Psychological treatments in secure settings have traditionally been based on psychodynamic and cognitive–behavioural approaches. Recent developments, supported by an emerging evidence base, have generated a significant amount of interest in mindfulness-based psychological therapies and their utility in diverse areas of mental healthcare. In this article we analyse the current evidence base and describe possible mechanisms of action of mindfulness-based psychological approaches. On the basis of the evidence, we advocate a cautious but positive approach to using mindfulness-based interventions in secure services.

Medical undergraduate training is currently going through a momentous period of change (Tosteson, 1990). New methods of learning and evaluation are being introduced which will radically alter medical training over the next few years. These changes are in part a response to the way medicine itself is being transformed. Medical educators can no longer hope to equip medical students, upon qualification, with enough basic knowledge and skills to last them throughout their medical careers. Today's students are embarking upon a process of learning which will continue throughout their medical lives. Medical practice will be very different, when today's students become tomorrow's hospital consultants and general practitioners.

This article describes how the M'Naghten Rules, which govern the law of insanity in England and Wales, came into existence. In relation to knowledge of the wrongfulness of the alleged act, the article reveals how the Court of Appeal has sought to limit the defence, whereas the courts of first instance, and a number of other jurisdictions, have adopted interpretations of the Rules that accord more closely with the law of insanity as it existed at the time of Daniel McNaughtan's trial and that the Rules were probably meant to formulate. Three cases are used to illustrate the difficulties resulting from the position adopted by the Court of Appeal. It is suggested that in cases where the insanity defence is raised, justice is likely to be better served by addressing specifically and separately the accused's understanding or appreciation of the moral wrongfulness of the alleged act and their knowledge as to whether the alleged act is contrary to the law of the land.

This article focuses on how to assess and manage risk in sexual offenders. It covers assessment issues, including interviews, taking a sexual history, assessing sexual deviance and assessing personality. The key step of case formulation is outlined and the development of risk management strategies, including monitoring, supervision and treatment, is described.

Highly active antiretroviral therapy (HAART) has led to a reduction in HIV-related morbidity and mortality, and the life expectancy of HIV-positive individuals has improved significantly. It is therefore becoming more likely that clinicians will encounter patients with psychiatric manifestations of the disease. This review summarises the evidence on prevalence, manifestations and treatment of psychiatric conditions in HIV-positive adults. The most prevalent psychiatric illness in this population is depression (35.6%), followed by substance misuse, anxiety, psychosis, adjustment disorder and bipolar affective disorder. Neurocognitive impairment is also common, ranging in severity from asymptomatic (the most frequent) to dementia (the least frequent). Effective treatment of both HIV and psychiatric manifestations is essential to maximising life expectancy and quality of life.

The provision of mental health teaching and training to staff in the care home sector by a dedicated educational team was established in Bridgend in 2003. A multiprofessional old age liaison psychiatry team was created in 2009 specifically to link closely with the teaching staff, further building on previous work on referral coordination and a single point of access. This article describes the application of barrier analysis to deliver both this new service and mental health education to the care home sector. Imaginative uses of information technology and multimedia to support the efforts of all staff are described, as are some pitfalls and hazards to avoid. The most effective elements of these developments are discussed, using barrier analysis as the explanatory model, with an emphasis on aspects that could be adopted more widely.

There is now a greater awareness among academics that teaching skills, like clinical and research skills, must be acquired and practised, usually over an extended period of time. In addition, teachers have a great responsibility in ensuring that medical students develop the knowledge, skills and attitudes to enable them to become competent and effective doctors. Although teaching theory is complex, attention to a few simple techniques and careful planning of teaching sessions and courses can greatly improve the experience for both students and teachers. This article discusses some of the theoretical aspects of teaching medical students and is followed by three articles which specifically address the teaching of child and adolescent, general and old age psychiatry to medical undergraduates.

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.

Recognising the vast extent of psychiatric morbidity internationally and the burden of mental illness on people, communities and nations, the World Psychiatric Association and the World Federation for Medical Education have recently published global guidelines for developing core curricula in psychiatry for medical students (Walton & Gelder 1999). More locally, major changes are taking place in undergraduate medical education throughout the UK. These changes represent a response to the appreciation, both by medical schools and by the General Medical Council (GMC), of two major pressures in undergraduate education. The first is that students have been asked over the years to accumulate more and more factual knowledge while the knowledge base in medicine itself expands and changes more rapidly. The second is that both understanding of illness and delivery of care are developing an increasing focus on the role of the community and community support. These general pressures have led to a number of specific recommendations, initially put forward by the GMC in their document Tomorrow's Doctors (GMC, 1993). This document encourages the reduction of ‘core knowledge’ taught to medical students to 65% of what has previously been taught, together with the identification of special study modules (SSMs), which would fill the remaining time in the curriculum. These SSMs would allow students to explore areas of particular interest in greater depth than was previously possible.

