There is now extensive evidence that different types of psychological therapy are effective for various psychiatric disorders, both in terms of symptom reduction and in improving the patient's capacity to function adaptively. In two articles, we set out some current ideas of how psychological therapies might ‘work’, drawing on neurobiological studies of brain plasticity and therapeutic efficacy. In this first article, we review the evidence that disorders of self-experience are common to many psychiatric disorders, and that psychological therapies ‘work’ on those disorders. The second article will appear in the next issue of Advances.

Benzodiazepines still play an important role in the management of anxiety disorders but dependence is associated with their therapeutic use. The key to effective and safe long-term use of benzodiazepines is: the careful selection of patients who might benefit from them; administration in clinical situations in which they are more likely to be beneficial; use of lower doses and in conjunction with an antidepressant, if possible; monitoring and managing their side-effects; and minimising the risk of withdrawal symptoms and relapse, mainly through tapering the dose and/or combining with effective psychological interventions.

Benzodiazepines are still widely prescribed in psychiatry, mainly for the treatment of anxiety-related disorders. This is not because they are only taken by a hard core component of patients who are addicted and do not need them; it is because they remain the most effective and rapid acting of all drug treatments. Strategies for practitioners to use them more confidently are described.

Shopping addiction (compulsive buying disorder) has been an area of increased interest in recent years. Shopping addiction can adversely affect the individual and their family, social and occupational life. The addiction is associated with high rates of psychiatric comorbidity. Early identification and appropriate management can limit the long-term adverse consequences and improve outcome. This article reviews the aetiology, epidemiology, clinical features, psychiatric comorbidity and management of the disorder.

In this article we ask what kind of phenomenon is internet sex addiction. From the perspectives of two practising psychiatrists, one of whom has worked in a weekly sexual disorders clinic for 12 years, and an anthropologist we explore whether a moral panic is emerging over sexual behaviour and the internet, and whether internet sex addiction forms part of any such panic. We ask whether many individuals who diagnose themselves as addicted to internet-based sex do so more out of a media-activated sensibility than a clinical reality. We also consider what developments in DSM-5 hold for this area.

The expansion of the concept of addiction to include non-chemical dependency, and the proposed reclassification of substance-related disorders in DSM-5 under ‘substance use and addictive disorders' are developments that require cautious appraisal.

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.

Sir Arthur Conan Doyle trained as a doctor and practised in a number of areas, but found real success only as an author. He is best known as the creator of the Sherlock Holmes stories. This article considers the individuals in Doyles' life that seem to have inspired the character of Holmes, a flawed genius with dark aspects (including intravenous drug use and instability of mood).

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.

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.