Aims — Patients with chronic viral hepatitis suffer from a high prevalence of psychiatric problems. Furthermore, the treatment for chronic viral hepatitis, with interferon (IFN) alpha, induces the occurrence of further psychopathological symptoms. The autors examined whether patients with a pre-existing psychiatric diagnosis had more severe IFN alpha-induced psychiatric adverse effects, and whether they were more likely to interrupt the IFN alpha therapy, compared with control patients with no pre-existing psychiatric diagnosis. They also examined the psychopharmacological management of the interferon-alpha-induced psychiatric side effects. Methods — The authors studied prospectively 60 patients with chronic hepatitis B or C in Cagliari, Italy. Patients underwent psychiatric assessment before starting interferon alpha and monthly throughout the therapy. Results — After adjusting for the baseline psychopathology, there was no statistically significant difference in interferon-alpha-induced psychiatric adverse effects between patients with a pre-existing psychiatric diagnosis and controls. There was also no evidence that psychiatric cases were more likely than controls to interrupt the IFN alpha therapy because of psychiatric side effects. Moreover, there was no difference in the psychiatric adverse effects severe enough to require psychopharmacological treatment. Finally, psychopharmaco-logical management successfully treated psychiatric symptoms induced by the IFN alpha. Conclusions — Patients with a pre-existing psychiatric diagnosis do not have a specific vulnerability to interferon-alpha-induced psychiatric adverse effects.

Declaration of Interest: none of the authors have conflict of interests in writing this paper; CM. Pariante is funded by the UK Medical Research Council and by the NARSAD and the Guy's and St Thomas Charity

Aims – A narrative review of studies on the psychiatrists’ opinion about the information process and the factors that may influence the extent to which patients are informed and involved in the information process. Methods – A literature review, without restrictions of time, was carried out using Medline and Psychlnfo databases. Results – Twenty three studies of interest were identified. The diagnosis of depression, anxiety and substances abuse are comunicated in a high percentage of cases; while the diagnosis of schizophrenia and other psychotic disordes are often concealed to patients. As far as pharmacological treatment is concerned, psychiatrists are more inclined to communicate those side effects which from their point of view are considered as less stressfull for the patient. No studies refer to the comunication of prognosis. The reasons adduced by psychiatrists for informing or not informing regard the etiology and the validity of some psychiatric diagnoses, the cognitive difficulties of patients, worries about stigmatizing or damaging patients. Conclusions – The choice to involve patients in treatment should be made from the prospective of promoting patient's well being rather than to depend on psychiatrists' communication difficulties, prejudices or on a habit of a paternalistic relationship style.

Declaration of Interest: none of the three authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work

Aims — This aim of this paper is to discuss a consumer -therapist co-run pilot group on self-injury held at an American college. Deliberate self-injury has come to be a common phenomenon in schools and colleges. However the treatment and understanding of self-injury still remains a challenge. Most people who self-injure remain hidden in society and do not seek therapy, due to the shame-filled stereotypes and misconceptions that surround self-injury. Group therapy has been discussed as ineffective by many in the mental health field while individual treatment has been controversial for decades. Method — The paper will discuss how this group treatment was informed by consumer empowerment philosophy and how consumer and therapist facilitators worked together to turn it into a healing experience. Results — This group was indeed challenging but confirmed that consumer- run programs are able to function as a catalyst to facilitate healing. It confirmed that breaking away from traditional models that allocate all power and hope for change to professionals might not only be an important step but, in cases such as treatment of self-injury, a necessity.

Declaration of Interest: none.

Aims — To investigate in a representative national sample (N=2,962) of patients living in Residential Facilities (RFs) patterns of polypharmacy as well as related variables, association between diagnoses and therapeutic patterns, and the rate of adverse events. Methods — Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the SOFAS, and comprehensive information about their sociodemographic and clinical status, and their pharmacological regimes were collected. Results — Conventional antipsychotics and second-generation antipsychotics were prescribed to 65% and 43% of the sample, respectively. Benzodiazepines were prescribed to two-thirds of the sample, while antidepressants were the least-used class of psychotropics. Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (±1.1); antipsychotic polypharmacy was also common. Many prescriptions were loosely related to specific diagnoses. Antiparkinsonianian drugs were prescribed to approximately 1/4 of the sample. Mild or severe adverse events in the previous month were reported for 9.9% and 1.4% of the sample, respectively. About 15% of patients suffered from tardive dyskinesia. Conclusions — Psychotropic drug prescription patterns for severe patients living in RFs are only sometimes satisfactory and offer the opportunity of improvement. Specific actions are required to improve prescription patterns for severe patients in RFs.

Declaration of Interest: in the past two years GdG has received two speaker fees from Janssen-Cilag and from Eli Lilly; GS has received one speaker fee from Solvay. RM, AP, SF and RT have received no fees or other financial support from pharmaceutical companies.

