Major change is currently occurring in psychiatric training. This editorial explores some of the implications for consultants and CPD. CPD policy and the fit with appraisal and revalidation are discussed. Consultant involvement in training is considered, including consultants' roles as trainers and their involvement in ‘post-CCT training’.

The health of family carers may affect not only their own lives but also the lives of the people for whom they provide care. This article describes how the caring role can affect the health and well-being of a carer of a person who has a mental or physical disorder. Suggestions are made about how to recognise and ameliorate some of the detrimental effects of the caring role on the carer's own health.

The number of older people is increasing in populations throughout the world. Alcohol use disorders in elderly people are a common but underrecognised problem associated with major physical and psychological health problems. Owing to the negative attitudes and inadequate training of healthcare professionals, alcohol misuse is not always being detected or effectively treated. Current diagnostic criteria and common screening instruments for alcohol use disorders may not be appropriate for elderly people. Older people are as likely to benefit from treatment as younger people and the basic principles of treatment are much the same. Better integrated and outreach services are needed. Training of healthcare professionals in this area and pragmatic research should be prioritised to improve detection, treatment and service provision for this vulnerable and neglected population.

Psychiatry in the UK and in many other countries is facing a fundamental crisis in attracting new graduates. This poorly understood problem may be related to negative undergraduate experiences. Many clinicians have learnt through an ‘apprenticeship’ model and few are formally taught how to teach students in a modern clinical setting. Learning theory provides useful models for learning and teaching that can improve undergraduate clinical experiences. A variety of means are available to help teaching clinicians apply these theories, including self-help using published literature and gaining teaching qualifications. As the majority of modern undergraduate psychiatry teaching occurs during clinical placements, the incorporated techniques will need to be sensitive to the teaching environment. Application of these principles to day-to-day teaching practice may help to reverse the current staff shortages.

Patients who repeatedly injure themselves present particular management problems for general psychiatric teams. This article, the first of a series of four, examines the characteristics of those that present to adult mental health services, and the possible underlying background and trigger factors that lead to these anxiety-raising events. Suggestions are made on preventive and assessment procedures, staff reactions and management strategies aimed at helping patients deal with the overwhelming feelings that underlie self-injury.

Scarcity of resources compared with need results in resource-allocation decisions that will have a beneficent effect on some clinical populations and will be detrimental to others. Political philosophy, through theories of social justice, aims to establish generally applicable principles to guide such decision-making. We introduce here the work of the foremost liberal political philosopher of the second half of the 20th century, John Rawls. As well as having implications for resource allocation, John Rawls's work is of relevance to law and ethics in clinical practice, especially for psychiatrists, who often work with vulnerable, disadvantaged and stigmatised people.

John Rawls's theory of justice has been embraced by both the political left and the right, albeit for different reasons. This commentary points out some caveats regarding Rawls's theory as applied to healthcare in general and psychiatry in particular. An alternative political philosophy, the theory of ‘entitlement justice’ as advanced by Nozick, is presented and it is argued that this has more real-life relevance for healthcare ethics than the Rawlsian theory of distributive justice. The reader is invited to determine which theory, if either, is the best fit for psychiatry. The article concludes with some thoughts on the limits to autonomy that mental illness imposes and likens it to the concept of ‘interstitial autonomy’.

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.

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 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.

Electroconvulsive therapy (ECT) remains an important treatment option for severe depressive illness, but it can have side-effects, including permanent gaps in memory. Where minimising the intellectual side-effects of treatment has priority, then treatment to only one side of the head (unilateral ECT) is preferable; where the speed of clinical improvement is paramount, then bilateral ECT may be preferred. The choice of how ECT is administered should, where possible, be part of the process of informed consent.