In many of the recent editorials of Acta Neuropsychiatrica I have commented upon the aspects of quality as regards the research that the journal publishes. The quality of research, which is more than its scientific rigour, is an important parameter that directly impacts upon the advancement of science and ultimately clinical knowledge. In practice, it is important for clinicians to know, whilst treating neuropsychiatric disorders, the benefits and limitations of our therapies. Clinically, it has long been appreciated that optimal quality of life (QoL) is ‘the ultimate goal’; however, equally, it is widely acknowledged that achieving this laudable aim is difficult and often equates to an artistic exercise, especially because the assessment and measurement of QoL pose significant challenges.

A number of articles in this issue of the Acta Neuropsychiatrica touch on this topic that is associated to some extent with therapeutic outcome Reference Rasmussen, Stevens, Kung and Mohan(1,Reference Macneil, Hasty, Conus and Berk2). It is therefore apt that this issue begins with a review by Alex Mitchell and colleagues Reference Mitchell, Kemp, Benito-León and Reuber(3) that examines the influence of cognitive impairment on health-related QoL in neurological disease. In general the more difficult an illness is to treat, the more important the issues pertaining to QoL become. Therefore, in this issue of Acta Neuropsychiatrica we have a number of papers that address the more refractory end of the spectrum of neuropsychiatric disorders such as psychosis and treatment-resistant depression.

With advances in technology and scientific knowledge, it is likely that increasingly ambitious medical procedures will be undertaken to treat the signs and symptoms of neuropsychiatric disorders. Already the availability of deep brain stimulation and vagus nerve stimulation suggest that a new more complicated and invasive field of neuropsychiatric treatment is fast emerging. However, with greater complexity so too assessment naturally becomes more sophisticated (and necessary) but at the same time is perhaps less definitive and more difficult to implement and interpret. Thus QoL needs to be given greater consideration in all our research. Ultimately, it is what we all want, and our patients desire most.