Aims – To evaluate the quality of acute psychiatric care concerning the management of violent behaviour and rapid tran-quilization. Methods – Data concerning 13 indicators, drawn from NICE recommendations, were collected in 19 Departments of Mental Health, in the frame of the SIEP-DIRECT's Project, to evaluate the implementation of NICE recommendations in Italian Mental Health Services. Results – In about two thirds of Departments of Mental Health (DMHs) professionals were trained in the management of violent behaviour, while written procedures existed only in one fourth of DMHs. About a half of the professionals working in Psychiatric Wards in General Hospital were trained in rapid tranquilization, while procedures on this topic are practically absent and specific care for monitoring intensively the heavily sedated patient was not frequent. Conclusions – Management of violent behaviour and rapid tranquilization are two critical areas in the care performed by Psychiatric Wards in General Hospital. Training on these topics is more frequent than implementation of procedures. NICE recommendations and SIEP indicators are useful tools for improving the quality of acute psychiatric care.

Declaration of Interest: None.

Aims — To describe patterns of experienced andanticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO). Methods — Cross-sectional survey on a sample of 50 people with clinical diagnosis of schizophrenia recruited in the Italian INDIGO sites of Verona and Brescia. The 41-item interview-based Discrimination and Stigma Scale (DISC-10), which assesses how experienced and anticipated discrimination affects the life of people with schizophrenia, was used. Results — The most frequently occurring areas of experienced discrimination were discrimination by family members (44%), making and keeping friends (33%), keeping (36%) and finding a job (34%), getting or keeping a driving licence (32%). Anticipated discrimination was common in applying for work, training or education (58%), lookingfor close relationships (50%) and doing something important (48%); 68% felt the need to conceal their diagnosis. Positive experiences were rare, and getting welfare benefits/disability pensions was the only area where participants reported being treated with advantage (34%) more commonly than with disadvantage (8%). Overall, experienced discrimination reported by Italian patients was in the intermediate position of the score range of all INDIGO sites, whereas anticipated discrimination was lower than that reported in the other countries. Conclusions — Interventions to reduce discrimination against people with schizophrenia may need to address both actual and anticipated discrimination. Targeted therapeutic strategies aiming to improve self-esteem of people with schizophrenia may be usefulto facilitate their social participation and full inclusion in the community.

Declaration of Interest: The authors declare they have not competing interests.

Aims The aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported. Methods – A narrative review based on the recent literature regarding cannabis use in the gen-eral population and patients with psychosis. Results – The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the general population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is currently observed in this vulnerable patient group. Conclusions – It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms.

Declaration of Interest: None.

Aims – To explore the current state of Italian social psychiatry research as evidenced by original papers published in peer-reviewed journals 2004-2006. Methods – Electronic databases and hand searches of leading peer-reviewed journals were used to identify original research papers published in 2004-2006, addressing a social psychiatric issue, having at least one Italian author, and reporting data from Italian samples. Results – A total of 174 papers were identified. A substantial proportion reported findings of international collaborative research. Quantitative methods dominated, with 86 papers on cross-sectional surveys. Only 18 papers showed results of intervention trials with pre and post measures. Most common target group were psychiatric patients in community mental health services which featured in 93 papers. Conclusions – There is a critical mass of Italian social psychiatry research, dominated by a few research centres and with considerable amount of international collaboration. The findings of this survey might reflect the relative shortage of national funding for social psychiatry research.

Declaration of Interest: None.

The significant decline in the number of psychiatric hospital beds for more than two decades across Europe has changed the landscape of mental health services. This has rekindled debates about bed shortages and the reasons for variations in the number of inpatient beds, admissions to hospital and length of stay. Analysis of European Union (EU) level data shows that the UK has a relatively low number of admissions to hospital, yet a much higher than average length of stay compared with 12 other EU Member States. Understanding this is difficult, but recent studies shed some further light on the patterns and predictors of admissions and length of stay.

