The use of complementary medicines in those with mental health problems is well documented. However, their effectiveness is often not established and they may be less harmless than commonly assumed.

To review the complementary medicines routinely encountered in psychiatric practice, their effectiveness, potential adverse effects and interactions.

Electronic and manual literature search on the effectiveness and safety of psychotropic complementary medicines.

Potentially useful substances include ginkgo and hydergine as cognitive enhancers, passion flower and valerian as sedatives, St John's wort and sadenosylmethionine as antidepressants, and selenium and folate to complement antidepressants. The evidence is less conclusive for the use of omega-3 fatty acids as augmentation treatment in schizophrenia, melatonin for tardive dyskinesia and 18-methoxycoronaridine, an ibogaine derivative, for the treatment of cocaine and heroin addiction.

Systematic clinical trials are needed to test promising substances. Meanwhile, those wishing to take psychotropic complementary medicines require appropriate advice.

There is an excess of death from natural causes among people with schizophrenia.

Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample of 7217 Finns aged ⩾30 years.

A comprehensive health examination was carried out at baseline. Schizophrenia was determined using the Present State Examination and previous medical records.

During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95% CI 2.06–3.90), and was2.25 (95%CI1.61–3.15) after further adjusting for somatic diseases, blood pressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was 2.50 (95% CI1.46–4.30) per increment of one neuroleptic.

There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Suicide prevention is a health service priority. Suicide risk may be greatest during psychiatric in-patient admission and following discharge.

To describe the social and clinical characteristics of a comprehensive sample of in-patient and post-discharge cases of suicide.

A national clinical survey based on a 4-year (1996–2000) sample of cases of suicide in England and Wales who had been in recent contact with mental health services (n=4859).

There were 754 (16%) current in-patients and a further 1100 (23%) had been discharged from psychiatric in-patient care less than 3 months before death. Nearly a quarter of the in-patient deaths occurred within the first 7 days of admission; 236 (31%) occurred on the ward, the majority by hanging. Post-discharge suicide was most frequent in the first 2 weeks after leaving hospital; the highest number occurred on the first day.

Suicide might be prevented among in-patients by improving ward design and removing fixtures that can be used in hanging. Prevention of suicide after discharge requires early community follow-up and closer supervision of high-risk patients.

Suicide prevention is a health service priority but the most effective approaches to prevention may differ between different patient groups.

To describe social and clinical characteristics in cases of suicide from different age and diagnostic groups.

A national clinical survey of a 4-year (1996–2000) sample of cases of suicide in England and Wales where there had been recent (< 1 year) contact with mental health services (n=4859).

Deaths of young patients were characterised by jumping from a height or in front of a vehicle, schizophrenia, personality disorder, unemployment and substance misuse. In older patients, drowning, depression, living alone, physical illness, recent bereavement and suicide pacts were more common. People with schizophrenia were often in-patients and died by violent means. About athird of people with depressive disorder died within a year of illness onset. Those with substance dependence or personality disorder had high rates of disengagement from services.

Prevention measures likely to benefit young people include targeting schizophrenia, dual diagnosis and loss of service contact; those aimed at depression, isolation and physical ill-health should have more effect on elderly people.

Previous studies of people convicted of homicide have used different definitions of mental disorder.

To estimate the rate of mental disorder in people convicted of homicide; to examine the relationship between definitions, verdict and outcome in court.

A national clinical survey of people convicted of homicide(n=1594) in England and Wales (1996–1999). Rates of mental disorder were estimated based on: lifetime diagnosis, mental illness at the time of the offence, contact with psychiatric services, diminished responsibility verdict and hospital disposal.

Of the 1594, 545 (34%) had a mental disorder: most had not attended psychiatric services; 85 (5%) had schizophrenia (lifetime); 164 (10%) had symptoms of mental illness at the time of the offence; 149 (9%) received a diminished responsibility verdict and 111 (7%) a hospital disposal – both were associated with severe mental illness and symptoms of psychosis.

The findings suggest an association between schizophrenia and conviction for homicide. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Some perpetrators receive prison sentences despite having severe mental illness.

Cannabis use is associated with mental health problems, and young people in particular are at risk.

To investigate the association between cannabis use and mental health in adolescence.

Data from 5551 adolescents aged 12–16 years were drawn from the Dutch Health Behaviour in School-Aged Children school survey, carried out as part of the international 2001 World Health Organization project.

After adjusting for confounding factors, cannabis use was linked to externalising problems (delinquent and aggressive behaviour) but not to internalising problems (withdrawn behaviour, somatic complaints and depression). An increasing frequency of use resulted in stronger links. No significant gender or age by cannabis interaction effects were found.