As UK Health Minister John Bowis knew the challenges, the progress and the disasters of mental health provision and policy. He learned from service users, carers and practitioners that reality was usually different from theory. He came to believe a new structure was necessary to give patients a one-stop shop of care and treatment, that patients should be more involved in decisions that affect them and that stigma must be tackled by education and by wider understanding of services and crisis management. He now campaigns in the European Parliament and in many parts of the world for mental health to be higher on national agendas and to be based on effective and humane policies that ensure the appropriate treatment is provided and provided with dignity”

Declaration of Interest: none

Objective – The study investigated eating disordered behaviours and life-habits correlated in a large sample of Northern Italian adolescents of both sexes. Methods – The study had a cross-sectional design. 2595 students (2,146 responders; mean age 17.2±1.7 years) attending high schools in Savona (Italy) in April and May 2001 were sampled. To assess eating attitudes, the Inventory for the Screening of Eating Disorders (ISED) was self-administered. Inquiries regarding possible risk factors for eating disorders were also made: socio-economic status, body weight, smoking and alcohol drinking habits, illegal drugs use. Results – Females scored significantly higher than males at ISED (13.4±7.7 vs. 7.6±5.8). 28.5% of females had a total ISED score above the cut-off point (18/19). Unhealthy eating behaviours were strongly associated with higher BMI, body image disturbance and illegal drugs use in both sexes; age had significant role only in males. No significant association between disordered eating behaviours and socio-economic status, smoking habit and alcohol consumption were found. Conclusions – Symptoms of eating disorders are quite spread in the Northern Italian female adolescents and associate with illegal drugs use. These data, with not negligible frequency of unhealthy eating behaviours and attitudes in males too, suggest that primary and secondary preventive interventions for teen-agers should be got ready.

Declaration of Interest: 1) the study received the financial support by Regione Liguria and ASL 2 of Savona; 2) the study didn't receive any forms of financing by pharmaceutical company support and any honoraria for consultancies or interventions was received by each author in the last two years; 3) any other involvements that might be considered a conflict of interest in connection with the submitted article. The authors state that if and when the manuscript accepted for publication, they automatically agree to transfer the copyright to the publisher

Aim — To assess the association between socio-demographic characteristics and community attitudes towards mentally ill people. Method — We assessed a sample of 280 subjects, stratified for sex and age, which has identified using the electoral registers of Brescia. A letter was sent to everyone in order to introduce the future potential study participant to the topics of the public attitudes towards mental illness and it included an invitation to take part in the study. After, 280 subjects were contacted by telephone. Finally, 174 persons, who expressed their willingness to collaborate, were visited by a team of four trained interviewers. The instruments used were: a semi-structured interview; the Community Attitudes to the Mentally III (CAMI) inven-tory, which is composed by 40 statements, concerning the degree of acceptance of mental health services and mentally ill patients in the community; and the Fear and Behavioural Intentions (FABI) inventory, which is composed by 10 items, concerning fears and behavioural intentions towards mentally ill people. 106 subjects refused to participate. Results — Factor analysis of the CAMI revealed three components Physical distance and fear, Social isolation and Social responsibility and tolerance. Factor 1 is associated with: people >61 years old; people being divorced/widowed/living separated; people who haven't participated in social or volunteer activities. Factor 2 is associated with: people > 41 years old; people being schooled at a level that's higher than elementary level; unemployed people. Factor 3 doesn't present any associations. Conclusions — The results of this study outline the need to: a) promote interventions focused to improve the general attitude towards people with mental illness; b) to favour specific actions in order to prevent or eliminate prejudices in subgroups of the population.

Declaration of Interest: in the last two years the authors have been paid by the IRCCS Centra San Giovanni di Dio Fatebenefratelli in Brescia (Italy), as employees and free professionals.

Aims – Service user involvement in mental health service development and research is becoming more common in countries like the UK. USA and Canada. This systematic review of the international scientific literature has been carried out to assess the stage of development of mental health service users involvement in research. Method – Systematic review of any research project actively involving service users in any part of the research process. Results – Thirty-five studies met the inclusion and exclusion criteria and were included in the systematic review. Nine studies used quantitative techniques, 24 used qualitative techniques and two studies used both quantitative and qualitative techniques. While three studies were user-led, in three other studies the users were simply consulted but did not have any active role in the research. The remaining 29 studies were based on a collaboration between service users and professional researchers. Conclusions – The involvement of mental health service users in the research process is feasible both in quantitative and qualitative research studies. The involvement of service users in research has a number of benefits; such research requires more accurate planning and more time than the traditional research.

Declaration of Interest: none.

