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.

This article is a brief review of the teaching role of psychiatrists and is directed at psychiatrists in the UK National Health Service who teach medical undergraduates. It reviews the responsibility of delivering teaching, the delineation of teaching duties, and the teaching roles of the psychiatrist in the changing environment of medical education. Application of good principles of clinical teaching and delivery of tomorrow's doctors in line with the General Medical Council's recommendations are discussed. The article also describes a recommended core curriculum in psychiatry for undergraduates, which lays out what should be taught.

In this article it is suggested that empathy is a core component of musical appreciation and particularly of the relationship between the singer and the audience. The brain pathways activated in musical appreciation are outlined and the nature of the empathic process considered with reference to Robert Schumann's songs and his experience of severe mental disorder. The article suggests that listening to Schumann's song cycle Dichterliebe (Poet's Love), or to other great music, is a useful component of continuing professional development and that such experience enhances therapeutic effectiveness and empathy, as well as increasing the understanding of the relationship between creativity and mental health.

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.

Children and adolescents with intellectual disability have high rates of psychiatric morbidity, the most common presentation being behavioural difficulties, especially in the context of autism. This clinical review describes the applicability of the full range of current psychopharmacological agents to the mental health difficulties commonly encountered in clinical practice in this field, with an emphasis on informing the choice of an initial ‘best fit’ single agent for the various clusters of symptoms and signs presented by individual patients. It is emphasised that the evidence base for most practice parameters in this area is extremely modest and that a high level of caution is recommended when applying this information in everyday practice. The article also discusses some of the specific difficulties and challenges encountered within the field and makes some practical suggestions for good practice.

ICD-10 and DSM-IV-TR diagnostic guidelines do not list psychopathy as a distinct psychiatric entity. However, there are significant overlaps between psychopathy and DSM-IV-TR Cluster B personality disorders. Neuroimaging studies implicate deficits in structure and function of frontal and limbic regions in this group of personality disorders, while highlighting both distinctions and overlaps between syndromes. Here, these data are reviewed and implications for diagnosis and clinical practice are discussed.

This commentary discusses the key issues facing undergraduate psychiatry teaching and the factors inhibiting psychiatrists' roles as medical educators. Potential solutions to allow psychiatrists to fully embrace their teaching role are presented. A particular focus is on enhancing teaching skills, challenging student perceptions of psychiatry and ensuring that teaching is protected, valued and appropriately rewarded. This requires a concerted approach on individual, organisational and policy levels.

Mania in late life is a serious disorder that demands specialist assessment and management. However, it is greatly under-researched, with only a paucity of studies specifically analysing older populations. The mainstay of the old age psychiatry workload will inevitably be concerned with assessing and managing dementia and depression, but the steady rise in the aging population with longer survival means that there will be an increase in absolute numbers of older people presenting with mania. There are no specific treatment algorithms available for mania in late life. This article reviews mania and hypomania in late life and concentrates on diagnosis, assessment and treatment, as well as on the management considerations associated with this important age group.

The scraps of historical data that exist about Buddy Bolden – a cornet player from New Orleans who influenced early jazz – have evoked curiosity in a wide range of writers, including psychiatrists. The latter are interested because Bolden ‘went berserk in a parade’ at the age of 29 and spent the rest of his life in an asylum. This article is about the novel Coming Through Slaughter by Michael Ondaatje, which is based on Bolden's life. I discuss how the form of the text – including its refusal to comment on where sense is lost – conveys to readers the bewilderment and conviction of Bolden's experience and allows them to share something of this.

This article focuses on service user involvement in supporting and undertaking mental health research. It is written from the author's perspective as a service user with bipolar disorder who has built on previous experience as an academic researcher in business and management studies by active involvement in a number of mental health research projects in a service user capacity. The article highlights contrasting approaches taken by different projects in how they involve service users and provides learning points based on the author's and other service users' experiences.

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.

