Until 50 years ago chronic pain was not considered to be a medical condition that required special evaluation and treatment facilities. Pain was considered to be an indicator of tissue damage and appropriate medical or surgical treatment was prescribed for this. The many patients who had continuing pain because of the results of disease or trauma or because acute treatment was unable to relieve the condition were not seen as suffering from a recognised pathological entity. It was not until a doctor, Sicilian-born John J. Bonica, had to pay his debts as a medical student through wrestling professionally, and later suffered persistent pain as a result, that chronic pain became a recognised condition in its own right. Bonica started a pain clinic in Tacoma, Washington State, in 1949 and wrote the first textbook on pain treatment, The Management of Pain, in 1953. There are now 2000–3000 pain clinics in the USA and almost 5000 worldwide.

There can be few more agonising experiences than being falsely accused of having sexually abused one's child – except perhaps to be told that one's long-standing memories of childhood abuse are an example of false memory syndrome. People have been profoundly hurt both by false accusations of abuse and by false denials and dismissals of memories of abuse. Both of these can happen.

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.

There is considerable work being carried out in neuroscientific laboratories to delineate the mechanisms underlying single-gene disorders, particularly those related to intellectual disability and autism spectrum disorder. Many clinicians will have little if any direct experience of this type of work and so find the procedures and terminology difficult to understand. This article describes some of the laboratory techniques used and their increasing relevance to clinical practice. It is pitched for clinicians with little or no laboratory science background.

Good communication skills are the basis of all effective doctor–patient relationships, and psychiatrists in particular have to manage many types of complex interaction. Research shows the benefits of communication skills training. This article describes strategies for teaching relevant clinical communication skills to trainee psychiatrists on MRCPsych courses and in local centres. The authors set out a sustainable training framework using higher trainees as tutors. There is a need for more widespread teaching of clinical communication skills in psychiatry and at an early stage of specialist training.

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.

Depression has a large socioeconomic burden, affecting an estimated 280 million people worldwide. Up to 55% remain symptomatic following pharmacological and psychological treatment and may be classified as having treatment-resistant depression. This commentary assesses two treatment options for this group – electroconvulsive therapy (ECT) and a novel approach, magnetic seizure therapy (MST) – with reference to a Cochrane Review comparing the two. The Cochrane analysis showed no clear benefit for MST, but the evidence is currently insufficient to draw firm conclusions.

Akathisia is a common and distressing side-effect of antipsychotic medication. The treatment of this condition is difficult and options are limited. This review of the literature was performed to develop an evidence-based algorithm for the management of antipsychotic-induced akathisia. There is limited high-level evidence to support the use of anticholinergics. Centrally acting β-adrenergic antagonists are potential treatments, although their use is limited by troublesome side-effects. Long-acting benzodiazepines and mirtazapine are potential well-tolerated treatments for the acute management of akathisia.

Advances in data science and machine learning have allowed for the analysis of increasingly complex and large data-sets. Digital devices are a source of such data, given their ability to collect information on users continuously and irrespective of location. Digital phenotyping aims to use these data to build a comprehensive picture of an individual's behaviour. Psychiatry is well-positioned to make use of this, since digital behaviour may be reflective of mental state. This article provides an overview of the field of digital phenotyping as it stands currently, on the verge of large-scale studies which may pave the way for clinical implementation in psychiatry.

This refreshment summarises some of the ways in which ‘insight’ has been understood in psychiatric practice and offers some critical thoughts about the notion.

Female drug-using offenders are a large but under-researched and vulnerable population with specific needs. Only a handful of randomised controlled trials of interventions for this population are of sufficient quality to shed light on what might work to reduce their criminal activity and drug use, and interpretation of the results of most of these trials is limited by an ‘unclear’ risk of bias due to a lack of descriptive information. Better-quality research is needed to inform practitioners and policy makers. In the meantime, this month's Cochrane Corner review provides cautious support for the use of some psychosocial treatments, particularly if delivered in a gender-responsive way addressing issues of abuse and victimisation, in the expectation that re-imprisonment can be prevented, even if there is no proven effect on re-arrest rates and only uncertain effects on substance use.

There are many different course designs for the teaching of old age psychiatry. It may be taught in blocks or spread over the undergraduate curriculum and/or integrated with either psychiatry or medicine for the elderly. Whichever approach is used, at the end of their undergraduate training, students should have the same core knowledge, skills and attitudes.

The Defence Mental Health Services (DMHS) provide an occupationally focused service for the UK armed forces when deployed and when at home. Although much of the work is similar to that carried out by National Health Service community mental health teams, there are many unique aspects to working with the military. Although carrying out operational duties is a key function of the armed forces, the majority of cases managed by the DMHS are not related to traumatic exposures; instead, adjustment, mood and substance use disorders form the bulk of the case work. However, DMHS personnel carry out a considerable amount of psychological education and command liaison functions to support the concept that the psychological welfare of troops is primarily a chain of command responsibility. This article outlines the structure and function of the DMHS and its approach to risk management.

The true incidence and prevalence of sexual abuse against children is difficult to ascertain. Differing sampling methods, definitions of sexual abuse and methods of information-gathering have a significant effect on the rates reported. General population studies (Morrison et al, 1994) in the USA and Europe reveal a rate between 0.7 and 1.83 per 1000 children. Data from prevalence studies (Morrison et al, 1994) highlight large differences, with rates varying from 7 to 62%; meanwhile, only between 2 and 17% of sexual assaults are reported to the police. Many of the reported offenders are not prosecuted because of difficulties with the child's statement. Some offenders are cautioned, others are charged with specimen charges or have their charges downgraded. Despite an increase in the reporting of sexual offences since the 1970s, they account for only approximately 3% of all offenders on probation and 8% of male offenders in prison even though the number and length of prison sentences for sex offenders has increased since the 1970s. Convicted female offenders remain a very small group with only 23 convicted female sex offenders in custody in 1989.