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.

In the treatment of resistant schizophrenia, a number of meta-analyses attempted to quantify the efficacy and tolerability of antipsychotic (AP) polypharmacy v. monotherapy with contradictory results. Recently, a systematic review and meta-analysis of randomised controlled trials investigated the efficacy and tolerability of AP combination v. monotherapy in schizophrenia. It included 31 studies: 21 double-blind (considered high-quality studies) and 10 open-label (considered low-quality studies). The meta-analysis showed that, overall, the combination of two APs was more effective than monotherapy in terms of symptom reduction (standardised mean difference (SMD) = −0.53, 95% confidence interval (CI) −0.87 to −0.19); however, this result was confirmed only in the subgroup of low-quality studies. Negative symptoms improved when combining a D2 antagonist with a D2 partial agonist (SMD = −0.41, 95% CI −0.79 to −0.03) both in double-blind and open-label studies. In the present commentary, the results of this systematic review are critically discussed in terms of their clinical and research implications.

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.

Several studies have evaluated the quality of life (QOL) in patients with Panic Disorder (PD). For instance, the Epidemiological Catchment Area Study (ECA) assessed the quality of life (QoL) using the subjective evaluation of health, psychosocial functioning and financial status as parameters (Regier et al., 1984). Among the general population, people with PD or panic attacks reported a low level of physical health in 35% of cases and a low degree of mental health in 38% of cases, similarly to people suffering from Major Depressive Disorder (29% and 39% respectively), but more frequently than the in individuals not affected by any disorder (24% and 12% respectively). Furthermore, 27% of patients with PD were in need of some form of social or financial support in contrast to 16% of people suffering from depression and 12% of unaffected people. The National Comorbidity Survey (NCS) (Magee et al., 1996) found serious interference in activities in 27% of agoraphobic patients. For instance, the agoraphobic subjects reported an average of 1.1 days of work lost in the previous month due to their psychopathology. Several Authors have studied the relationship between PD and a worse quality of life and/or a worse ability to function. In a review on the topic, Mendlowicz & Stein (2000) provided an integrated view of the issue of quality of life in patients with anxiety disorders and concluded that the existing studies almost uniformly show a marked impairment of quality-of-life and psychosocial functioning in individuals with anxiety disorders. However, as noted by the Authors above, “despite the growing number of studies undertaken during the past 15 years, the investigation of quality of life in individuals with anxiety disorders is still in its infancy.” Rucci et al. (1993) evaluated the prevalence of subthreshold psychiatric disorders in primary care and their association with the patients health perception, disability in daily activities and psychological distress Subjects with subthreshold disorders reported levels of psychological distress, disability in daily activities and perceived health comparable to those of patients with full-fledged ICD-10 disorders. Despite the scientific and clinical importance of the topic, relatively few studies have evaluated the prevalence and impact of subthreshold affective disorders in general (Schotte & Cooper, 1999) and panic symptoms in particular (for instance Bellini & Galverni, 2003) in non psychiatric populations. Moreover, the literature on the relationship between sub-threshold or residual PD and quality of life is scant. To this end, we decided to investigate the impact of panic-agoraphobic “spectrum” on the quality of life of subjects who did not meet the criteria for a full blown PD. We adopted the definition of “spectrum” developed by Cassano and colleagues (Cassano & Pini, 2000; Rucci & Maser, 2000), which refers to a dimensional view of psychopathology that includes a broad array of manifestations of the target disorder, including its most severe symptoms as well as a range of more subtle features related to the core condition, which may include temperamental traits, prodromal indicators, or residual symptoms. Although they are frequently associated with specific DSM-IV disorders, these conditions are also found in individuals who have never met full DSM-IV diagnostic criteria. Our hypothesis for this study was that the presence of subthreshold panic-agoraphobic symptomatologies in otherwise healthy individuals would significantly impair the quality of life despite the absence of a full-blown PD diagnosis.