Psychosocial aspects of treatment have become increasingly important with the changes in psychiatric practice away from the hospital to the community. Effective psychosocial interventions and high staff morale are likely to be the key to the success of a community-based mental health service. There is a growing expectation that all psychiatrists should have a basic knowledge of therapeutic approaches in order to take a leading role in the multi-disciplinary team. They should be able to assess patients for a range of psychological and psychotherapeutic treatments. This role is vital as the matching of the patient's needs with the appropriate treatment is the key to a successful outcome.

‘Educational supervisor’ is the term now used by the General Medical Council for a consultant who has junior doctors working with him/her, whether employed by the National Health Service or a university. This paper represents our views of the role of the educational supervisor, rather than official College policy.

Depressive symptoms commonly occur in schizophrenia and have a significant impact on the distress and burden of the illness. Yet they are often overlooked, inadequately characterised by current classification systems and not consistently integrated into treatment. We discuss nosology, practical and clinical implications of symptom differentiation, and the role of causal and confounding factors, including iatrogenic, as targets for therapeutic intervention. The evidence base of psychosocial and psychotropic management is reviewed, with recommendations for the treatment of established syndromal depression in people with schizophrenia.

As with most issues in medicine, the prevention and management of a problem is best understood when the origins are known. The term ‘false memory syndrome’ (FMS) came into use in March 1992 with the foundation of the False Memory Syndrome Foundation (FMSF), a non-profit-making organisation established in the USA by a group of families in which one or more of the parents was accused. The parents in these families were reacting to a phenomenon which developed in a characteristic form in the preceding decade and had become common enough by 1991 for a number of them to realise that they were not alone, and to join in setting up the Foundation with a professional and scientific advisory board.

Medical practice must be regulated, but the form this currently takes is increasingly based on a ‘technical’ view, which wrongly assumes that practice is straightforward and that error is the result of individual failure. The metaphor of ‘delivery’ is currently used to characterise medical practice but this usage is fundamentally flawed. An alternative is presented, supported by a growing literature, that shows that professional practice generally (and medical practice in particular) is characterised by complexity, uncertainty and unpredictability. Practitioners use their judgement and wisdom, developed in their own practice and in their contacts with fellow practitioners. Often, practitioners choose between options that are not ideal, and may need to decide on what they believe is best for an individual rather than what is ‘right’ in some absolute sense. Doctors must find ways of giving a clearer account of their practice, and in so doing become more truly accountable.

Obesity is common in patients with mental illness. Weight-loss surgery, known as bariatric surgery, is becoming a familiar intervention for treating people who are morbidly obese and for whom other weight-reduction methods have failed. This article offers guidance for mental health professionals on the assessment and management of patients with mental illness undergoing such treatment. Assessment is of the patient's suitability for surgery, taking into account their mental health diagnosis, expectations, knowledge and insight into the psychological impact of surgery, and ability to address and cope with lifestyle changes before and after surgery. The patient's capacity and ability to cooperate and engage with services are also assessed. Potential risks and complications of bariatric surgery and how the weight-loss procedures may affect patients' mental health and management of their medication are addressed.

Success in preventing and responding to criminal behaviours on psychiatric wards may sometimes require cooperation between mental health services and local police services. This is especially so when seeking legal remedies through the criminal justice system. This article describes police perceptions of psychiatric services and psychiatric patients. It also reviews police procedures and factors that influence their response when the police are requested to intervene following an alleged criminal act by an in-patient. A case vignette is used to highlight the causes of tensions and guide the reader through the steps that might be considered when the issue of prosecution arises.

The cognitive behavioural analysis system of psychotherapy (CBASP) is a new therapy specifically designed to treat chronic depression. Conceptually the bio-psychosocial signs and symptoms of chronic depression are viewed as the result of either arrested maturational development at a Piagetian preoperational stage (in early-onset patients) or heightened emotionality and general functional regression (in late-onset patients). In this therapy, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. The focus is primarily on interpersonal interactions, including with the therapist, through the latter's disciplined personal involvement. In this article we outline the therapy process and key mechanisms of change using examples to illustrate specific techniques. We also outline the theoretical model underpinning CBASP and summarise the evidence from a large clinical trial.

The role of the general practitioner (GP) in the care of individuals with mental health problems has long been recognised. Goldberg & Huxleys' (1980) pioneering work on the pathways to mental health care demonstrated that only a fraction of identified mental health problems are referred on to psychiatrists. Goldberg & Bridges (1987) estimated that between 20 and 25% of a GP's workload concerns mental health, with only about 5% referred on to psychiatrists. Shepherd (1991) insisted that the only real hope for significant improvement in mental health care lay in the improvement of GP provision – there will simply never be enough psychiatrists.

