Intimate partner violence (IPV) is highly prevalent worldwide. Women are disproportionately more likely than men to experience IPV towards them at any point in their lifetime. Psychological therapies could be offered to women who experience IPV as part of the treatment of subsequent mental health problems. This Cochrane review assesses how beneficial or potentially harmful psychological therapies can be for women who receive them compared with standard care alone. The review also attempts to contextualise the results in clinical practice.

Despite record-breaking numbers of opiate related deaths in the UK in 2019, pharmacological management of opiate dependence has evolved little since the advent of methadone in 1965. Along with harm minimisation and psychosocial interventions, the mainstay of pharmacological treatment remains opioid substitution therapy (OST) using methadone or buprenorphine, with many patients receiving OST for many years. Even with these treatments, opiate users continue to face mortality risks 12 times higher than the general population, and emerging evidence suggests that individuals who remain on long-term OST present with a range of physical and cognitive impairments. Therefore, with a growing ageing opiate dependent population who would benefit from detoxification from OST, this article provides an overview of the current state of opiate dependence in clinical practice, explores the reasons why availability and acceptability of detoxification pathways are declining, and discusses emerging pharmacological therapies that could provide benefit in relapse prevention.

Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

Internet gaming disorder (IGD) is a condition in which the individual is preoccupied with playing online video games and unable to regulate this behaviour, resulting in adverse physical and psychological consequences. Although there is some debate about whether IGD is an addiction or a coping mechanism, global evidence indicates that the condition is increasing in prevalence with recent advances in technology and its higher penetration into routine life. Male children and adolescents located in East Asian countries are at higher risk than others in the world. Attention-deficit hyperactivity disorder, depression and anxiety are typically associated with IGD. Given the continuing ambiguity regarding the diagnosis and screening tools for the disorder, it has become all the more relevant for mental health practitioners and academics to attend to this condition and develop evidence-based treatments. This review summarises both the existing evidence for the disorder and the debates that surround it.

Clinical decision-making in psychiatry is affected by many factors, including how best to reduce risks of harm while promoting autonomy and personal recovery. This article proposes guidance for clinical decision-making that is consistent with civil liability law. It emphasises collaboration, clarification of the available information and communication of decisions as a basis for recovery-oriented risk management.

Much exists in the literature on filicide and the characteristics of perpetrators and their victims but there is little in the way of practical advice on how to manage perpetrators of filicide in secure psychiatric wards. Clinically, these patients can rapidly respond to medical treatment, only to be faced with the reality of what they have done. In the authors' experiences, certain aspects of their management are particularly challenging due to the emotive nature of their offence. These include managing the interpersonal dynamics on a ward, the media interest that surrounds the case and rehabilitation back into the community. In this article we outline a brief background to filicide in the context of mental illness and describe our experiences of managing the practical difficulties outlined above. The approaches used, outcomes and the supporting evidence base are discussed and illustrated through examples.

Balancing risk and safety in long-term care settings can be challenging while providing and respecting patients’/residents’ needs and rights in terms of sexual expression. We look at factors affecting the expression of sexuality, including staff attitudes and reactions, and the lack of policies governing sexuality. We review the various statute and case law, other legislative and quasi-legal provisions governing sexuality and sexual expression. Finally, we consider the need for clear policies and training for both staff and family members.

Socratic questioning is at the core of collaborative clinical communication, with a wide array of applications in behavioural medicine and psychotherapy. This brief article describes the process of therapeutic Socratic questioning, illustrates its clinical applications in therapy and provides a brief update on its recent developments.