Aims — To investigate in a representative national sample (N=2,962) of patients living in Residential Facilities (RFs) patterns of polypharmacy as well as related variables, association between diagnoses and therapeutic patterns, and the rate of adverse events. Methods — Structured interviews focusing on each patient were conducted by trained research assistants with the manager and staff of each RF. Patients were rated with the HoNOS and the SOFAS, and comprehensive information about their sociodemographic and clinical status, and their pharmacological regimes were collected. Results — Conventional antipsychotics and second-generation antipsychotics were prescribed to 65% and 43% of the sample, respectively. Benzodiazepines were prescribed to two-thirds of the sample, while antidepressants were the least-used class of psychotropics. Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (±1.1); antipsychotic polypharmacy was also common. Many prescriptions were loosely related to specific diagnoses. Antiparkinsonianian drugs were prescribed to approximately 1/4 of the sample. Mild or severe adverse events in the previous month were reported for 9.9% and 1.4% of the sample, respectively. About 15% of patients suffered from tardive dyskinesia. Conclusions — Psychotropic drug prescription patterns for severe patients living in RFs are only sometimes satisfactory and offer the opportunity of improvement. Specific actions are required to improve prescription patterns for severe patients in RFs.

Declaration of Interest: in the past two years GdG has received two speaker fees from Janssen-Cilag and from Eli Lilly; GS has received one speaker fee from Solvay. RM, AP, SF and RT have received no fees or other financial support from pharmaceutical companies.

The population surviving to old age in sub-Saharan Africa (SSA) is increasing rapidly in consonance with the rest of the world. Nevertheless, the sub-region offers unique challenges to survival across the lifespan. The determinants of health and ageing in SSA are thus likely different from those in higher income countries. The need to explore pressing epidemiological and health service challenges of older people living in SSA in the context of multiple social changes and rapid ageing of the population provided the rationale for the Ibadan Study of Ageing (ISA). This article appraises ISA findings in relation to late-life depression. It concludes that healthcare policies in SSA need to deliberately prioritise the treatment of depression and other mental health problems in late-life in order to stem the neglect of older people's mental health in the region.

Randomised controlled trials (RCTs) are designed and powered to measure one single outcome, called primary outcome (Sibbald & Roland, 1998; Barbui et al., 2007). The primary outcome is the pre-specified outcome of greatest clinical importance and is usually the one used in the sample size calculation (Accordini, 2007). In addition to the primary outcome, RCTs may have several other outcomes, called secondary outcomes. In contrast with the analysis of the primary outcome, the analysis of secondary outcomes and its interpretation may be complicated by at least two factors:

1. 1) the trial may not have enough statistical power to detect differences (so it is possible to incur in a type II error, that is failing to see a difference that is present);

2. 2) increasing the number of secondary outcomes generates the problem of multiplicity of analyses, that is the proliferation of possible comparisons in a trial (and increasing the number of comparisons increases the possibility to incur in a type I error, that is detecting significant differences by chance). For all these reasons, the results of the analysis of primary outcomes is considered less susceptible to bias than the analysis of secondary outcomes.

Objective – To present three probabilistic models (Poisson, negative binomial, Waring) to analyze the distribution of the number of contacts of patients followed using a psychiatric case register. Design – Longitudinal to obtain the distribution of the number of contacts (during 91 days following that of the first contact) observed on patients followed using the South-Verona Psychiatric Case Register during the period 1/1/79-31/12/91. Results – There were a total number of 6913 contacts on 3454 subjects. The chi-square test for the goodness of fit yields a significant result both for the Poisson distribution (3580 with 6 degrees of freedom, p < 0.001) and for the negative binomial distribution (65.47 with 18 degrees of freedom, p < 0.001); on the other hand a non significant result was obtained for the Waring distribution (25.31 with 19 degrees of freedom, p = 0.151). Conclusions – The Poisson distribution gave a very poor fit for the distribution of contacts. The negative binomial distribution could be employed to analyze the pattern of contacts when the right tail of the distribution is not important. The Waring distribution is the best of the three presented. Moreover, the variance of the Waring distribution can be decomposed in three components: a random component, a component which accounts for endogenous factors and another component which accounts for esogenous factors. Therefore the Waring distribution is useful when one wants to make comparisons between psychiatric case registers of the same country or of different countries.

Objective – Cognitive Behavioural Therapy for the treatment of Social Phobia has proved effective through several controlled trials and meta-analyses. In spite of this the CBT has not spread in clinical field yet. Therefore our aim was to verify the effectiveness of the CBT in a public mental health service and to compare our results with those described by experimental research. Design and setting – Partecipants were 11 public mental health center clients, with a primary diagnosis of Social Phobia (according to DSM-IV criteria). The transportability of CBT to a common clinical setting was examined comparing treatment outcome data, at the end of the treatment and at a six months follow up, with results described in controlled efficacy studies. We employed self completion rating scales relating to both general health conditions and life satisfaction (SF36) and trend of symptoms (LSPS). Moreover we recorded the Clinical Global Impression (CGI) and Patient's Global Impression (PGI). Results – Despite differences in setting, clients and treatment providers, both the magnitude of change from pre treatment and maintenance of change at a six months follow up were comparable with the parallele findings in the efficacy studies. Conclusions –. The results attest the effectiveness of CBT even in a public mental health center setting so, in consideration of the fact that social phobia is a very common disease and involve high degree of severity, chronicity and disability, we hope that this effectual and relatively cheap therapy will be routinely applied in public mental health services.

This contribution initially describes some traditional tools that are commonly used to measure drug tolerability, including measures that take into considerations both clinicians’ and patients’ views. Subsequently, it highlights a few studies that compared the patient and clinician's perspective in the evaluation of drug tolerability, trying to understand whether health care providers and patients perceive antipsychotic tolerability in different ways, and whether these different ways may have implica-tions in terms of treatment adherence and outcome. Finally, some clinical and research implications are suggested and discussed.

Objective – To review recent literature documenting how family, twin and molecular genetic studies of eating disorders have revolutionized our conceptualizations of anorexia and bulimia nervosa. Methods – We summarized extant litera-ture on genetic epidemiology of eating disorders. Results – Results of extant studies highlight the underlying biological vulnera- bilities associated with these conditions. Genetic research has also opened up new avenues and approaches for exploring how the environment exerts its influence on risk. Conclusions – We discuss state-of-the-science findings in the genetics of eating disorders, explore various mechanisms of gene-environment interplay, and discuss implications of this research for science, practice, families and individuals with eating disorders.

The British Journal of Psychiatry is an independent mainstream general psychiatric journal that competes reasonably well with others in the field. It does so by keeping a healthy balance between the demands of its readers, its contributors and the need for good science. It publishes an eclectic mix of original articles, reviews, editorials, reappraisals, comment, opinion and extras, the latter including poetry, short summaries, literature and psychiatry, and a touch of humour. These contributions are not always in keeping with the harsh requirements of the impact factor, but we judge that this makes for a better all-round journal that advances psychiatry in all its manifold aspects and is anything but dull.