The history of the concept of the placebo effect and research into its quantification and mechanisms are reviewed, particularly in relation to psychiatry. Research has demonstrated a notable placebo effect in depression: a large proportion of the clinical effect of antidepressant medication is attributable to the effect. Various mechanisms have been hypothesised: anxiety relief, expectation, transference, ‘meaning effects' and conditioning. Recent research from neuroimaging has unveiled that the effect is associated with biological correlates in the brain. Despite the renewal of research into the placebo effect, many questions remain unanswered. This partly reflects philosophical obstacles such as the mind/body dichotomy, which are inherent in conceptualising the effect. However, it also demonstrates the vast scope for further research into this area. Ultimately, an understanding of the processes that underlie the placebo effect should allow a rationalised therapeutic approach to be developed to maximise the clinical benefit of the therapeutic encounter.

Children and adolescents with learning disabilities have high rates of mental health problems and behavioural difficulties. Comorbid disorders such as epilepsy, autism and attention-deficit hyperactivity disorder are common. Despite this, many areas in the UK are failing to provide a psychiatric service for these young people and their families. The children suffer as a result and may have to move away from home unnecessarily, at enormous emotional and financial cost. Each area should have a specialised multidisciplinary health team working closely with colleagues from education and social services to assist these complex children and give them the best chance to fulfil their potential.

Psychiatric services for children and adolescents with learning disabilities have been subject to fashion and aspiration rather than pragmatic planning, at different times being claimed by different specialties. As services have atrophied, it has become clear how distinct are the clinical issues that arise in this group; issues that show developmental psychiatry at its starkest with a combination of organic, dynamic and systemic factors that require community teamwork. As services and specialties regroup, this evolving area is likely to continue defining itself, perhaps taking in adults with developmental disorders, to emerge as a new specialty, developmental psychiatry. It remains to be seen where this will sit within the health service.

The world wide web has many advantages for the psychotherapist and for the client, but it poses new challenges too. This article considers both in relation to information, disinformation and information overload; openness and availability of information; and the anomalies of being present, and able to meet other presences, in virtual space but with no physical body and with an identity that may be created for the occasion.

Stammering results in involuntary disruption of a person's capacity to speak. It begins at an early age and can persist for life for at least 20% of those stammering at 2 years old. Although the aetiological role of anxiety in stammering has not been determined, evidence is emerging that suggests people who stammer are more chronically and socially anxious than those who do not. This is not surprising, given that the symptoms of stammering can be socially embarrassing and personally frustrating, and have the potential to impede vocational and social growth. Implications for DSM–IV diagnostic criteria for stammering and current treatments of stammering are discussed. We hope that this article will encourage a better understanding of the consequences of living with a speech or fluency disorder as well as motivate the development of treatment protocols that directly target the social fears associated with stammering.

Multiple sclerosis is the most common disabling neurological illness affecting young and middle-aged adults. Although attention has tended to focus mainly on its neurological manifestations, reports of the presence of neuropsychiatric symptoms date back to the writings of Charcot in 1877. This article details the neuropsychiatric sequelae of multiple sclerosis and the evidence base for available treatments.

If personality disorder is no longer to be a diagnosis of exclusion it needs a conceptual framework that fits both the symptoms of the illness and the behavioural problems that constitute its current diagnostic criteria. In this article, we suggest that personality disorder is best understood as disorganisation of the capacity for affect regulation, mediated by early attachments. We present evidence for this argument based on both developmental and neurobiological research.

Since its original conception by Bowlby to explain an important evolutionary function of the child–caregiver relationship, attachment theory has been supported by much empirical research in a variety of settings. However, although attachment theory began as a clinical enterprise, its wider application to the everyday clinical understanding of adult mental health problems has lagged behind the available research. The theory can afford valuable insight not only into the developmental nature of common psychiatric disorders, but also into the development of the therapeutic relationship. This article gives an overview of (a) the current conceptualisations of attachment and the measurement of attachment for clinical research purposes and (b) the application of attachment theory to different psychopathologies. The importance of attachment to the therapeutic relationship will be discussed in a future article.

The quality, completeness and coverage of ethnicity data in mental health services has long been regarded as unsatisfactory. The Department of Health's new 5-year action plan for delivering race equality in mental healthcare seeks to improve this key building block by setting out actions to improve both the quality of information and its analysis and dissemination. However, those that are tangible and specific are few: annual surveys of service users, national censuses of mental health in-patients and tables of National Confidential Inquiry suicide cases and in-patient deaths by ethnicity. The opportunity to seek improvements in the quality and coverage of key routine data-sets such as ethnic monitoring in primary care and the Hospital Episode Statistics database has not been seized. Moreover, the plan does not mention proposed changes in civil registration (births and deaths) and the coroner service and their potential benefit. The continuing gaps in the information base justify a stronger emphasis on the processes necessary to bring about change rather than on what ethnic monitoring should provide.