The Mini-Mental State Examination (MMSE) is the most widely used bedside cognitive test. It has previously been shown to be poor as a case-finding tool for both dementia and mild cognitive impairment (MCI). This month's Cochrane Corner review examines whether the MMSE might be used as a risk prediction tool for later dementia in those with established MCI. From 11 studies of modest quality, it appears that the MMSE alone should not be relied on to predict later deterioration in people with MCI. As this is the case, it is likely that only a combination of predictors would be able to accurately predict progression from MCI to dementia.

Sleep is essential for survival and humans spend approximately one-third of their life asleep. Adequate sleep is needed to maintain both physical and psychological health. Routinely getting less than the recommended amount of sleep for your age can have profound negative effects on health, such as increasing the likeliness of psychiatric illness, diabetes, cardiovascular disease and stroke. In children and adults with neurodevelopmental disorders, the prevalence of sleep disorders is significantly higher than in the general population. Given the relationship between sleep and psychiatric disorders, it is essential that psychiatrists have knowledge of the principles of sleep medicine. In this article, we focus on the common sleep disorders found in those with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and give an overview of screening, diagnosis and management.

Measuring outcomes is becoming an increasingly standard (and highly complex) part of what mental health services are expected to do. Practising psychiatrists will need to have a good understanding of approaches to outcome measurement: used well, they have the potential to amplify the patient voice, promote good-quality services and facilitate research. We discuss what constitutes an outcome measure, the different ways that such measures can be obtained and the mechanisms for assessing the quality and appropriateness of an outcome measure. We outline the rapidly evolving research and policy context regarding outcome measurement, with particular reference to the UK's National Health Service. We also consider the potential pitfalls to outcome measurement, such as added clinical burden, inappropriate incentivisation of behaviour and incorrect interpretation of results. We discuss ways that such difficulties can be avoided or their effects mitigated.

The pharmacological treatment of the elderly differs from that of younger patients, mainly because of altered pharmacokinetics and the higher proportion of patients with organic disorders. We deal here with dementia, delirium, affective disorder, late-life schizophrenia, sleep disturbance, and rapid tranquillisation.

Consultation–liaison psychiatry in renal medicine provides a unique experience for the psychiatrist. There is the opportunity to work with a specialist multi-disciplinary team managing patients with chronic and complex physical problems in in-patient and out-patient settings. We aim to consider the common psychiatric problems experienced by renal patients and the particular problems that face the renal team and the liaising psychiatrist in relation to assessment and treatment.

Immigration is increasing and government policies are shifting. Clinicians need to be aware of the mental health needs of immigrants and the challenges of delivering appropriate care. In certain circumstances there are potential conflicts between doctors' clinical, ethical and legal responsibilities. Detention of refugees and asylum seekers may have a detrimental effect on mental health and can result in significant psychiatric morbidity. Ongoing management of foreign nationals following hospital treatment may be complicated by the threat of deportation and its implications for the patient's mental health.

The purpose of this article is to update practitioners on the latest published research into the prevalence of prolonged cerebral seizure activity following electroconvulsive therapy (ECT). This research is drawing attention to the real practical challenges of recording and reading an electroencephalogram (EEG) tracing in the ECT clinic. In particular, determination of the seizure end-point is not always practicable and this poses a major problem in the detection and management of prolonged cerebral seizure activity. Some practical tips are suggested, and an update is given on the status of EEG monitoring in the assessment of seizure adequacy.

Not all traumatic events cause post-traumatic stress disorder (PTSD), and people develop PTSD symptoms after events that do not seem to be overwhelmingly traumatic. In order to direct services appropriately, there is a need to distinguish time-limited post-traumatic symptoms and acute stress reactions (that may improve spontaneously without treatment or respond to discrete interventions) from PTSD, with its potentially more chronic pathway and possible long-term effects on the personality. In this article, we describe acute and chronic stress disorders and evidence about the most effective treatments.

We have developed this succession of articles as a series of iterative steps, each seeking to uphold the recovery values of co-working and collaboration, looking for agreement and commonality but valuing equally diverse viewpoints and difference. Our conclusion is that this is the beginning of a creative dialogue on choice as a route to recovery for people who are psychiatrically detained. We commend our method of engaging with the inevitable tensions and dilemmas by: clarifying the story behind difficult interactions, identifying the relevant guiding principles and jointly working to explore from different viewpoints what can be done to promote recovery.

The main aim of genetic counselling is to inform about disorders that may have a genetic basis. The following definition is a helpful starting point: