There is urgent need to search for a dementia treatment that can delay its progression and reduce its financial and societal burden. Despite lacking evidence, there is a large number of commercial brain-training products on the market that claim they improve cognition. The Cochrane review under consideration looks at whether cognitive training maintains or improves cognition in those with mild to moderate dementia compared with control and alternative interventions. This commentary puts its findings into clinical perspective.

Nitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.

Alcohol use disorders (AUD) are common, particularly in patients attending mental health services. Clinicians are often hesitant to explore with patients their relationship with alcohol and the role that it has in their presenting complaint, despite being ideally placed to optimise on a ‘teachable moment’ and initiate treatment, where necessary. This article provides an overview of AUD and their identification and management options.

This is an overview of epidemiology relevant to mental health problems in old age. We start by reviewing some basic terminology: the definitions of prevalence and incidence; the difference between descriptive and analytical epidemiology; the differences between study designs, including cross-sectional, case–control and cohort studies. We then cover the main epidemiological features of the major psychiatric diseases that affect older people (dementia and its different types, depression, late-onset schizophrenia, bipolar affective disorder, delirium, anxiety-related disorders, eating disorders, alcohol and substance misuse, personality disorders) and suicide.

We end with some descriptive statistics regarding quality of life in older people.

Shortcomings of randomised controlled clinical trials include their high cost, which often precludes very long-term studies and very large populations, and ethical constraints of randomisation. Observational studies are a valuable alternative and we outline their use in epidemiological research to study very long-term effects of lifestyle and medication on dementia, to explore (using Mendelian randomisation) the association between Alzheimer's dementia and individual traits, and to evaluate population-wide health inequalities and lifespan changes in risk factors for psychiatric illness.

Sialorrhoea (hypersalivation) is a common adverse effect of clozapine. If severe, it can affect patients' quality of life and adherence to the treatment. Clinicians therefore need to proactively manage this effect. At present, no drugs are licensed to manage clozapine-induced sialorrhoea, although there are many off-label treatment options, with variable effectiveness. Anticholinergic medications are commonly prescribed for it, but they have limited effect and can worsen constipation. This article gives a brief overview of other practical and pharmacological management options.

In this article we re-examine the conclusions of our article on advance statements in adult mental healthcare that was published in 2010 in the light of new literature published in the intervening decade. We explore the results of studies on the implementation and effectiveness of advance statements in adult mental health services, and then summarise recommendations for legislative changes from the Independent Review of the Mental Health Act 1983 that are relevant for England and Wales.

Caring for people in distress or illness is emotionally draining and physically demanding. This article focuses on the experiences and needs of health service staff as professional carers. It overviews the current circumstances in the UK and links readers to the findings of: the Stevenson/Farmer Review of 2017; the report of the General Medical Council on the state of medical education and practice of 2018; and the British Medical Association survey of doctors and medical students published in 2019. We review the sources of stress that affects healthcare practitioners and introduce the concepts of emotional labour, psychological safety and psychosocial resilience. We draw attention to the vital importance of social support and leadership to protecting healthcare staff. We conclude this review of the topic by outlining a stepped model for actions that aim to: develop staff of healthcare services and help them to thrive at work; support staff who are struggling at work; and intervene to care for staff who are distressed or unwell whether they are continuing to work or not.