The impending regulatory changes for all medical professionals in the UK will make it necessary for doctors to be relicensed and, in the case of specialists, to be recertified. This editorial argues strongly in favour of recertification and proposes that continuing professional development is one of the main planks on which recertification of psychiatrists should be based. We present cogent reasons for this, as well as evidence that improved learning contributes positively to healthcare. We also recommend that psychiatrists should make learning objectives more clinically focused as well as properly resourced.

During the period 2000–2004 the average annual suicide rate in England and Wales was 10.2 deaths per 100 000 population over 10 years of age. About a quarter of those who take their own lives are in contact with mental health services in the year before their death. This means that an average in-patient, sector or community psychiatrist is likely to experience the death of at least one patient by suicide in most years. Suicides by patients cause considerable distress for the psychiatrist that is unlikely to resolve until after the coroner's hearing. This article discusses suicide prevention and provides guidance for psychiatrists on preparing for a coroner's inquest following a patient's death that may have been by suicide.

Procedures following suicide differ in Scotland from elsewhere in the UK and we describe the investigation of deaths by procurators fiscal and fatal accident inquiries that may ensue. Higher Scottish suicide rates, and possible reasons for these, are mentioned. Suicide risk cannot be accurately quantified in individual patients but psychiatrists should take the view that good management can collectively reduce the risk among all patients. We comment on practical and emotional issues for clinicians who are coping with the suicide of a patient.

The Human Rights Act was introduced into UK law in 2000 and must be considered in all cases, including mental health review tribunals. Article 8 (the right to respect for private and family life) comprises two parts and has embedded in it ‘tests’ that must be applied when assessing any interference with this protected right. A review of Article 8 case law reveals how it is used and how it can be applied in a myriad of clinical situations. Because it involves the right to respect for private life, and is in a sense individualised, it will potentially affect people (both patients and staff) in the mental health services in a variety of ways. Article 8 has implications not only for patients but also for clinicians and healthcare organisations.

This article examines how madness is depicted in the work of Dostoyevsky. It gives a brief account of Dostoyevsky's life before looking at the many ways in which he portrayed insanity. It suggests that he provided a sophisticated and complex picture of mental illness which has relevance for how contemporary clinicians conceive of psychiatric illness.

Paranoid personality disorder is a neglected topic in clinical psychiatry, and is often the subject of diagnostic confusion and therapeutic pessimism. This article presents a summary of the key diagnostic issues relating to paranoid personality disorder and describes various psychological and social processes mooted to be central to the genesis of paranoid thinking and behaviours. The evidence relating to paranoid personality disorder and risk of violence is summarised and clinically useful guidance for the safe treatment of people with the disorder is outlined.

Plants have been used for medicinal purposes for centuries, treating everything from non-specific ailments such as backache and colds to serious conditions, including depression and cancer. In this review, a few commonly known plants with psychotropic effects (St John's wort, Ginkgo biloba, kava, ginseng and valerian) are discussed by way of illustration. The readers' attention is brought to important interactions between herbal remedies and conventional drugs. A background to the constituents of herbs, possible mechanisms of action and an explanation of their antioxidant properties is given.

This article offers an introduction to advocacy on behalf of people with mental disorders and/or intellectual disabilities. It concentrates mainly on the issues related to independent specialist advocacy, but refers to other forms also. The term is itself contentious, having different meanings in different contexts. Some of these controversies are outlined here. Inevitably, diverse interpretations imply varying practices, and these too are illustrated briefly. Legislation and concordance of expectations are both contributing to a set of standards to which most advocates in the UK and Ireland will adhere. The requirements that such legislation makes of mental healthcare staff working with independent specialist advocates are outlined, and the ethical dimension of mental health advocacy is noted.

Nearly half of people with severe mental illness use cannabis sometime in their lives and during their illness. Its use can have multiple and severe consequences for the course of the illness. Despite the significance of the problem, managing cannabis use in this group is a recently developing topic and is still in its infancy. This article reviews the current state of knowledge on the management of people with severe mental illness who continue to use cannabis, specifically focusing on different models of service provision, and psychological and pharmacological interventions.

Over the past decade, the study of error in medicine has expanded to incorporate new insights from cognitive psychology, generating increased research and clinical interest in cognitive errors and clinical decision-making. The study of cognitive error focuses on predictable errors in thinking that result from the use of cognitive shortcuts or ‘heuristics’. Heuristics reduce the time, resources and cognitive effort required for clinical decision-making and are a feature of mature clinical thinking. Heuristics can also lead to bias and must be used with an awareness of their weaknesses. In this article, we describe heuristics commonly used in clinical decision-making and discuss how failure of heuristics results in cognitive error. We apply research findings on decision-making in medicine to decision-making in psychiatry and suggest directions for training and future research into cognitive error in psychiatry.