There has been recent debate regarding the efficacy of electroconvulsive therapy in the treatment of depression. This has been based on narrative reviews that contradict existing systematic reviews and meta-analyses. In this special article, we highlight the mistakes that occur when interpreting evidence using narrative reviews, as opposed to conventional systematic reviews and meta-analyses.

Background – As a large number of persons are exposed to prescribed psychotropic drugs, their utilisation and impact should be further explored at the population level. Aims – To illustrate the interest of pharmacoepidemiological studies of psychotropic drugs by selected examples of major public health issues. Method – Selective review of the literature. Results – Many questions remain unsolved regarding the behavioural teratogenicity of prenatal exposure to psychotropic drugs, the impact of their increasing use in children, the long-term cognitive consequences of exposure to benzodiazepines, and the risks associated with extension of indications of antipsychotic drugs. Conclusion – Pharmacoepidemiological studies need to be further developed owing to the large number of public health questions raised by the extensive and expanding use of psychotropic drugs.

Aims – To describe what users with schizophrenia think about the causes of their disorder. Methods – In each of the 10 participating Italian mental health centres, 25 users with schizophrenia were consecutively recruited and asked to complete the Users' Opinions Questionnaire (UOQ). Results – 150 out of 198 respondents mentioned at least one social cause for their mental disorder, and 114 reported exclusively social causes. Family conflicts were the most frequently reported social cause (21%), followed by traumas (20%), work and study difficulties (17%), and psychological disturbances (17%). Ten percent of the respondents mentioned biological causes. Biological causes were more frequently reported by users who were aware of their diagnosis of schizophrenia, whereas social causes by those who just knew they suffered from a psychosis. Difficulties in social relationships were more frequently pointed out by respondents with an earlier onset of the illness and a higher number of compulsory admissions in the previous 12 months. These users expressed more scepticism about the usefulness of the treatments they received, and perceived a greater social distance. Conclusions – Users' beliefs about the causes of their disorder should be taken into account by psychiatrists in order to improve their working alliance with them.

Declaration of Interest: None of the authors has had any interest or he/she has received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work. None of the authors has received any form of fee for his/her participation in this study. This study was supported by a grant received from the “M. Lugli” Foundation (grant no. 2–18–8).

No treatment has caused a greater revolution in the treatment of people with schizophrenia than chlorpromazine. The new generation of drugs has been embraced by psychiatry with an enthusiasm fostered by the unmet needs of both patients and industry. Recent, independently funded trials have highlighted already existing data illustrating how the new antipsychotics drugs are an additional advance but not a revolution. In this story there are lessons for psychiatry to opt for science rather than seduction.

Aims – Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely – with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. Methods – This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. Results – In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. Conclusions – This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary Psychiatric Care Facilities have the potential to act as hubs of expertise not only for treatment, rehabilitation, community integration and ser-vice co-ordination for the severely mentally ill, but also for research and training.

Declaration of Interest: None.

Aims – Psychiatric patients often are not informed about their diagnosis and their involvement in the decision making process is rare. Aim of the study was to explore the informative needs of patients with schizophrenia and the knowledge about their illness. Method – Three focus groups were conducted with 25 long-stay patients with the diagnosis of schizophrenia, attending the Mental Health Centre of the South-Verona Community-based Mental Health Service. The group discussions were audiotaped and transcribed. Results – The authors identified 18 different thematic categories which were used by two raters to classify all patient contributions. The interrater reliability was satisfactory. The qualitative analysis evidenced that patients have little knowledge about their illness. Patients had confuse and vague ideas on schizophrenia but their knowledge on drug names, dosages and side effects appeared precise and detailed. Several patients have looked for information in encyclopedias and medical dictionaries. Conclusion – The findings suggest a need of patients affected by schizophrenia for an information exchange with their psychiatrists that takes into account their informative needs, corrects wrong beliefs and actively involves them in therapeutic decisions.

Having first introduced the pragmatic health care trial, the discussion then focuses on a selected list of technical problems that are important for the design, analysis and inference from such trials. The first is lack of independence of participants’ outcomes do to clustering either arising from a cluster randomized design or to the way treatment is delivered (therapist and group effects). The second and third concern the implications of non-adherence to treatment and subsequent loss to follow-up, particularly, when non-adherence is associated with missing outcome data. Finally, it is argued that pragmatism and a desire for a scientific explanation should not be regarded as mutually exclusive.

