This Cochrane review supports existing recommendations for risperidone and advances understanding of the use of valproate in patients with schizophrenia who are agitated or aggressive.

Harm in talking therapies, and in healthcare professionals’ relationships with patients generally, has received little attention in comparison with harm by medication and other treatments. There has been little research into causes, types and effects. Professionals behave as if it does not happen and tend to react defensively to complaints. We believe that it is essential for professionals to understand the potential for harm and evaluate their actions in order to make them safer. This article defines harm in the therapeutic context, discusses its prevalence and then focuses on adverse idealising transference: the adverse effects that may arise when a patient transfers idealising feelings onto the professional.

Sexual boundary violations by healthcare professionals is a subject that has largely been ignored in the UK. There has been little research into the field. It is rarely taught on professional training courses and practitioners appear to know very little about it. The history of sexual boundary violations is littered with failures to notice, failures to report and inadequate justice for victims and perpetrators alike. Perpetrators are commonly assumed to be predators. Given the many widely reported recent events in our media of both predatory and other sexual offenders, we believe it is timely for all healthcare and other professions working with vulnerable people to take the problem seriously, to provide appropriate services for victims, evaluation and assessment of perpetrators, and sanctions that fit the crime in order to regain public trust.

In this commentary, I draw on Hook & Devereux to explore the role of insecure attachment in boundary-violating doctors. I also explore the potential contribution of personality dysfunction in that small proportion of doctors who breach professional boundaries.

Clear policies regarding sexual expression, sexual behaviour and related decision-making assist in ensuring that the rights of people with mental disorder or intellectual disability are upheld, and that staff know how to react to situations consistently and lawfully without interfering on the basis of their own moral judgements or personal beliefs. Sensitive and holistic planning of care that complies with domestic law, international human rights law and statutory guidance is necessary to complement such policies. Non-intimate physical contact, masturbation, sexual relationships, contraception, sterilisation and vasectomy, pregnancy, termination of pregnancy, sexual dysfunction, parenthood, marriage and civil partnership, divorce, prostitution, pornography, and sex aids and toys are all matters that may properly be part of care planning.

This brief article reflects on the relationship between psychiatrists and pharmaceutical companies (pharma), which continues to generate debate and concerns. We suggest that psychiatrists should consider both the biomedical ethical principles and how values guide actions and clinical decision-making in their dealings with pharma. In addition, the Royal College of Psychiatrists should err towards eschewing influences that might be regarded by others as distorting its position, and individual psychiatrists should declare interests that others might regard as competing/conflicting in order to maintain the trust of patients and the public.

Choosing an intervention for a patient experiencing distressing symptoms and/or suffering with a mental disorder is part of routine practice for clinicians. While there are now many effective pharmacological and psychological therapies for mental health problems, syndromes and persistent physical symptoms (e.g. chronic pain), choosing the ‘right’ therapy can sometimes be a challenge. This can certainly be the case when it comes to psychological therapies. There are many different approaches to choose from and many have not been subjected to rigorous study.

In this article, we aim to help inform and guide the busy clinician in choosing a psychological therapy for their patient. We give a brief overview of the major psychotherapy modalities and consider which guidelines to refer to and which psychological therapies have been found to be most effective for the presenting problem(s) seen in clinic. Lastly, we discuss the limitations of the current guidelines in relation to comorbid presentations and consider how this can be best addressed.

Funding for mental health services in England faces many challenges, including operating under financial constraints where it is not easy to demonstrate the link between activity and funding. Mental health services need to operate alongside and collaborate with acute physical hospital services, where there is a well-established system for paying for activity. The funding landscape is shifting at a rapid pace and we outline the distinctions between the three main options – block contracts, episodic payment and capitation. Classification of treatment episodes via clustering presents an opportunity to demonstrate activity and reward it within these payment approaches. We discuss the results of our research into how well the clustering system is performing against a number of fundamental criteria. We find that, according to these criteria, clusters are falling short of providing a sound basis for measuring and financing services. Nevertheless, we argue that clustering is the best available option and is essential for a more transparent funding approach for mental healthcare to demonstrate its claim on resources, and that clusters should therefore be a starting point for evolving a better funding system.

Alzheimer's disease pathology accumulates years before the onset of clinical symptoms and has been termed ‘preclinical dementia’. Biomarkers have been developed to detect this pathology – namely, brain amyloid deposition and markers of neurodegeneration. In this article we describe these biomarkers and review the evidence for their clinical use in predicting risk both in the cognitively ‘normal’ and in those who already have established cognitive decline. We also discuss the limitations and ethical considerations of these tests and consider whether we should start incorporating Alzheimer's disease biomarkers into clinical practice. We find that, because many cognitively healthy people will have Alzheimer's pathology, and it is not clear whether this does help predict future risk of Alzheimer's disease, diagnosing preclinical dementia carries numerous ethical implications and is currently not being advocated outside research settings.