Objective - The present paper represents the second part of a larger review on the studies assessing needs for care in mental health field. In the first part, studies assessing needs for services in the general population were reviewed. In this second part studies assessing needs on individual level were reviewed and the role played by the assessment of individual needs in planning mental health care was discussed. Methods - Studies published in international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs in the general population and in psychiatric patients were reviewed separately. The latter were reviewed on the basis of the diagnostic category (psychotic and non psychotic patients) and setting of care (outpatients and inpatients). Studies on particular categories, such as homeless, children and adolescents, elderly and patients with aggressive behaviour, have been also reviewed. Results - Psychotic patients show a wide range of both clinical and social needs. Patients followed by community-based mental health services show similar number of clinical and social needs, while inpatients (with the exception of acute patients) show more social needs. For both community-based mental health patients and inpatients, social needs are most frequently unmet and psychopharmacological treatments are used more frequently than psychotherapeutic or rehabilitative interventions. Non psychotic patients show lower number of needs than psychotic patients; these needs are both clinical and social, with a higher total number of clinical needs, but a higher number of unmet social needs. Conclusions - Studies on needs for care provide an interesting perspective on people suffering from mental illness. In the routine clinical practice needs assessment could be a valuable tool for providing specific, individualised and effective mental health care.

Objective - The aim of this article is to explain the current status of deinstitutionalisation and of community care development in the UK. Design — Literature review of articles and reports on deinstitutionalisation. Setting — Articles included in the review related either to the whole of the UK, to England and Wales, or to a specific area such as London. Main outcome measures — The review was carried out pertaining to the question of the extent to which community care can or should take over the functions of the asylum, with particular reference to those at risk of behaving violently. These functions include those that are manifest, or explicit, and those that are latent, or unintended but implicit (Bachrach, 1976). Results — The example of patients at risk of violent behaviour is one that highlights the continuing relevance of both these sets of functions, which are argued to be exerting a powerful influence on the processes of asylum closure and community care development. This influence is seen in delayed asylum closure, transinstitutionalisation (the shift of some patients from asylums to other institutions), and the institutionalisation of aspects of community care. Conclusions — Both the manifest and the latent functions of asylums must be acknowledged by those involved in planning community care; where it is felt desirable that community care does not take over certain functions, the consequences of this must be anticipated so that they can be prevented or dealt with in other ways.

Objective - The present study was conducted to determine the excess of mortality in long-term psychiatric inpatients. Setting - Psychiatric hospital, Bologna, Italy. Design – Retrospective study on a cohort of 264 chronic psychiatric inpatients, followed up for ten years since January 1981. Mortality measures were computed by psychiatric diagnosis, length of stay and «still resident at follow-up/discharged» condition. Main measures – Standardized mortality ratios were computed with reference to the mortality by age of the population resident in Bologna in the years 1981- 1991. Presence in the cohort was expressed in person/years. Results – The excess of deaths in the cohort was 2.89 (CI 95%: 2.12-3.86) for males and 2.38 (CI: 1.66-3.31) for females. A remarkable excess of deaths for both sexes was observed in the class of age 15/44 (18.33 for males, CI 9.14-32.81; 60 for females, CI: 21.91-130.6 ) and in association with a diagnosis of personality disorder/alcohol abuse (11.25 for males, CI: 5.13-21.36; 5 for females, CI: 1.35-12.8). Length of stay and age of patients were inversely associated with SMRs. Conclusion – The present study confirms that the excess of mortality is high in psychiatric long-term inpatients and that it may be concentrated in younger classes of age, first years after admission and in subjects with diagnoses of personality disorder/alcohol abuse.

World Psychiatry, the official journal of the World Psychiatric Association (WPA), is now published in five languages (English, Spanish, Chinese, Russian and French) and reaches more than 33,000 psychiatrists in 121 countries. It received recently its first impact factor, 3.896. The publication of the journal has two objectives. The first is to reach as many psychiatrists of the various countries of the world as possible, disseminating information on recent significant clinical, service and research developments in a language that can be assimilated by the vast majority of them. The second is to give voice to psychiatrists of all regions of the world, encouraging submission of research papers, commentaries and reports on innovative service modalities. Related to this second objective has been the establishment by the WPA of a task force aiming to promote dissemination of psychiatric research conducted in low and middle income countries. Among the objectives of this task force is to advise and support the editors of high quality journals produced in those countries in their efforts to achieve indexation.

Declaration of Interest: None.