Simple schizophrenia is a sometimes controversial diagnosis. Here we review the concept with particular reference to its history in diagnostic systems. Using an illustrative real case of a 25-year-old man, we show that there is a need to retain this diagnostic category, which may fit better within proposed dimensional (psychomotor poverty, disorganisation and reality distortion) rather than categorical classifications of schizophrenia. Symptoms of the disorder may be better revealed by functional assessment than by relying on descriptive psychopathology.

It has been suggested that a recovery-focused approach and treatment under the Mental Health Act are mutually exclusive, hence the limited applicability of ‘recovery’ in forensic psychiatry. This is heightened if recovery is seen as a ‘model’ that does or does not fit, and lessened if seen as ‘values-in-action’ that need reinterpretation in context.

Behaviour therapy, namely exposure and response prevention, has for many years been the treatment of choice for most patients with obsessive—compulsive disorder (OCD). However, at least 25% of patients with OCD refuse exposure and response prevention or drop-out early. Of those who do comply, about 75% make reasonable gains and maintain them in the long-term. This means that 50% of patients who are offered treatment by exposure and response prevention either refuse, drop-out or show little improvement. Many patients find exposure distressing and this is probably the main reason for dropping-out early. Treatment failures tend to be associated with a depressed mood, over-valued ideation, slowness, mental compulsions and severe degrees of avoidance.

In this overview we discuss the palliative psychiatric care of older people towards the end of life. We briefly consider ethics, dementia care, delirium, depression, anxiety, grief and physician-assisted suicide. We also discuss hope, dignity, spirituality and existentialism. We hope that this article will encourage clinicians to reflect on the effects of terminal illnesses on the mental health of dying people and the current provision of palliative psychiatric care.

Journal clubs are a mandatory aspect of psychiatric training in the UK, yet are not always seen as a stimulating experience. Clarifying the aim of the club and tailoring it to the needs and wishes of the audience is an essential step. Teaching skills in critical appraisal is often seen as the main purpose of journal clubs. Depending on the audience, being able to formulate questions from clinical dilemmas, search the literature, and integrate research evidence, clinical expertise and the patient's needs and wishes may be as important. Linking these tasks in the journal club with routine clinical practice increases the chances of changing attitudes and behaviour and thus influencing care. New approaches to using social media and online formats mean that journal clubs are no longer restricted to a particular place or time, although the social aspect of meeting colleagues continues to be important for many.

Medications prescribed by psychiatrists are known to elevate serum prolactin levels, but hyperprolactinaemia remains underrecognised, as the adverse effects of an elevated prolactin are mostly not visible. Hyperprolactinaemia can lead to adverse health outcomes, so clinicians need not only to be alert to its symptoms, but to manage the consequences as well. In this article we provide a brief overview of prolactin physiology, regulation and function. We list various factors that can lead to elevated serum prolactin. We discuss the interpretation of blood results and the management of psychotropic-induced hyperprolactinaemia. We include a flow diagram to assist clinicians in decision-making in the clinical management of hyperprolactinaemia.

Parkinson's psychosis can be very challenging to manage, with limited treatment options available. There is a good evidence base to support the use of clozapine, but practical obstacles often prevent its use. There is a drive nationally to set up services so that people with Parkinson's psychosis can access treatment with clozapine in a timely manner and, where possible, with initiation in the community. The authors describe their experiences in setting up clozapine services specifically for this patient group in England and offer a practical approach to the assessment of Parkinson's psychosis. They also outline the evidence base in relation to treatment options and share their experiences of prescribing clozapine for Parkinson's psychosis.

Children with either normal or impaired cognitive abilities presenting to child and adolescent mental health services (CAMHS) with psychiatric or behavioural problems may have an underlying syndromic or neurological diagnosis. Diagnostic clues exist in the measurement of growth and head circumference, recognition of dysmorphism and in the full physical and, in particular, neurological examination of the individual. Recognition of these clues will allow referral, as necessary, for further investigation or surveillance. Prompt diagnosis of disorders is important for many reasons: the provision of an explanation for the child's current difficulties and the anticipation of further difficulties; the recognition of genetic, and therefore reproductive, implications for parents and siblings; the recognition of a grim prognosis; and access to any available treatments.

Substance misuse worsens the prognosis for people suffering psychosis and places them at risk of being denied appropriate mental health service interventions. To increase the chances of its success, the plan of management for patients with coexisting psychosis and substance misuse should be based on a valid formulation of their problems, which in turn is dependent on the clinician having (a) a thorough understanding of the bidirectional and changing ways that substance use and mental illness symptoms can interact, (b) an awareness of their own biased implicit assumptions about causality in explaining these interactions and (c) a framework for assessment and formulation. This article addresses these three areas with reference to the evidence base and to clinical experience in a way that guides mental health clinicians in the assessment of patients with coexisting psychosis and substance misuse.

