Objective — To consider research conducted in the sub-field of mental health geography, concentrating on work published in English.Methods — The paper offers an comprehensive, in-depth and critical reading of the relevant literature on mental health geography since the inception of this subfield of inquiry in the early- 1970s.Results — The paper identifies three ‘waves’ of research within work on mental health geography. It describes these ‘waves’ in detail, interprets certain strengths and weaknesses of the first two ‘waves’, which are well-established, and provides suggestions about important questions to be addressed in a future third ‘wave’. Conclusion — Much excellent research has so far been undertaken within mental health geography, but there is scope to increase the relevance of this research through widening the focus of research and by being prepared to connect research more directly to mental health policy and politics.

Objective – This article attempts to provide an overview of different methods of analysis of information on service utilization from different approaches. Methods – A systematic review of the studies of pattern of care is done. The analysis of pattern of care has been divided into three different approaches: cross-sectional, longitudinal and dynamic. Results – In cross-sectional studies, information on utilization is based on the total number of contacts with mental health services during a given period. In the second approach, called longitudinal, survival analysis is applied considering the interval of time between each contact. The third type of analysis, called here the «dynamic» approach, involves the application of mathematical models based on the Markov chain to analyse the probability of change from one type of contact to another. Conclusions – We emphasise the need for further studies designed to analyse data from psychiatric case registers with standardised models for mental health services utilization analysis.

Objective – Epidemiological principles underpin much medical research particularly that concerned with the planning and evaluation of health services, including research in community and social psychiatry. The aim of this paper is to review some of the common uses of epidemiology in community psychiatric research and to discuss some methodological issues that arise frequently in epidemiological research in community settings. Methods – This is a review of the relevant literature and of the work currently in progress in the department of psychological medicine of the university of Wales College of Medicine. Results – Among the many uses of epidemiology in health care, four are especially relevant in community psychiatric settings: the assessment of the mental health needs of the population (four approaches are described: the collection of routine data, surveys of existing patients, surveys of the general population and statistical modelling), the identification of risk factors of disease, the contribution to prevention and the assessment of the clinical effectiveness of health care interventions. The most important methodological issues include causal inference which in epidemiology takes the form of explaining the association between an exposure and disease (chance, bias, confounding, reverse causality and causality), the issue of confounding and how to adjust for it and issues arising in the context of specific study designs. Conclusion – Epidemiology has become a set of methods used to investigate a wide range of clinical questions. Population based research is an essential part of clinical research but epidemiological knowledge is also needed by clinicians in order to critically appraise and interpret the scientific literature.

— During the last three decades, we have witnessed dramatic improvements in both the psychosocial and pharmacological treatments of affective disorders. Administered in concert with the new medications advances in pharmacology have produced, disorder-specific psychosocial treatments have further improved the prognosis and course of bipolar and unipolar disorder. Methods — We review our research on unipolar and bipolar disorder and their treatment, in particular interpersonal psychotherapy (IPT) and modifications thereof. Results — We provide empirical evidence that IPT is an efficacious acute and maintenance treatment for affective disorders. Our cumulative research and clinical experience suggest that interpersonal relations and circadian and social rhythms influence affective illnesses and that psychotherapy may aid in normalizing problems in these areas for patients with affective illnesses. Conclusions — Despite the excitement generated by the recent progress in research on mental disorders and their treatment, we are yet to fulfill the promise that the explosion of knowledge about targeted pharmacotherapies or psychotherapies would seem to offer. To move our field forward, we must continue to apply scientific rigor and thought to understanding the suitability of current nomenclatures, the impact of comorbid psychiatric and medical illnesses and symptoms on the manifestation and treatment of affective disorders, and the practicality of widespread utilization of new treatments.

Objective – To present an overview on current progress and future directions in psychiatric genetics. Methods — The review of studies that have demonstrated a genetic contribution to a wide range of psychopathology using family, twin, adoption studies and exploration of the methods and limitations of molecular genetic studies. Results – Single gene disorders has been the area that is most straightforward with striking advances in disorders such as Huntington Disease and early onset familial Alzheimer disease. Complex phenotypes such as schizophrenia and affective disorder have presented greater difficulties but late onset Alzheimer disease and dyslexia are examples where replicated molecular genetic findings suggest that gene identification is feasible even for multifactorial disorders. Conclusion – The combination of increasingly complete information on the genome together with accessibility to this on the internet provide the essential tools for the search for susceptibility genes. Another essential requirement in trying to identify genes of small effect is well characterized large scale collections of cases and this demands the interaction of epidemiological and clinical researchers. Advances in genomics will also allow tailoring of Pharmaceuticals pointing at treatment response and side effects. Hopefully all this perspectives together, will improve our understanding of the neurobiological pathogenesis of diseases such as Schizophrenia, Depression and Bipolar disorder ‘legitimizing’ them in the public view.

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.

Objective – The aim of this study is to evaluate the presence of triggering life-events for the onset of Obsessive–Compulsive Disorder in women (OCD). Design – Clinical controlled study. Setting – Service for depressive and anxiety disorders; Department of Neuroscience, Psichiatric Unit, University of Turin. Methods – The study compares twenthy-nine women with OCD (DSM-IV criteria) with twenthy–nine healthy control women matched for demographic features and with twenthy-ni– ne women with Bulimia Nervosa (DSM-IV criteria) matched for age, age at onset, education and marital status. All patients were assessed with the Clinical Structured Interview for DSMIII-R (SCID) and with the Interview for Recent Life Event by Paykel. Moreover, OCD patients were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and bulimic patients with the Eating Disorder Inventory (EDI). Results – The study demonstrates that the only specific life event that is significantly associated with the onset of OCD is “having a new born child” No significant differences in frequency and severity of stressing life events were found in the three groups. Conclusions – The results confirms the findings of our previous study: post partum is the only risk factor for the onset of OCD in female population, compared to healthy control. Furthermore, this research points-out the importance and the specificity of this association showing that post partum is not a risk factor in all psychiatric disorders.