Inserting adults with psychic problems into families has recently been practiced in various European countries and also in Italy, where some mental health departments support such families. Beyond the well known story of Gheel, the etero and omofamily care of psychiatric patients has a forgotten history. Methods – On the basis of unexplored and exceptionally rich sources from the archives of the asylums in Florence, as well as of the Province di Florence, which funded assistance to the mentally ill – this research focuses on the subsidized “domestic custody” of hundreds of psychiatric patients, who had already been institutionalized. Beginning in 1866, outboarding was supported by the provincial administration in Florence with the collaboration of the asylum medical direction. Results – In the late 19th C. and in the early 20th C. prestigious psychiatrists sought alternatives to the institutionalisation. These alternatives involved varied participants in a community (the patients and their families, the administrators and the medical specialists, the neighborhood and the police). The families played a special role that historians of the psychiatry exclusively dedicated to the insane asylums have not really seen. Conclusions – The role of the families in the interaction with the psychiatric staff is not, even on a historiographical level, simply an additional and marginal chapter of the practices and of the culture of the mental health. These archival evidence contradicts some common places on the past of the Italian psychiatry before 1978, and provokes new reflections of possible relevance to the present.

Research evidence guiding the identification of pragmatic and effective actions aimed at improving the selection, availability, affordability and rational prescribing of medicines for mental disorders is sparse and inconsistent. In order to boost the development of new research, in this commentary we suggest to organise and classify all the activities in this area under a common theoretical framework and nomenclature, adopting the term ‘public health psychopharmacology’. Public health psychopharmacology is proposed as a research discipline, based on contributions from the fields of regulatory science, health services research and implementation science. Implementing the term public health psychopharmacology may offer advantages, as the scientific community would be more focused on common goals and objectives, with, likely, an increasing body of research evidence of practical use.

Aims – To describe the health status, resource consumption and costs of patients with dysthymic disorder in the Italian primary care setting. Methods – A total of 79 general practitioners (GPs) participated the study. Diagnosis was based on each GP's clinical assessment. At entry the Mini-International Neuropsychiatric Interview (MINI) was used as a supporting diag- nostic aid. Health status was measured with the SF-36 questionnaire. Resource consumption and costs regarded the six months before enrolment. Results – Out of 598 patients enrolled by GPs according to their clinical assessment, 503 fulfilled the MINI cri- teria and 95 did not. The latter had a better perception of their health than the former. Resource consumption was similar in the two groups; and the total per patient six-month costs did not differ significantly. Conclusions – The study confirms there may be a gap between standardised criteria for defining dysthymia and everyday clinical practice. All dysthymic patients diagnosed by GPs might be considered together from a health policy perspective.

Declaration of Interest: this research was partly supported by a contribution from Sanofi-Synthelabo Italy.

Objective – To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure. Design – «Case control». Cases had a GHQ–12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness. Setting – Six single handed primary care practices. Measures – Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index. Results – The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems. Conclusions – The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.

Objective — To discuss the contribution of epidemiology and epidemiological methods to psychosomatic medicine. Method — Critical review of the literature, including both philosophical concepts and empirical data. Results — The adjective «psychosomatic» has been used in two different ways: in the so called «psychosomatic» or holistic approach to medicine; and in a narrower approach, referring to particular disorders in which psychological factors were considered to have a fundamental aetiological role. While the ideal of the holistic, «humanistic» or «anthropological» approach should probably be never abandoned, the practical limitations of encompassing models, including Engel's bio-psycho-social model are also obvious: they may be heuristically sterile. On the other side, in relation to the narrow psychosomatic approach, psychogenetic views in the so called «psychosomatic illnesses» have been strongly criticized on empirical grounds. The potential of epidemiological methods to study these illnesses, but also «somatopsychic» disorders is shown in a number of papers in the empirical literature. We have grouped such contributions, including our own experience, in the five categories suggested by M. Shepherd for epidemiological methods in general: 1) the completion of the spectrum of disease; 2) the establishment of outcome; 3) the actuarial assessment of morbid risk; 4) the evaluation of the efficacy of treatment; and 5) the conceptual construction of diagnosis and classification. Conclusions — The contribution of epidemiological data to areas of interest in psychosomatic medicine has been relevant in recent years. The potential of epidemiological methods in this area is very important both to increase knowledge and to improve the quality of clinical practice.

Aims — The aims of the study was to evaluate if environmental factors can influence the effectiveness of therapeutic intervention of subjects with intellectual disabilities. Methods — 46 adolescents and adults with mental retardation, in semi-residential rehabilitative treatment, have been assessed over a 2-years period. The evolution of adaptive functioning over time has been assessed through the AAMD-ABS. The development of the adaptive skills at follow-up has been correlated with socio-economic and cultural factors. Results — Linear regression showed that age of both parents, mother's health status, lack of one parent, SES, and housing conditions, represent significant covariates to predicting evolution of the adaptive functioning; these factors independently influence effectiveness of the therapy from the kind of treatment. Conclusion — The results demonstrate that effectiveness of the therapy can be conditioned from ability to fulfil the needs of the families, through social and supporting programs.

Declaration of Interest: none.