Pregnancies in women with serious mental illness are high risk and such women are also less likely to engage in the recommended health screening for women of reproductive age. Hence, reproductive health issues are important aspects of physical healthcare that should be assessed in women accessing mental health services. Pregnancy planning and management are crucial in reducing risk of relapse in women with affective disorders, and psychiatrists should acquaint themselves with the screening programmes and reproductive and sexual health services in their area and encourage their patients' uptake of these. Clinicians should be aware of the reproductive impact of medications and the needs of specific groups of women.

In England and Wales diminished responsibility is a partial defence to the charge of murder. If successfully argued by the defence, it reduces the charge from murder to manslaughter and thus avoids the mandatory life sentence. Alcohol has been reported to be a feature in up to 80% of all homicides but for many years the judiciary have set an almost unattainable threshold for the disease of alcoholism to amount to a finding of diminished responsibility, in accordance with other aspects of criminal law. Reform of the law on murder is likely to take many years but it is timely to recap the current law on diminished responsibility and review advances in case law in England and Wales on alcohol.

Testing for illicit drug use is used in pre-employment checks, the criminal justice system, sports medicine and for screening and confirmatory purposes in patients with physical and mental illnesses. The types of drugs tested for and the methods used vary depending on the indication. This article focuses primarily on blood, urine and oral fluids, which are specimens more commonly used in mental health settings, although hair and sweat are increasingly used in medico-legal cases and in child protection issues. The main drugs and their metabolism are discussed to gain a better understanding of the methods used and for accurate interpretation. Methods to ensure validity during sample collection are explored. False-positive and false-negative tests are common and possible confounders are discussed.

The importance of considering antisocial behaviour among people with autism-spectrum disorders is apparent from the significant number of case reports and case series describing criminal behaviour of people with a diagnosis of Asperger syndrome. The evidence so far does not support a specific association between the syndrome and criminal offending. However, a small yet significant number of offenders with autism who engage in illegal behaviour find themselves socially excluded or detained in secure provisions for prolonged periods. This article gives an overview of the scant empirical evidence relating to criminality within the context of Asperger syndrome, and offers suggestions for managing the syndrome in mentally disordered offenders.

The deprivation of liberty safeguards apply to England and Wales. In Scotland, trends and uncertainties in the use of welfare guardianship (the equivalent action under Scottish law) provide a useful comparison. In both jurisdictions, there are risks to the rights of individuals.

Immigration is increasing and government policies are shifting. Clinicians need to be aware of the mental health needs of immigrants and the challenges of delivering appropriate care. In certain circumstances there are potential conflicts between doctors' clinical, ethical and legal responsibilities. Detention of refugees and asylum seekers may have a detrimental effect on mental health and can result in significant psychiatric morbidity. Ongoing management of foreign nationals following hospital treatment may be complicated by the threat of deportation and its implications for the patient's mental health.

Nearly a decade ago, the Department of Health published its strategic development plan for mental healthcare for women. It focused on the ways in which mental health services for women should be configured to take account of the context of women's lives and the complexity of their health needs. This commentary argues that attention to the reproductive and sexual health of women in mental healthcare is at the centre of a gender-sensitive and modern mental health service.

Developmental dyslexia (reading disability) is a specific impairment in learning to read that affects 3–6% of school children in English-speaking countries. It is overrepresented in clinical populations referred to child and adolescent mental health services because of its high comorbidity with conduct disorder, attention-deficit hyperactivity disorder and other developmental disorders. Clinicians may fail to identify it unless they maintain a high degree of awareness and make specific inquiries. A three-stage approach (routine screening, in-depth examination and referral for further testing) is described. The features of dyslexia and the clues to its diagnosis are discussed. A number of simple tests for identifying it are available and familiarity with these should improve diagnostic accuracy. In addition to treating psychiatric comorbidity, the clinician can help the child by working with educational professionals to ensure that educational needs are met. Evidence-based early interventions are available. Later reading interventions improve reading but rarely bring about normalisation.

Mental capacity refers to a person's ability to make decisions, which may include consenting to medical treatment. People are presumed to have this capacity. Individuals may lack capacity because of an impairment or disturbance that affects the way their mind or brain works. Legal frameworks are in place for acting and making decisions on behalf of individuals who lack the mental capacity to do so for themselves, in their best interests. A case illustration is used to outline the principles involved under the Mental Capacity Act 2005 for England and Wales. We describe in detail the assessment of capacity to consent to treatment in this case and good practice in making best interests decisions in everyday clinical practice.

The European Convention on Human Rights and the Human Rights Act 1998 (which enacts most of the Convention rights into UK law) are playing an ever-increasing role in determining the standards of treatment of those detained by the state and hence is of particular importance for those in hospitals, prisons or similar institutions. The European Convention on Human Rights is a ‘living instrument’ such that judgments emanating from the European Court of Human Rights will continually build upon previous jurisprudence and evolve over time. As Article 3 case law has evolved, its interpretation has broadened to now include a thorough scrutiny of hospital and prison conditions and healthcare provision where people are kept in detention. This article provides an in-depth update on recent Article 3 case law, but more importantly describes new developments in its application in the clinical setting.

