Aims – This study aims to explore: a) the feasibility of psycho-educational interventions for families of users with schizophrenia in clinical practice by trained staff; b) the benefits and problems encountered by professionals in the use of these interventions. Methods – 46 professionals from 23 Italian Mental Health Sen'ices (MHS) attended at a three-module training course in psycho-educational interventions and four supervisions in the subsequent year. Following the course, participants provided the intervention to families of users with schizophrenia. The difficulties and benefits encountered by trainees to use the intervention were registered on the Family Intervention Schedule.Results – 83% of the participants completed the training course. Following the course, the intervention started in 71 families from 17 MHS. 76% of trainees provided the intervention to 2-5 families, while 13% of them only held informative sessions on schizophrenia. During the supervision period, the organisational difficulties experienced by the professionals were stable, while the benefits increased. Differences in benefits and difficulties were detected in relation to the trainees’ experience and professional roles. Conclusions – It is possible to introduce psycho-educational interventions in MHS after a relatively brief period of training and supervision of the staff. Organisational difficulties need to be addressed to increase the dissemination of these interventions on a large scale.

Declaration of Interest: None of the authors has had any interest or he/she has received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work. None of the authors has received any form of fee for his/her participation in this study. This study was supported by grants received from the “M. Lugli” Foundation (grant n. 2/18/8) and from the National Institute of Health, Italy (grant no. 1AL/F3).

Objective - This paper reports on acceptability and test-retest reliability of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their relatives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, according to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - Acceptability of VECS and VSSS to subjects was good: most items were easily understood and all subjects cooperated and gave accurate evaluations. The test-retest reliability (1-2 weeks interval) of VECS and VSSS was good in patients and relatives both when considering item-by-item percentage agreement and Cohen's weighted kappa in each dimension. Conclusions - The findings presented in this paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable and reliable way and that VECS and VSSS have good performance in the psychometric properties studied.

The author makes the case for the necessity of inpatient psychiatric services in a comprehensive, community based, system of care. The editorial begins with an historical perspective on mental hospitals. It then discusses acute and intermediate psychiatric inpatient units. A section also covers forensic units, also indispensable for a region or population of any size. The editorial concludes with a call for recognizing the purpose and value of inpatient services and thus using them most effectively.

Declaration of Interest: None.

This article reviews common sources of suffering in patients with advanced illness, identifies challenges in appropriately diagnosing and treating depression in this setting, and examines the relationship between depression and other key clinical outcomes in the setting of advanced disease. A systematic literature review was conducted. Most of the existing research on patients with advanced illness has been conducted with cancer patients. Approximately 18 percent of patients with advanced illness meet criteria for major or minor depression; multiple psychiatric co-morbidities occur frequently. Prevalence rates increase as patients become sicker. However, depression is frequently underdiagnosed and undertreated in the setting of advanced illness. One of the key clinical challenges is differentiating depression from grief. Both psychosocial and psychopharmacologic interventions have been shown to be effective in treating depression in patients with advanced cancer. In conclusion, depression is a regular complication of advanced illness, reduces quality of life, compromises family member function, interferes with treatment decisions, and may shorten survival. However, numerous effective treatment approaches, including both medications and psychotherapy, exist and can be used to alleviate depression.

Improving access and rational use of psychotropic medications in low- and middle-income countries is an important factor in reducing the public health burden resulting from mental illness. This paper considers each component of the medications management cycle to identify current barriers to improvement. Selection is hindered by a lack of up to date local essential drugs lists, while procurement and distribution can be affected by the type of system used: centralised or decentralised, government-run or independent, push or pull. Rational use involves patients, prescribers and policy-makers and requires consideration of who is able to prescribe, how prescribing decisions are made and how to ensure patient-centred care. We include a number of recommendations based on these issues, while emphasising the importance of ensuring the broader context of mental illness and its management is not overlooked when improving access to psychotropic medications.

Authors are a necessary and most appreciated basis for the publishing of any scientific journal. They should be welcomed for their creativity, originality and productivity, not stigmatized in general as cheaters and criminals because a very few were tempted beyond their control to cut the slices a bit too thin, overdo the utilization of leftover data, listed too many authors to a paper, forgot to report a harmless study to an ethical committee, or in very few cases commit severe actions of fraud.

