This month's Cochrane Corner meta-analysis evaluates the evidence for the use of aripiprazole in ‘autism spectrum disorders’ – although in fact, outcome measures mainly included subtypes of challenging behaviour and side-effects. Aripiprazole was found to be effective in reducing irritability and hyperactivity, while causing extrapyramidal side-effects and weight gain. Only three trials were included in the review, with two small trials eventually included in the meta-analysis. All trials were conducted in under-18s in the USA, with no requirement for a trial of behavioural management before psychotropic medication, and excluding under-18s with important comorbidities such as medicated attention-deficit hyperactivity disorder. All three studies were sponsored and funded by the manufacturer of aripiprazole. Further, a discontinuation trial showed no evidence of sustained benefit beyond 16 weeks of treatment.

Formal communication skills training is the norm at UK medical schools, and evidence is mounting that it is effective in a number of domains, including patient satisfaction and shared decision-making, leading to improved treatment adherence. However, applying these models in mental health settings is challenging, despite the fact that positive therapeutic relationships and an ability to actively manage consultations are the cornerstone of psychiatric practice. Communication skills training is still too often regarded as better suited to physical health consultations than more complex psychiatric interviews. Here, it is considered why this might be, with reference to the one eligible randomised controlled trial identified in this systematic literature review.

Systematic reviews have developed over the past 40 years as a method for integrating findings from the available studies relating to clinical problems and interventions into one publication. Systematic reviews employ a variety of data analytic techniques including meta-analysis, which combines treatment effects across disparate studies in order to produce a truer estimate of treatment effect. The Cochrane Collaboration was established in order to facilitate access to high-quality evidence and specifies stringent guidelines for the production of systematic reviews. A Cochrane Systematic Review (CSR) includes consideration of the risk-of-bias of the selected studies in reaching conclusions. A recent CSR is used as an example to demonstrate the process of conducting a CSR, the data analytic methods employed and the assumptions made when employing these methods. There is a discussion of issues the reader will need to be aware of when considering the findings of a CSR and how this might differ from other systematic reviews including some consideration of how CSRs apply to the brain impairment literature.