This commentary aims to support and elaborate on some of the specific issues raised by Dein & Woodbury-Smith. Although I agree with many of their comments, I believe that the role of neuropsychological and sensory impairments, as well as dysfunctional coping strategies among individuals with an autism-spectrum disorder who offend, need to be expanded from a psychological perspective. In my experience, the assessment of these factors plays a crucial role in guiding opinions on mental capacity, individual interventions, risk assessment and management. Elements of psychopathy in autism also require clarification. It could be argued that by understanding these issues, any attempts at social inclusion and preventing offending will be more successful.

The internet abounds with promises of ‘miracle cures’ for autism and within the published research literature there are numerous claims and counter-claims for the effectiveness of specific therapies. Systematic evaluations, however, indicate that few treatment programmes have a sound evidence base, and even those interventions that do produce positive findings are not successful for all children. To date, the best researched programmes are those involving intensive, early, home-based intervention, and those with a focus on communication and parent–child interaction. This article assesses the evidence base for some of the better evaluated therapies. There is, as yet, no evidence that any one programme is superior to all others. Indeed, large individual differences in response to intervention suggest that the focus of research now needs to shift to the study of which components of therapy work best for which children and under which conditions.

There are many difficulties associated with the diagnostic guidelines for personality disorder in the current international classificatory systems such as ICD–10 and DSM–IV. These lead not only to significant overlap with DSM Axis I disorders, resulting in high rates of diagnoses of comorbidities and multiple personality disorders, but also to lack of adequate capture of core personality pathology. The current classifications are also unhelpful in treatment selection, presumably the prime reason for assessing individuals in the first place. In this article we highlight various deficits and inadequacies related to the nosology of the current systems and suggest some strategies for dealing with these. We offer an integrated model of assessing and diagnosing personality disorders. We attempt to demonstrate how using a more integrated approach minimises or even eliminates some of the key problems highlighted in the current systems.

This article reviews the literature on advance statements, including current mental health law and guidance in England and Wales, ethical and practical advantages, disadvantages and barriers to implementation. The idea of planning psychiatric treatment for a time when mental capacity may be impaired is not new. Yet there has been a renewed interest following the introduction of the Mental Capacity Act's 2005 provision of legally binding advance decisions to refuse treatment. In addition to information on treatment refusals, advance statements provide information on treatment preferences and personal care instructions which, although not legally binding, should inform treatment decisions. Advance statements are not yet widely used, but existing limited evidence suggests that they could reduce coercion and improve service users' satisfaction with treatment.

Many memorable characters in Western culture could be viewed as having features of autism or Asperger syndrome. In spite of the familiarity of autistic stereotypes such as Star Trek‘s Mr Spock, more completely described characters with autism are still unusual. In recent years there has been a growing interest in autism, mirrored by an increase in depictions of autism in popular works of fiction and autobiography. In this article I will outline the issues that have preoccupied writers and the techniques they have used to demonstrate autistic difference. Some writers have illuminated aspects of the autistic triad of social impairment, abnormalities of language and need for sameness. Other writers have opened our eyes to the autistic world view in its strangeness and richness. Still more have started to examine prejudice, disability rights and the implications of an international autism community. As in other areas of mental health, literature can help inform, entertain and question our attitudes and values.

The prevalence of tattoos is higher among people with mental disorders and those likely to come in contact with mental health services. The motivations for acquiring a tattoo are varied and tattoos can give clues to the presence of particular psychiatric conditions and to the inner world of patients. Psychiatrists need to be aware of the health and safety issues surrounding the tattooing procedure and be able to give appropriate advice to their patients if they wish to acquire a tattoo. The issue of capacity must be considered. This may be particularly relevant for clinicians working with adolescents, the most common age group for acquiring tattoos. Owing to the high proportion of adults who subsequently regret their tattoos and the associated psychological and social distress, clinicians should be aware of methods of tattoo removal.

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.

This article reports the results of a synthesis of qualitative research articles about lay perspectives on prescribed psychotropic medicines. It updates and elaborates on a model of medicine-taking developed by Pound and colleagues. In this model, the concept of resistance refers to the various ways in which people take prescribed medicines while trying to minimise their intake. The synthesis included 12 papers published since 1992. The findings are presented at the societal level, in terms of the social meanings of mental health problems and medication, and at the individual level; the latter covers active engagement and lay evaluation, as well as the outcomes of evaluation, including the doctor–patient relationship. Although it can be difficult to achieve in the current clinical environment, there is much scope for developing more concordant relationships with patients in relation to prescribing and using psychotropic medicines.