The managerial way of thinking, meeting every author with systems of control and limitations is like poison to creative minds. Instead of appointing editors as policemen, we may preferably meet the vast majority of classical scholarly working scientists with trust, confidence and support, facilitating the process of disseminating the results from their creative minds – and of course consequently show the deliberately cheating researchers the door when they act unfaithfully to the scientific society.

Backgroung – Little is known about specific treatment needs of mentally ill clients abusing substances and infected by HIV. The major gap concerns residential programmes. Aims – To explore differences in outcomes between seropositive and seronegative dually diagnosed opiate dependent clients who participated in a residential therapy programme. Methods – Data were gathered on 154 clients treated in a therapeutic community in Milan between October 1999 and September 2004. Odds ratios with 95% confidence intervals were used to study the association between HIV serostatus and outcome. Results – At 12-month follow-up, seropositive clients were more likely to relapse. Conclusions – The impact of HIV seropositivity on behavioural outcomes should be taken into consideration when planning residential programmes for the HIV (+) dually diagnosed population. Further research could test the need of incorporating dedicated treatments into existing programmes.

Declaration of interest: None.

Objective – To describe a preliminary evaluation of a group CBT approach which has been fully integrated into the routine care for acute psychotic inpatients, admitted to a typically overburdened inner-city psychiatric general hospital unit. Design – The design is pre-post. A comparison of some indicators between the years preceding (1997) and following the beginning of the group therapy (1998) has been carried out. Setting – Psychiatric ward of S. Filippo Neri in Rome, in 1998. Method – The study compared the rate of rehospitalization, the rate of compulsory admission, the use of physical restraints, the episodes of violent behaviour and the escape from the ward. During the last three months of 1998 patients' satisfaction was also measured. Results – Overall 385 patients attended the group therapy, 79% of all inpatients in the period, with an average number of 4 sessions per patient. 59% of participants in the group in 1998 had a diagnosis of schizophrenia or paranoid disorder. The total compulsory admissions declined by 1/3 (p>0.001), the «revolving door» patients declined by 1/3 (p<0.05), compulsory admissions in «revolving door» patients declined by 3/4 (p<0.005), violent episodes by almost half (p<0.001), physical restraints and patients escape from the ward almost disappeared. Patients' opinion about the participation to the group was excellent. Conclusions – It is likely, but not sure, that the improvements were directly attributable to the introduction of the group treatment. Moreover, the group was clearly found to be useful by the majority of the participants. Some asked for further help of this type on discharge. These preliminary results are promising and make us confident they will act as stimuli for other colleagues to implement and evaluate this approach in other settings.

Aims – To assess using two well-know scales (DAI-30 and SWN) the drug attitude and subjective well-being of patients treated with haloperidol or second-generation antipsychotics (SGA) in four different Italian communities. Methods – The sample included 145 patients taking five different antipsychotics (APs) in mono-therapy: haloperidol, clozapine, olanzapine, risperidone, quetiapine. A stepwise multiple regression analysis (SMRA) was used to analyse the contribution of different AP treatments and of other predictors to SWN and DAI-30 scores. Results – Univariate analyses showed no differences in DAI-30 and SWN scores across treatments. The SMRA showed that SWN scores were negatively correlated with the severity of the psychoses (BPRS scores), while the DAI-30 scores were negatively correlated with the severity of the psychoses and positively correlated both with the length of drug treatment and with the use of olanzapine. Conclusions – Our study does not confirm a better drug attitude in patients treated with SGA with respect to haloperidol. The only partial exception is the better performance of olanzapine over haloperidol on DAI-30, which could be due to the lower use of anticholinergic drugs during olanzapine treatment. The differences between the SWN and DAI-30 may give good reason for the use of both instruments during AP treatments.

Declaration of Interest: No grants have been received for this study. In the last two years: Matteo Balestrieri has received grants from AstraZeneca, Eli Lilly, BMS, Janssen-Cilag, Boehringer-Ingelheim, Innova-Pharma, Pfizer, Bristol, Abbott, Lundbeck; Guido Di Sciascio has received grants from AstraZeneca, Eli Lilly, BMS, Janssen-Cilag, Sanofi-Aventis, Wyeth, Boehringer- Ingelheim; Elisa Maso has received grants from Pfizer; Cesario Bellantuono has received grants from Eli Lilly, BMS, Boehringer- Ingelheim, Innova-Pharma, Italfarmaco; The other authors have not received any grants in the last two years.