Internet-delivered cognitive and/or behavioural therapy (I-C/BT) for post-traumatic stress disorder (PTSD) addresses problems of access to evidence-based psychological treatments and is becoming more widespread. This commentary explores the effectiveness of I-C/BT for PTSD compared with waiting-list/treatment as usual controls as reported in Simon et al’s (2021) Cochrane Review and in subsequent studies. The results suggest that I-C/BT may reduce PTSD symptoms immediately post-treatment, without long-term effects. However, the very low certainty of evidence and inconsistent quality of I-C/BT interventions prohibits recommendations until further high-quality research becomes available.

Self-harm (intentional self-poisoning or self-injury) is common, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for self-harm, first published in 1998 and previously updated in 1999. We have now divided the review into three separate reviews. This review is focused on pharmacological interventions in adults who self-harm.

Maintenance drug treatment in bipolar disorder is a key component of management. There is clinical uncertainty about the relative efficacy of valproate, either alone or in combination, particularly in comparison to lithium. This month's Cochrane corner review aimed to summarise the best evidence available. This commentary puts the findings into their clinical context and updates them in the light of subsequent analyses and the recent revision of the NICE guidelines on bipolar disorder.

The pharmacological treatment of depression is often hampered by side-effects and unsatisfactory response to treatment. Vortioxetine is one of the newest antidepressants on the market, purportedly with a different mechanism of action compared with other antidepressants. This month's Cochrane Corner review examines the evidence available for the use of vortioxetine as a first-line treatment for depression in adults. This commentary puts the Cochrane review's findings into their clinical context and revises them in view of earlier and later studies.

Self-harm is a significant social and healthcare problem, with substantial morbidity and healthcare costs. It has strong links to further self-harm and to suicide. The current review is one of three that investigate interventions in preventing recurrence of self-harm, and it focuses on pharmacological treatment. The conclusions are limited by the small number and size of trials identified, and the low quality of evidence. No benefit on recurrence of self-harm was detected in three small trials of antidepressants, but the types studied are ones that are now less commonly used. A small trial of flupentixol suggested a possible benefit on repetition, but this has not been replicated. One small trial of lithium showed no benefit, but this was in contrast to a recent large meta-analysis showing a significant anti-suicidal effect of lithium when used to treat mood disorder. The review highlights important areas for further research.

Music therapy attempts to facilitate communication and expression – core problems for autistic people – through the development of experiences and relationships mediated by music. This commentary assesses a Cochrane Review of the effects of music therapy, compared with placebo or standard care, for autistic people, and its conclusion that music therapy is probably associated with an increased chance of global improvement and perhaps a slight increase in quality of life and reduction in total autism symptom severity in the short to medium term. The review was not able to examine longer-term effects as the longest follow-up period was 12 months. The certainty of the evidence was graded from moderate to very low, and therefore the results need to be viewed with caution.

High expressed emotion (EE) in families is known to increase risk of relapse for people with schizophrenia. This Cochrane Review by Chien et al suggests that family-based interventions such as psychoeducation may result in a reduction in caregiver burden, a shift from high to low EE, and perhaps also reduce patient relapse rates. However, there was a high degree of heterogeneity in the combined study sample and a significant risk of bias across studies. The authors’ decision to only include studies reporting both a family member and a patient outcome means relevant evidence in this area may not have been incorporated.

Cognitive health, and prevention of its decline to dementia, has risen in prominence with a corresponding exploration of modifiable risk factors to prevent a decline in cognitive health with age. This commentary discusses a new Cochrane review that examines the effect of vitamin and mineral supplementation in maintaining cognitive health in cognitively healthy adults in mid- and late-life. From a heterogeneous body of evidence, the quality of which ranged from very low to moderate, the review draws the conclusions of little or no benefit of supplements.

Agitation and psychosis are two common distressing symptoms of dementia. The results of this issue's Cochrane Corner review suggest that, if a pharmacological approach is required, the use of risperidone and other atypical antipsychotics for the purpose of managing these symptoms seems questionable. Furthermore, typical antipsychotics, haloperidol in particular, might have a greater impact on agitation and psychosis than already recognised. This commentary critically appraises the evidence on the efficacy of typical and atypical antipsychotics for agitation and psychosis in dementia.