Mortality among psychiatric patients has been found to be higher than the general population, not only in those long-term residents in old-fashioned psychiatric hospitals or attending hospital-based psychiatric services (Harris & Barraclough, 1998) but also in those treated in modern community-based systems of care (Amaddeo et al., 1995; Grigoletti et al., 2009).

Individuals with schizophrenia have higher mortality rates compared to the general community. Apart from an increased risk of suicide, people with schizophrenia have an increased risk of death related to a wide range of comorbid physical conditions. There is evidence to suggest that much of this mortality is avoidable. The provision of assertive management of comorbid physical disorders has the potential to help close the differential mortality gap. While the primary data are robust, there is less empirical evidence to guide policy makers and service providers when dealing with these problems. Focused clinical programs aimed at reducing risk factors (e.g. smoking, obesity) and shared care between mental health teams and primary care providers can help reduce the burden of avoidable deaths. In light of recent evidence suggesting that the mortality gap has widened in recent decades, there is an urgent need to address the burden of avoidable deaths in those with serious mental illnesses.

Given the uncontested role of psychiatric illnesses in both fatal and non-fatal suicidal behaviours, efforts are continuously made in improving mental health care provision. In cases of severe mental disorder, when intensified treatment protocols and continuous supervision are required due to individual's impaired emotional, cognitive and social functioning (including danger to self and others), psychiatric hospitalisation is warranted. However, to date there is no convincing evidence that in-patient care prevents suicide. In fact, quite paradoxically, both admissions to a psychiatric ward and recent discharge from it have been found to increase risk for suicidal behaviours. What elements in the chain of well-intentioned approaches to treating psychiatric illness and suicidality fail to protect this vulnerable population is still unclear. The same holds true for the identifications of factors that may increase the risk for suicide. This editorial discusses current knowledge on this subject, proposing strategies that might improve prevention.

An extensive literature documented a mortality differential for natural causes between psychiatric patients and the general population. Less clear is the pattern for cancer diseases. Methodological problems arise when trying to explain such mortality gap: selection bias and reverse causation; time-dependent confounders that are also intermediate variables; complex relationships within a life course have to be considered. We try to explain such problems in terms of causal graphs. Excess risk for causes of death which are not attributable to higher prevalence of risk factors or treatment side-effects and higher mortality rates for avoidable causes have been also documented. These findings underline the need for research on health promotion and preventive programs targeted to psychiatric patients.

Run-in periods are frequently used when designing a clinical trial. In this paper we analysed the implications of runin periods for interpreting the results of clinical trials and applying these results in clinical practice. Study reports should indicate in details how run-in periods were carried out.

The magnetic resonance imaging studies investigating the volumes of the orbitofrontal cortex in patients suffering from schizophrenia are here presented, trying to elucidate its role for the pathophysiology and for the cognition of the disease.

Aims – Based on findings from population surveys, we provide an overview of the public's emotional reactions to people with mental illness. Methods – A literature search for populations studies using measures of emotional response to people with mental illness was carried out. In addition, data on the public's emotional reactions, originating from representative surveys conducted in Germany in the years 1990, 1993 and 2001, were analysed. Results – Positive emotional reactions to people with mental illness are most prevalent, followed by fear and anger. This pattern appears relatively stable across different cultures. In recent years, the emotional response of the public remained unchanged or even deteriorated. The public seems to react quite differently to people with different mental disorders. Emotional reactions have a substantial effect on the desire for social distance. The association between familiarity with mental disorder and the desire for social distance is to a considerable extent mediated through emotions. Conclusions – The public's emotional reactions to people with mental disorder are relatively under-researched. More research may help better understand the complexities of the stigma surrounding mental illness. Interventions aimed at reducing the stigma of mental illness may benefit from paying more attention to emotions.

