The evidence base for cognitive-behavioural therapy (CBT), family therapy, psychoeducation and cognitive remediation as adjuncts to antipsychotic medication in the treatment of schizophrenia is well established. It is, however, clear that the moderate effect size of the best researched of these treatments (CBT) compared with treatment as usual reduces to small when compared with an active psychological treatment. It would seem that many different psychosocial interventions de liver benefit in schizophrenia. We are now at a stage in their development when new treatments are being energetically piloted and combination treatments tested. This article outlines the most promising of these new interventions and attempts to answer the crucial question as to their differential effects on different psychotic presentations.

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review document Treatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.

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.

Since 2013, hoarding disorder has been recognised as a standalone diagnosis in the DSM, affecting an estimated 2–6% of the general population. This article outlines the arguments for and against this separate classification and considers the differentiation of hoarding disorder from normative collecting. It then discusses aetiology, assessment, course and treatment (both psychological and pharmacological interventions). It concludes with a discussion of ethical and legal considerations, in particular the fact that the inclusion of hoarding disorder as a distinct diagnosis in DSM-5 confers specific protections for people with the disorder under the Equality Act 2010.

Psychiatrists called on to assess the reliability of witness testimony in the courts enter an arena fraught with uncertainties. This commentary discusses Commane & Kopelman's exploration of both the ‘normal’ fallibility of memory and disordered memory and considers the unavoidable limitations of their guidance on memory assessment and medico-legal work.

Rates of suicide and self-harm are rising in many countries, and it is therapeutically important to explore the personal stories and relationships that underlie this behaviour. In this article psychoanalytic and psychodynamic principles and concepts in relation to violence towards the self are introduced and the various unconscious meanings of suicide and self-harm are explored within a relational context and attachment framework. We describe how a psychodynamic approach may enhance the risk assessment and treatment of patients presenting with self-harm and suicidality, particularly examining the role of transference and countertransference within the therapeutic relationship.

Working with people who are experiencing mental health difficulties brings many challenges about how best to progress towards shared goals. The cognitive-behavioural therapy (CBT) approach can provide a structure and framework for effective treatment. It aims to help people identify goals and work towards them. We describe a practical approach that provides a structure for step-by-step planning, engaging the patient and promoting planned change.

Meditation, a component of ashtanga yoga, is an act of inward contemplation in which the mind fluctuates between a state of attention to a stimulus and complete absorption in it. Some forms of meditation have been found to be useful for people with psychiatric conditions such as anxiety, depression and substance use disorder. Evidence for usefulness of meditation for people with psychotic disorders is mixed, with reported improvements in negative symptoms but the emergence/precipitation of psychotic symptoms. This article narrates the benefits of meditation in psychiatric disorders, understanding meditation from the yoga perspective, biological aspects of meditation and practical tips for the practice of meditation. We also explain possible ways of modifying meditative practices to make them safe and useful for the patient population and useful overall as a society-level intervention.

The assessment and management of violent behaviour in mentally disordered patients are no longer the sole domain of forensic psychiatrists, but are increasingly part of the day-to-day work of all psychiatrists and mental health professionals. Violence risk assessment has become a huge industry, and although the importance of dynamic, as well as actuarial, risk factors is now recognised, a more systematic approach exploring the psychodynamics in the aetiology, assessment and treatment of violent behaviour is often lacking. In this article I revisit some of the key psychodynamic principles and concepts relevant to an understanding of violence, summarising the historical contributions of key psychoanalytic writers on violence and aggression, and exploring the ideas of more contemporary writers working in the field of forensic psychotherapy. A psychodynamic framework for working with violent patients is introduced, focusing on the setting and containment, specific therapeutic interventions and monitoring countertransference reactions.

Mindfulness is increasingly being recommended to help patients with recurrent depression and anxiety stay well. However, current treatment recommendations ask a lot in terms of commitment, with around 100 hours of practice and learning over a 2-month period. There is therefore increased interest in approaches that deliver key mindfulness skills in a shorter time frame.

The diagnosis of dissociative identity disorder (DID) remains a contentious area in mental health. Patients experiencing such difficulties are often harshly identified as suggestible neurotics and interested clinicians as fanatics. However, for the sufferer, DID is as real and has as much impact as any other psychiatric diagnosis.

