Background. The legal definition of suicide in England and Wales (E & W) gives rise to a high proportion of open verdicts and an underestimated suicide rate. We examined whether the ratio between open and suicide verdicts in E & W has changed between 1974 and 1991 and whether it varies according to coroners' qualifications.

Methods. Temporal changes of the ratio of open and suicide verdicts were examined using logistic regression adjusting for confounders such as changing age and gender distributions of suicide victims and the methods they use.

Results. Adjusted for age at death and suicide method, the ratio between open and suicide verdicts had, over successive 3-year time periods, increased with a factor 1·21 (95% CI 1·20–1·23) for male and 1·15 (95% CI 1·14–1·17) for female deaths. Medical coroners were 1·25 (1·08–1·44) times more likely than non-medical coroners to return open rather than suicide verdicts.

Conclusions. As a likely result of factors in the death registration system, the ratio between open and suicide verdicts has increased substantially in E & W since the early 70s. In 1990 it was higher than in any other comparable country. This has important implications for comparisons of time trends in suicide between E & W and other countries.

Background. The possibility that monoaminergic neurotransmission is altered in pathological gambling was examined.

Methods. Monoamines and their metabolites were measured in CSF obtained at level L4–5 from ten pathological gamblers and seven controls.

Results. A decrease in dopamine and an increase in 3,4-dihydroxyphenylacetic acid and homovanilic acid was found. Noradrenaline and its metabolite 3-methoxy-4-hydroxyphenylglycol was also increased but 5-hydroxytryptamine and 5-hydroxyindoleacetic acid were unchanged.

Conclusion. It is suggested that the function of the dopaminergic system, possibly mediating positive and negative reward, and the noradrenergic system, possibly mediating selective attention, is changed in pathological gambling.

Background. Aggression has been suggested to be related to abnormal brain 5-HT activity. This amine is synthesized in brain from tryptophan, which is transported through the blood–brain barrier in competition with other amino acids. The relationship between tryptophan and its endogenous amino acid competitors in plasma might thus influence the availability of tryptophan in the brain and consequently brain 5-HT activity.

Methods. Plasma amino acids were determined in 89 offenders who had committed various violent and non-violent crimes and in 14 healthy controls.

Results. Both tryptophan and its competitors were higher in offenders who had committed violent crimes compared both with non-violent offenders and with controls. No difference was, however, seen in the relationship between tryptophan and its competitors.

Conclusions. The results support the contention that violent behaviour is related to biochemical deviations but could not explain a possible decreased brain 5-HT activity.

Background. The treatment of Tourette's syndrome (TS) is often unsatisfactory. However, there is some evidence that transdermal nicotine patch (TNP) application may improve tics of non-smoking TS patients who are refractory to haloperidol treatment.

Methods. In this open study we applied two 10 mg TNP for 2 consecutive days to four TS patients whose symptoms were not controlled by haloperidol and to a never-medicated TS patient, all of whom are non-smokers. The Yale Global Tic Severity Scale (YGTSS) and a quantified video-taped micro-structured analysis of tics (head-shake tics, eye-blinks, vocal tics, facial grimace and other body tics) were both carried out to assess the change after the application of TNP.

Results. TNP application significantly reduced the YGTSS by an average of 50%, with no reported side-effects, for up to 4 weeks but not 16 weeks, as compared with TNP-free period. Consistent with these results, the total counts of tics also showed a significant decrease for up to 4 weeks after the TNP application.

Conclusion. TNP application differentially affected individually quantified tics, which may suggest a differential role of nicotinic receptors in the generation of different tics.

To the Editor: The paper by Chalder et al. (26, 791–800) in a cross-sectional study concludes that the diagnosis of ‘ME’, which makes an external attribution for fatigue, ‘seems to protect against psychological distress but not against disability’. We should like to offer strong support for this conclusion from the prospective data of a patient involved in a 12-year study of the outcome of neurotic disorder.

To the Editor: A recent Editorial (McGee et al. 26, 441–447) posed the general question ‘Are life events related to the onset of breast cancer?’, but then debated whether or not life events are directly related to the diagnosis of this condition. The distinction is small but vital. On the basis of our own large study (Cooper & Faragher, 1993) we, too, would be reluctant to infer a direct link ; however, we would infer that the occurrence of a major stress event will increase the risk of a breast cancer being detected in some women if other important psychosocial factors are present also.