Objective — The implementation of a simple methodology to estimate full costs of services provided by a public mental health centre. Setting. CPS (NHS Mental Centre) Ussl 35, Magenta, Lombardy Region. Method — To estimate full costs of 16 types of service we followed a two step procedure. The first step was to estimate all costs attributable to the CPS. In the second one, we allocated this estimate to each type of service provided. We attributed to the CPS the following cost items: personnel, utilities (telephone, electricity, water, heating and cleaning), land & building, transports (for services provided outside the clinic) and a share of general cost of the USSL to which the CPS belongs. Full cost of each service was then calculated on the base of the yearly number of services provided and the time spent by each health professional. Results — In 1995, the CPS provided 14, 562 services. Total costs amounted to L 1,356 million, and more than three quarters of this amount was attributable to the personnel working at the CPS. Unit costs ranged from L 5,300 (drug administration) to L 442,400 (family therapy involving two professionals for 90 minutes) The unit cost of psychiatric visits, psychologist consultations and nurse domiciliary visits were L 105,300, L 106,600 and L 78,000, respectively. Conclusions — This approach requires accessible data and is relatively simple to manage. Some refinements are required, especially to improve the methodology for the determination and the allocation of overheads. However, we are convinced that this cost accounting procedure provides acceptable estimates of the services provided by the CPS. These estimates suggest that charges to be used to fund NHS providers may be too low, especially if fee-for-service will be the main funding source.

Aims — Description of students' opinions about schizophrenia and depression. Methods — The study was carried out on a sample of 445 secondary school students, randomly allocated to a “schizophrenia” or a “depression” group (N=221 and N=224, respectively). Each respondent was asked to read a case—vignette describing a case of schizophrenia or depression, and then to fill the Questionnaire on the Opinions about Mental Illness — General Population's version (QO—GP). Results — 35% of students in “schizophrenia” group vs. 85% in “depression” group attributed a correct diagnosis to case—vignette. 19% of students in the “schizophrenia” group vs. 39% in the “depression” group believed that these mental disorders can recover. Affective and civil rights were more frequently acknowledged to patients with depression than to those with schizophrenia. In both groups, the majority of students stated that mentally ill patients were unpredictable and socially dangerous. Students who reported TV stories on people with mentally ill were more frequently convinced on their unpredictability and social dangerousness. Conclusions — These results outline the need to: a) plan educational campaigns for students on mental disorders; b) alert media professionals on the impact that the way they present crimes committed by mentally ill patients may have on general population.

Declaration of Interest: None of the authors has had any interest or she has 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 two years. None of the authors has received any form of fee for her participation in this study.

The corpus callosum (CC) is the brain's largest white matter tract, mostly composed by both myelinated and unmyelinated fibres, connecting the two cerebral hemispheres. The CC can be divided into different sections: rostrum, genu, body, isthmus and splenium (Aboitiz et al., 1992). Myelinated fibres predominate in the midbody and the splenium while unmyelinated fibres are more numerous in the rostrum and the genu. The callosal fiber disposition approximately reflects brain topography: the anterior sections connect the frontal lobes, the median sections connect temporal and parietal regions, and the posterior sections link occipital areas (Pandya et al., 1971). This traditional picture, however, which has been obtained mainly through studies in non-human primates has been partly modified by modern diffusion tensor imaging studies in humans (Hofer & Frahm, 2006). The CC matures after birth through adolescence and into early adulthood and is involved in different cognitive processes such as sensory-motor integration, attention, language, arousal and memory. Its size has been shown to be associated with handedness, sex (i.e., greater splenium in females and greater genu in males, Dubb et al., 2003) and cerebral laterality (i.e., inverse correlation between callosal connectivity and brain lateralization in males; Luders et al., 2003), and age (Ota et al., 2006) Specifically, age-related callosal degeneration has been detected by a diffusion tensor imaging (DTI) study (Ota et al., 2006) in the sub-regions that connect areas which are thought to be vulnerable to normal aging: the genu, rostral body, and isthmus. This result replicated post mortem findings of callosal degeneration in rostral body, anterior midbody and isthmus (Aboitiz et al., 1996).