The recent expansion of neuroscientific knowledge is changing the nature of psychotherapeutically competent psychiatric practice. For example, components of medical psychotherapy that optimise neuroplasticity and restructure and reinforce synaptic connections can bring about enduring therapeutic changes in patients' personal functioning, experience and behaviour. By renewing their connection to the advancements of neuroscience, psychiatrists in all specialties can build their identities as professionals and their skills as practitioners, making psychotherapeutic interventions more effective for their patients.

This article makes a case for training and developing psychotherapeutically competent consultant general psychiatrists. It describes what such psychiatrists should know and suggests that they should be able to prescribe psychotherapy rationally and assess its outcome. They should be able to deliver some psychological treatments themselves but, more importantly, they should be competent to apply psychotherapeutic knowledge and emotional literacy skills to their routine clinical practice. Possible CPD experiences are suggested to increase the competencies of existing consultant general psychiatrists.

Up to a third of patients with schizophrenia develop treatment resistance. Clozapine has been established as the most effective antipsychotic medication for treatment-resistant schizophrenia. However, it is significantly underutilised in this population. Possible reasons include clinicians' lack of experience with the drug and negative attitudes towards it. African-Caribbean patients are less likely to be treated with clozapine compared with their White counterparts and more likely to have treatment discontinued due to perceived risk of agranulocytosis. This paper discusses the current evidence relating to the underuse of clozapine and factors responsible for this.

Clozapine remains underutilised as the only antipsychotic for treatment-resistant schizophrenia, despite liberal National Institute for Health and Clinical Excellence guidelines for its consideration. Bearing in mind its monitoring requirements and poor tolerability, suggestions are made for patients who fail to improve on other antipsychotic drugs. Clozapine may be offered to apparently unsuitable patients, although this is fraught with difficulty. A realistic appraisal of the alternatives is essential in this situation. Optimising plasma clozapine levels, alongside the use of rehabilitative interventions and adjuncts as necessary, will maximise efficacy, and there are numerous options to minimise side-effects. Clozapine requires a lengthier trial than other antipsychotics and discontinuation should be avoided if possible, as the results are generally very poor. Established successful clozapine treatment can induce substantial functional gains which accrue with time: patients are retained in treatment and relapse is prevented. Such optimal outcomes justify the initial effort expended by all.

This article describes the concept of quality of life (QoL) as applied to mental health. It also outlines relevant tools for measuring QoL, both generic and health-specific, and explains their approaches and purposes. These tools are intended to enable researchers to ask questions that are more patient-centred and psychosocial than traditional clinical measures for evaluating outcomes of treatment. However, a number of studies have criticised existing QoL tools in terms of their sensitivity to change and their relevance to mental health patients' concerns. Studies have shown that patients can give accurate self-reports even when ill. Given that government and professional policies favour effective service user involvement and routine outcome monitoring, more effort should be made to develop measures in partnership with service users, as this might better reflect individual priorities in assessment of quality of life.

Issues such as sexual dysfunction, hypersexuality, risky sexual behaviour and mental capacity in relation to sexual activities arise frequently in people with psychosis. However, they may not always be given a priority in doctor-patient interactions, despite their often critical importance from the patient's perspective. Having a working knowledge of these topics may improve the quality of psychiatric intervention for people with severe mental illness. This article explores these topics, with a particular emphasis on assessment and management in everyday practice.

For many patients with bipolar disorder there is a long delay between the onset of illness and receiving a diagnosis and the initiation of treatment. This may have an adverse effect on the clinical outcome. Early intervention in bipolar disorder has received less attention than in schizophrenia, and there are relatively few specialist services in this area. This article reviews the literature on the early detection of bipolar disorder and on the effectiveness of pharmacological, psychological and psychosocial interventions in the early phase of the disorder.

Various UK reports have identified issues of poor health and social care for people with an intellectual disability. Such reports emphasise the vital importance of addressing human rights issues in the future to improve and address shortcomings in such care. Article 8 of the European Convention on Human Rights affords protection for private and family life, and applies irrespective of whether someone has the capacity to make such decisions affecting their life. This in particular is important for people with an intellectual disability. Compared with the rest of the Convention, there has been relatively more case law pertaining to Article 8. This review considers Article 8 case law involving people with an intellectual disability in the areas of community care, accommodation, day centres, lifting and hoisting, sexual relations, marriage and education. In doing so, it demonstrates the varied application and core principles for use of the Article in clinical practice and decision-making.

Psychiatry has had a significant influence on both Hollywood and world cinema. In turn, psychiatrists' fascination with psychiatric themes in films has inspired scores of books and bibliographies about films and psychiatry. Advances in medical education have led to the development of core-competency-based curricula for both undergraduate and postgraduate students. Learning objectives underpin such competencies. However, teaching competencies in the workplace is hampered by practical and ethical issues, especially in the case of psychiatric patients. Medical educationalists have found films to be a useful teaching tool with their larger-than-life vivid portrayals. In this article we demonstrate, with examples, the use of films and discrete film clips to achieve specific learning objectives that can be incorporated easily into most undergraduate and postgraduate teaching programmes in psychiatry.

Acceptance and commitment therapy (ACT) is a descendant of cognitive-behavioural therapy (CBT). The model draws techniques from a wide variety of sources and unites them within a philosophical and scientific framework to create a principle-driven therapy. Psychopathology is understood as a narrowing behavioural repertoire that develops over time through maladaptive strategies to cope with unwanted private events. The six core components of the therapy remain consistent across a wide range of clinical conditions. The approach combines processes of acceptance and mindfulness with those of commitment and behavioural change to produce increased psychological flexibility and an expanded behavioural repertoire. Since its introduction in 1999 an increasing number of trials show promising results for a wide range of conditions.