Aim – The aim of the study was to determine how carer need for closure relates to expressed emotion. It also examined the links between carer need for closure and patient functioning including patient need for closure. Methods – In a cross-sectional study, 70 caregivers of patients with psychosis completed the Need for Closure Scale (NFCS), the Camberwell Family Interview (CFI) and measures of distress, burden, coping and social network. The NFCS was assessed in terms of its two primary dimensions: a need for simple structure (NFSS) and Decisiveness. Patients also completed measures of psychotic symptoms and affect, and in 50 matched caregiver patient dyads, direct comparisons were undertaken between caregiver and patient NFCS scores. Results – No links were found between caregiver NFC and EE in this predominately low EE sample. More decisive carers had higher levels of self esteem, were less distressed, and resorted less to avoidant coping. The need for simple structure was greater in carers who lacked a confidante. As predicted, patients reported significantly higher NFSS and lower Decisiveness scores than carers, but no relationship was observed between caregiver NFC and patient symptoms of psychosis. Conclusions – Carers reporting confident decision making were also more likely to report adaptive functioning in terms of having lower levels of avoidant coping and distress, and higher levels of self esteem. The results suggest that this style of thinking might be a helpful way of coping with some of the difficulties involved in caring for someone with psychosis.

Aim – Literature documents that the judgments people hold about themselves, their life, and their future are important ingredients of their psychological functioning and well-being, and are commonly related to each other. Methods – We used confirmatory factor analysis (CFA) under the classical test theory, regression analysis, and a cross national design. Results – This study provides new findings attesting to the hypothesis that evaluations about oneself, one's life, and one's future rest on a common mode of viewing experiences which we named “Positive Orientation”. Conclusions – Results from an Italian and a Canadian study are resented, attesting to a latent dimension that lies at the core of positive evaluations and that corroborates the utility of the new construct as a critical component of individuals’ well-functioning.

Declaration of Interest: This study was partially supported by Grants from the MIUR, 2002 and 2005, and by a Grant from the University of Rome “La Sapienza”, 2002 to Gian Vittorio Caprara. Authors declare “no potential conflict of interest”.

Aim – To explore knowledge, treatment setting, attitudes and needs associated with patients in early phases of psychosis among general practitioners (GPs) in Prague, andto compare results with GPs from 6 countries participating in the International GP Study (IGPS) on Early Psychosis (Canada, Australia, New Zealand, England, Norway,Austria). Methods – Survey questionnaires were mailed to 648 GPs in the city of Prague. Results – The response rate was 19.9%. Prague GPs showed significantly lower diagnostic knowledge of early phases of psychosis compared to their international colleagues. They frequently indicated depression/anxiety and somatic complaints as early warnings of psychosis. They more often considered their behaviour to be problematic and more commonly handed them over to specialists. The majority of Prague GPs wished specialized outpatient services for low-threshold referrals of such patients. Conclusions – Along the mental health reforms in the Czech Republic which emphasis the role of primary care, GPs' knowledge of the early warning signs of psychosis needs to be improved.

Declaration of Interest: The study was supported by an unrestricted grant from Sanofi-Synthélabo SA, Switzerland, to the principal investigators of the IGPS (AES, DU). The authors have stated that there are none; all authors are independent from the funding body and the views expressed in this paper have not been influenced by the funding source.

Aim – To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages. Methods – Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs. Results – Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users. Conclusion – It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

Aim-To develop and measure consensus about which type of message should be included in population-level campaigns to reduce mental health-related stigma. Methods - A panel of 32 experts attending an international conference on mental health stigma participated in a consensus development exercise. A modified nominal group technique was used incorporating two voting rounds, an overview of research evidence and group discussion. Results - There was high consensus (≥ 80°) regarding the inclusion of two of the message types presented - (i) recovery-oriented and (ii) see the person messages, and reasonable consensus (≥ 70°) regarding (iii) social inclusion / human rights and (iv) high prevalence of mental disorders messages. Ratings differed according to whether the participant was a psychiatrist or had personal experience of mental ill health. Analysis of the qualitative data revealed four themes: (i) benefits of messages countering the ‘otherness’ of people with mental ill health; (ii) problematic nature of messages referring to aetiology; (iii) message impact being dependent on the particular audience; (iv) need for specific packages of messages. Conclusions - This study supports the use of recovery-oriented messages and see the person messages. Social inclusion / human rights messages and high prevalence of mental disorders messages also merit consideration.

Declaration of Interest: This study was funded through a National Institute for Health Research (NIHR) Applied Programme grant awarded to the South London and Maudsley NHS Foundation Trust, and in relation to the NIHR Specialist Mental Health Biomedical Research Centre at the Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust. The views and opinions expressed herein are the authors and do not necessarily reflect those of the funding bodies. GT has received an unrestricted educational grant from Lundbeck and commissions from the Commonwealth of Australia for a review of their mental health plan. GT and CH lead the independent evaluation team for the UK ‘Time to Change: Let's end mental health discrimination now’ programme. GT has been a member of the independent evaluation team for Scotland's ‘See Me’ campaign.

