With almost a million people dying by suicide worldwide each year, reducing the rate of suicidal behaviour is a priority in many countries.

To examine whether additional psychosocial interventions following an episode of self-harm reduce the likelihood of subsequent suicide.

We conducted a systematic review and meta-analysis of data from randomised controlled trials of interventions for people following self-harm. Likelihood of suicide was compared by calculating the pooled root difference in suicide rate with 95% confidence intervals.

We obtained suicide data from 18 studies with a total population of 3918. Eighteen suicides occurred among people offered active treatment and 19 among those offered standard care (pooled root difference in suicide rate 0.0, 95% CI – 0.03 to 0.03). The overall rate of suicide among people participating in trials was similar to that reported in observational studies of people who self-harm.

Results of this meta-analysis do not provide evidence that additional psychosocial interventions following self-harm have a marked effect on the likelihood of subsequent suicide.

Depression following myocardial infarction is associated with poor cardiac prognosis. It is unclear whether antidepressant treatment improves long-term depression status and cardiac prognosis.

To evaluate the effects of antidepressant treatment compared with usual care in an effectiveness study.

In a multicentre randomised controlled trial, 2177 myocardial infarction patients were evaluated for ICD–10 depression and randomised to intervention (n=209) or care as usual (n=122). Both arms were evaluated at 18 months post-myocardial infarction for long-term depression status and new cardiac events.

No differences were observed between intervention and control groups in mean scores on the Beck Depression Inventory (11.0, s.d.=7.5 v. 10.2, s.d.=5.l, P=0.45) or presence of ICD-10 depression (30.5 v. 32.1%, P=0.68). The cardiac event rate was 14% among the intervention group and 13% among controls (OR=1.07, 95% CI 0.57-2.00).

Antidepressant treatment did not alter long-term depression post-myocardial infarction status or improve cardiac prognosis.

The stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.

To describe DSM – IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.

We conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity.

Of those with a baseline DSM—IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group.

Further study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.

It remains unclear how much various factors contribute to the placebo response.

To estimate the therapeutic impact of follow-up assessments on placebo response in antidepressant trials.

Double-blind, placebo-controlled antidepressant trials that reported weekly changes in Hamilton Rating Scale for Depression (HRSD) scores over 6 weeks were selected. Included studies (n=41) were divided into those that conducted four, five or six follow-up assessments. Reductions in HRSD scores as a function of the different follow-up schedules were compared.

An extra follow-up visit at week 3 was associated with a 0.86 further reduction in HRSD score; an extra visit at week 5 was associated with a 0.67 further reduction. These effects represented approximately 34–44% of the placebo response that occurred over these time frames. Two additional visits were associated with twice the reduction in HRSD score than one, suggesting that the therapeutic impact of assessment visits is cumulative and proportional. A comparable therapeutic effect was also found in participants receiving active medication.

Follow-up assessments in antidepressant treatment trials incur a significant therapeutic effect for participants on placebo, and this represents about 40% of the placebo response.

Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory.

To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study.

A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments.

Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist–Revised (especially on Factor 1) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished ‘completers' from ‘non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%).

Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.

Low cholesterol has been reliably demonstrated in people who self-harm.

To determine whether people who self-harm also have low levels of essential fatty acids (EFAs) and to examine associations between the EFAs and serotonergic function.

Depression, impulsivity and suicidal intent were measured in patients with self-harm (n=40) and matched controls, together with plasma lipids and EFAs. Platelet serotonergic studies were carried out in a subgroup (n=27).

Patients with self-harm had significantly more pathology on all psychometric measures, lower mean total cholesterol levels (418 (s.d. =0.93) v. 4.87 (s.d.=0.83) mmol/l, P=0.003) and lower mean total EFA levels (89. 5 (15.6) v. 103.7 (17.1) μg/ml, P=0.0001) than controls after adjustment for confounding variables. Total n-3 and n-6 EFA levels were also significantly lower. Impulsivity and depression scores were significantly inversely correlated with both n-6 EFAs and n-3 EFAs, but were not associated with total or low-density lipoprotein cholesterol levels. Platelet serotonergic measures did not differ between groups, and were not related to psychobiological measures.

Lower plasma EFA levels combined with low cholesterol concentrations were associated with self-harm as well as impulsivity and affect. This was not related to platelet serotonergic measures.

Little is known of the epidemiology and care needs of people with adolescent-onset psychosis.

To examine prevalence and the cross-sectional disability, needs and service provision for adolescent-onset psychosis in areas of central Scotland with a total population of 1.75 million.

