Adequate sexual expression is essential to many human relationships and provides a sense of physical, psychological and social well-being. Epidemiological and clinical studies show that depression and schizophrenia are associated with impairment of sexual function and satisfaction, even in untreated patients. Most antidepressant and antipsychotic drugs have adverse sexual effects but it is difficult accurately to identify the incidence of treatment-emergent dysfunction, as disturbances can be reliably detected only from systematic enquiries made at baseline and during treatment. Growing awareness of the adverse effects of psychotropic drugs has led to attempts to use adjuvants or substitute treatments to resolve sexual dysfunction. More studies of the effects of antidepressant and antipsychotic drugs on sexual function are needed.

This paper reviews the evidence base supporting the use of pharmacological treatments for child and adolescent psychiatric disorders. Recent advances in knowledge are highlighted, with some of the controversies. New evidence supports a role for selective serotonin reuptake inhibitors in the treatment of anxiety disorders and obsessive–compulsive disorder. Educational and behavioural approaches remain the mainstay of treatment for children and adolescents with autism, but there is evidence that adjunctive medication may be effective. Atypical antipsychotics have been investigated in the treatment of Tourette syndrome and early-onset schizophrenia. Many questions remain unanswered and further research is needed in all areas of paediatric psychopharmacology.

There is a requirement that appraisal of consultants will have been introduced by all National Health Service (NHS) trusts from April 2001. The implication is that all consultants would have had their first annual appraisals by the end of March 2002. In this paper, the authors discuss the development of appraisal as a concept and the societal context in which it has arisen in medicine. They introduce the format for conducting appraisal within NHS trusts and discuss the likely benefits and possible limitations of appraisal.

This article attempts to give a flavour of the influence that psychoactive substances have had on many authors and the literary process. It explores the idea of the narrative as it is applied to addictive disorders and gives a range of examples of writing about different substances that might enhance the reader's knowledge of current drug culture. The portrayal in literature of doctors with addictions is presented as a warning against the development of such problems in psychiatrists. The authors hope to have demonstrated that literature can be a valuable tool in understanding the experience of drug and alcohol use and addiction.

This paper considers how death and dying are presented in literature. A wide range of texts, principally but not exclusively from the English language tradition, is used to illustrate themes. Broad categories are suggested for the study of death: some authors give personal accounts of their impending death or their sense of bereavement; some use literature to structure and order our thoughts about death; and some treat death as a literary device, using it, for example, as a symbolic representation of the decay of society. It concludes that the biggest obstacles that health professionals and patients face as they attempt to understand death in literature are concerned not with a lack of appropriate emotional depth, but with difficulties either in understanding the conventions of literature or in coming to terms with the cultural gaps imposed by time and place.

In 2000, about 350 million adults used the internet and people increasingly take articles from websites to medical appointments. The quality and safety of websites vary widely and some users are reluctant to access mainstream sites. People are vulnerable to misinformation and exploitation: there is evidence that online purchases have caused morbidity and mortality. This paper reviews the current evidence on the dissemination of health information on the internet and the various strategies that are developing to assess and screen site quality. Such strategies include ‘quality assurance’ marking, specially designed search engines, and operational criteria for individuals to apply to sites. It also discusses the medical community's roles and responsibilities in relation to this burgeoning area.

Since the start of the National Health Service, data have been collected on admissions to psychiatric in-patient units, first as the Mental Health Enquiry, then as part of Hospital Episode Statistics. Some details have changed but many have stayed remarkably consistent. Published literature on the wide range of research and policy work undertaken using this data source is reviewed. Early work was central to the government's deinstitutionalisation policy in the early 1960s. Subsequent studies cover a wide range of epidemiological and health services research issues. A new statistical base, the Mental Health Minimum Data Set, covering individuals receiving all types of health care is currently being set up. This will supplement (but not replace) admission statistics.

Sleep disorders are relevant to psychiatric practice in a number of ways, including the possibility that they may be misdiagnosed as fundamentally psychiatric conditions in patients of all ages. This risk exists in a wide range of collectively very common sleep disorders which need to be considered in explaining insomnia, excessive sleepiness or disturbed episodes of behaviour associated with sleep (parasomnias). Examples given include circadian sleep–wake cycle disorders (such as the delayed sleep phase syndrome), obstructive sleep apnoea, narcolepsy, Kleine–Levin syndrome, sleep paralysis and rapid eye movement (REM) sleep behaviour disorder. Failure to recognise and treat such disorders is likely to cause and perpetuate psychological problems. Correct recognition requires familiarity with the range and manifestations of sleep disorders.

Why? … because. This commentary to John Skelton's paper (Skelton, 2003, this issue) addresses the question, ‘Why should I, a busy consultant serving a population of 40 000 in north Lincolnshire and having considerable difficulty in keeping up with the latest developments about antipsychotic drugs, use my precious time for CPD reading about death and dying in literature?’ The answer is two-fold: death and dying is intrinsically an important and relevant subject for psychiatrists; and literature gives useful opportunities for modelling, comparing, contrasting and experimenting with circumstances removed from the patient's immediate situation but still recognised as ‘real life’. Great literature demonstrates authenticity. If the experiences described are true to life, perhaps the strategies that were used in this literary work, or are suggested through their absence, may be effective in your patient's (or even your own) predicament. Literature, or ‘the humanities', can enhance good practice in medicine (Evans & Greaves, 1999).

The teaching of medical skills to medical students and to other doctors is a skill in itself. The traditional ‘apprenticeship’ system of learning within medicine is now known to be inefficient and flawed, in both the UK and in other countries where it has been scrutinised. This article sets out guiding principles to help doctors set up ‘teaching the teachers' courses, which teach the skills of teaching. Psychiatrists at all grades, from senior house officer up to consultant, need some teaching skills, and the authors outline how to plan a course, determine the needs of potential learners and set its objectives and content. Guidance is given on some of the opportunities that are available to obtain formal qualifications in medical education.