A growing body of evidence suggests that the most common type of dementia in schizophrenia differs from Alzheimer's disease in its clinical features, natural course, neuropathology, neuroanatomical substrates and prognosis. Furthermore, there is some evidence that the risk of developing cognitive impairment and its progression in early-onset schizophrenia differ compared with late- or very-late-onset schizophrenia. The diagnosis and management of dementia in schizophrenia is challenging for both general adult and old age psychiatrists. This article reviews the evidence base regarding dementia in schizophrenia. It discusses the diagnosis of dementia in schizophrenia, its management and prognosis, and identifies some future research opportunities.

Payment by results (PbR) for mental health services is currently being piloted with the aim of arriving at a national tariff for mental health by 2013/2014. The Department of Health has also established two pilot sites to consider applicability of PbR for learning disability services. This article outlines the concept of PbR in learning disability services and describes the progress of the pilot work being undertaken in this area.

Chronic fatigue syndrome (CFS) is syndrome of unremitting fatigue of at least 6 months' duration that causes significant disability. Exercise therapy has a proven track record in medicine and could be effective for some patients with CFS. An updated Cochrane review of eight studies appeared to suggest that exercise helps fatigue symptoms, but with only a small probability of recovery and/or improvement in daily function. Provisional data on acceptability suggest that most patients are willing to participate. However, one key study (PACE), which was well powered and influential in the Cochrane review, has been met with considerable controversy owing to lack of clarity on outcomes. Following release of the PACE study primary data, re-analysis suggested smaller effect sizes than initially reported.

This article explores the challenges of developing clinical risk management practice and policy within large mental healthcare organisations. The national context is outlined and requirements of organisations explained. Consideration is given to how clinical risk relates to clinical quality and the benefits of standardisation are explored. We highlight the complexities and conflicts of implementing standardised procedures, given the current evidence base, and the difficulties of applying this in clinical practice. Using concepts from strategic planning and psychology, we suggest an approach to respond to these factors at a local level to achieve better outcomes for service users and clinicians.

We consider key facets of the concept of mental health recovery and how they are reflected in other concepts that run through the emerging focus on public mental healthcare. We widen the scene to portray the niche into which recovery fits and show how it and recent research indicate why psychiatrists should use the social sciences more widely to complement neuroscience.

Pica is a condition associated with a number of physical and mental health diagnoses. The potentially fatal consequences of pica and the links with significant physical health problems are not always recognised. Pica is like other forms of behaviour that can challenge: clinicians must seek the underlying cause and treat this first, before primarily pursuing a behavioural form of treatment. In this article, we discuss the associations, consequences, assessment and management options available for pica to guide professionals. Pica often presents in a way individual to the particular patient, so tailoring of assessment and treatment is important.

Depression, in its severest forms, causes severe morbidity, has a high incidence of mortality and requires emergency treatment. In a previous article in this journal (Porter & Ferrier, 1999), we discussed the emergency treatment of severe depression by pharmacological means and electroconvulsive therapy (ECT). Here, we will discuss the contribution of non-pharmacological aspects of management to fast, effective and safe treatment of severe depression. We will also complete our review of this subject by examining the efficacy of some emerging therapeutic interventions for severe depression.

Since 2013, hoarding disorder has been recognised as a standalone diagnosis in the DSM, affecting an estimated 2–6% of the general population. This article outlines the arguments for and against this separate classification and considers the differentiation of hoarding disorder from normative collecting. It then discusses aetiology, assessment, course and treatment (both psychological and pharmacological interventions). It concludes with a discussion of ethical and legal considerations, in particular the fact that the inclusion of hoarding disorder as a distinct diagnosis in DSM-5 confers specific protections for people with the disorder under the Equality Act 2010.

Mental illness in very young children is relatively rare and the number of 0- to 4-year-olds seen in secondary care psychiatric services has recently declined. Conceptualisation of mental illness in this age group is shifting towards a model that views disorders as part of the wider spectrum of diagnoses, rather than distinct, developmentally specific conditions. This article discusses the epidemiology of psychiatric illness in preschool children, evaluates assessment tools that have only recently been validated for use in secondary care and considers evidence of the efficacy and cost-effectiveness of early intervention using treatments encompassing pharmacological, psychological and social approaches.

It is over 40 years since the principle of informed consent was accepted in the USA and it has been long established in other common law jurisdictions. But for decades English law has been constrained by the Sidaway case, which effectively perpetuated a form of medical paternalism. Nevertheless, a patient-centred approach can be traced to one of the judgments in that case, and in the case of Montgomery the Supreme Court has now adopted an approach to consent which is based on self-determination and autonomy and is more closely aligned to professional practice. It calls for a dialogue between doctor and patient, recognition of the patient's right to make a choice and recognition by the doctor of their duty to provide the comprehensible information necessary for the patient to exercise choice, having regard to what a prudent patient, in that patient's circumstances and with that patient's characteristics, would want to know.

Rapid-cycling bipolar affective disorder presents a unique spectrum of therapeutic difficulties. This article outlines some practical guidelines on the assessment and management of the disorder in the light of current research and clinical practice.