This article reviews the putative role of emotion dysregulation in diverse clinical presentations and considers some of its aetiological factors, such as insecure attachments in early life and traumatic experiences in later life. The neurobiology of emotional processes is described in relation to the ‘window of tolerance’ model of arousal levels optimal for information processing. Treatment options are considered and ways to regulate distress, derived from different approaches, are summarised in a ‘toolbox’. Fictitious case vignettes illustrate clinical applications.

Charcoal-burning has become a common method of attempted suicide in Asia and survivors are often intoxicated with carbon monoxide (CO). Reports of the neuropsychiatric aspects of CO poisoning date back to 1914. This article outlines the neuropsychiatric sequelae that have been described secondary to CO poisoning. The underlying pathophysiology and management strategies, including acute management and cognitive rehabilitation, are discussed as these topics are of relevance to psychiatrists.

This article covers the basic principles of systematic reviews and meta-analyses while discussing the problems associated with the traditional narrative review. It explores the role of the overview as a formal method of combining information from all relevant studies about a particular health condition. It also describes how the review tries to minimise bias so as to avoid reaching the wrong conclusions from the available research data. Important issues that need to be considered when appraising an overview are outlined. Some terms used in reporting systematic reviews and meta-analyses are introduced, such as risk ratio, mean difference, confidence interval and the forest plot.

There is considerable debate about the diagnosis of personality disorder in adolescence. It is argued that, because personality is still developing in the teenage years, it is impossible to state with certainty that a young person's personality is disordered. Alternatively, some researchers and clinicians argue that it is possible to diagnose emerging personality disorder on the basis of trait theories of personality. We review the evidence for both sides of the debate.

Anxiety has reported prevalence rates between 38 and 72% among people with dementia. It has a negative impact on cognitive impairment and is associated with agitation and poor quality of life. The presence of excessive anxiety can be difficult to establish in people with dementia, especially when expressive or receptive speech is impaired. Unfortunately, there is a lack of research on the treatment of anxiety in dementia, and also on the wider issue of the management of anxiety disorders in old age. We explore the prevalence, presentation and diagnosis of anxiety in dementia and discuss the therapeutic options available.

Domestic violence is a major public health problem because it is common and associated with physical and mental health morbidity. It is more common in psychiatric patients but is underdetected by mental health professionals. Routine enquiry increases detection but needs to be introduced in the context of comprehensive training, and only where referral and care pathways have been developed. High-risk patients should be referred to multi-agency risk assessment conferences for multidisciplinary assessment and safe management.

This article describes the psychological experiences of guilt and shame. Although these affects have an important role in holding our communities together, they can also become extremely distressing and debilitating for individuals. As such, they are transdiagnostic problems which are frequently encountered in mental healthcare. The origin of these affects is considered from religious, cultural and psychological perspectives. The article then explores the clinical manifestations of guilt and shame. Finally, consideration is given to therapeutic options, including general approaches as well as specific psychological therapies.

A growing body of evidence suggests that the most common type of dementia in schizophrenia differs from Alzheimer's disease in its clinical features, natural course, neuropathology, neuroanatomical substrates and prognosis. Furthermore, there is some evidence that the risk of developing cognitive impairment and its progression in early-onset schizophrenia differ compared with late- or very-late-onset schizophrenia. The diagnosis and management of dementia in schizophrenia is challenging for both general adult and old age psychiatrists. This article reviews the evidence base regarding dementia in schizophrenia. It discusses the diagnosis of dementia in schizophrenia, its management and prognosis, and identifies some future research opportunities.

Sex is central to most intimate relationships, and there is inevitably a two-way interaction between sex and intimacy. Sex is a physical, a psychological and an interpersonal event, and treatment of sexual problems should take account of all three aspects. Couple relationship problems that can affect sexual interaction include pervasive hostility, poor communication, lack of trust and disparate levels of sexual desire. Therapists should be able to manage therapy sessions with both partners present, without taking sides, and treating the relationship, rather than either individual, as the ‘client’. They should be able to balance the physical approach to problems with managing relationship issues and the partners' individual psychological problems. Techniques are recommended for understanding and modifying the couple relationship during therapy, as well as for dealing with specific sexual problems using a behavioural systems approach.