Objective – Analysis of figures and characteristics of suicide behaviour in the area of Varese and the neighbouring northern towns (Valceresio, the valleys around Luino and northern Verbano), with the purpose of finding out preventing measures. Design – Epidemiological-descriptive survey. The 1995-1997 ISTAT death cards, included in the death files of the former USSL of Varese have been taken into consideration. Only those people who were resident at the suicide moment have been included in the survey. Afterwards the psychiatric service archives were consulted, to find any possible contact between the subjects in the ISTAT files and the psychiatric services themselves. With regard to these patients, some information such as suicide attempts, psychiatric pathology and first contact with the psychiatric services have been pointed out. Setting – Arcisate, Cittiglio, Luino and Varese districts, where the Community Mental Health Services 1 and 2 of “Azienda Ospedaliera Universitaria Macchi” of Varese operate. Main outcome measures – The suicide rates in the studied area have been reckoned and, through direct standardization, the rates of the single districts have been compared. Results – There were 78 suicides ( 24 females and 54 males): rate of 8.2 per 100.000. In accordance with the national trend, there is evidence of a general reduction of the suicide phenomenon, except among the youngest. Districts of Luino and Arcisate are geographic areas to examine in the time, because a wider sample could reveal a higher risk. Young and elderly people are the most affected among the males and, 55/64- year-old people, both males and females, are at higher risk. Suicide methods vary with the age. A high percentage of subjects are not married and with low education. Less than one third of the subjects had come into contact with the psychiatric service. Conclusions – These data allow a comparison with the national survey and an analysis of the suicide features in the study area. The purpose is to elaborate preventing strategies with multi- dimensional approach whose efficacy may be proved in the future by setting up a provincial observatory.

Objective - assessment of the burden perceived by a sample of key-relatives of schizophrenic patients. Design - Observational study of key-relatives of patients with a PSE-CATEGO diagnosis of active paranoid schizophrenia. Assessment of possible correlations between the family burden, the patients' symptoms and disabilities, as well as the relatives attitude of overinvolvement and criticism. Setting - Inpatient and outpatient psychiatric units of the Department of Psychiatry of the First Medical School, University of Naples. Subjects - 25 patients, with a diagnosis of active paranoid schizophrenia, according to ICD-9 diagnostic criteria, minimun illness history 1 year, at least one previous admission, living with at least one adult relative. Main outcome measures - Standardized assessment of patients clinical status and social disability and of relatives clinical status attitude and perceived burden. Results - The burden, both objective and subjective, was found to be present to a marked or very marked degree in more than 50% of the inteviewed relatives. A marked effect of the patients illness was observed especially on relatives social contacts and leisure activities. Also the attitudes of criticism and overinvolvement were detected in the great majority of the relatives. 52% of the relatives, when assessed by the PSE-9, received a psychiatric diagnosis. The objective burden was found to be associated with some «negative» symptoms and deficits of social functioning in the patients. Finally, significant correlations were observed between the objective and subjective dimensions of the burden and the relatives attitudes of hypercriticism toward the patients. Conclusions - The present study seems to be relevant both from the epidemiological point of view and for psychiatric care planning.

A discussion of epidemiologic researches for the evaluation of psychiatric care is presented. With regard to the Italian context the author stresses the importance of analytical studies over the descriptive ones. The main design options for the evaluation of quality of care are then considered in the psychiatric framework.

In individuals with coronary artery disease and concurrent depressive symptomatology, the evidence on the beneficial and harmful effects of antidepressants is very limited. Recently, a study was carried out to describe depressive symptoms and the treatments provided under real-world circumstances to cardiac patients who entered the Mayo Clinic cardiac rehabilitation program. Antidepressant use was associated with reductions in depressive symptoms, but also with poorer cardiovascular outcomes. In this commentary, the results of this study are discussed in view of their clinical implications for everyday clinical practice and for the production of knowledge.

Aims – There has been recent concern about interactions between academia and the pharmaceutical industry. This article seeks to explore the basis for the current sense of crisis. Methods – The approach taken is a historical one, outlining the origins of the crisis. Results – The analysis outlines the roles that brands, patents, and the control of the scientific literature play in the current marketing of psychotropic drugs, and describes the processes of guideline capture and brand fascism. Conclusions – The analysis makes it difficult to see current interactions between industry and academia as anything but bad for academia. One option that might restore some balance would be to restrict scientific meetings and journals to communications that made all relevant scientific data available, excluding exercises that restrict access to data.

Declaration of Interest: In recent years I have had consultancies with, or been a chairman or speaker at symposia for, or received support to attend meetings from Astra-Zeneca, and Lundbeck. I have been expert witness for the plaintiff in the past decade in 15 legal actions involving antidepressants and on patent case, and have been consulted on a much greater number of attempted suicide, suicide, and suicide-homicide cases linked to treatment, in which I have offered the view that the treatment was not involved or have declined to give a view.

Objective – To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure. Design – «Case control». Cases had a GHQ–12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness. Setting – Six single handed primary care practices. Measures – Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index. Results – The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems. Conclusions – The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.