Aims – The Diagnostic Interview for Psychoses (DIP) is a comprehensive interview schedule for psychotic disorders, linked to the OPCRIT diagnostic algorithm, bridging the gap between fully structured, lay-administered schedules and semistructured, psychiatrist-administered interviews. Here we describe the validity, reliability and applications of the Italian version of the DIP. Methods – The interview was translated into Italian and its content validity tested by back translation. Sixty patients, drawn from among those who contacted the South-Verona Community Mental Health Service, were included in the study. Each patient was first assessed independently by two raters, one of whom conducted the interview, while the other assumed the role of observer. Subsequently (median: 89 days), 44 of these patients were re-interviewed by a third rater, who made an independent assessment. Diagnostic validity was assessed in 18 cases, interviewed with the DIP and using the SCAN as ‘gold standard. Results – The mean duration of the interview was 37 minutes for the inter-rater interviews and 39 minutes for the retest interviews. Good to excellent inter-rater reliability was demonstrated for both ICD-10 and DSM-IV diagnoses, while in the test-retest reliability pairwise agreement was high for half of the items. Diagnostic validity was good, with twelve out of the 18 DIP-OPCRIT diagnoses (67%) matching the SCAN diagnosis. Conclusions – Overall, the results support the reliability and validity of the Italian translation of the DIP. The Italian version will be useful both in routine practice to establish standard reference diagnoses of psychosis and in the research field, where it can be used by academic researchers in clinical trials and epidemiological studies.

Aim – Instruments to measure the process - the daily activities of home care workers - have received little attention and may impede research in refining the active ingredients, the clientele best served and continuous quality improvement. We developed a decade ago in Quebec, Canada, a new daily contact log (relevé quotidien des contacts or RQC) that has now reached in practice 1 million entries. Methods – Three features distinguish the RQC development, namely, practical ergonomics, a clear logic, and response categories easy to understand and retain. The instrument is filled following any 10-minute or more contact with or about the client, and covers the location, time and actors of the episode of care, and the nature of the intervention (crisis, representing, accompanying, discussing) in 10 areas (i.e. medication, daily living activities, housing, relationships, substance abuse, legal, etc.). Inter-rater agreement for each RQC response category and rater agreement with a criterion measure (coded vignettes) were evaluated. Results – Kappa coefficients and intra-class correlation coefficients yielded results ranging from at least moderate to generally substantial agreement for all 77 response categories. Conclusions – The new RQC may support international studies of the implementation and application of various forms of intensive home care, refining its indications, and serves as a clinical and managerial tool to ensure quality of the interventions. Declaration of Interest: The study was financed by funds from the Fonds de la recherche en santé du Québec (FRSQ) and the Canadian Institutes of Health Research (CIHR). The authors have not been involved with any other forms of financing that might be considered a conflict of interest in connection with the submitted article.

Declaration of Interest: The study was financed by funds from the Fonds de la recherche en santé du Québec (FRSQ) and the Canadian Institutes of Health Research (CIHR). The authors have not been involved with any other forms of financing that might be considered a conflict of interest in connection with the submitted article.

Aim – We aimed at developing a prioritized set of quality indicators for schizophrenia care to be used for continuous quality monitoring. They should be evidence-based and rely on routine data. Methods – A systematic literature search was performed to identify papers on validated quality indicators published between 1990 to April 2008 in MEDLINE, the Cochrane databases, EMBASE and PsycINFO. Databases of relevant national and international organizations were searched. Indicators were described with respect to meaningfulness, feasibility and actionability. A workshop with relevant stakeholders evaluated the measures through a structured consensus process. Results – We identified 78 indicators through literature search and selected 22 quality indicators. Furthermore, 12 structural and case-mix indicators were choosen. Only five quality indicators were rated “essential indicators” (priority 1), 14 were rated “additional first choice” (priority 2), and three were rated as “additional second choice” (priority 3). Only four indicators assessed outcome quality. In the majority of indicators the evidence base supporting the indicator recommendation was weak. None of the selected indicators was validated in experimental studies. Conclusions – Evidence and validation base played only a subordinate role for indicator prioritisation by stakeholders indicating that there are discrepancies between clinical questions and requirements in schizophrenia care and scientific research.

Declaration of Interest: Stefan Weinmann and Thomas Becker received an unrestricted grant from the Federal Association of Local Health Funds (AOK-BV) for the whole project. Christiane Roick is an employee of the AOK-BV. All authors declare that there are no other financing arrangements or payments that might be considered a conflict of interests related to the present paper.

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 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.

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”.