The unavailability of psychotropic and analgesic drugs for medical purposes results in suffering that goes unrelieved. Their excessive availability results in overmedication and suffering of a different kind.

To highlight the discrepancies between the demand for and supply of controlled drugs for licit purposes by different communities, and to promote their rational utilisation.

Review of the United Nations, World Health Organization and other literature on the licit use of narcotic analgesics and psychotropic substances.

Thereare large differences in the use of psychotropics and analgesics by different countries. The differences between industrialised and non-industrialised countries are particularly striking. There is evidence of unmet need in some countries and overutilisation in others.

Governments, international organisations, health professionals and the pharmaceutical industry must work together to ensure an adequate supply of psychotropic and analgesic drugs for medical and scientific purposes, and to implement appropriate measures to minimise the development of misuse and dependence.

Changes in the character of medical authorship.

To compare the impact of industry-linked and non-industry linked articles.

We compared articles on sertraline being coordinated by a medical writing agency with articles not coordinated in this way. We calculated numbers of Medline-listed articles per author, journal impactfactors, literature profiles and citation rates of both sets of articles.

Non-agency-linked articles on sertraline had an average of 2.95 authors per article, a mean length of 3.4 pages, a mean Medline listing of 37 articles per author (95% CI 27–47) and a mean literature profile of 283 per article (95% CI 130–435). Agency-linked articles on sertraline had an average of 6.6 authors per article, a mean length of 10.7 pages, a mean Medline listing of 70 articles per author (95% CI 62–79) and a mean literature profile of 1839 per article (95% CI 1076-2602). The citation rate for agency articles was 20.2 (95% CI 13.4–27.0) and for non-agency articles it was 3.7 (95% CI 3.3–8.1).

The literature profiles and citation rates of industry-linked and non-industry-linked articles differ. The emerging style of authorship in industry-linked articles can deliver good-quality articles, but it raises concerns for the scientific base of therapeutics.

The National Confidential Inquiry into suicides in England and Wales found that a quarter of suicides are preceded by mental health service contact in the year before death. However, visits to accident and emergency departments due to self-harm may not lead to a record of mental health service contact.

To determine the proportion of suicides preceded by accident and emergency attendance in the previous year.

We obtained the list of probable suicides in Leeds for a 38-month period, and examined the records from thecity's accident and emergency departments for a year before each death.

Eighty-five (39%) of the 219 people who later died by suicide had attended an accident and emergency department in the year before death, 15% because of non-fatal self-harm. Final visits dueto self-harm were often shortly before suicide (median 38 days), but the National Confidential Inquiry recorded about a fifth of them as‘not in contact’ with local mental health services.

Although many suicides are preceded by recent attendance at accident and emergency departments due to non-fatal self-harm, local mental health service records may show no recent contact. Suicide prevention might be enhanced were accident and emergency departments and mental health services to work together more closely.

Self-injury is a neglected area of self-harm research and we know little about its epidemiology, hospital care and outcome.

To provide epidemiological data on self-injury and compare hospital management of self-injury with that for self-poisoning.

Data were collected on all self-harm attendances to the general hospitals in Leeds over an 18-month period.

People attending hospital for self-injury or self-poisoning do not form mutually exclusive groups. There were higher proportions of self-injury episodes compared with self-poisoning, where a history of self-harm or contact with mental health services had been recorded. Fewer psychosocial assessments were carried out after episodes of self-injury compared with self-poisoning but, when they were, follow-up was recommended more often.

The clinical importance of self-injury is not mirrored by the level of psychosocial assessment and after-care provided.

A report from a 1980s cohort claimed that suicidal behaviour was four times less common in UK-resident people of Caribbean origin with psychosis than in British Whites. Since then, evidence has accumulated that the rate of suicide and suicidal ideation has been increasing.

To compare rates of suicidal behaviour in people of Caribbean and British White origin in a large multi-centre sample of patients with psychosis.

A secondary analysis of 708 patients with psychosis followed up for 2 years. Outcome measures of reported suicide and attempted suicide were adjusted for socio-economic and clinical differences between groups at baseline.