We identified and contacted 103 young people using an opt-out research design. Fifty-three participants and their carers and keyworkers were interviewed using a modified version of the Cardinal Needs Schedule.

The 3-year prevalence was 5.9 per 100 000 general population. Twenty-one (20%) adolescents were not in contact with mental health services; 80% of first admissions were to adult acute psychiatric wards. Those interviewed had high levels of morbidity: 29 (55%) had serious to pervasive impairment of functioning; there were relatively high levels of side-effects, negative symptoms, anxiety, occupational, friendship and family difficulties. Care provision was better for ‘clinical' than for ‘social' domains; 20% had five or more unmet needs; 17% had at least one intractable problem.

This low-prevalence disorder requires an assertive multi-agency approach in the context of a national planning framework.

Trials have demonstrated benefits of long-chain omega-3 essential fatty acid (n-3 EFA) supplementation in a variety of psychiatric disorders.

To assess the efficacy of n-3 EFAs in improving psychological well-being in patients with recurrent self-harm.

Patients (n=49) presenting after an act of repeated self-harm were randomised to receive 1.2 g eicosapentaenoic acid plus 0.9 g decosahexaenoic acid (n=22) or placebo (n=27) for 12 weeks in addition to standard psychiatric care. Six psychological domains were measured at baseline and end point.

At 12 weeks, the n-3 EFA group had significantly greater improvements in scores for depression, suicidality and daily stresses. Scores for impulsivity aggression and hostility did not differ.

Supplementation achieved substantial reductions in surrogate markers of suicidal behaviour and improvements in well-being. Larger studies are warranted to determine if insufficient dietary intake of n-3 EFAs is a reversible risk factor for self-harm.

Low socio-economic status is associated with a higher prevalence of depression, but it is not yet known whether change in socio-economic status leads to a change in rates of depression.

To assess whether longitudinal change in socio-economic factors affects change of depression level.

In a prospective cohort study using the annual Belgian Household Panel Survey (1992–1999), depression was assessed using the Global Depression Scale. Socio-economic factors were assessed with regard to material standard of living, education, employment status and social relationships.

A lowering in material standard of living between annual waves was associated with increases in depressive symptoms and caseness of major depression. Life circumstances also influenced depression. Ceasing to cohabit with a partner increased depressive symptoms and caseness, and improvement in circumstances reduced them; the negative effects were stronger than the positive ones.

The study showed a clear relationship between worsening socio-economic circumstances and depression.

Previous studies of borderline personality disorder report neuropsychological impairments in several domains, including memory. No studies have compared memory functioning in high-risk prisoners with borderline personality disorder with similar prisoners with other personality disorders.

To explore mnemonic impairments in prisoners undergoing personality assessment as part of the dangerous and severe personality disorder initiative or detained in a medium secure facility.

We investigated memory function in 18 prisoners with borderline personality disorder and 18 prisoners with other personality disorders.

Prisoners with borderline personality disorder exhibited a pattern of multi-modal impairments in the immediate and delayed recall of verbal and visual information, with some association with affective instability. These deficits were not associated with the severity of personality disturbance.

These data suggest that memory deficits have some specificity in relation to the constituent traits of borderline personality disorder and indicate that neuropsychological assessment may be a source of useful adjunctive information for distinguishing between the cognitive and psychological difficulties of individual prisoners.

Chinese herbal medicine has been used to treat millions of people with schizophrenia for thousands of years.

To evaluate Chinese herbal medicine as a treatment for schizophrenia.

A systematic review of randomised controlled trials (RCTs).

Seven trials were included. Most studies evaluated Chinese herbal medicine in combination with Western antipsychotic drugs; in these trials results tended to favour combination treatment compared with antipsychotic alone (Clinical Global Impression ‘not improved/worse’ n= 123, RR=0.19, 95% CI 0.1-0.6, NNT=6,95% CI 5–11; n=109, Brief Psychiatric Rating Scale ‘not improved/worse’ RR=0.78,95% CI 0.5-1.2; n=109, Scale for the Assessment of Negative Symptoms ‘not improved/worse’ RR=0.87,95% CI 0.7-1.2; n= 109, Scale for the Assessment of Positive Symptoms ‘not improved/worse’ RR=0.69,95% CI 0.5-1.0, NNT=6 95% CI 4-162). Medium-term study attrition was significantly less for people allocated the herbal/antipsychotic mix (n=897, four RCTs, RR=0.34,95% CI 0.2–0.7, NNT=23,95% CI 18-43).

Results suggest that combining Chinese herbal medicine with antipsychotics is beneficial.