Appropriate housing and support are essential elements in the care of many people with mental health problems, and housing has a major impact on the quality of their lives. In the post-deinstitutionalised services of most high-income countries, a complex range of supported accommodation is available, mostly in the private (for-profit and not-for-profit) sector. We describe the different forms of accommodation and consider recent trends in policy and practice and the evidence base in this area. We also discuss quality issues and the potential impact of the recovery movement.

This article covers what clinicians need to know before undertaking a risk assessment of a sexual offender. It discusses general information about sexual offenders (characteristics, aetiological models, recidivism rates and legal responses); the association between mental disorders and sexual offending; risk and protective factors; and risk assessment tools.

Sex is central to most intimate relationships, and there is inevitably a two-way interaction between sex and intimacy. Sex is a physical, a psychological and an interpersonal event, and treatment of sexual problems should take account of all three aspects. Couple relationship problems that can affect sexual interaction include pervasive hostility, poor communication, lack of trust and disparate levels of sexual desire. Therapists should be able to manage therapy sessions with both partners present, without taking sides, and treating the relationship, rather than either individual, as the ‘client’. They should be able to balance the physical approach to problems with managing relationship issues and the partners' individual psychological problems. Techniques are recommended for understanding and modifying the couple relationship during therapy, as well as for dealing with specific sexual problems using a behavioural systems approach.

There is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.

The use of simulated patients in medicine offers students a standardised learning experience and a reproducible way of exploring attitudes and teaching communication skills. This would seem to be particularly relevant to psychiatry with its focus on attitudes and interpersonal skills, but doubts have been raised about the utility of simulated patients in teaching skills such as empathy and the generalisability of this learning to the real world. This, tempered with cost implications, may have limited the use of simulated patients to assessment through objective structured clinical examinations rather than to teaching and to learning. This article examines the educational advantages and disadvantages of the use of simulated patients in psychiatric teaching and argues that their judicious use complements undergraduate and postgraduate training in psychiatry. The article offers practical tips on writing simulated patient scenarios to deliver specific learning objectives and discusses the potential use of novel simulation techniques in psychiatric education.

In the second of two articles on rare causes of dementia, the authors describe toxic, iatrogenic, nutritional, traumatic, metabolic, neoplastic and autoimmune causes of dementia. Disorders are graded according to their prevalence, to give an idea of the likelihood of their presentation. Guidance is given on the investigation of uncommon cognitive impairment and dementia, especially in early-onset illness.

Fyodor Dostoyevsky is widely regarded as the greatest 19th-century Russian writer and a giant in world literature. He is familiar to literary-inclined psychiatrists for his rich and accurate portrayal of mental illness in several of his works. But his own chronic addiction to gambling and its consequent perils are less well-known. This article discusses The Gambler, one of Dostoyevsky's early (1866) semi-autobiographical novellas, inspired by his own addiction to roulette, focusing on its depiction of gambling. To better understand Dostoyevsky the gambler, the article also presents brief excerpts from letters that he wrote to his wife in 1867, when his gambling addiction appears to have been at its worst. Finally, the relevance of the central theme of this work, gambling addiction, to the present-day psychiatrist is discussed.

Video technology was first used in psychiatric services in the 1950s but came into general use in the 1990s, particularly in North America and Australia. Video has utility across all ages and in a wide range of clinical situations. These include case conferencing for patients with complex problems (e.g. when planning discharge from specialist inpatient units), psychological assessment and treatment, Mental Health Act assessments, suicide risk assessment and work in forensic settings. Potential for benefit may be most obvious in remote locations, but video use is also relevant in urban settings. Lack of training and experience, inadequate access to equipment and insufficient technical support have all limited the take-up of this technology in the UK. This article briefly reviews the literature and outlines technical and cost considerations when using video technology. Three services in Scotland are described to illustrate ways in which videoconferencing can enhance services.

Substance misuse remains relatively common among adolescents. It can be conceptualised as one manifestation of a broader conduct problem or disinhibitory syndrome that is genetically transmitted. Some substances, notably alcohol, have potential direct effects on brain development. Availability of substances is a necessary condition for use, and recent marketing developments have unleashed a range of new agents. Nevertheless, there is considerable scope for prevention, brief intervention, pharmacological and more elaborate psychosocial treatments.

The article briefly describes the structure of the civil courts in England and Wales and explains how laws are drafted. This information is used as a basis for understanding the rule of precedent: how earlier court decisions may be binding in later cases. The article explains what law reports are, how cases are reported in the legal literature and how they may be located and cited. A number of key cases are summarised to illustrate the process of judicial reasoning and to show how case law contributes to psychiatric practice and defines the legal structure of medical work. A list of useful legal websites is given.

Cognitive dysfunction is one of the major contributors to the burden of epilepsy. It can significantly disrupt intellectual development in children and functional status and quality of life in adults. Epilepsy affects cognition through a number of mechanisms in complex interrelationship. Cognitive deficits in epilepsy may be treated indirectly through aggressive seizure control using anti-epileptic drugs or surgery, and by treating comorbid conditions such as depression. The beneficial effects of reducing seizures may offset the adverse cognitive side-effects of these therapies. Direct treatment of cognitive impairment in epilepsy mainly involves memory rehabilitation. Other direct treatments are mostly experimental and their evidence base is currently poor.