In a country with a liberal drug policy like The Netherlands, cannabis use is associated with aggression and delinquency, just as in other countries. Cannabis use was not associated with internalising problems. Alcohol use and regular smoking were strong confounding factors.

There has been little reported research into the effect of war on the behaviour and emotional well-being of pre-school children.

To investigate the relationship between exposure to war trauma and behavioural and emotional problems among pre-school children.

Atotal of 309 children aged 3–6 years were selected from kindergartens in the Gaza Strip, and were assessed by parental reports in regard to their exposure to war trauma, using the Gaza Traumatic Checklist, and their behavioural and emotional problems, using the Behaviour Checklist (BCL) and the Strengths and Difficulties Questionnaire (SDQ).

Pre-school children were exposed to a wide range of traumatic events. The total number of traumatic events independently predicted total BCL and SDQ scores. Exposure to day raids and shelling of the children's houses by tanks were significantly associated with total behavioural and emotional problems scores.

Direct and non-direct exposure to war trauma increases the risk of behavioural and emotional problems among pre-school children, which may present as non-specific psychopathology.

Information on psychiatric morbidity of prisoners has almost entirely been based on research in Western countries and it is uncertain whether these research findings are applicable to other settings.

The primary objective was to investigate the prevalence of psychiatric disorders in Iranian prisoners.

Through stratified random sampling, 351 prisoners were interviewed using the clinical version of the Structured Clinical Interview for DSM-IVAxis I Disorders and the Psychopathy Checklist: Screening Version.

The majority (88%) of prisoners met DSM – IV criteria for lifetime diagnosis of at least one Axis I disorder and 57% were diagnosed with current Axis I disorders. Opioid dependence (73%) had the highest prevalence among lifetime diagnoses, whereas major depressive disorder (29%) was the most common current diagnosis. Psychopathy was recorded in 23%. Prevalence rates of psychiatric disorders were significantly different among offence categories.

The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of Iran, with treatment challenges that appear to be different from those observed in inmates in Western countries.

Approximately 1 in 200 UK pregnancies ends in stillbirth. Although serious psychological effects of stillbirth on mothers are well established, much less is known about the impact of such loss on fathers.

To assess the psychological morbidity of fathers in the pregnancy and post-partum year subsequentto a stillbirth, to test within-couple effects and to identify risk factors.

This was a community-based cohort study of 38 pregnant couples whose previous pregnancy had ended in stillbirth, and 38 pair-matched controls. Psychological assessments took place antenatally and at 6 weeks, 6 months and 1 year postnatally.

Fathers in the index group experienced significant levels of anxiety and post-traumatic stress disorder antenatally, but all of their symptoms remitted postnatally (after the birth of a live baby). Fathers' symptom levels were lower than those of mothers at all time points. In contrast to mothers, fathers experienced greater anxiety when a subsequent pregnancy (following stillbirth) was delayed.

The vulnerability of fathers to psychological distress during the pregnancy after a stillbirth needs to be recognised.

High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes.

To investigate the relationships between carer expressed emotion, patients' symptoms and carer characteristics during a recent relapse of psychosis.

A total of 86 patients and carers were investigated in a cross-sectional design.

Patients whose carers showed high expressed emotion had significantly higher levels of anxiety and depression, but not more psychotic symptoms or lower self-esteem. Linear regression showed that carers' critical comments predicted anxiety in patients. Critical comments were related to low carer self-esteem and avoidant coping strategies. Low carer self-esteem was also related to carer depression, stress and carer ‘burden’, and to low patient self-esteem.

Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of psychosis.

An increased incidence of brain white-matter hyperintensities has been described in major depressive disorder, but the impact of such hyperintensities on treatment outcome is still controversial.

To investigate the relationship of brain white-matter hyperintensities with cardiovascular risk factors and with treatment outcome in younger people with major depressive disorder.

We assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people with major depressive disorder prior to initiating antidepressanttreatment. We also assessed hyperintensities in 35 matched controls.

We found no significant difference in the prevalence of white-matter hyperintensities between the depression and the control groups. Left-hemisphere subcortical hyperintensities correlated with lower rates of treatment response. We found no correlation between global hyperintensity measures and clinical outcome. Brain white-matter hyperintensities correlated with hypertension and age and with total cardiovascular risk score.

Subcortical white-matter hyperintensities in the left hemisphere (but not in other brain areas) may be associated with poor response to antidepressant treatment in major depression.