Objective – To discuss the difficulties encountered in providing rehabilitation to multi-problematic clients, and possible remedies. Method – The principles of psychiatric rehabilitation are outlined in the frame of the bio-psycho-social model and in the light of long-term follow-up studies. The limits of professional services and the importance of natural networks for successful rehabilitation and social adjustment are highlighted. Results – Worker cooperatives and consumer self-help associations seem to successfully complement health and social services in meeting the complex needs of this population. Conclusions – The integration of formal and informal networks of care is a major challenge and a relatively neglected, but important area of interest in contemporary psychiatric rehabilitation.

Declaration of Interest: no conflict of interests.

Objective – Delusions and lack of insight have traditionally been viewed as the defining characteristics of insanity and in modern psychiatry continue to be central to the diagnosis of psychosis. Little is known about the mechanisms of delusion formation and much of the research into delusions and lack of insight has been focussed on schizophrenia, in spite of the fact that these symptoms are also prominent in other disorders e.g., affective psychosis. The objective of this paper is to review the literature on existing theories of delusions and insight with reference to the effects of affective disturbance on memory processes. Method – Narrative review supplemented by literature searches using Medline, PsycINFO and EMBASE databases for the period 1980 to present using terms “delusion”, “insight” and “affect”. Results – The role of affect on memory in normal psychology and delusions in psychopathology is being increasingly recognised. We sketch out a theory which gives weight to locating the formation and maintenance of mood congruent and mood incongruent delusional beliefs (and insight into such beliefs) within a model of normal memory processes. Conclusion – We conclude that delusional beliefs may represent false or biased memories of internal or external events modified and strengthened of by affective states. We propose that insight rests on an ability to identify these memories as internally generated or biased. In view of the growing body of knowledge accumulating from the study of memory, emotion and their neuropsychological correlates we would suggest using this as an evidence base for the further neuropsychiatric investigation of delusional beliefs.

Declaration of Interest: none.

Objective – The objectives of the paper are the following: i) to describe the activities and the costs of care for patients with severe mental disorders; ii) to evaluate the association between costs, clients' characteristics and outcome measures. Methods – Patients were administered the following instruments twice a year: BPRS, GAF, HoNOS, DAS II, VSSS-54, QPF. Use of psychiatric services and other resources were collected for each patient over a two-year period. Results – The average yearly cost per patient is Euro 3,300. First-contact patients cost twice as much as patients already in treatment. Service costs are associated to patients' age, marital status and working condition. Annual costs are also associated with the initial score of BPRS, GAF, DAS and HoNOS. In multiple regression analysis age, initial BPRS and DAS scores, as well as being a first-contact patient, are strongly positively associated to annual costs. Conclusions – These results highlight the importance of monitoring routine activities of psychiatric services and the flow of funds for psychiatric care in the Italian public health system.

Declaration of Interest: the research project was funded by a grant from the Lombardy Region Health Authority.

Objective – Description of opinions on schizophrenia and its psychosocial consequences in a sample of general population. Methods – The study has been carried out in 29 GP units stratified by geographic area and population density of their catchment areas and randomly selected. Each respondent was asked to read a case-vignette describing a patient who met ICD-10 criteria for schizophrenia, and then to fill the Questionnaire on the Opinions about Mental Illness General Population's version (QO-GP). Results – Data on 714 respondents were collected. 21% of the sample identified a case of schizophrenia, 66% of depression/anxiety disorder, and 13% of “nervous breakdown”. Factors most frequently mentioned as causes of detected disorder were stress (72%), heredity (62%), family difficulties and psychological traumas (45%). More pessimistic opinions about psychosocial consequences of schizophrenia were found among respondents with lower educational level and older age. Respondents who referred the case-vignette to schizophrenia reported more pessimistic opinions about psychosocial consequences of detected disorder. Conclusions – The results of this study outline the need to plan educational campaigns on mental illnesses, which take into account the socio-cultural characteristics of the target populations.

Declaration of interest: none of the seven 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, in the last 2 years.

Objective – On a basis of a large study on anxiety disorders and after a relevant literature review (no Italian survey being present in the last ten yrs on the specific topic), our present purpose is to estimate the one-month point-prevalence of panic symptoms in the primary care setting; to evaluate differences existing between patients with and without panic symptomatology. Methods – The sampling involves all consecutive patients visited by a primary care physician every day over four weeks during the recruitment period. Setting Primary care physician's (PCP) waiting-room, with immediate administration of inventories in the waiting room, under direct supervision of one Author (EG). Main outcome measures – Self-administered inventories as GHQ-12, STAI-Y1-Y2, Panic Attack and Anticipatory Scale. Results – Out of 409 subjects attending PCP's office during the recruitment period, 327 gave their oral consensus and 305 completed their assignments, constituting our sample. The 21.3% (65 cases) of our sample has shown panic symptoms in the last month. This subgroup with panic is significantly younger and more educated than the subgroup without panic. Moreover the female to male ratio is 2.6:1. Significant differences had been found in the health perception, which is negatively affected by the presence of panic attacks and by GHQ-12 and STAI-Y1-Y2 total scores. These scores are significantly higher than those from panicless patients. Conclusion – Our survey highlights that at least one of five patients visited by the PCP is on average suffering from panic symptoms. This might be related to the well-known physical components of panic symptomatology, but also to the increasing importance of the involved sub-threshold elements.

Declaration of Interest: no forms of support from any companies. One of the Authors (EG) had one-month fellowship at the University of Murcia relating to present research involvement.

Aims – Reconstructing the models used for approaching the inequalities issues in health, idenfiying the most relevant theoretical and conceptual contributions. Method – Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch using the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002; integrated with manual search. The material was classified according to the conceptual and theoretical interpretative models or to the analyses of the association 'inequalities-health' where health was expressed as mortality, morbidity or services utilisation. Results – Four different interpretative models about the genesis of inequalities were identified. Further theoretical developments overcome the distinction among conceptuals contrapositions selection versus causation, statistic artefactual versus real differences, individual behaviours versus material context. Since the 80's the concept of material deprivation has been enlarged to include social deprivation to explain health inequalities. The social exclusion is related to material deprivation and to social fragility enlarging the traditional aspects of poverty. The theories that better adapt to the psychiatric field are the social selection and social causation. Conclusions – The social exclusion and the new methodologies for measuring the inequalities seems to be an effective way for understanding of the inexplored aspects of the mental health inequalities.

Declaration of Interest: This work was partly funded by the Department of the Public Health Sciences “G. Sanarelli” of the University of Rome “La Sapienza” and the Department of Medicine and Public Health of the University of Verona.