Electroencephalography (EEG) is a non-invasive investigation that can aid the diagnosis of psychiatric and neuropsychiatric disorders. A good predictor of an abnormal EEG recording is the presence of an organic factor identified during the clinical assessment. The non-invasiveness and low cost of the procedure and its ability to measure spontaneous brain activity appear to attract clinicians to utilise this investigative tool. However, studies have reported that EEGs arising from psychiatric referrals have the lowest abnormality detection rate. The focus of this article is to improve this by highlighting the current pitfalls and providing recommendations for appropriate utilisation of EEG. We describe specific EEG changes associated with major psychiatric disorders. We conclude by offering pragmatic considerations when referring a patient for EEG, emphasising the fact that the information provided to the neurophysiologist plays a crucial role in interpreting the EEG recording in a diagnostically meaningful way.

Ingmar Bergman was a Swedish director, writer and producer for film, stage and television. He directed 62 films, most of which he also wrote. Many of his films were set in the landscape of Sweden and he explored the themes of death, illness, cruelty, betrayal, mental illness, religion, and relationships between partners, children and their parents. Known as an auteur, he frequently used his film-making to examine issues from his own childhood.

Despite the guidance published in revised Codes of Practice and by the Royal College of Psychiatrists, implementation of Section 136 of the Mental Health Act 1983 is still variable. Government funding in England to establish places of safety in psychiatric facilities has been effective but custody suites are still used excessively, especially for those who are brought in intoxicated. Patients feel criminalised by this use of custody suites and by the use of police vehicles rather than ambulance transport for conveyance to the place of safety. There is often a delay in commencing the assessment and the first doctor does not always have Section 12 approval as recommended in the Codes of Practice. The importance of the local Section 136 group tasked with developing and overseeing the implementation of local policy and monitoring is highlighted. There is a need for monitoring locally, but ideally in a form that can be used nationally for benchmarking and research.

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.

A recommendation of the UK's National Dementia Strategy is to develop the skills of the care workers who provide day-to-day care for people with dementia. On the basis of a systematic review of the literature, we suggest evidence-based areas in which the skills of care workers can be developed to reduce the incidence of difficult behaviour and the use of antipsychotic medication in dementia. We discuss core features of carer training, education and practice. Psychiatrists involved in the training of carers can teach new skills to carers. Psychiatrists in community mental health teams can, through leadership and clinical liaison, reinforce and enable these skills in care homes, domiciliary services and in-patient settings serving people with dementia.

A variety of therapies have been developed or adapted to treat personality disorder over recent years. This article will review skills-based treatments (as opposed to insight-based treatments). Two approaches are outlined: cognitive-behavioural therapy and dialectical behaviour therapy. The article details the underpinning theory and the model of personality disorder utilised by the two approaches, and describes how the therapy is applied. Evidence of therapeutic efficacy is presented along with information about accessing training and therapy materials.

Complaints inevitably accompany clinical care. This article explores complaints primarily in the context of the UK National Health Service complaints system. However, much of the content will apply to other settings, such as the independent sector. The infrequent but serious ramifications of complaints are also considered, including retraining and suspension. The article is written from a medical perspective but considers the roles of other professionals, the organisation and the complainant.

This article reviews the recent changes in the law in England and Wales relating to consent to treatment for young people, in particular the Mental Capacity Act 2005 and the 2007 amendments to the Mental Health Act 1983. Using a fictitious case study, it offers a structured approach to the application of these new items of legislation that could be useful to trainers and their trainees.

Epilepsy is a common neurological condition with wide-ranging neuropsychiatric manifestations. The relationship between epilepsy and psychiatry has been recognised for centuries. However, the wide range of neuropsychiatric comorbidities and their extent is only now beginning to be appreciated. The impact of these comorbidities on patients' help-seeking behaviour, seizure control and quality of life suggests that early detection and treatment are of paramount importance. Clinical issues in relation to accurate recognition and appropriate management of neuropsychiatric conditions in epilepsy are discussed.