This commentary challenges psychiatry's dismissive and disbelieving attitude towards DID. The authors (a person with DID and a clinician) acknowledge the limited understanding of DID's aetiology and the paucity of associated neurological findings, but ask whether this is not the case for many other accepted psychiatric conditions. They call for UK psychiatric practice to move on from the debate and for the Royal College of Psychiatrists to take the lead, with inclusion of DID in core psychiatric training and guidelines on approaches to diagnosis and treatment.

Although cognitive therapy is a promising treatment for depression, high drop-out rates and, conversely, the specific elements that make the intervention effective continue to puzzle practising clinicians. This article discusses both therapist-related factors (including competence and competencies) and patient-related factors (such as engagement in therapy and external logistical problems with attendance) that are related to drop-out and suggests practical ways to address them and improve outcomes. It examines cognitive and behavioural elements of manualised cognitive therapy and discusses findings relating to cognitive–behavioural therapy (CBT) in particular.

As we age, there are characteristic changes in our thinking, reasoning and memory skills (referred to as cognitive ageing). However, variation between people in the timing and degree of change experienced suggests that a range of factors determine individual cognitive ageing trajectories. This narrative review considers some of the lifestyle factors that might promote (or harm) cognitive health. The focus on lifestyle factors is because these are potentially modifiable by individuals or may be the targets of behavioural or societal interventions. To support that, the review briefly considers people's beliefs and attitudes about cognitive ageing; the nature and timing of cognitive changes across the lifespan; and the genetic contributions to cognitive ability level and change. In introducing potentially modifiable determinants, a framing that draws evidence derived from epidemiological studies of dementia is provided, before an overview of lifestyle and behavioural predictors of cognitive health, including education and occupation, diet and activity.

Cognitive–behavioural therapy (CBT) is an effective treatment for a number of psychiatric disorders in adults of all ages. With the proportion of the population aged 65 or over increasing steadily, it is important to be aware of how the CBT needs of this age group can be best met. This article provides an overview of CBT and the historical context of using it with older people. Although an understanding of the individual, irrespective of age, is at the core of CBT, potential modifications to the procedure and content aimed at optimising its effectiveness for older people are discussed.

Clinical research suggests that empathy is associated with better clinical outcomes in various areas of medical care, raising the question of whether a similar effect occurs in psychiatry. The aim of this review is to explore philosophical, neuroscientific and psychological perspectives on the concept of empathy in the context of the day-to-day work of clinical psychiatrists. The definition of empathy is outlined and sociodemographic factors, working conditions and psychiatrists’ beliefs that can potentially affect empathy in clinical encounters are explored; educational and training aspects are also reviewed. The review concludes suggesting that research on empathy is needed to understand contextual, training and relational factors that could benefit mental healthcare as well as the working conditions of clinical psychiatrists, both inextricably linked.

This article outlines common psychodynamics in psychosis. We consider psychosis as a response to unbearable aspects of reality and illustrate how psychodynamic concepts of psychological defence can be used as a framework for understanding this. We also present a psychodynamic approach to understanding the development of psychosis, using the stress–vulnerability model, and discuss interpersonal dynamics in psychosis, particularly their relevance to therapeutic relationships and to interactions between patients and their families. The perspectives presented are intended to complement and enrich other frameworks rather than compete with them.

The DSM–IV classification of body dysmorphic disorder (BDD) refers to an individual's preoccupation with an ‘imagined’ defect in his or her appearance or markedly excessive concern with a slight physical anomaly (American Psychiatric Association, 1994). An Italian psychiatrist, Morselli, first used the term ‘dysmorphophobia’ in 1886, although it is now falling into disuse, probably because ICD–10 (World Health Organization, 1992) has discarded it, subsuming the condition under hypochondriacal disorder.

Leadership is a key role for psychiatrists, with many models that can be adopted depending in part on the nature of the individual and their training, the primary task of the team and the nature of the organisation. In this article we suggest a new concept and model of leadership, ‘psychotherapeutic leadership’. We discuss the theoretical background to this model, its benefits and the implications for training and professional development.

The scientific study of human sexuality is now accepted as mainstream practice but early researchers in the field often attracted considerable criticism. Masters and Johnson were pioneers in observing and describing normal sexual function and consequently they provided unique insights into helping to understand sexual dysfunction. Their contribution to describing the physiological process of sexual response alongside potential psychological factors resulting in and maintaining sexual dysfunction is widely acknowledged. Their work continues to influence contemporary sexual medicine and psychosexual therapeutic practice.