Mental health services are moving towards a balanced-care model. The shift recommended by the World Health Organization is currently being reflected only in service delivery, and has not been clearly reflected in the training curriculum. This change in service delivery has implications for teaching and learning. This article looks at how best the curriculum can incorporate aspects of community psychiatry and hospital work for medical students and junior doctors in training. This move towards balanced care also requires teaching staff to consider how to make use of collaborative working and to develop effective working relationships.

This article discusses the definition, nature and origins of clinical errors and potential means of prevention. The relationship between clinical errors and medical negligence is examined, as are the characteristics of litigants and events that prompt litigation. Legal aspects of medical negligence are outlined and clinical situations most commonly associated with negligence claims are described. Probably no more than 1 in 7 adverse events in medicine results in a negligence claim and the factors that predict whether patients will resort to litigation include a prior poor relationship with the clinician and the feeling that they are not being kept informed. The actual rate of negligence claims in psychiatry is unknown, but it is rising. Clinicians must therefore be aware of the risks and of which areas of practice are most risky.

Over the years, the number of mentally disordered offenders in England and Wales subject to restriction orders has steadily increased. The Home Secretary, through the Mental Health Unit at the Home Office, is responsible for overseeing the treatment of these individuals. As psychiatrists work in partnership with the Mental Health Unit in the treatment of these patients, it is essential to understand the Unit's role and functions. In this article, we describe the philosophy, structure and functions of the Mental Health Unit and its statutory role in the care of mentally disordered offenders subject to restriction orders.

This review focuses on screening and assessment in general psychiatric settings, where drug use is unlikely to be known to service providers. It builds on the recurrent finding that psychiatric patients are at high risk of substance misuse. The application of self-report questionnaires and rating scales and more in-depth assessment instruments is outlined, as are biological screening techniques. The use of brief self-completion questionnaires probably offers the most practical approach to routine screening by non-specialist staff in general hospital settings. The importance of implementing such tools lies in reaching an accurate diagnosis, choosing treatments more appropriately and monitoring the management of patients' psychiatric disorders.

With fundamental changes to the way services are commissioned and resourced within the UK's National Health Service (NHS), optimising the efficient and effective use of resources has become a key task for mental health clinicians and managers. A core step in this process is ensuring that resources are optimally allocated across the service. This article outlines steps in resource allocation, including understanding how resources are managed through budgets, the link between resource matching and care delivery, and methods of reallocating resources to improve service performance. Influencing appropriate allocation is a critical role for psychiatrists, working with both managers and commissioners in the decision-making process. Understanding resource allocation from a management perspective should improve the ability of psychiatrists to influence this process more effectively.

Conversion disorders tend to be poorly understood and diagnosis can be difficult. In this article, we aim to clarify what conversion disorders are and how they can be distinguished from other psychiatric disorders that involve physical symptoms. Prevalence, prognosis and relationship to organic disease are controversial areas; we outline what is known about them and provide some historical context. Aetiological theories and management strategies are discussed, the latter with the aid of case vignettes.

Curriculum is not the same as syllabus. The latter is a statement of topics to be studied in a specific course. The former ranges from a statement of purpose, aims and contents (the paper curriculum) to how these are applied in practice, what learners do and the behaviours, knowledge and performances that they see as important. The Postgraduate Medical Education and Training Board (PMETB) defines curriculum as:

Srinivas et al provide a comprehensive guide to the law, regulations and practice concerning the management of ‘restricted patients', who are the responsibility of both the clinical services treating them and the Home Office. In doing so, they make the assumption, with apparent approval, that there is a ‘partnership’ between clinicians and the Home Office. However, partnership assumes parties working towards a common goal on an equal footing. Neither assumption is correct here. Although forensic mental health services direct themselves explicitly towards enhancing public safety, they do so in conjunction with treatment aimed at the relief of dysphoria in the patient. The interest of the Home Office in the patient's mental health is solely in terms of its impact on the risk of harm to others. There is therefore no ‘partnership’. Rather, there is constructive tension between agencies working towards differently valued and balanced objectives. Certainly the relationship is not one of equal power.

Over the past few years electroconvulsive therapy (ECT) has come under increased scrutiny in the UK, with the first systematic review of patients' experiences and new national guidelines. Our aim in this article is to translate recent and sometimes confusing research and policy statements into practical guidance that benefits patients. We examined the evidence on the permanent memory and cognitive effects of ECT, with a focus on delineating their nature, understanding how ECT may cause them, informing prospective patients about them, and assessing their impact on former patients. We describe a simple and effective method for assessing retrograde amnesia. Data do not exist at this time to confirm the mechanisms by which ECT exerts its adverse effects, but clinicians should fully inform patients of the possible permanent adverse effects of the treatment, which include amnesia, memory disability and cognitive disability, and should provide follow-up testing using relevant instruments.