People of Caribbean origin had a lower risk of suicidal behaviour than British Whites (odds ratio adjusted for age and gender 0.49, 95% C1 0.26–0.92). There was a strong negative interaction between ethnic group and age: suicidal acts were four times less likely in people of Caribbean origin aged over 35 years compared with British Whites, but there was no large or significant difference in those under 35.

The previously reported lower relative risk of suicidal behaviour in people of Caribbean origin with psychosis is restricted to those over 35 years, suggesting that the protective effect of Caribbean origin is disappearing in younger generations.

We have suggested recently that there may be a subgroup of schizophrenia, namely schizophrenia with dyskinesia and striatal pathology Might movement disorders be more common in relatives of those with schizophrenia and dyskinesia than in relatives of those without dyskinesia?

To determine the prevalence of abnormal movements in first-degree relatives of people with schizophrenia who themselves do or do not have abnormal movements.

Chronically ill, never-treated people with schizophrenia in south India (n=70) and their first-degree relatives (n=181) were examined for dyskinesia using the Abnormal Involuntary Movements Scale (AIMS) and for parkinsonism by the Simpson and Angus scale.

Of all relatives, 25 (14%) had dyskinetic movements in at least one body area and 6 (3%) had parkinsonism. Siblings of people with schizophrenia and dyskinesia, compared with siblings of people without dyskinesia, had a higher total AIMS score and more had mild dyskinetic movements in at least one area (5/15 v. 3/34, P=0.04). There were no between-group differences in parkinsonism.

Dyskinesia but not parkinsonism is more common in siblings of people with schizophrenia who have the corresponding movement disorder.

The number of psychiatric beds per capita in Japan is the highest in the world, and a replication of earlier British research is needed to identify possible means of improving the mental health system.

To describe the current situation of psychiatric hospitals in Japan and to examine the relationship between negative symptoms of schizophrenia and social environments.

In-patients with schizophrenia were randomly selected from 139 hospitals. Data were obtained for 2758 participants using several scales, including the Manchester Scale and social environment scales.

Negative symptom scales showed a significant correlation with under stimulating social environments in hospitals.

This study confirms the results from the UK and provides evidence for the importance of community-based care and for providing more-stimulating rehabilitation environments.

Most anxiety/depression is not effectively treated.

Open evaluation of a free clinic giving immediate computer-aided cognitive – behavioural therapy (CBT) self-help plus brief advice from a therapist.

Test of outcome of self-referrals who used one of four computer-aided CBT systems for depression, phobia/panic, general anxiety or obsessive-compulsive disorder.

The equivalent of one full-time clinician managed 355 referrals over a year. Of the 266 who had a screening interview 79% were suitable. Completers and non-completers of computer-aided CBT had similar pre-treatment features, with very chronic, moderately severe problems. Completers of the computer-aided self-help had a mean total of an hour's live therapist support over 12 weeks. They improved significantly and clinically meaningfully with three of the four systems and felt ‘fairly satisfied’. Improvement resembled that in controlled and other trials of computer-aided CBT.

Computer-aided self-help is a‘clinician extender’ that greatly cuts per-patient therapist time without impairing improvement. It could reduce the per-patient cost of CBT.

Childhood sexual abuse is a non-specific risk factor for psychopathological disorders in childhood and later life. The response of non-abusing parents to disclosure of abuse may influence the child's outcome.

To assess the level of psychopathological symptoms in parents and children following disclosure of sexual abuse and the changes following a parental treatment intervention.

Parents completed standardised rating scales about their own and their child's symptoms. These were repeated following the intervention.

Thirty-nine parents of 31 children completed scales at the baseline assessment; 18 repeated these following interventions. Initially, parents reported high rates of psychopathological symptoms in themselves and their children, which were reduced following the intervention.

This study confirms the high rates of psychopathological symptoms found in parents of children following disclosure of sexual abuse. Children clinically identified for intervention had higher measured levels of psychopathological symptoms. Targeted treatment interventions are needed.