Sleep disturbances are common in dementia and are associated with numerous problems. Medication is not clearly effective and is potentially problematic, giving a clear role for non-pharmacological measures. The Cochrane Review discussed here suggested that physical and social activities and carer interventions potentially improve sleep in dementia, although the evidence was not conclusive. The review was limited by the heterogeneity present and the low quality of evidence. The authors’ choice of primary outcomes leads to a wider discussion on the clinical relevance of available outcomes in evaluating sleep in dementia and the potential role for patients and carers in informing this.

Outcomes for people with schizophrenia are improved by expedient diagnosis and specific treatment. ICD-11 and DSM-5 have reduced the importance of Schneider's first rank symptoms (FRS) in the diagnosis of schizophrenia; however, FRS may still offer a useful triage tool for the early identification of schizophrenia and initiation of antipsychotic therapy in high-demand and resource-poor settings. This commentary considers a Cochrane review that assesses the diagnostic accuracy of one or multiple FRS in diagnosing schizophrenia in adults and adolescents.

This commentary gives a very brief overview of depression in epilepsy (prevalence, risk, associations between the two conditions, antidepressant medication) and assesses the quality and results of a Cochrane Review comparing antidepressants with placebo and psychotherapy in managing the condition. Although antidepressants were not shown to be more effective than other interventions and no link between antidepressants and increased seizure frequency was observed, the low-quality evidence obtained cannot provide conclusive answers.

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.

This is an updated version of a Cochrane review first published in Issue 3, 2006 (Perry 2006). The review represents one in a family of four reviews focusing on the effectiveness of interventions in reducing drug use and criminal activity for offenders. This specific review considers interventions for female drug-using offenders.

Female drug-using offenders are a large but under-researched and vulnerable population with specific needs. Only a handful of randomised controlled trials of interventions for this population are of sufficient quality to shed light on what might work to reduce their criminal activity and drug use, and interpretation of the results of most of these trials is limited by an ‘unclear’ risk of bias due to a lack of descriptive information. Better-quality research is needed to inform practitioners and policy makers. In the meantime, this month's Cochrane Corner review provides cautious support for the use of some psychosocial treatments, particularly if delivered in a gender-responsive way addressing issues of abuse and victimisation, in the expectation that re-imprisonment can be prevented, even if there is no proven effect on re-arrest rates and only uncertain effects on substance use.

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.

Although a significant proportion of prisoners and patients in secure hospitals are sex offenders and victim surveys reveal a high level of hidden sexual victimisation, the authors of this Cochrane review found only very limited support for pharmacological intervention with sex offenders. Given the nature and extent of the problem of sexual offending and the promise shown by new drugs, there is a need for clinical scientists, lawyers and ethicists to rise to the challenge of ascertaining the effectiveness and safety of drugs which are being used to treat sex offenders, some involuntarily, without the evidence base to justify confidence as to their effectiveness and safety.

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.

The diagnosis of dementia poses several challenges, as a consequence of which the condition has been widely reported to be underdiagnosed in the general population. Currently, there is no single diagnostic test for dementia and the clinical judgement of primary care physicians is therefore a key determinant in identifying which patients are referred to specialist services for further assessment. This month's Cochrane Corner review found that the clinical judgement of general practitioners is more specific (58–99%) than sensitive (34–91%) in diagnosing dementia, although the data were limited by small sample size and significant heterogeneity. This commentary provides a critical appraisal of this systematic review and attempts to extrapolate conclusions relevant to current clinical practice, including potential areas of further research, to facilitate appropriate and timely referral of patients with suspected dementia to specialist services.