Aim – To investigate the relation between medication-related factors and adherence in people with schizophrenia in outpatient treatment. Methods – The sample comprised 409 outpatients (ICD-10 diagnosis of schizophrenia) with clinician-rated instability in four European cities (Amsterdam, The Netherlands; Verona, Italy; Leipzig, Germany; London, Great Britain). Adherence was assessed using the Medication Adherence Questionnaire (patient perspective), and the Clinician Rating Scale (clinician perspective). Examined medication-related factors were type (atypical vs. typical), application (oral vs. depot), daily dose frequency of antipsychotic medication (Medication History Scale), number of side effects (Liverpool University Neuroleptic Side Effect Rating Scale), and patient attitudes toward medication (Drug Attitude Inventory). Multiple regression analysis was used to identify predictors of adherence by medication-related factors. Results – Adherence, as rated by patient and clinician, was predicted by patient attitude towards medication, but was unrelated to type of drug, formulation or side effects of antipsychotic medication. A high daily dose frequency was associated with better adherence, but only when rated by the patient. Conclusions – In order to improve adherence there is a need to seriously consider and attempt to improve patient attitude toward medication. However, type of antipsychotic and other medication-related factors may not be as closely related to adherence as it has often been suggested.

Declaration of Interest: The study was funded by a grant from the Quality of Life and Management of Living Resources Program of the European Union (QLG4-CT-2001–01734). JM, AS, CB, MK, CB, LB, and BP declare that they have not received any form of financing including pharmaceutical company support or any honoraria for consultancies or interventions during the last two years. DR has received honoraria from Eli Lilly, Janssen Cilag and Astra Zeneca for consultancy work, and Anita Patel has received research consultancy funding from Servier. TB reports research funding to the department from Astra Zeneca, GlaxoSmithKline and Affectis for clinical trials and investigator-initiated trials; the department has also received funds to a minor extent for symposia and in-house training from Astra Zeneca, Bristol-Myers Squibb, Eisai, Janssen Cilag, Lilly Germany, Lundbeck, Novartis, Pfizer, Servier, and Wyeth. All authors declare that they have no other involvements that might be considered a conflict of interest in connection with this article.

Il consumo di sostanze psicotrope, oltre ad essere un importante fattore di rischio per lo stato di salute individuale, rappresenta un fenomeno con significative ricadute in ambito sociale (Santinello et al., 2006; Serpelloni et al., 2009). Come riportato nella Relazione annuale sullo stato delle Tossicodipendenze in Italia (2009), nel 2007 sono stati registrati, nella regione Veneto, circa 11 decessi ogni 100000 abitanti a seguito di incidenti stradali droga-correlati. In particolare, le fasce detà maggiormente interessate dal fenomeno sono risultate, per le femmine, quelle tra i 14 e i 24 anni e, per i maschi, quelle tra i 19 e i 24 anni.

L'adesione al trattamento è stata definita come la consonanza del comportamento di una persona alle indicazioni mediche (Fawcett, 1995; Myers & Nidence, 1998). Le revisioni della letteratura orientate ad analizzare questo argomento rilevano che, nei Paesi sviluppati, solo il 50% dei pazienti affetti da patologie croniche aderisce al trattamento, mentre nei Paesi in via di sviluppo si riscontrano tassi ancora più bassi. Per esempio, negli Stati Uniti, circa 50 milioni di adulti sono affetti da ipertensione, ma solo il 50% di essi sono stati diagnosticati e trattati adeguatamente; tra i pazienti trattati soltanto il 51% aderisce al trattamento. Analogamente, in Australia, solo il 43% dei pazienti affetti da asma assume i farmaci prescritti per l 'intera durata del trattamento e solo il 27.8% usa i farmaci prescritti come preventer (World Health Organization, 2001). Sul piano della frequenza, l 'analisi della letteratura indica che tra il 20% e il 90% dei pazienti affetti da disturbi psichici abbandona il trattamento, con un 'ampia variabilità di incidenza dovuta alle differenze nella definizione di mancata adesione e alla diversità dei campioni studiati.

I got in touch with Leon Eisenberg at the very end of his long and fulfilling professional life, or, to be precise, he got in touch with me. On December 12th, 2006 I received a sharp and hilarious comment on a paper I had written on the change of the name “mental retardation” to “intellectual disability” and its relation to stigma. In a friendly tone, it distilled joy of life and “bonheur”. The author recalled an old editorial at the American Journal of Psychiatry which explained that soldiers with neuropsychiatric problems were classified under a code known as ‘Section 8’ during the Second World War. “In no time at all, this classification number spread throughout the military community and became a term of derision. If you were thought to be a bit odd, you were called a ‘Section 8. Army psychiatrists concerned about the stigma changed the terminology from “Section 8” to “Simple Adult Maladjustment”. Not long after the change was made, the author of the editorial was in a base camp watching a film starring Jerry Lewis. He was astonished to hear members of the audience call out ‘Look at the ‘Sammy. After a moment he realized that “Sammy” stemmed from the initial letters “S.A.M.” of “Simple Adult Maladjustment”.