taken to avoid adverse medication interactions and tomonitor antipsychotic medication in particular as cigarette consumptionreduces.

This article explores the uses of the terms social exclusion and social inclusion in a mental health context. We briefly describe the origins of the term social exclusion and analyse its connotations in relation to four key dimensions: the relative, multifactorial, dynamic and transactional. We discuss Levitas's three discourses concerning social exclusion (the redistributionist, moral underclass and social integrationist) and present a case in favour of a fourth perspective, societal oppression. Focusing on social inclusion as a remedy for the ills of social exclusion, we discuss implications for contemporary mental health policy, practice and research. We highlight the potential contribution of social psychology to social inclusion theory. We conclude that a better theoretical understanding of causal mechanisms is needed to enable the development of more socially inclusive mental health services.

Recent technological advancements have been used to help people with dementia remain independent. These are reviewed and case vignettes are used to explain their use in common scenarios. The ethical perspective and current evidence are explored in the context of telecare use.

The Human Rights Act 1998 was introduced into UK law in 2000. It must be considered in all clinical cases, including mental health review tribunals. The number of mental health cases brought to the European Court of Human Rights that breach Article 3 has been very few. However, Article 3 will need to be considered in the clinical setting in complaints arising from conditions of detention, seclusion, control and restraint. This article analyses the case law, illustrating its evolution and also demonstrating the fundamental and core concepts that underpin the Act that can be used in clinical practice.

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.

This article outlines the majority of the adverse physical effects that have been described secondary to the consumption of alcohol at levels above recommended sensible limits. These conditions are cited according to the organ system they belong to. Only brief descriptions are provided because of the vastness of this topic. The underlying pathophysiology of tolerance and withdrawal is touched upon as this is of relevance to the psychiatrist. Definitions of the terms used describing alcohol misuse, and sensible upper limits of alcohol consumption are also mentioned.

Smoking is the largest single cause of preventable illness in the UK. Thosewith mental health problems smoke significantly more and are therefore atgreater risk. The new Health Act (2006) will require mental healthfacilities in England to be completely smoke-free by 1st July 2008. Thisarticle reviews the current literature regarding how smoking affects boththe physical and mental well-being of people with mental health problems. Italso considers the effects of smoke-free policy in mental healthsettings.

A good medical history is an essential starting point in ensuring that thephysical health needs of people with severe mental illness are addressed.Psychiatrists have an important role in helping to tackle the general illhealth, excess of undiagnosed physical illness and reduced survival ratesamong their patients. To do this they need to use their medical training,communication skills and regular contact with patients. Assessments shouldinclude family history, past and current physical health, medication,lifestyle, healthcare and physical symptoms. Some groups of patients willneed more detailed assessments.

A growing body of evidence suggests that late-onset depression (depression occurring for the first time in later life) differs from early-onset (recurrent) depression in terms of clinical features, aetiology, neuroanatomical substrates and prognosis. Some evidence suggests that late-onset depression is more associated with somatic symptoms, cognitive deficits, cerebral structural abnormalities, vascular disease (‘vascular depression’) and poorer treatment outcomes than is early-onset depression. Both general adult and old age psychiatrists face the challenges of managing late-onset depression. In this article we attempt to clarify specific issues relating to late-onset depression in terms of clinical features, aetiology, treatment response and prognosis.

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.

Intellectual and other more specific neurocognitive impairments inschizophrenia are important for understanding the aetiology of the conditionand its likely outcome. However, these impairments are not usuallyconsidered important for supporting a diagnosis in suspected earlyschizophrenia. IQ testing is widely available and probably acceptable tomost people likely to be experiencing the early stages of psychosis and whomight be unable or unwilling to disclose details of their history and mentalstate or to cooperate with more comprehensive neuropsychological assessment.Although in general IQ tests have only limited diagnostic value inschizophrenia, the finding of a substantial decline in IQ score from theestimated premorbid level may be helpful in supporting a provisionaldiagnosis of early schizophrenia in cases without organic signs in which theclinical picture is unclear or incomplete. More important, the results of IQtests may contribute to a better understanding of patients' impairments andassist clinical management in a number of ways, as illustrated here by threefictional case studies.