Aim – To determine the rates of psychiatric hospitalisation and to evaluate the predictors of readmissions in a cohort of 887 schizophrenic patients at their “first” psychiatric admission. Methods – Data were collected using the hospital dis-charge database of the Lazio region, Italy. The cohort included patients admitted to a psychiatric ward in 1999, with a main diagnosis of schizophrenia and no prior psychiatric hospitalisation during the 5 years preceding the index admission. Psychiatric read-missions were considered up to year 2004. Kaplan-Meier survival curves and logistic procedures were performed to estimate the cumulative readmission incidence and ORs of readmissions for potential confounders. Results – During the 4-year follow-up, 44.3% of the patients were readmitted at least once. An active treatment among community psychiatric facilities at the time of index admission predicted a higher readmission risk. However, for those who experienced their first admission in a private ward read-mission risk was consistently higher, whether or not having had such a treatment. Conclusions – Risk of readmission in a psychiatric ward appears to be related to the level of integration with mental health community facilities, while length of stay is strongly affected by service system variables. Possible uses of medical information systems in this field are described.

Declaration of Interest: none.

Aims – This paper attempts to examine the current state of mental health services in Central and Eastern Europe. Methods – Selected review of available literature has been done with emphasis on information complied by World Health Organization (WHO). Results – The magnitude and burden of mental disorders is high in Europe, the mental health services are inadequate in most Central and Eastern European countries and human rights situation is unsatisfactory. However, there are some positive recent developments worth noting. These include increased attention to human rights, cooperation and collaboration at subregional level and emergence of family and consumer associations. Conclusions – A concerted and systematic attempt needs to be made to respond to the challenge of providing adequate and human rights-based mental health services in Central and Eastern European countries. The framework developed by WHO can assist the countries in their initiatives aimed at improving mental health systems.

Declaration of Interest: none

Aims — Empathy is an important basis of all provider-patient interaction, including general practice. Little has been known about the details of how general practitioners express empathy to their patients. In the present study, it was a main aim to carry out a detailed qualitative study of actual sequences through which empathy was achieved, by focusing on the form, function, and categorisation of such sequences. Methods — The study drew on the qualitative method of conversation analysis. Transcriptions of 77 British general-practitioner-patient interactions were analysed in detail in order to identify and characterise sequences in which empathy was achieved. Results — Four types of empathy were identified, described, and analysed: cognitive empathy, affective empathy, sharing empathy, and nurturant empathy. Although sequences involving empathy typically were brief and occurred relatively rarely, the analyses demonstrated that the sequences often concerned matters of great importance to the interactants. Conclusions — The study underlined the need to focus also on phenomena that occur relatively rarely in consultations. For this purpose, the method of conversation analysis was a useful tool.

Declaration of Interest: there was no conflict of interest.

Aims – The prevalence of overweight and obesity and the role of possible related factors were analysed among Italian early adolescents. Method – The survey reported here is part of the larger “Health Behaviour in School Aged Children” (HBSC) trans-national study, which is co-ordinated by the European Office of the World Health Organization. The data were gathered through self-administered questionnaires filled out by a representative sample of 4,386 (48.4% males) Italian students (11-, 13- and 15-year old). Results – The overall prevalence is 16.7% for overweight and 2.5% for obesity. Boys are more at risk than girls for the two phenomena. Moreover, age group, mother's education, area of residence, physical activity, and sedentary behaviour show a significant association with both outcomes. Conclusion – Findings of the present study are in agreement with similar studies carried out on early adolescents population, showing that prevalence in overweight and obesity decreases during this phase and is more diffused among boys than girls. The prevalence of both diseases is higher in the South and Islands. Sedentary behaviour and physical activity are substantive factors which preventive interventions could act on.

Declaration of Interest: the HBSC study is partly funded by the University of Padova through a scholarship attributed to Dr. Alessio Vieno (Year 2001 – prot. CPDR013233).

Aims – Description of prejudice and stereotypes of mental illness in two samples with or without psychiatric Residential Facilities in their communities. It has been evaluated if the ongoing naturalistic relationship with the mentally ill was sufficient to modify the stigma of mental illness. Methods – The study has been carried out in 7 small towns with Residential Facilities and in 7 small towns without Residential Facilities on a sample of 560 people. Each respondent was asked to fill the Questionnaire on the Opinions about Mental Illness - General Population's version (QO-GP). Results – Data on 557 respondents (99.5%) were collected. The most frequent opinion in the general sample was to reject the possibility to admit patients to Psychiatric Hospital. The significance (p <.01) between the two samples was found for only 5 items that concern the “treatment-outcome”, while no difference was found about the stereotypes of mental illness. Conclusions – The results outline that the ongoing naturalistic relationship do not modify the stereotypes of mental illness, but only some aspects of prejudice (care and civil rights). As a consequence we need to plan structured, effective and more specific educational campaigns on mental illnesses.

Declaration of Interest: in the last 2 years, none of the five 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.

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.

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).