The prescription of antipsychotic medication in children and adolescents (<18 years of age) has increased immensely for a wide range of disorders including psychoses, bipolar disorder, conduct disorder, pervasive developmental disorder and obsessive–compulsive disorder. This has led to some concerns particularly as the evidence base in some areas is not strong, and antipsychotic medication – both first generation (FGA) and second generation (SGA) – is associated with considerable side-effects. Evidence from an increasing number of randomised controlled trials (RCTs) points to therapeutic efficacy with moderate to large effect sizes. However, some RCTs have a small number of participants, are of short duration, and many are industry funded. The use of antipsychotics alongside psychosocial interventions can be recommended in certain disorders, provided there is continued, careful monitoring. It is important to note, however, that for many conditions the use of antipsychotics is not licensed in the UK.

Mental health payment by results (PbR) is a disruptive new prospective payment system intended to replace National Health Service block contracts in England and provide a mechanism for opening up the mental health economy. Patients are allocated to one of 21 treatment clusters, each with a different price or tariff. Clinicians perform cluster allocation using the Mental Health Clustering Tool. The clustering process makes demands on clinicians' time even with support from information systems. Clustering is novel and it is unclear how it will work in practice. The process is likely to be susceptible to gaming.

We review the various functional cognitive disorders (FCDs) – complaints about memory function or another cognitive process in the absence of relevant neuropathology. These are increasingly coming to the attention of psychiatrists and neurologists and FCD encompasses some newly recognised conditions in addition to classic types such as pseudodementia and psychogenic amnesia. The clinical features, neuropsychological findings and treatment are presented and discussed.

Recent years have seen a dramatic increase in the advances and applications of medical imaging techniques. Tools with familiar acronyms such as MRI, EEG/MEG and PET/SPECT have provided invaluable information not only about the brain structure and function associated with psychiatric disorders, but increasingly about the mechanisms underpinning these disorders. This evolving understanding of the specific pathophysiology of mental disorder paves the way for improvement in the diagnosis, treatment and prognosis of the disorders managed in everyday clinical practice. This article gives an overview of the main neuroimaging approaches, contemporary applications of this technology to psychiatric disorder and signposts to the exciting possibilities for the future.

Cannabis use is more common among people with severe mental illness than in the general population. It has detrimental effects on the course of the illness, physical health and social life of users, as well as being a financial burden on health services. It is important to understand why some people with severe mental illness continue to use cannabis, despite experiencing its effects on their condition. This article reviews research on the scale of cannabis use by such patients, the effects on the course of their illness, possible reasons to explain why they use it, and how they can be assessed in clinical settings, as well as providing some assessment tools to measure various characteristics related to cannabis use.

Food insecurity occurs when an individual lacks the financial resources to ensure reliable access to sufficient food to meet their dietary, nutritional and social needs. Adults living with mental ill health, particularly severe mental illness, are more likely to experience food insecurity than the general adult population. Despite this, most interventions and policy reforms in recent years have been aimed at children and families, with little regard for other vulnerable groups. Initiating a conversation about access to food can be tricky and assessing for food insecurity does not happen in mental health settings. This article provides an overview of food insecurity and how it relates to mental ill health. With reference to research evidence, the reader will gain an understanding of food insecurity, how it can be assessed and how food-insecure individuals with severe mental illness can be supported. Finally, we make policy recommendations to truly address this driver of health inequality.

Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.

This article attempts to give a flavour of the influence that psychoactive substances have had on many authors and the literary process. It explores the idea of the narrative as it is applied to addictive disorders and gives a range of examples of writing about different substances that might enhance the reader's knowledge of current drug culture. The portrayal in literature of doctors with addictions is presented as a warning against the development of such problems in psychiatrists. The authors hope to have demonstrated that literature can be a valuable tool in understanding the experience of drug and alcohol use and addiction.

The authors review contemporary indications for neurosurgical interventions in the management of chronic and refractory mental disorder, the procedures involved, their efficacy and known adverse effects. These data are presented within the context of a brief historical overview of the use of neurosurgery for mental disorder. In addition to a consideration of neurosurgical procedures that rely on the creation of putative therapeutic lesions, we also review two novel, non-destructive neurosurgical electrostimulation treatments that may represent viable alternatives to conventional ablative neurosurgery: vagus nerve stimulation and deep brain stimulation.

Most child and adolescent mental health services recognise the existence of, and need for treatment in, attention-deficit hyperactivity disorder (ADHD). Many specialist multidisciplinary ADHD clinics have been developed in recent years, and many paediatricians have included the treatment of ADHD as an important part of their clinical activity. A good deal of the justification for this increase in therapeutic activity has been the demonstration that ADHD is indeed a predictor of adult mental health problems. General adult psychiatry, however, has not followed suit in identifying and treating substantial numbers of affected people. It is likely none the less that an increasing load in adult psychiatry will develop. A rising number of young people will enter adult life still receiving stimulant medication or other treatment for ADHD, and adult psychiatrists are likely to be consulted. Furthermore, an increasing number of adults are likely to recognise themselves as having been disabled by ADHD and therefore to seek assistance. In many cases, individuals with adult ADHD who require specific treatment for the condition will have been treated unsuccessfully for disorders with overlapping symptom profiles such as anxiety, depression, bipolar disorder and antisocial personality disorder.